NUR 4132 Chapter 16: Giving Birth McKinney: Evolve Resources for Maternal-Child Nursing, 5th Edition
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NUR 4132
Institution
NUR 4132
MULTIPLE CHOICE
1. The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products
a. continues except when placental functions are reduced.
b. increases as blood pressure decreases.
c. diminishes as the spiral arteries are compr...
nur 4132 chapter 16 giving birth mckinney evolve resources for maternal child nursing
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NUR 4132
Chapter 16: Giving Birth
McKinney: Evolve Resources for Maternal-Child Nursing,
5th Edition
MULTIPLE CHOICE
1. The maternity nurse understands that as the uterus contracts during labor, maternal-
fetal exchange of oxygen and waste products
a.
continues except when placental functions are reduced.
b.
increases as blood pressure decreases.
c.
diminishes as the spiral arteries are compressed.
d.
is not significantly affected.
ANS: C
During labor contractions, the maternal blood supply to the placenta gradually stops as the
spiral arteries supplying the intervillous space are compressed by the contracting uterine
muscle. The maternal blood supply to the placenta gradually stops with contractions and the
exchange of oxygen and waste products decreases.
2. A student nurse is trying to assess vital signs on a laboring woman. Which statement by the
registered nurse is the best rationale for assessing maternal vital signs between contractions?
a.
During a contraction, assessing fetal heart rates is the priority.
b.
Maternal circulating blood volume increases temporarily during contractions.
c.
Maternal blood flow to the heart is reduced during contractions.
d.
Vital signs taken during contractions are not accurate.
ANS: B
During uterine contractions, blood flow to the placenta temporarily stops, causing a relative
increase in the mother’s blood volume, which in turn temporarily increases blood pressure and
slows pulse. It is important to monitor fetal response to contractions, but the question is
concerned with the maternal vital signs so assessing the fetal heart rate is not the priority. Vital
signs are altered by contractions but are considered accurate for that period of time. However,
they do not reflect the woman’s baseline.
PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 289 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Health Promotion and Maintenance
3. Which mechanism of labor occurs when the largest diameter of the fetal presenting part
passes the pelvic inlet?
a.
Engagement
b.
Extension
c.
Internal rotation
d.
External rotation
ANS: A
, Engagement occurs when the presenting part fully enters the pelvic inlet. Extension occurs
when the fetal head meets resistance from the tissues of the pelvic floor and the fetal neck
stops under the symphysis. This causes the fetal head to extend. Internal rotation occurs when
the fetus enters the pelvic inlet. The rotation allows the longest fetal head diameter to conform
to the longest diameter of the maternal pelvis. External rotation occurs after the birth of the
head. The head then turns to the side so the shoulders can internally rotate and are positioned
with their transverse diameter in the anteroposterior diameter of the pelvic outlet.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 299 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
4. To adequately care for patients, the nurse understands that labor contractions facilitate
cervical dilation by
a.
contracting the lower uterine segment.
b.
enlarging the internal size of the uterus.
c.
promoting blood flow to the cervix.
d.
pulling the cervix over the fetus and amniotic sac.
ANS: D
Effective uterine contractions pull the cervix upward at the same time that the fetus and
amniotic sac are pushed downward. The contractions are stronger at the fundus. The internal
size becomes smaller with the contractions; this helps to push the fetus down. Blood flow
decreases to the uterus during a contraction.
PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 290 OBJ: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
5. A student asks how pregnant women can usually tolerate the normal blood loss associated
with childbirth. Which response by the nurse is best? “It is because they have
a.
a higher hematocrit.”
b.
increased blood volume.”
c.
a lower fibrinogen level.”
d.
increased leukocytes.”
ANS: B
Women have a significant increase in blood volume during pregnancy, which allows them to
tolerate the normal blood loss seen in delivery. The hematocrit decreases with pregnancy due
to the high fluid volume. Fibrinogen levels increase with pregnancy. Leukocyte levels
increase during labor, but that is not the reason for the toleration of blood loss.
6. To assess the duration of labor contractions, the nurse determines the time
a.
from the beginning of one contraction to the beginning of the next.
b.
from the beginning to the end of each contraction.
c.
of the strongest intensity of each contraction.
d.
of uterine relaxation between two contractions.
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