Labour and birth

Which of the following is a pre-labour sign?
a. Full cervical dilation
b. Onset of regular contractions
c. Nesting and lightening
d. Placental delivery

Nesting and lightening

The latent phase of the first stage of labour is best described by:
a. Rapid cervical dilation from 4–10 cm
b. Delivery of the fetus
c. Cervical dilation of 0–3 cm with more effacement than dilation
d. Strong pushing contractions

Cervical dilation of 0-3cm with more effacement than dilation

The active phase of labour is characterized by:
a. Cervical dilation slowing down
b. Delivery of the placenta
c. Contractions becoming irregular
d. Rapid dilation and fetal descent

Rapid dilation and fetal descent

The second stage of labour begins with:
a. Cervix 4 cm dilated
b. Delivery of the placenta
c. Full cervical dilation
d. Regular Braxton Hicks contractions

Full cervical dilation

What event marks the third stage of labour?
a. Birth of the baby
b. Delivery of the placenta
c. Complete effacement
d. Onset of contractions

Birth of baby

During the fourth stage of labour, nursing priorities include:
a. Vaginal exams every 15 minutes
b. Preparing for a C-section
c. Stabilizing the birthing person
d. Initiating artificial rupture of membranes

Stabilizing the birthing person

A patient reports increased vaginal discharge and back pain. These symptoms most likely indicate:
a. Postpartum hemorrhage
b. False labour
c. Pre-labour
d. Placental abruption

Pre-labour

One key reason nurses assess amniotic fluid status after ROM is to:
a. Evaluate dilation
b. Confirm GTPAL score
c. Ensure fetal well-being
d. Rule out infection immediately

Ensure fetal well-being

Which of the following supports the onset of labour?
a. Full bladder
b. Inactivity
c. Cervical ripening and fetal descent
d. Breech presentation

Cervical ripening and fetal descent

What is the gold standard for confirming ROM?
a. Cervical dilation
b. Nitrazine or ferning test
c. Leopold's maneuver
d. Blood pressure change

Nitrazine or ferning test

What fetal heart rate is considered normal during labour?
a. 90–120 bpm
b. 110–160 bpm
c. 150–180 bpm
d. 130–180 bpm

110-160 bpm

What is resting tone in uterine monitoring?
a. Contraction strength
b. Time between contractions when uterus relaxes
c. Uterine rupture risk
d. Position of fetus

Time between contractions when uterus relaxes

Frequency of contractions is measured from:
a. End of one to start of the next
b. Peak to peak
c. Start of one to start of the next
d. Start to end of the same contraction

Start of one to start of the next

Effacement refers to:
a. Cervical softening
b. Cervical thinning, measured in percent
c. Descent of the fetus
d. Opening of the cervix in cm

Cervical thinning, measured in percent

A station of 0 indicates the fetal presenting part is:
a. Above the ischial spines
b. At the level of the ischial spines
c. Engaged in the pelvic inlet
d. Visible at the perineum

At the level of the ischial spines

Which of the following is a non-invasive way to monitor fetal heart rate?
a. Internal scalp electrode
b. External tocodynamometer
c. Intermittent auscultation with Doppler
d. Continuous intrauterine pressure catheter

Intermittent auscultation with Doppler

Leopold's maneuvers are used to:
a. Measure cervical dilation
b. Assess fetal presentation and position
c. Time contractions
d. Perform ROM

Assess fetal presentation and position

What assessment tool is used to monitor uterine contraction intensity?
a. Blood pressure cuff
b. Palpation and client description
c. Amniotic fluid COAT
d. Ultrasound

Palpation and client description

The most appropriate setting for a healthy pregnancy in pre-labour is:
a. In-patient unit
b. Hospital delivery suite
c. At home
d. Emergency department

At home

Which of the following is NOT assessed during a vaginal exam?
a. Fetal station
b. Effacement
c. Cervical dilation
d. Fetal heart rate

Fetal heart rate

Which factor most strongly impacts a birthing person’s comfort level?
a. Cervical dilation
b. Partner support and sense of control
c. Fetal station
d. Stage of labour

