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Quizzes > Health & Medicine > Human Anatomy & Medicine

Maternal & Child Health Nursing Quiz: Master Intrapartum & Postpartum Care

Ready to ace intrapartum nursing questions and postpartum care trivia? Dive in now!

Difficulty: Moderate
2-5mins
Learning OutcomesCheat Sheet
Paper art illustration of laboring mother pushing newborn silhouette on sky blue background for nursing quiz

Calling all dedicated nursing students and practicing RNs! Wondering at what time is the laboring client encouraged to push? Our free nursing quiz tackles labor push timing in nursing, guiding you through vital maternal and child health nursing quiz concepts. Delve into essential intrapartum nursing questions, challenge yourself with our postpartum nursing quiz, and sharpen your care skills for new mothers. Click through our maternal and child health nursing quiz for focused practice, and test deeper knowledge with classic obstetrics nursing quiz challenges. Ready to boost confidence and ace clinical scenarios? Take the quiz now and empower your nursing journey!

When does the second stage of labor officially begin?
Onset of regular contractions
Onset of full cervical dilation
Delivery of the placenta
When the fetal head crowns
The second stage of labor starts when the cervix reaches full dilation at 10 cm and ends with the birth of the baby. This stage is characterized by the mother's urge to push. ACOG: Stages of Labor and Delivery
Which reflex triggers the maternal urge to push during labor?
Rooting reflex
Ferguson's reflex
Babinski reflex
Moro reflex
Ferguson's reflex is triggered by stretching of the pelvic floor and vaginal walls, producing the involuntary urge to push. It coordinates uterine contractions and maternal bearing down. NCBI: The Ferguson Reflex
What is considered the optimal maternal position for effective pushing?
Lateral decubitus on left side
Prone flat on abdomen
Supine with legs straight
Semi?upright with support
A semi?upright position uses gravity to aid descent, improves maternal comfort, and enhances uterine perfusion. Supported upright positions have been linked to shorter second stage durations. NCBI: Upright Positions in Labor
What is 'laboring down' in the context of the second stage?
Administering oxytocin during second stage
Using episiotomy to speed birth
Delaying active pushing until urges intensify
Immediate pushing at 10 cm dilation
Laboring down allows the fetus to descend passively, reducing maternal exhaustion and improving oxygenation. Active pushing is delayed until the maternal urge is strong. ACOG: Second Stage of Labor Opinion
Why should a laboring patient void before beginning the second stage?
Increases risk of uterine atony
Causes oxytocin overdose
A full bladder impedes fetal descent
Leads to excessive cervical swelling
A distended bladder can obstruct the birth canal and slow fetal descent, leading to prolonged second stage. Voiding also improves maternal comfort and prevents bladder trauma. NCBI Bookshelf: Labor Support Interventions
Which sign indicates that the fetal head is engaging in the pelvis?
Descent to 0 station
Onset of back labor
Membrane rupture
Crowning of the head
Engagement is defined as the widest part of the fetal head reaching the ischial spines, which corresponds to 0 station. This indicates readiness for the second stage. ACOG: Stages of Labor
Which factor is most important for guiding when to begin pushing?
Time since membrane rupture
Fetal station and maternal urge
Duration since last contraction
Maternal heart rate
The combination of fetal descent (station) and a strong maternal urge to bear down guides safe timing for pushing. Contraction frequency and rupture time are secondary. NCBI: Intrapartum Management
What is the recommended maximum length for a mother's breath?holding while pushing?
20 seconds
12 seconds
2 seconds
6 seconds
Short, sustained pushing is recommended to prevent maternal and fetal hypoxia. Guidelines suggest breath-holding under 6 seconds per push effort. Cochrane: Pushing Techniques
Which technique helps coordinate effective pushing?
Pushing only during rest periods
Rapid inhalation between pushes
Exhaling slowly while bearing down
Holding breath throughout contraction
Exhaling slowly while bearing down prevents Valsalva-related hypoxia and improves maternal energy. It also reduces the risk of fetal distress. NCBI: Pushing Techniques
What maternal sign indicates that pushing should pause?
Maternal tachycardia
Increased uterine tone
Urge to defecate
Nonreassuring fetal heart rate
