Chapter 13-14 OB test 2

Causes relaxation of smooth muscle tissue

progesterone

Increment

buildup of uterine contraction

Decrement

descent or relaxation of uterine muscle fibers

Causes stimulation of uterine muscle contractions

estrogen

What would be detected when using continuous fetal monitoring but not intermittent monitoring?

-types of decelerations -variability

Leopold maneuver 2: identifies what?

-use palms of hands on the sides of uterus to identify fetal back and small body parts

Signs placenta is ready to deliver

-uterus rises upward -sudden trickle of blood -uterus changes its shape to globular -umbilical cord lengthens

Leopold maneuver 3: identifies what?

-what the presenting part is place one hand just above symphysis. note whether the part palpated feels like the fetal head or the breech and whether it is engaged

List in order the steps the nurse would take when performing the leopard's maneuver 1. determine position 2. determine attitude 3. determine presentation 4. confirm presentation

1. determine presentation 2. determine position 3. confirm presentation 4. determine attitude

A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position B. Apply a fetal scalp electrode C. Insert an IV catheter D. Perform a vaginal exam

A. Assist the client into the left-lateral position

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? 1) FHR fluctuates less than 5 beats per minute. 2) FHR fluctuation range is undetectable. 3) FHR fluctuates over 25 beats per minute. 4) FHR fluctuates from 6 to 25 beats per minute.

4. FHR fluctuates from 6 to 25 beats per minute. Explanation: Variability is described in four categories: absent, fluctuations range undetectable; minimal, fluctuations range observed at <5 beats per minute; moderate (normal), fluctuation range from 6 to 25 beats per minute; and marked, fluctuation range >25 beats per minute.

normal umbilical cord pH

7.2-7.3

Light or firm touch to the energy field of the body using the hands to redirect the energy fields that lead to pain A.) therapeutic touch B.) patterned breathing C.) effleurage D.) acupressure

A

A nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? a) Administer oxygen via face mask. b) Place the mother in a supine position. c) Increase the rate of the oxytocin (Pitocin) intravenous infusion. d) Document the findings and continue to monitor the fetal patterns.

A Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

A nurse is providing care for a client who is in active labor. Her cervix is dilated to 5 cm, and her membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds, and have beat-to-beat variability of 20/min. There is no slowing of FHR from the baseline. The nurse should recognize that this client is exhibiting signs of which of the following? (Select all that apply) A. Moderate variability B. FHR accelerations C. FHR decelerations D. Normal baseline FHR E. Fetal tachycardia

A,B,D Explanation: A. CORRECT: There is moderate variability of 20 beats/min (6 to 25/min is expected). B. CORRECT: FHR accelerations are present with increases up to 150 to 155/min lasting for 25 seconds. C. INCORRECT: There are no FHR decelerations because the FHR does not slow down. D. CORRECT: There is a normal baseline FHR of 115 to 125/min (110 to 160/min is expected). E. INCORRECT: There is no evidence of fetal tachycardia because there is a normal baseline FHR of 115 to 125/min.

A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3-5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. Which of the following actions should the nurse take? (Select all that apply) A. Encourage use of patterned breathing techniques B. Insert an indwelling urinary catheter C. Administer opioids analgesic medication D. Suggest application of cold E. Provide ice chips

A,C,D

A nurse is caring for a client in the third stage of labor. Which of the following findings indicate that placental separation? (select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagina E. Fundus firm upon palpation

A,D,E

A nurse is reviewing the FHR and notes it to be in the range of 100-106 bp over the past 10 min. Which conditions might the nurse suspect? (Select All that apply) A.) fetal hypoxia B.) prolonged umbilical cord compression C.) maternal fever D.) effect of maternal analgesia E.) prematurity F.) fetal hypothermia

A,b,d,f

A nurse in L&D is caring for a client in labor and applies an external fetal monitor and tocotransducer. The FHR is around 140/min. Contractions are occurring every 8 min and 30 to 40 seconds in duration. The nurse performs a vaginal exam and finds the cervix is 2 cm dilated, 50% effaced and the fetus is at a -2 station. Which of the following stages and phases of labor is this client experiencing? A. First stage, latent phase B. First stage, active phase C. First stage, transition phase D. Second stage of labor

A. First stage, latent phase

A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic blocks is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical

A. Pudendal Explanation: A pudendal block is a transvaginal inject of local anesthetic that anesthetizes the perineal area for the episiotomy and repair, and the expulsion of the fetus. Epidural blocks are administered during labor and allow the client to participate in the second stage while remaining comfortable. Spinal blocks are administered in the late second stage but most commonly preceding a cesarean birth. Paracervical blocks are used early in labor to block pain of uterine contractions but are rarely used today.

