NM 704 EXAM 3 MODULE 7 - COMPREHENSIVE TEST BANK: SECOND
STAGE LABOR MANAGEMENT & PHYSIOLOGY
200 MULTIPLE-CHOICE QUESTIONS WITH VERIFIED ANSWERS,
DETAILED RATIONALES, AND EVIDENCE-BASED CONTENT
1. A 32-year-old primigravida at 39 weeks gestation is in active labor.
Her cervix is 8 cm dilated, and she suddenly reports a strong,
involuntary urge to bear down. According to the physiological
definition, when does the second stage of labor begin?
A. When the cervix is completely dilated to 10 cm.
B. When the fetal head reaches a +2 station.
C. When the woman experiences the involuntary reflexive urge to push.
D. When regular contractions occur every 2-3 minutes.
Correct Answer: C
Rationale: The physiological definition of the second stage of labor
begins with the woman's involuntary urge to push, irrespective of
cervical dilation. The traditional biomedical definition relies solely on
complete cervical dilation.
2. A nulliparous woman is 10 cm dilated but states she has no urge to
push. The fetus is at a 0 station. The provider decides to delay active
pushing. Which of the following is an anticipated benefit of this
expectant management?
A. A shorter overall second stage of labor.
B. An increased chance of a spontaneous vaginal delivery.
,C. An increased risk of fetal oxygen desaturation.
D. A decreased likelihood of the fetus descending and rotating.
Correct Answer: B
Rationale: Delayed pushing in the absence of an urge is associated with
passive descent, which facilitates fetal internal rotation and increases
the likelihood of spontaneous vaginal deliveries, while reducing
operative deliveries and maternal exhaustion.
3. A laboring woman is completely dilated and begins actively pushing
using a Valsalva maneuver under the direction of her nurse. Which of
the following is a documented adverse effect associated with
this coached pushing technique?
A. Increased fetal oxygen saturation.
B. Decreased incidence of perineal trauma.
C. Improved pelvic floor function at 3 months postpartum.
D. A longer duration of the second stage of labor.
Correct Answer: D
Rationale: Coached pushing with a Valsalva maneuver is associated
with longer second-stage durations, decreased fetal oxygenation,
increased perineal trauma, and worse postpartum pelvic floor
outcomes, including decreased bladder capacity.
4. The Ferguson Reflex is a crucial physiological event during the
second stage. What is its primary effect?
A. It causes relaxation of the pelvic floor muscles to allow fetal descent.
B. It results in a surge of oxytocin, which enhances contraction strength.
C. It triggers an increase in maternal heart rate to improve perfusion.
D. It stimulates the release of endorphins to reduce maternal pain.
Correct Answer: B
Rationale: The Ferguson Reflex, triggered by pressure on the pelvic
,floor, leads to a surge of oxytocin. This surge increases the strength and
effectiveness of uterine contractions and the maternal pushing effort.
5. A multiparous woman at 6 cm dilation begins to feel a strong urge
to push. The nurse observes the fetal station is +1. Which statement
best reflects the current evidence regarding pushing at this point?
A. It is strictly contraindicated due to a high risk of cervical laceration.
B. It will likely cause significant cervical edema, prolonging labor.
C. There is no evidence showing harm from pushing prior to complete
dilation.
D. It will almost certainly lead to a shoulder dystocia.
Correct Answer: C
Rationale: The provided material explicitly states there is no evidence
showing harm associated with pushing before complete cervical
dilation, although anecdotal concerns exist.
6. The traditional biomedical definition of the second stage of labor
ends with which event?
A. Delivery of the placenta.
B. Full effacement of the cervix.
C. Birth of the infant.
D. Crowning of the fetal head.
Correct Answer: C
Rationale: The biomedical definition specifies the second stage begins
with complete cervical dilation and ends with the birth of the infant.
7. What is the physiological basis for the urge to push, as described by
the Ferguson Reflex?
A. Pressure of the fetal head on the sacral promontory.
B. Stimulation of a nerve plexus from pressure on the pelvic floor.
, C. Stretching of the perineal body.
D. Hormonal changes from placental separation.
Correct Answer: B
Rationale: The urge to push is generated by the Ferguson Reflex, which
involves stimulation of a nerve plexus when the presenting part
descends and applies pressure on the pelvic floor.
8. At what fetal station is the urge to push usually considered to
occur?
A. 0 station.
B. -1 station.
C. +1 station.
D. +3 station.
Correct Answer: C
Rationale: The physiological basis for the urge to push, triggered by
pressure on the pelvic floor, is usually considered to occur when the
presenting part reaches a +1 station.
9. Which of the following is an anecdotal concern about pushing prior
to complete dilation, despite a lack of evidence?
A. Fetal malpresentation.
B. Uterine rupture.
C. Cervical edema or cervical lacerations.
D. Prolapsed umbilical cord.
Correct Answer: C
Rationale: Anecdotally, early pushing is thought to potentially cause
cervical edema or cervical lacerations, though the provided text states
there is no evidence to confirm harm.