A nonreassuring fetal heart rate pattern warrants pausing to assess and intervene, preventing fetal compromise. The other options do not universally require cessation of pushing. ACOG Practice Alerts
Which hormone surge facilitates the maternal urge to push?
Oxytocin
Cortisol
Progesterone
Prolactin
Endogenous oxytocin increases uterine contractility and stimulates Ferguson's reflex, triggering the push urge. Progesterone and prolactin have different primary roles during pregnancy and lactation. NCBI: Oxytocin in Labor
What is 'crowning' during childbirth?
Onset of uterine contractions
The widest head circumference appearing at the introitus
Rupture of membranes
Placental separation
Crowning occurs when the fetal head remains visible at the vaginal opening without receding between contractions. It signals imminent birth. ACOG: Stages of Labor
Which practice reduces perineal trauma during pushing?
Pushing with breath?holding
Controlled, slow pushing
Squatting unsupported
Forceful, rapid bearing down
Slow, controlled pushing with gradual fetal head descent reduces perineal tearing. Sudden rapid pushes increase the risk of large lacerations. Cochrane: Maternal Position and Perineal Outcome
Why is guided pushing no longer routinely recommended?
It increases breastfeeding success
It shortens labor excessively
It prevents episiotomies
It may increase maternal exhaustion and fetal distress
Studies show coached pushing can cause maternal fatigue, increased blood pressure, and fetal heart rate decelerations. Spontaneous pushing is now preferred unless indicated. ACOG: Second Stage Pushing
What is the typical maternal position for passive descent?
Supine with stirrups
Trendelenburg
Prone with a belly bolster
Side-lying with pillows
Side-lying with pillows promotes comfort and allows pelvic expansion for passive descent without active pushing. Supine positions can compress major vessels. NCBI: Labor Positions
Which sign signals that the fetal head has descended to +2 station?
Head is 2 cm below ischial spines
Membranes are bulging
Crowning is occurring
Contractions occur every 2 minutes
+2 station indicates the fetal head is 2 cm below the ischial spines, nearing crowning. Stations range from - 5 to +5. ACOG: Fetal Station
In an epidural laboring patient, what cue best guides when to push?
Verbal request to push
Fixed time intervals from last contraction
Maternal blood pressure increase
Presence of a strong Ferguson's reflex
Even with epidural analgesia, the Ferguson's reflex remains the best indicator of fetal descent and the urge to push. Timed coached pushing can be harmful without this cue. ACOG: Pushing with Epidural
What complication may result from prolonged breath?holding during pushing?
Increased amniotic fluid volume
Enhanced fetal movement
Reduced uteroplacental perfusion
Higher oxytocin levels
Valsalva maneuver during breath-holding increases intrathoracic pressure, reducing venous return and uteroplacental blood flow. This may lead to fetal hypoxia. Cochrane: Pushing and Perfusion
How does occiput posterior fetal position affect pushing?
Reduces need for analgesia
Speeds up descent automatically
Prevents cervical dilation
May prolong second stage and increase back pain
In the occiput posterior position, the fetal head does not align optimally with the birth canal, leading to longer pushing and maternal back pain. Rotation often occurs during descent. ACOG: Occiput Posterior Position
What is the recommended maximum duration for the active second stage in a primigravida without epidural?
1 hour
30 minutes
3 hours
5 hours
Guidelines define prolonged second stage for primigravidas without epidural as over 3 hours. With epidural, the threshold is longer. Extended duration raises risks of infection and hemorrhage. ACOG Practice Bulletin: Dystocia
Which maternal condition is a contraindication to directed Valsalva pushing?
Hypothyroidism
Gestational diabetes
Uncontrolled hypertension
Mild anemia
In patients with uncontrolled hypertension, Valsalva pushing may sharply elevate maternal blood pressure, risking stroke. Alternative spontaneous pushing is safer. NCBI: Intrapartum Hypertension
What nursing action supports physiologic bearing down?
Encouraging open-glottis pushing
Timing pushes every minute
Applying fundal pressure externally
Instructing breath-holding
Open-glottis pushing (exhaling while pushing) maintains oxygen flow and reduces maternal strain. It is recommended over closed-glottis techniques. Cochrane: Open vs Closed Glottis
During delayed pushing, what fetal assessment remains crucial?
Continuous fetal heart rate monitoring
Maternal blood glucose
Hourly amniotic fluid sampling
Daily ultrasound checks