On the fetal heart monitor you see early decelerations. What is the cause of this finding?* A. The baby's head is pressing against the pelvis or soft tissue B. It is due to uteroplacental insufficiency. C. It is caused by cord compression. D. It is caused by a prolapsed uterus.

A. The baby's head is pressing against the pelvis or soft tissue

Which of the following statements describe a variable deceleration? A. Variable decelerations are uniform. B. On the fetal tracing, the heart rate will mirror the mother's contraction and represent uteroplacental insufficiency. C. On the fetal tracing, the heart rate will increase after the mother's contraction and return to baseline after the contraction ends. D. On the fetal tracing, the heart rate will go up and down and present when the cord is being compressed.

A. Variable decelerations are uniform.

Controlled breathing techniques to reduce pain through a stimulus-response conditioning A.) therapeutic touch B.) patterned breathing C.) effleurage D.) acupressure

B

A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following should statements the nurse include in the teaching? (select all that apply.) A. "It is considered a noninvasive procedure." B. "It can detect abnormal fetal heart tones early." C. "It can determine the amount of amniotic fluid you have." D. "It allows for accurate readings with maternal movement." E. "It can measure uterine contraction intensity."

B,D,E

A nurse in L&D is completing an admission assessment for a client who is at 39 weeks gestation. The client reports that she has been leaking fluid from her vagina for 2 days. Which of the following conditions is the client at risk for developing? A. Cord prolapse B. Infection C. Postpartum hemorrhage D. Hydramnios

B. Infection Explanation: rupture of membranes for longer than 24 hr prior to delivery increases the risk that infectious organisms will enter the vagina and then eventually into the uterus

A client experiences a large gush of fluid from her vagina while walking in the hallway of the birthing unit. Which of the following actions should the nurse take first? A. Check the amniotic fluid for meconium B. Monitor FHR for distress C. Dry the client and make her comfortable D. Monitor uterine contractions

B. Monitor FHR for distress

A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus B. Palpate the fundus of the uterus C. Grasp lower uterine segment between thumb and fingers D. Stand facing client's feet with fingertips outlining cephalic prominence

B. Palpate the fundus of the uterus

A nurse is caring for a client who is in the transition phase of labor and reports that she needs to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A. Assist the client to the bathroom B. Prepare for an impending delivery C. Prepare to remove a fecal impaction D. Encourage the client to take deep, cleansing breaths

B. Prepare for an impending delivery Explanation: The urge to have a bowel movement indicates fetal descent and complete dilation

A nurse is caring for a client who is in active labor. The client reports lower back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. Which of the following nonpharmacological nursing interventions should the nurse recommend to the client? A. Abdominal effleurage B. Sacral counterpressure C. showering if not contraindicated D. Back rub and massage

B. Sacral counterpressure

The client is requesting information on the various pain medication management techniques that are available so she can decide which option she would like to choose for impending delivery. While gathering together the information, the nurse would indicate which technique as becoming very popular and effective? A.) spinal analgesia B.) neuraxial analgesia/anesthesia C.)epidural analgesia D.) systemic analgesia

B.) neuraxial analgesia/anestheia Explanation: Neuraxial analgesia/anesthesia is the administration of analgesic or anesthetic agents, either continuously or intermittently, into the epidural or intrathecal space to relieve pain. It does not interfere with the progress or outcome of labor. It involved minimal motor blockade. Systemic analgesia and regional analgesia/anesthesia have become less popular due to complications

A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." D. "It is needed to prevent oligohydramnios."