STAGE LABOR MANAGEMENT & PHYSIOLOGY
200 MULTIPLE-CHOICE QUESTIONS WITH VERIFIED ANSWERS,
DETAILED RATIONALES, AND EVIDENCE-BASED CONTENT
1. A 32-year-old primigravida at 39 weeks gestation is in active labor.
Her cervix is 8 cm dilated, and she suddenly reports a strong,
involuntary urge to bear down. According to the physiological
definition, when does the second stage of labor begin?
A. When the cervix is completely dilated to 10 cm.
B. When the fetal head reaches a +2 station.
C. When the woman experiences the involuntary reflexive urge to push.
D. When regular contractions occur every 2-3 minutes.
Correct Answer: C
Rationale: The physiological definition of the second stage of labor
begins with the woman's involuntary urge to push, irrespective of
cervical dilation. The traditional biomedical definition relies solely on
complete cervical dilation.
2. A nulliparous woman is 10 cm dilated but states she has no urge to
push. The fetus is at a 0 station. The provider decides to delay active
pushing. Which of the following is an anticipated benefit of this
expectant management?
A. A shorter overall second stage of labor.
B. An increased chance of a spontaneous vaginal delivery.
,C. An increased risk of fetal oxygen desaturation.
D. A decreased likelihood of the fetus descending and rotating.
Correct Answer: B
Rationale: Delayed pushing in the absence of an urge is associated with
passive descent, which facilitates fetal internal rotation and increases
the likelihood of spontaneous vaginal deliveries, while reducing
operative deliveries and maternal exhaustion.
3. A laboring woman is completely dilated and begins actively pushing
using a Valsalva maneuver under the direction of her nurse. Which of
the following is a documented adverse effect associated with
this coached pushing technique?
A. Increased fetal oxygen saturation.
B. Decreased incidence of perineal trauma.
C. Improved pelvic floor function at 3 months postpartum.
D. A longer duration of the second stage of labor.
Correct Answer: D
Rationale: Coached pushing with a Valsalva maneuver is associated
with longer second-stage durations, decreased fetal oxygenation,
increased perineal trauma, and worse postpartum pelvic floor
outcomes, including decreased bladder capacity.
4. The Ferguson Reflex is a crucial physiological event during the
second stage. What is its primary effect?
A. It causes relaxation of the pelvic floor muscles to allow fetal descent.
B. It results in a surge of oxytocin, which enhances contraction strength.
C. It triggers an increase in maternal heart rate to improve perfusion.
D. It stimulates the release of endorphins to reduce maternal pain.
Correct Answer: B
Rationale: The Ferguson Reflex, triggered by pressure on the pelvic
,floor, leads to a surge of oxytocin. This surge increases the strength and
effectiveness of uterine contractions and the maternal pushing effort.
5. A multiparous woman at 6 cm dilation begins to feel a strong urge
to push. The nurse observes the fetal station is +1. Which statement
best reflects the current evidence regarding pushing at this point?
A. It is strictly contraindicated due to a high risk of cervical laceration.
B. It will likely cause significant cervical edema, prolonging labor.
C. There is no evidence showing harm from pushing prior to complete
dilation.
D. It will almost certainly lead to a shoulder dystocia.
Correct Answer: C
Rationale: The provided material explicitly states there is no evidence
showing harm associated with pushing before complete cervical
dilation, although anecdotal concerns exist.
6. The traditional biomedical definition of the second stage of labor
ends with which event?
A. Delivery of the placenta.
B. Full effacement of the cervix.
C. Birth of the infant.
D. Crowning of the fetal head.
Correct Answer: C
Rationale: The biomedical definition specifies the second stage begins
with complete cervical dilation and ends with the birth of the infant.
7. What is the physiological basis for the urge to push, as described by
the Ferguson Reflex?
A. Pressure of the fetal head on the sacral promontory.
B. Stimulation of a nerve plexus from pressure on the pelvic floor.
, C. Stretching of the perineal body.
D. Hormonal changes from placental separation.
Correct Answer: B
Rationale: The urge to push is generated by the Ferguson Reflex, which
involves stimulation of a nerve plexus when the presenting part
descends and applies pressure on the pelvic floor.
8. At what fetal station is the urge to push usually considered to
occur?
A. 0 station.
B. -1 station.
C. +1 station.
D. +3 station.
Correct Answer: C
Rationale: The physiological basis for the urge to push, triggered by
pressure on the pelvic floor, is usually considered to occur when the
presenting part reaches a +1 station.
9. Which of the following is an anecdotal concern about pushing prior
to complete dilation, despite a lack of evidence?
A. Fetal malpresentation.
B. Uterine rupture.
C. Cervical edema or cervical lacerations.
D. Prolapsed umbilical cord.
Correct Answer: C
Rationale: Anecdotally, early pushing is thought to potentially cause
cervical edema or cervical lacerations, though the provided text states
there is no evidence to confirm harm.