Continuous FHR monitoring during delay ensures early detection of distress, as passive descent without maternal effort still poses risk. Other assessments are not standard intrapartum. ACOG: FHR Monitoring
Which factor does NOT significantly affect the maternal push effort?
Fetal station
Maternal positioning
Analgesia type
Color of the delivery room walls
Environmental color has no physiologic effect on pushing ability. Analgesia, positioning, and station all influence maternal effort and fetal descent. NCBI: Labor Environment
What complication is increased by prolonged second stage?
Placenta previa
Endometritis
Hyperemesis gravidarum
Gestational diabetes
Long second stage increases infection risk like endometritis due to prolonged membrane rupture and interventions. The other conditions are antenatal. ACOG: Dystocia Risks
How does maternal exhaustion affect pushing?
Improves fetal descent
Eliminates the urge to push
Decreases efficiency of bearing down
Shortens the second stage
Exhaustion leads to poor muscle coordination and weaker efforts, prolonging the second stage. Effective rest or laboring down may restore strength. NCBI: Maternal Exhaustion
Which maternal blood gas change occurs during closed-glottis pushing?
Respiratory acidosis
Metabolic alkalosis
Normal pH
Respiratory alkalosis
Closed-glottis pushing increases CO? retention and intrathoracic pressure, causing transient respiratory acidosis. Open-glottis pushing avoids this. Cochrane: Gas Exchange
In a multipara, what is the recommended maximum second stage duration without epidural?
5 hours
4 hours
1 hour
2 hours
For multiparas without regional analgesia, second stage under 2 hours is considered normal. Over this, risks for maternal morbidity increase. ACOG Bulletin
Which sign suggests the end of the second stage?
Birth of the baby
Placental separation
Rupture of membranes
Cervix dilated to 10 cm
The second stage ends with the delivery of the fetus. Full dilation marks its beginning. Placental separation is the third stage. ACOG: Labor Stages
What is the primary purpose of coaching in directed pushing?
Speed up cervical dilation
Synchronize pushing with contractions
Prevent episiotomy
Eliminate maternal fatigue
Directed pushing aims to coordinate maternal efforts with peak contraction pressure for efficient descent. However, it may not benefit all patients. ACOG Opinion
How does maternal obesity impact second stage pushing?
It often prolongs labor and increases operative delivery
Lowers risk of shoulder dystocia
Reduces need for analgesia
Has no effect on descent
Obesity is associated with longer second stages, higher rates of cesarean and forceps deliveries due to altered uterine contractility and soft?tissue dystocia. NCBI: Obesity and Labor
Which maneuver may assist rotation of an occiput posterior fetus during pushing?
Directed episiotomy
Fundal pressure
Immediate vacuum extraction
Maternal pelvis rocking
Pelvic rocking in all-fours or hands-and-knees positions can help rotate the fetus into occiput anterior. Fundal pressure is discouraged. Coalition on Pushing
In the presence of a compound presentation, when should pushing commence?
When membranes rupture
After manual repositioning of the presenting part
When maternal urging begins
Immediately upon full dilation
A compound presentation (hand alongside head) must be reduced manually to prevent limb injury before pushing. Pushing prematurely risks fetal trauma. NCBI: Compound Presentation
What is an appropriate management for a laboring client with a persistent occiput transverse position at +3 station?
Attempt manual rotation or operative vaginal delivery
Continue spontaneous pushing indefinitely
Increase oxytocin infusion
Immediate cesarean without trial
At low transverse position (+3), manual rotation followed by forceps or vacuum can expedite birth. Prolonged pushing risks maternal and fetal injury. ACOG Bulletin: Operative Delivery
Which fetal heart rate pattern during pushing indicates immediate action?
Early decelerations
Variable decelerations during resting tone
Accelerations during contractions
Persistent late decelerations
Persistent late decelerations indicate uteroplacental insufficiency and fetal hypoxia, necessitating prompt intervention or assisted birth. Early decels and accelerations are benign. ACOG: FHR Patterns
Why might an oxytocin infusion be reduced during the second stage?
To improve cervical dilation
To promote placental separation
To avoid maternal hypotension
To decrease uterine hyperstimulation during pushing
Excessive uterine activity from oxytocin can compromise fetal oxygenation during pushing. Reducing the rate balances contraction strength with safety. ACOG: Oxytocin Management
