Ch 13 Labor and Birth Process 30Qw/exp

The nurse is teaching a patient, who is pregnant for the first time, about the signals that indicate the beginning of labor. Which sign will the nurse mention as a signal for the beginning of labor? 1 Involuntary contractions 2 Pain in the pelvic joints 3 100% effacement of the cervix 4 Full dilation of the cervix

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What will the nurse mention about the effect of secondary powers during labor to the patient? 1 Contractions are expulsive in nature. 2 The intraabdominal pressure is decreased. 3 Contractions move downward in waves. 4 Contractions begin at pacemaker points.

1 As soon as the presenting part of the fetus touches the pelvic floor, the patient uses secondary powers or bearing-down efforts. This results in contractions that are expulsive in nature. The voluntary bearing-down efforts of the patient also result in increased intraabdominal pressure. Primary powers signal the beginning of labor with involuntary contractions that move downward over the uterus in waves. These contractions begin at pacemaker points in the thickened muscle layers of the upper uterine segment.

The nurse is caring for a patient in the first stage of labor. What maternal physiologic changes does the nurse expect? 1 Decrease in absorption of solid food 2 Increase in systolic and diastolic pressures 3 Increase in nausea and vomiting sensation 4 Increase in cardiac output by 30% to 50%

1 During the first stage of labor, gastrointestinal motility and absorption of solid foods are decreased, and stomach-emptying time is slowed down. Only systolic blood pressure increases during uterine contractions in the first stage of labor. Systolic and diastolic pressures increase during contractions in the second stage of labor and return to baseline levels between contractions. Nausea and vomiting sensations may occur during the transition from first stage to second stage of labor. In the first stage of labor, the cardiac output increases by 10% to 15%. Cardiac output increases by 30% to 50% only at the end of the first stage of labor and not in the first stage.

The nurse is caring for a patient who is in the third trimester of pregnancy. The patient reports pain in the pelvic joints. What does the nurse recognize as the cause of the pain? 1 There is relaxation of the pelvic joints. 2 There is decreased mobility of the ligaments. 3 The joint of the symphysis pubis is narrowing. 4 The pelvis may not support vaginal birth.

1 In the third trimester of pregnancy, the pelvic joints relax, leading to pain. There is increased mobility of the pelvic joints and ligaments as a result of hormonal influences. Widening of the joint of the symphysis pubis and the resulting instability may cause pain in any or all of the pelvic joints. Pain in the pelvic joints does not indicate that the pelvis may not support vaginal birth. A heart shaped android pelvis may not support spontaneous vaginal birth.

On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? 1 The fetal presenting part is 1 cm above the ischial spines. 2 Effacement is 4 cm from completion. 3 Dilation is 50% completed. 4 The fetus has achieved passage through the ischial spines.

1 Station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Passage through the ischial spines with internal rotation would be indicated by a plus station such as +1.

The nurse palpates the fontanels and sutures to determine the fetal presentation. What is the feature of the anterior fontanel? 1 It is diamond shaped in appearance. 2 It measures about 1 cm by 2 cm. 3 It closes after 6 to 8 weeks of birth. 4 It lies near the occipital bone.

1 The anterior fontanel is diamond shaped and measures about 3 cm by 2 cm. It closes by 18 months after birth. It lies at the junction of the sagittal, coronal, and frontal sutures. The posterior fontanel is triangular in shape and measures about 1 cm by 2 cm. It closes 6 to 8 weeks after birth. It lies at the junction of the sutures of the two parietal bones and the occipital bone.

The nurse palpates the fontanels and sutures of a fetus during the vaginal examination of a patient in labor after the rupture of membranes. Where does the nurse locate the lambdoid suture? 1. A 2. B 3. C 4. D

1 The fetal skull is composed of two parietal bones, two temporal bones, the frontal bone, and the occipital bone. The lambdoid suture lies between the parietal bone and the occipital bone. The sagittal suture lies between the two parietal bones. The coronal suture lies between the parietal bone and the frontal bone. The frontal suture separates the two halves of the frontal bone.

The nurse is assessing a patient in labor. The nurse documents the progress in the effacement of the cervix and little increase in descent. Which phase of labor is the patient in? 1 Latent phase 2 Active phase 3 Transition phase 4 Descent phase

1 The patient is in the latent phase of the first stage of labor. In this phase, there is more progress in the effacement of the cervix and little increase in the descent of the fetus. In the active and transition phases, there is more rapid dilation of the cervix and increased rate of descent of the presenting part of the fetus. The descent phase, or active pushing phase, occurs in the second stage of labor. In this phase, the patient has a strong urge to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

What response does the nurse expect when a laboring patient is administered analgesic medication early in labor? 1 Painless intrauterine contractions 2 Increased frequency of contractions 3 Increased intensity of contractions 4 Rapid descent of the fetus

1 Uterine contractions are usually independent of external forces. Laboring patients who are administered analgesic medication have normal but painless uterine contractions. However, uterine contractions may decrease in frequency and intensity temporarily, if narcotic analgesic medication is administered early in labor. The first and second stages of labor are lengthened, and the rate of fetal descent slows down.