Partner support and sense of control

Which is a non-pharmacological intervention for labour comfort?
a. Morphine
b. Epidural
c. Effleurage
d. Nitrous oxide

Effleurage

What is the purpose of counterpressure during labour?
a. Induce contractions
b. Promote fetal descent
c. Alleviate back labour pain
d. Slow labour progression

Alleviate back labour pain

What is an appropriate nursing response when a labouring client expresses pain?
a. Encourage silence
b. Acknowledge discomfort and offer support
c. Tell them pain is normal and will go away
d. Delay intervention until fully dilated

Acknowledge discomfort and offer support

Pharmacological options for labour pain include all EXCEPT:
a. Acetaminophen
b. Nitrous oxide
c. Massage therapy
d. Epidural

Massage therapy

Imagery and visualization are used in labour to:
a. Increase uterine tone
b. Distract and promote relaxation
c. Monitor fetal descent
d. Measure contractions

Distract and promote relaxation

When a nurse provides warm compresses and supports breathing techniques, they are:
a. Promoting placental expulsion
b. Applying pharmacological therapy
c. Using evidence-based comfort strategies
d. Conducting fetal monitoring

Using evidence-based comfort strategies

Which of the following is part of COAT assessment for amniotic fluid?
a. Opacity
b. Appearance
c. Amount
d. Timing of contractions

Amount

Which intervention supports mother-baby friendly care?
a. Delayed skin-to-skin
b. Keeping infant in nursery
c. Immediate breastfeeding initiation
d. Routine formula feeding

Immediate breastfeeding initiation

The WHO’s 10 steps for respectful birthing care include:
a. Routine restriction of food and fluids
b. Use of verbal motivation to reduce pain
c. Freedom of movement and choice of birth partner
d. Early discharge regardless of mother’s condition

Freedom of movement and choice of birth partner

The second stage of labour begins with:
a. Cervical dilation of 4 cm
b. Complete cervical dilation and effacement
c. Delivery of the placenta
d. Onset of Braxton Hicks contractions

Complete cervical dilation and effacement

What characterizes the passive phase of the second stage of labour?
a. Intense pushing with every contraction
b. Waiting for a surgical team
c. Allowing the fetus to descend naturally
d. Delivering the placenta

Allowing the fetus to descend naturally

Encouraging the birthing person to push only when they feel the urge promotes:
a. Prolonged labour
b. Closed-glottis pushing
c. Open-glottis pushing
d. More use of epidurals

Open-glottis pushing

Closed-glottis pushing is associated with:
a. Improved fetal oxygenation
b. Decreased maternal fatigue
c. Increased risk of fetal hypoxia
d. Better pelvic floor outcomes

Increased risk of fetal hypoxia

Which nursing action is appropriate during the second stage of labour?
a. Encourage directed pushing
b. Administer oxytocin
c. Offer position changes and verbal support
d. Perform fetal delivery

Offer position changes and verbal support

A burning sensation during delivery of the head is likely due to:
a. Ruptured membranes
b. Perineal stretching
c. Contraction intensity
d. Breech presentation

Perineal stretching

What is a nursing priority during the delivery of the fetus?
a. Telling the birthing person to push harder
b. Inspecting the placenta
c. Promoting comfort with warm compresses
d. Delivering the baby

Promoting comfort with warm compresses

What should the nurse do immediately after visualizing the fetal head?
a. Prepare for placenta delivery
b. Tell the birthing person to hold their breath
c. Encourage relaxed breathing
d. Begin suturing

Encourage relaxed breathing

During the second stage, who confirms full dilation?
a. Nurse practitioner
b. Nursing student
c. Trained healthcare provider
d. Respiratory therapist

trained healthcare provider

What is one key reason for avoiding frequent vaginal exams during labour?
a. Increased fetal movement
b. Risk of infection
c. Cost of equipment
d. It is unnecessary

Risk of infection

Which of the following birth positions should be used?
a. Supine only
b. Lithotomy only
c. The one chosen by the birthing person when possible
d. Whatever is easiest for the provider