What is the effect of maternal valsalva pushing on intracranial pressure?
Stabilizes pressure
Has no effect
Increases intracranial pressure
Decreases intracranial pressure
The Valsalva maneuver raises intrathoracic pressure, which in turn elevates central venous and intracranial pressures. This can be risky in patients with elevated intracranial pressure. NCBI: Valsalva Effects
When is instrumental delivery preferred over prolonged pushing?
Fetal heart rate decelerations with maternal exhaustion
Latent first stage prolongation
Early labor with good descent
Mild maternal anemia
Operative vaginal delivery is indicated when the second stage is prolonged with signs of fetal compromise and maternal fatigue. It shortens pushing and reduces risk. ACOG Bulletin
Which assessment confirms effective maternal pushing?
Maternal tachycardia
Rising blood pressure
Fetal descent with each contraction
Increased maternal pain scores
Effective pushing is validated by measurable fetal descent on vaginal exam with contractions. Vital signs alone do not confirm mechanical progress. ACOG: Second Stage Assessment
What intervention mitigates pelvic floor injury during late second stage?
Lithotomy position
Fundal pressure
Perineal support during crowning
Timed Valsalva
Manual perineal support reduces rapid stretching and controls head emergence, lowering rates of severe tears. Lithotomy and fundal pressure can worsen injury. Cochrane: Perineal Support
Which finding suggests uterine rupture during pushing?
Loss of contraction tone and fetal distress
Decreased maternal temperature
Rapid cervical dilation
Increased fetal movement
Uterine rupture often presents with sudden loss of uterine tone, abdominal pain, vaginal bleeding, and fetal heart rate abnormalities. Prompt recognition is critical. ACOG: Uterine Rupture
How does an operative epidural block alter the second stage?
May prolong pushing due to decreased urge
Eliminates the need for pushing
Shortens the second stage
Prevents fetal descent entirely
A denser epidural can reduce pelvic floor sensation, blunting the push reflex and prolonging the second stage. Modified techniques or assistance may be necessary. ACOG: Epidural and Labor
Which lab finding might you monitor if prolonged Valsalva pushing occurs?
Arterial blood gas
Platelet count
Serum glucose
Liver enzymes
Prolonged closed-glottis pushing may cause respiratory acidosis; monitoring arterial blood gas can guide respiratory support. Other labs are unrelated. NCBI: Respiratory Effects
In a patient with significant pelvic floor scarring, how should pushing be modified?
Encourage low?force, frequent open?glottis pushes
Proceed straight to cesarean
Avoid pushing until full crowning
Use maximal Valsalva efforts
Low?force, frequent open-glottis pushing reduces further tissue trauma in scarred pelvic floors. High Valsalva can worsen damage. JOGC: Pelvic Floor Injury
What is the role of the expulsion phase curve in monitoring second stage progress?
Documents episiotomy use
Records maternal pain levels
Measures contraction strength only
It graphically tracks fetal descent relative to time
The expulsion phase curve (partograph) plots fetal station against time to detect arrest of descent and guide timely intervention. It's an evidence-based tool. WHO: Partograph
How does intrauterine pressure catheter data influence pushing guidance?
It sets maternal heart rate targets
It ensures contractions exceed 200 Montevideo units before pushing
It measures fetal scalp pH
It times episiotomy incision
Montevideo units above 200 are associated with adequate contraction strength for effective descent before encouraging pushing. Lower values suggest augmentation. ACOG: Montevideo Units
In which scenario is a prolonged latent phase of the second stage identified on partograph?
No descent for 2 hours in a multipara
Crowning within 30 minutes
Station +4 at full dilation
Full dilation less than 1 hour
A multiparous patient showing no fetal descent within 2 hours of full dilation meets criteria for prolonged latent second stage. This is plotted on the partograph. WHO Partograph
How do maternal cardiovascular changes during pushing impact fluid management?
Decreased cardiac output requires fluid restriction
Hypotension during pushing needs diuretics
Stable hemodynamics allows unrestricted fluids
Elevated preload demands careful volemic monitoring
Valsalva and contractions increase preload; volume status must be optimized to prevent overload and hypotension post-delivery. Judicious fluid management is crucial. NCBI: Hemodynamics in Labor
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Study Outcomes