Nurses can advise their patients that which of these signs precede labor? Select all that apply. 1 A return of urinary frequency as a result of increased bladder pressure 2 Persistent low backache from relaxed pelvic joints 3 Stronger and more frequent uterine (Braxton Hicks) contractions 4 A decline in energy, as the body stores up for labor 5 Uterus sinks downward and forward in first-time pregnancies

1, 2, 3 After lightening, a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor , women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term.

The nurse is caring for a patient who had a normal vaginal birth. The patient is concerned about the shape of the infant's head. What does the nurse tell the patient? Select all that apply. 1 The bones of the skull continue to grow after birth. 2 The shape of the head undergoes molding during labor. 3 The head assumes its normal shape within a month. 4 The skull bones of an infant are generally firmly united. 5 The sutures and fontanels make the skull flexible

1, 2, 5 The bones of the skull continue to grow for some time after birth to accommodate the infant's brain. During labor, the shape of the head gets molded as the bones undergo a slight overlapping. The sutures and fontanels are membranous structures that unite the skull bones and make the skull flexible. Molding can be extensive, but the heads of most newborns assume their normal shape within 3 days after birth. The skull bones are held together by sutures and fontanels and are not firmly united in an infant.

What are the common signs that are observed in the days preceding labor? Select all that apply. 1 Persistent low backache 2 Sudden increase in lethargy 3 Blood-tinged cervical mucus 4 Increase in weight up to 1.5 kg 5 Profuse vaginal mucus

1, 3, 5 Common signs that precede labor include persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Brownish or blood-tinged cervical mucus may be passed. The vaginal mucus becomes more profuse in response to the extreme congestion of the vaginal mucous membranes. In the days preceding labor, women generally have a sudden surge of energy. They also experience a loss of 0.5 to 1.5 kg in weight. This is caused by water loss resulting from electrolyte shifts that in turn are produced by changes in estrogen and progesterone levels.

What are the factors that speed up the dilation of the cervix? Select all that apply. 1 Strong uterine contractions 2 Scarring of the cervix 3 Pressure by amniotic fluid 4 Prior infection of the cervix 5 Force by fetal presenting part

1, 3, 5 Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix, which are, in turn, caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can promote cervical dilation. Scarring of the cervix may occur following a surgery. Prior infection or surgery may slow cervical dilation.

The nurse is assessing a pregnant client and determines that the client has a round pelvis with moderate depth, straight sidewalls, curved sacrum, and wide subpubic arch. The nurse also finds that the client's ischial spines are blunt. How should the nurse classify the client's pelvis based on these findings? 1 Android 2 Gynecoid 3 Anthropoid 4 Platypelloid

2 Based on the shape, depth, and other characteristics of the pelvis, health care providers classify it into four different types. The presence of a round pelvis with moderate depth, straight sidewalls, curved sacrum, and a wide subpubic arch indicates that the client has a gynecoid pelvis. If the client's pelvis is heart-shaped and has convergent sidewalls with a narrow subpubic arch, then it would be classified as an android pelvis. If the client's pelvis is oval with a narrow subpubic arch, then it would be classified as an anthropoid pelvis. If the client's pelvis is flat with a slightly curved sacrum, then it indicates that the client has a platypelloid pelvis.

What are the factors that enable the baby to initiate respiration immediately after birth? 1 Fetal respiratory movements increase during labor. 2 Fetal lung fluid is cleared from the air passage. 3 Arterial carbon dioxide pressure is decreased. 4 Arterial pH and bicarbonate level is increased.

2 Fetal lung fluid is cleared from the air passage as the infant passes through the birth canal during labor and vaginal birth. There is a decrease in fetal respiratory movements during labor. Arterial carbon dioxide pressure (Pco2) increases. There is a decrease in arterial pH and bicarbonate levels. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for action.

Nurses can help their patients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? 1 Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours 2 Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours 3 Lull: no contractions; dilation stable; duration of 20 to 60 minutes 4 Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

2 The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

The nurse is performing the pelvic examination of a patient during the prenatal visit. Which pelvic type is least favorable for a vaginal birth? 1 Gynecoid 2 Android 3 Anthropoid 4 Platypelloid

2 The android pelvis is heart shaped and angulated. The sidewalls are convergent, the sacrum is slightly curved, and the terminal portion is often beaked. The subpubic arch is narrow, often resulting in cesarean births or difficult vaginal forceps births. It is least favorable for vaginal birth. The gynecoid pelvis is slightly ovoid or transversely rounded. The sidewalls are straight, and the sacrum is deep and curved. The subpubic arch is wide, thus enabling spontaneous vaginal births. The anthropoid pelvis is oval and wider anteroposteriorly. The sidewalls are straight, sacrum slightly curved. The subpubic arch is narrow and may result in a forceps vaginal birth. The platypelloid pelvis is flattened anteroposteriorly and wide transversely. The sidewalls are straight, the sacrum slightly curved, and the subpubic arch is wide, resulting in spontaneous vaginal birth.