C. "It is needed to counteract hypotension."

A nurse is caring for a client and her partner during the second stage of labor. The client's partner asks the nurse to explain how he will know when crowning occurs. Which of the following responses should the nurse make? A. "The placenta will protrude from the vagina." B. "Your partner will report a decrease in the intensity of contractions." C. "The vaginal area will bulge as the baby's head appears." D. "Your partner will report less rectal pressure."

C. "The vaginal area will bulge as the baby's head appears."

The mother has delivered the placenta. You note that the shiny surface of the placenta was delivered first. What delivery mechanism is this known as AND is this the maternal or baby's surface of the placenta? A. Duncan mechanism, maternal B. Schultze mechanism, maternal C. Schultze mechanism, baby D. Duncan mechanism, baby

C. Schultze mechanism, baby

A nurse is caring for a client who is in active labor and becomes nauseous and vomits. The client is very irritable and feels the urge to have a BM. She states, "I've had enough. I can't do this anymore. I want to go home right now." Which of the following stages of labor is the client experiencing? A. Second stage B. Fourth stage C. Transition phase D. Latent phase

C. Transition phase Explanation: The transition phase of labor occurs when the client becomes irritable, feels rectal pressure similar to the need to have a bowel movement, and can become nauseous with emesis

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: A.) therapeutic touch B.) patterned breathing C.) effleurage D.) acupressure

C. effleurage Effleurage is a form of touch that involves light circular fingertip movements on the abdomen and is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation.( pg 470)

A nurse in labor and delivery is planning care for a newly admitted client who reports she is in labor and has been having vaginal bleeding for 2 weeks. Which of the following should the nurse include in the plan of care? A. Inspect the itroitus for a prolapsed cord B. Perform a test to identify the ferning pattern C. Monitor station of the presenting part D. Defer vaginal examinations

D. Defer vaginal examinations

A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. Which of the following actions should the nurse take? A. Administer oxygen via nasal cannula at 2 L/min B. Apply a warm blanket C. Assist the client to a side-lying position D. Place an oxygen mask over the client's nose and mouth

D. Place an oxygen mask over the client's nose and mouth

A nurse is reviewing the electronic monitor tracing of a client who is in active labor. the nurse should know that a fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions

D. Relaxation between uterine contractions

A nurse in the Labor & delivery unit receives a phone call from a client who reports that her contractions started about 2 hr ago, did not go away when she had 2 glasses of water and rested, and became stronger since she started walking. Her contractions occur every 10 min and last about 30 sec. She hasn't had any fluid leak from her vagina. However, she saw some blood when she wiped after voiding. Based on this report, which of the following critical findings should the nurse recognize that the client is experiencing? A. Braxton Hicks contractions B. Rupture of membranes C. Fetal descent D. True contractions

D. True contractions

Application of a finger or massage at a trigger point to reduce pain A.) therapeutic touch B.) patterned breathing C.) effleurage D.) acupressure

D.) acupressure

Leopold maneuver 4: identifies what?

Identifies fetal attitude facing the woman's feet, place both hands on the lower portion of abdomen and move hands gently down the sides of the uterus toward the pubis. Note the cephalic prominence or brow

3 phases of stage 1 of labor and cm dilation

Latent phase: 0-3cm Active phase: 4-7cm Transition phase: 8-10cm

Stage of labor that begins with complete cervical dilation and ends with birth of infant

Stage 2

Stage of labor that starts after birth till the separation and delivery of placenta

Stage 3

Stage of labor which is the "restorative stage" 1-4hours after birth

Stage 4

The nurse encourages a woman in labor to ambulate based on the understanding that it helps with which of the following? (Select all that apply.) A.) increases urge to push during second stage B.) encourages rotation of fetus C.) widens one side of the pelvis D.) enlists the aid of gravity to move the fetus E.) enhances the effectiveness of contractions F.) helps the fetus line up with the angle of the pelvis

a, b,d,e,f

A woman received morphine during labor to help with pain control. What findings would the nurse need to monitor the newborn for after birth? A.) decreased alertness B.) increased crying C.) inhibited sucking D.) respiratory depression E.) increased agitation F.) low Apgars G.) delay in effective feeding

a, c, d, g

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency? a. every 15 min b. every 10 min c. every 20 min d. every 5 min

a. every 15 minutes During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus every 15 minutes and then every 30 minutes for the next hour. pg 491