The one chosen by the birthing person when possible

Which cardinal movement occurs first during vaginal birth?
a. Internal rotation
b. Extension
c. Engagement and descent
d. External rotation

Engagement and descent

What is the nurse’s scope of practice during delivery of the fetus?
a. Cut the umbilical cord
b. Deliver the fetus
c. Promote comfort and explain what is happening
d. Inspect and suture the perineum

Promote comfort and explain what is happening

The most appropriate documentation during second stage labour includes:
a. Equipment location
b. Frequency of hospital meals
c. Fetal heart rate, contractions, and support provided
d. Newborn feeding plans

Fetal heart rate, contractions, and support provided

After delivery, the nurse should immediately:
a. Remove the baby to a warmer
b. Apply oxygen to the mother
c. Encourage skin-to-skin contact
d. Begin fundal massage

Encourage skin to skin contact

What natural trigger helps deliver the placenta?
a. Caffeine
b. Uterine rupture
c. Release of oxytocin
d. Supine positioning

Release of oxytocin

Skin-to-skin contact, breastfeeding, and nipple stimulation all:
a. Slow placenta delivery
b. Prevent postpartum depression
c. Stimulate oxytocin release
d. Increase risk of hemorrhage

Stimulate oxytocin release

Who is responsible for repairing the perineum after birth?
a. Nurse
b. Nurse practitioner
c. Delivering healthcare provider
d. Midwife assistant

Delivering healthcare provider

What is the typical time frame for placental delivery?
a. Within 5 minutes
b. 30–60 minutes
c. Within 15 minutes
d. Immediately after birth

Within 15 minutes

What might be a culturally sensitive question related to placenta care?
a. "Would you like us to dispose of the placenta for you?"
b. "Do you plan to ingest the placenta?"
c. "Are there any traditions you'd like to observe related to the placenta?"
d. "Do you know what the placenta is used for?"

Are there any traditions youd like to observe related to placenta

What is a traditional practice in some cultures regarding the placenta?
a. Cremation
b. Discarding it immediately
c. Burying it with ceremony
d. Storing it in the freezer for years

Burying it with ceremony

The fourth stage of labour begins with:
a. Cervical dilation
b. Delivery of the placenta
c. Rupture of membranes
d. Return of menstruation

Delivery of placenta

Which vital assessment is part of immediate postpartum care?
a. Fetal station
b. Bishop score
c. Fundus and lochia
d. GTPAL

Fundus and lochia

During the fourth stage, nurses must assess for:
a. Ectopic pregnancy
b. PROM
c. Postpartum hemorrhage
d. Breech position

Postpartum hemorrhage

How often should vital signs be assessed during the immediate postpartum period?
a. Once every shift
b. Only if the mother is symptomatic
c. Frequently, as per protocol (e.g., every 15 minutes)
d. After baby’s first feeding

Frequently, as per protocol

A priority nursing intervention before first ambulation postpartum is to:
a. Check blood glucose
b. Measure intake/output
c. Assess orthostatic hypotension risk
d. Apply abdominal binder

Assess orthostatic hypotension risk

A nurse is assessing the lochia and finds heavy bleeding with clots. What is the best initial response?
a. Document and reassess in 2 hours
b. Massage the fundus and call for assistance
c. Start IV fluids immediately
d. Administer pitocin

Massage the fundus and call for assistance

What is fundal assessment primarily evaluating?
a. Cervical position
b. Uterine tone and location
c. Fetal descent
d. Placental shape

Uterine tone and location

What is the expected fundal location immediately postpartum?
a. Two fingers below the umbilicus
b. At the symphysis pubis
c. At or just below the umbilicus
d. Midline thoracic area

At or just below the umbilicus

Why is bonding and breastfeeding encouraged in the fourth stage of labour?
a. It keeps the baby awake
b. It prevents maternal fever
c. It promotes oxytocin release and maternal-infant connection
d. It replaces pain medications

It promotes oxytocin release and maternal-infant connection