The Chinese University of Hong Kong

Faculty of Medicine
The Nethersole School of Nursing
Bachelor of Nursing Programme (2016-17)

NURS4121 Nursing for Complex Health Needs

eLearning exercise (14/2/2017)

Revision on Labour Care

1. Mrs Chan, 30-year-old, G1P0, is now admitted for irregular uterine contractions. She
is now at 39 weeks gestation. After examination, she is in latent phase of labour.
Her contractions are 2 in 10 minutes. Vital signs are normal. She worries that she
cannot tolerate the labour pain and request Pethidine injection in advance. As a
midwife, what will be your most appropriate response?

A. Decline her request as Pethidine can cross placenta and is harmful to fetus
B. Discuss with her both pharmacological and nonpharmacological pain relief
methods
C. Reassure her that latent phase does not require analgesics
D. Inform obstetrician to prescribe Pethidine

2. In admission ward, Mrs Chan is lying on the bed and complaints gush of clear fluid
coming out from bottom suddenly. She is at term gestation. You approach to her and
see a loop of cord outside the vulva. What should be the most appropriate actions
taken in sequence?
i. Push back the cord inside vagina
ii. Confirm fetal viability
iii. Elevate the buttocks with extra pillows
iv. Inform obstetrician

A. i ,ii, iv
B. ii, iii, iv
C. ii, i, iv
D. iv, iii, i
3. Mrs Wong is 32-year-old primigravida, with spontaneous onset of labour at 39 weeks.
Membranes were ruptured when cervix fully dilated 75 minutes ago. She has been on
active pushing since then. Mother is very exhausted.

PV exam repeated: Cervix fully dilated, vertex, Station +2, ROA, membrane not felt.
CTG reactive, contractions 3 in 10 minutes. What should be the next step?

A. Perform Vacuum extraction

B. Give syntocinon
C. Perform Caesarean section
D. Continue pushing

4. Which of the following indications are related to epidural analgesia for woman who is
in labour?
i. Multiple pregnancy
ii. Previous intrauterine death
iii. Severe preeclampsia
iv. Primigravida

A. i & ii
B. ii &iv
C. i &iii
D. iii &iv

5. Mrs Lee is 25-year-old G2P1 at 39 weeks gestation. She had previous caesarean
section done two years ago. Obstetrician has discussed with her that she can try
vaginal birth this time (VBAC). Now she is admitted because of membranes have been
ruptured. Mrs Lee looks very anxious. As a midwife, what will be your most
appropriate care to her?

A. Reassure her and assess if she is in labour

B. Inform obstetrician immediately as this is high risk case
C. Arrange type and screen and alert operating theatre
D. Reassure her that she will be fine provided that she delivers the baby on the same
day
6. Which of the following indications are on top priority for electronic continuous fetal
heart monitoring?
i. Woman with uneventful antenatal history and spontaneous onset of labour
ii. Woman with oxytocin infusion for induction of labour
iii. Woman develop fresh vaginal bleeding
iv. Woman with ruptured of membranes

A. i & iv
B. ii & iv
C. i &iii
D. ii & iii

7. Which of the following are absolute contraindications for induction of labour?

i. Fetal distress
ii. Previous caesarean section
iii. Major placenta praevia
iv. Grand multiparous

A. i & iv
B. ii & iii
C. ii & iv
D. i & iii

8. Which of the following is regarded as normal labour?

i. There is steady cervical dilatation and descent of the presenting part
ii. There is reassuring fetal heart tracing
iii. The liquor is meconium stained
iv. There is significant fall in maternal blood pressure

A. iii, iv
B. i,ii,
C. ii,iii
D. i,iv
9. Mrs Cheung gave birth to an infant at 40 weeks gestation by normal vaginal delivery.
The delivery was very smooth. Immediately after birth, the infant is not crying. What
should the midwife do immediately?

A. Provide tactile stimulation

B. Give positive pressure ventilation
C. Inform paediatrician immediately
D. Perform chest compression

10. Which of the following conditions are at risk of postpartum haemorrhage?

i. Multiple Pregnancy
ii. Grand Multiparous
iii. Large uterine fibroids
iv. Retained gestational products

A. i &iv
B. ii &iii
C. iii & iv
D. all of the above

END