  1. Identify optimal labor push timing -

    Determine at what time the laboring client is encouraged to push by applying evidence-based criteria for cervix dilation, fetal descent, and maternal readiness.

  2. Apply intrapartum nursing principles -

    Utilize best practices from intrapartum nursing questions to support safe labor progression, ensuring appropriate coaching during each contraction.

  3. Interpret maternal and fetal assessment data -

    Analyze vital signs, fetal heart rate patterns, and contraction strength to guide decisions on labor push timing in nursing practice.

  4. Evaluate postpartum nursing interventions -

    Assess and prioritize critical care measures after delivery, including fundal checks, lochia assessment, and maternal comfort strategies in a postpartum nursing quiz context.

  5. Strengthen HESI exam skills in maternal-child health -

    Reinforce core concepts through a free maternal and child health nursing quiz, boosting confidence and competence for exam success.

Cheat Sheet

  1. Optimal Timing for Pushing -

    The laboring client is encouraged to push once the cervix is fully dilated (10 cm) and the fetus is at or below +2 station, aligning with ACOG guidelines on second”stage management. This moment triggers the Ferguson reflex, enhancing effective expulsive efforts - remember "10 and +2" for labor push timing in nursing. (Source: American College of Obstetricians and Gynecologists)

  2. Recognizing the Ferguson Reflex -

    The Ferguson reflex is a neurohormonal response where uterine contractions and fetal descent stimulate oxytocin release and an involuntary urge to bear down. Nurses can cue clients by saying "Feel the squeeze - push with the wave" to reinforce this natural mechanism during intrapartum nursing questions. (Source: Journal of Midwifery & Women's Health)

  3. Effective Pushing Techniques -

    Closed”glottis pushing resembles a Valsalva maneuver, while open”glottis (breathing out during push) reduces maternal fatigue and improves fetal oxygenation. Use the simple mnemonic "OPEN" (Out-breath, Push, Engage, Navigate) to coach clients in maternal and child health nursing quiz scenarios. (Source: World Health Organization)

  4. Optimal Maternal Positions -

    Upright positions (squatting, hands-and-knees, or side-lying) use gravity to aid fetal descent, whereas lithotomy may be needed for monitoring or complications. Encourage trial of "G.R.A.V.I.T.Y." positions - Gravity, Rest, Adaptable, Vital support, Informable, Toned muscles, Yielding descent - to maximize comfort and efficiency. (Source: Cochrane Library)

  5. Rest and Recovery Between Contractions -

    To prevent exhaustion, instruct clients in paced breathing (e.g., 1:2 inhale-exhale ratio) during intervals, preserving energy for effective pushing. Reinforce the phrase "Breathe in calm, breathe out power" for postpartum nursing quiz confidence and energy conservation. (Source: American Journal of Obstetric Nursing)

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