When assessing a patient for the possibility of a vaginal birth, what must the nurse keep in mind about the coccyx of the bony pelvis? 1 It is the part above the brim of the bony pelvis. 2 It is movable in the latter part of the pregnancy. 3 It has three planes: the inlet, midpelvis, and outlet. 4 It is ovoid and bound by the pubic arch anteriorly

2 The coccyx is movable in the latter part of the pregnancy, unless it has been broken and fused to the sacrum during healing. The bony pelvis is separated by the brim into the false and the true pelves. The false pelvis is the part above the brim and plays no part in childbearing. The true pelvis is involved in birth and is divided into three planes: inlet, midpelvis, and outlet. The pelvic outlet is the lower border of the true pelvis. Viewed from below it is the ovoid. It is shaped somewhat like a diamond and bound by the pubic arch anteriorly, the ischial tuberosities laterally, and the tip of the coccyx posteriorly.

Which pelvic shape is most conducive to vaginal labor and birth? 1 Android 2 Gynecoid 3 Platypelloid 4 Anthropoid

2 The gynecoid pelvis is round and cylinder shaped, with a wide pubic arch. Prognosis for vaginal birth is good. Only 23% of women have an android-shaped pelvis, which has a poor prognosis for vaginal birth. The platypelloid pelvis is flat, wide, short, and oval. The anthropoid pelvis is a long, narrow oval with a narrow pubic arch. It is more favorable than the android or platypelloid pelvic shape.

The nurse is assessing a pregnant patient who is paralyzed due to a spinal injury at the level of the twelfth thoracic vertebra. Presently, she is in full-term gestation and under nursing care. What should the nurse inform the patient? 1 "You may have a prolonged labor." 2 "You may have painless uterine contractions." 3 "Your uterus may not contract due to paralysis." 4 "Your baby may develop neurologic problems."

2 The pregnant patient is paralyzed due to a spinal lesion above the twelfth thoracic vertebra. In this case, the patient would not perceive the uterine contractions and thus would have painless uterine contractions. The spinal injury has no effect on the duration of labor. The uterine contractions are not dependent on any external forces, and thus this patient would have normal uterine contractions. Neurologic problems in the fetus are not a complication associated with spinal cord injury.

The nurse is briefing a patient who is pregnant for the first time about lightening. Which statement should the nurse mention to describe lightening to the patient? 1 It occurs when true labor is in progress. 2 It allows the patient to breathe more easily. 3 It decreases the pressure on the bladder. 4 It leads to decreased urinary frequency.

2 When the fetal head descends into the true pelvis during lightening, the patient will feel less congested and can breathe more easily. In a first-time pregnancy, lightening occurs about 2 weeks before term. In a multiparous pregnancy, lightening may not take place until after the uterine contractions are established and the true labor is in progress. This shift increases the pressure on the bladder and causes a return of urinary frequency. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

During the vaginal examination of a laboring patient, the nurse analyzes that the fetus is in the right occiput anterior (ROA) position at -1 station. What is the position of the lowermost portion of the fetal presenting part? 1 2 cm above the ischial spine. 2 1 cm above the ischial spine. 3 at the level of the ischial spine. 4 1 cm below the ischial spine.

2 When the lowermost portion of the presenting part is 1 cm above the ischial spine, it is noted as being minus (-)1. When positioned 2 cm above the ischial spine, it is -2 station. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (+)1.

The nurse knows that the second stage of labor, the descent phase, has begun when the: 1 amniotic membranes rupture. 2 cervix cannot be felt during a vaginal examination. 3 woman experiences a strong urge to bear down. 4 presenting part is below the ischial spines.

3 During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation.

In which stage of labor does the nurse expect the placenta to be expelled? 1 First 2 Second 3 Third 4 Fourth

3 The placenta is expelled in the third stage of labor. The placenta normally separates with the third or fourth strong uterine contraction after the infant has been born. The first stage of labor lasts from the time dilation begins to the time when the cervix is fully dilated. The second stage of labor lasts from the time of full cervical dilation to the birth of the infant. The fourth stage of labor lasts for the first 2 hours after birth.