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as: a. baseline variability b. baseline FHR c. short-term variability d. fetal bradycardia

b. baseline FHR. The baseline FHR averages 110 to 160 beats per minute over a 10-minute period. Fetal bradycardia occurs when the FHR is less than 110 beats per minute for 10 minutes or longer. Short-term variability is the beat-to-beat change in FHR. Baseline variability refers to the normal physiologic variations in the time intervals that elapse between each fetal heartbeat observed along the baseline in the absence of contractions, decelerations, and accelerations.

The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured when the result is which of the following? a) 5.5 b) 6.5 c) 5.0 d) 6.0

b.) 6.5 Explanation: Amniotic fluid is alkaline, so the membranes are probably ruptured if the pH ranges from 6.5 to 7.5.

A client arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcome of the amniotomy? a) Less pressure on her cervix b) Decreased number of contractions c) Increased efficiency of contractions d) The need for increased maternal blood pressure monitoring

c) Increased efficiency of contractions Explanation: Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? a) The contractions are regular. b) The membranes have ruptured. c) The cervix is dilated completely. d) The client begins to expel clear vaginal fluid.

c) The cervix is dilated completely.

A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority? a. fetal position b. signs of infection c. FHR d. maternal comfort level

c. FHR When membranes rupture, the priority focus should be on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. Prolonged rupture can lead to an infection. Assessing the fetal position and maternal comfort are important but should not be the primary focus.

A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? a) Variability b) Accelerations c) Early decelerations d) Variable decelerations

d) Variable decelerations

When assess FHR patterns which finding would alert the nurse to a possible problem? a. early decelerations b. accelerations c. variable decelerations d. prolonged decelerations

d. prolonged decelerations Explanation: prolonged decelerations are associated with prolonged cord compression, abrupt placentae, cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.

What is Duncan presentation?

dull maternal surface of placenta emerges first

These decelerations are prior to or early in contraction

early deceleration

These decelerations are usually caused by head compression

early deceleration

These decelerations require no immediate intervention

early deceleration

Applying warm compresses to the perineum can reduce the need for an ______________

episiotomy

patterns indicating abnormal fetal acid-base status

fetal bradycardia, sinusoidal pattern, recurrent late decelerations

Causes of fetal bradycardia

fetal hypoxia, prolonged maternal hypoglycemia, fetal acidosis, administration of analgesic or anesthetic drugs to mom, hypothermia, maternal hypotension, prolonged umbilical cord compression, and fetal congenital heart block

Leopold maneuver 1: Palpate the __________ of uterus identify the _____________ & _____________

fundus presenting part fetal lie (longitudinal or transverse)

What is Uteroplacental insufficiency?

is a complication of pregnancy when the placenta is unable to deliver an adequate supply of nutrients and oxygen to the fetus, and, thus, cannot fully support the developing baby.

These decelerations are usually caused by uteroplacental insufficiency (UPI)

late deceleration

These decelerations happen late in contraction

late deceleration

What is molding?

overlapping of cranial bones under pressure of powers of labor and demands of unyielding pelvis

Acme

peak or highest intensity of uterine contraction

What is Schultz presentation?

shiny fetal surface of placenta emerges first

To ensure that the mater heart rate is not confused with FHR you would:

simultaneously auscultate the radial pulse and FHR

Stage of labor that begins with first contraction and ends with full dilation of cervix

stage 1

what is nesting?

sudden burst of energy

most reliable indication of fetal oxygenation and acid-base condition at birth

umbilical cord blood acid-base analysis

These decelerations are abrupt with fetal insult; and not related to the contraction

variable deceleration

These decelerations are usually caused by umbilical cord compression (CC)

variable deceleration

What is effacement?

when cervix gets shorter and shorter for birth (paper thin) cervix 2cm: 0% effaced cervix 1cm: 50% effaced cervix 0cm: 100% effaced

What is lightening?

when fetus defending into pelvic inlet