Chapter 8 Intrapartum Assessment and Interventions

Chapter 8  Intrapartum Assessment and Interventions

Complete Chapter Questions And Answers
 

Sample Questions

Multiple Choice

1. In caring for a primiparous woman in labor, one of the factors to evaluate is uterine activity. This is referred to as the __________ of labor.a. Passengerb. Passagec. Powersd. Psyche

ANS: c

Feedback
a.
The passenger refers to the fetus.
b.
The passage refers to the pelvis and birth canal.
c.
Powers refer to the contractions.
d.
Psyche refers to the response of a woman to labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Knowledge | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Easy

2. The provision of support during labor has demonstrated that women experience a decrease in anxiety and a feeling of being in more control. In clinical situations, this has resulted in:a. A decrease in interventionsb. Increased epidural ratesc. Earlier admission to the hospitald. Improved gestational age

ANS: a

Feedback
a.
Studies have shown that with a support person, be it a family member, friend, or professional such as a Doula or nurse, the patient experiences a decrease in anxiety and has a feeling of being in more control. This, in turn, results in a decrease in interventions, a significantly lower level of pain, and an enhanced overall maternal satisfaction.
b.
There is decreased use of pain medication with continuous labor support.
c.
There is no evidence that continuous labor support results in earlier admission to the hospital.
d.
There is no evidence that continuous labor support results in improved gestational age for the fetus.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: PSI, Psychosocial Integrity | Difficulty Level: Moderate

3. When caring for a primiparous woman being evaluated for admission for labor, a key distinction between true versus false labor is:a. True labor contractions result in rupture of membranes, and with false labor, the membranes remain intact.b. True labor contractions result in increasing anxiety and discomfort, and false labor does not.c. True labor contractions are accompanied by loss of the mucus plug and bloody show, and with false labor there is no vaginal discharge. d. True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

ANS: d

Feedback
a.
Rupture of membranes can occur prior to labor or during labor.
b.
A woman’s response to labor may not be reflective of her status in labor but is influenced by expectations and emotional status.
c.
Loss of the mucus plug can occur prior to the onset of labor.
d.
True labor contractions bring about changes in cervical effacement and dilation, and with false labor there are irregular contractions with little or no cervical changes.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

4. The mechanism of labor known as cardinal movements of labor are the positional changes that the fetus goes through to best navigate the birth process. These cardinal movements are:a. Engagement, Descent, Flexion, Extension, Internal rotation, External rotation, Expulsion b. Engagement, Descent, Flexion, Internal rotation, Extension, External rotation, Expulsion c. Engagement, Flexion, Internal rotation, Extension, External rotation, Descent, Expulsion d. Engagement, Flexion, Internal rotation, Extension, External rotation, Flexion, Expulsion

ANS: b

Feedback
a.
The order of the cardinal movements is incorrect.
b.
Engagement occurs when the greatest diameter of the fetal head passes through the pelvic inlet. Engagement can occur late in pregnancy or early in labor. Descent is the movement of the fetus through the birth canal during the first and second stages of labor. Flexion is when the chin of the fetus moves toward the fetal chest. Flexion occurs when the descending head meets resistance from maternal tissues. This movement results in the smallest fetal diameter to the maternal pelvic dimensions. It typically occurs early in labor. Internal rotation is the movement, the rotation of the fetal head, that aligns the long axis of the fetal head with the long axis of the maternal pelvis. It occurs mainly during the second stage of labor. Extension is the movement facilitated by resistance of the pelvic floor, causing the presenting part to pivot beneath the pubic symphysis and the head to be delivered. This occurs during the second stage of labor. External rotation is when the sagittal suture moves to a transverse diameter and the shoulders align in the anteroposterior diameter. The sagittal suture maintains alignment with the fetal trunk as the trunk navigates through the pelvis. Expulsion is the movement that occurs when the shoulders and remainder of the body are delivered.
c.
The order of the cardinal movements is incorrect.
d.
The order of the cardinal movements is incorrect.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Comprehension | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate

5. A woman is considered in active labor when:a. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.b. Cervical dilation progresses to 3 cm with effacement of 30, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.c. Cervical dilation progresses to 8 cm with effacement of 80%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.d. Cervical dilation progresses to 10 cm with effacement of 90%, contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds.

ANS: a

Feedback
a.
Characteristics of this phase are the cervix dilates, on an average, 1.2 cm/hr for primiparous women and 1.5 cm/hr for multiparous women. Cervical dilation progresses from 4 to 7 cm with effacement of 40% to 80%. Fetal descent continues and contractions become more intense, occurring every 2 to 5 minutes with duration of 45 to 60 seconds, and discomfort increases.
b.
Cervical dilation progresses to 3 cm with effacement of 30, indicating the early or latent phase of labor.
c.
Cervical dilation progresses to 8 cm with effacement of 80%, indicating the transition phase of labor.
d.
Cervical dilation of 10 cm with effacement is the end of the first stage of labor.

KEY: Integrated Process: Clinical Problem Solving | Cognitive Level: Analysis | Content Area: Maternity | Client Need: Physiological Adaptation | Difficulty Level: Moderate