The nurse is caring for a multiparous patient. In which stage can the nurse expect the fetal head to be engaged in the pelvic inlet? 1 About 2 weeks before term 2 Before the start of active labor 3 When labor stage I begins 4 After labor is established

4 In a multiparous patient, the abdominal musculature is relaxed. The fetal head often remains freely movable above the pelvic brim and becomes engaged in the pelvic inlet only after labor is established. In a nulliparous patient, the uterus sinks downward and forward about 2 weeks before term, when the presenting part of the fetus descends into the true pelvis. The fetal head is engaged in the pelvic inlet before the onset of active labor. The abdominal muscles are firm in a nulliparous pregnancy and direct the presenting part into the pelvis. The first stage of labor lasts from the onset of regular uterine contractions to full dilation of the cervix.

A primigravida asks the nurse about signs she can look for that indicate that the onset of labor is getting closer. The nurse should describe: 1 weight gain of 1 to 3 lbs. 2 quickening. 3 fatigue and lethargy. 4 bloody show.

4 Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens. Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct.

The nurse assisting a laboring patient is aware that the birth of the fetus is imminent. What is the station of the presenting part? 1. -1 2. +1 3. +3 4. +5

4 Station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines. The placement of the presenting part is measured in centimeters above or below the ischial spines. Birth is imminent when the presenting part is at +4 to +5 cm. When the lowermost portion of the presenting part is 1 cm above the spine, it is noted as minus (-)1. When the presenting part is 1 cm below the spine, the station is said to be plus (+)1. At +3, the presenting part is still descending the birth canal. Birth is imminent when the presenting part is at +4 to +5 cm.

When assisting a patient in labor, the nurse expects to observe the cardinal movements that lead to the birth of the baby. Arrange the movements in the order of their occurrence. 1. Internal rotation 2. Extension 3. Descent 4. Flexion 5. Restitution 6. Engagement

6, 3, 4, 1, 2, 5 The cardinal movements that occur in a vertex presentation are engagement, descent, flexion, internal rotation, extension, restitution (external rotation), and finally birth by expulsion. The fetal head is said to be engaged in the pelvic inlet when the biparietal diameter of the head passes through the pelvic inlet. During descent, the presenting part progresses through the pelvis. As soon as the descending head meets resistance from the cervix or pelvic wall or pelvic floor, it undergoes flexion. The fetus flexes such that the chin is brought into closer contact with the fetal chest. Internal rotation begins at the level of the ischial spines but is not completed until the presenting part reaches the lower pelvis. When the fetal head reaches the perineum for birth, it undergoes extension. It is deflected anteriorly by theperineum. Restitution occurs after the head is born.It rotates briefly to the position it occupied when it was engaged in the inlet.

The nurse is performing a vaginal examination of a pregnant patient who is in the first stage of labor. During the examination, the patient reports that she has an urge to bear down. Why does the patient feel this urge? Select all that apply. A The descending part of the fetus reaches the pelvic floor. B The presenting part of the fetus descends into the true pelvis. C Levels of estrogen increase and levels of progestogen decrease. D Levels of progestogen increase and levels of estrogen decrease. E Levels of oxytocin increase due to activation of stretch receptors in the vagina.

A, E When the presenting part of the fetus reaches the pelvic floor, it activates stretch receptors in the posterior vagina and releases endogenous oxytocin in a pregnant woman, which causes the urge bear down and push the baby out. This phenomenon is called the Ferguson reflex. The presenting part of the fetus descends into the true pelvis about 2 weeks before term; this "dropping" does not cause the urge to bear down. Levels of estrogen and progestogen do not change due to vaginal stimulation. Receptors in the vagina are activated rather than inhibited, which releases oxytocin and causes the urge to push.

The nurse informs the patient that she will likely have difficulty delivering vaginally, and a cesarean delivery may be necessary. Which findings led the nurse to this conclusion? Select all that apply. A The patient has a gynecoid pelvis. B The patient has an android pelvis. C The patient has an anthropoid pelvis. D The fetus is in a cephalic presentation. E The fetal head is in a brow presentation.

B, E The android pelvis is heart-shaped, and it resembles the male pelvis. The pelvic outlet in this type is very narrow, which may make vaginal delivery difficult. Thus, the patient with this type of pelvis is most likely to require a cesarean delivery. If the fetal head is in a brow position, the diameter of the head is often too large to pass through the pelvis; therefore, a resolution is required before vaginal delivery, or a cesarean delivery is necessary. A gynecoid pelvis is round in shape, and it is the classic female pelvis. An anthropoid pelvis is oval in shape, and it resembles the pelvis of anthropoid apes. The gynecoid and anthropoid pelvises have a comparatively broader pelvic outlet, and vaginal delivery is the usual mode of birth with these types. The fetus is in a cephalic presentation for 96% of births. Cephalic presentation does not create difficulties for vaginal delivery or necessitate a cesarean delivery.