Chapter 6: Antepartal Tests, The Intraparatum assessment and interventions, fetal heart rate assessment

10. The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient? 1. "We will inject 1 mL of sterile water intramuscularly, and it will last for about an hour." 2. "We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes." 3. "We will inject 1 mL of sterile water subcutaneously, and it will last for about a half hour." 4. "We will inject 0.5 mL of sterile water intramuscularly, and it will last for about 3 hours."

ANS 2 Sterile water injections are subcutaneous injections of 0.5 ml. and provide 60 to 90 minutes of lower back pain relief.

The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing? 1. Green: very low risk of evolution, no action 2. Red: unacceptably high risk of acidemia, deliver 3. Yellow: moderate risk of evolution, increase surveillance 4. Orange: acceptable low risk of acidemia, prepare for possible urgent delivery

ANS 4 Based on the five-tier FHR interpretation system, this tracing is classified as orange, which means there is an acceptable low risk of acidemia and the nurse should prepare for possible urgent delivery

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring strip. How would the nurse assess this? 1. Time the amount of time in between the ending of one contraction and the beginning of another. 2. Palpate the maternal abdomen right after a contraction ceases. 3. Palpate the maternal abdomen during a contraction. 4. Monitor the patients' vocalizations and facial expressions.

ANS: 3 Intensity is evaluated by palpating the fingertips on the maternal abdomen. Timing the amount of time between the ending of one contraction and the beginning of another would determine frequency. Palpating the maternal abdomen right after a contraction ceases would determine resting tone

Which actions indicate the is assessing uterine activity? Select all that apply. 1. Feeling the maternal abdomen in between contractions 2. Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart 3. Evaluating that the EFM strip shows 200 MVU every 10 minutes. 4. Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline for 15 seconds twice in a 20-minute period 5. Evaluating that the EFM strip shows that each contraction lasts 1 minute

ANS 1,2,3,5 Resting tone is an interpretation of uterine activity, Frequency is an interpretation of uterine activity, Intensity is an interpretation of uterine activity, Duration of uterine contractions is an interpretation of uterine activity

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next? 1. Perform fetal scalp stimulation for 5 seconds. 2. Check maternal allergies in the patient chart. 3. Apply heat packs to the maternal chest and head. 4. Stimulate the fetus with a vibroacoustic device

ANS 2 Fetal tachycardia can be caused by maternal or fetal infection and antibiotics may be administered; typically, penicillin is administered and a penicillin allergy would require a different medication

The nurse is using the Parer and Ikeda five-tier system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia and evidence of impending fetal asphyxia. What is the next best step for the nurse? 1. Perform conservative measures. 2. Prepare for urgent delivery. 3. Assist provider in immediate delivery. 4. Increase surveillance of patient.

ANS 2 Orange indicates an acceptably low risk of acidemia and preparation for possible urgent delivery. Blue and Yellow are risk for acidemia, Red high risk acidemia

The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the maternal reasons for fetal bradycardia? Select all that apply. 1. A maternal fever in labor is usually due to dehydration and therefore should be treated with a fluid bolus. 2. Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. 3. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. 4. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. 5. Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.

ANS 2,3,4,5 Terbutaline is given to mothers for uterine tachysystole in labor, and its effect is limited to how quickly the drug is cleared from the maternal system. Illicit drugs such as cocaine can cause fetal tachycardia and additionally can cause placental abruption. Fetal tachycardia can be linked to maternal anxiety, and taking steps to reduce it can correct the FHR. 5. There is no link between hypertension and fetal tachycardia. Additionally, lisinopril is an ACE inhibitor that is not recommended in pregnancy

5. While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she would like to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient? 1. IUPC to make sure that her contractions are adequate to keep labor progressing 2. FSE to make sure that her fetus is tolerating the hydrotherapy 3. Telemetry to allow for the patient to accomplish her birth plan 4. External EFM to make sure that there is continuous monitoring

ANS 3 Telemetry would allow for continuous monitoring while allowing patients free movement and the ability to use hydrotherapy

A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first? 1. Give the mother oxygen to increase the fetal heart rate. 2. Immediately call the provider into the room. 3. Check to make sure that the maternal radial pulse is being recorded correctly. 4. Adjust the monitor on the maternal abdomen

ANS 3 The maternal heart rate is usually significantly lower than the fetal heart rate and is therefore tracked underneath the fetal heart rate. It is therefore important to check and make sure that the maternal heart rate is being tracked correctly before initiating any efforts for the fetus. 4

6. The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate? 1. "Adolescents usually have very effective coping mechanisms." 2. "Teenagers always have larger babies than older patients." 3. "Adolescents' ego integrity is less easily threatened by stress and pain." 4. "Your response to pregnancy, labor, and delivery will differ from that of an adult because your cognitive development is not yet complete."

ANS 4 According to AWHONN, teenagers have incomplete cognitive development. fewer coping mechanisms than adults, and ego integrity of adolescents is more easily threatened by stress and pain.

An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next? 1. Prepare Chrissy for the placement of an internal monitor. 2. Take the required two blood pressure readings every 15 minutes prior to insertion of the internal fetal monitor due to her pregnancy-induced hypertension. 3. Discuss with the health care provider the fact that Chrissy's blood type is O negative and she should therefore receive Rhogam before insertion of an internal monitor. 4. Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.

ANS 4 GBS positivity is a contraindication to the placement of an internal monitor.

The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take? 1. Check the patient's input and output. 2. Take a blood pressure to determine if the mother has hypotension. 3. Change the mother's position from supine to left lateral. 4. Check the mother for vaginal bleeding and severe abdominal pain

ANS 4 Placental abruption is a possible cause of fetal bradycardia and is an emergency. Lateral side helps with bradycardia but isn't the most urgent. Hypotension and dehydration are possible causes of fetal bradycardia but not urgent

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate? 1. "Telemetry is used mostly for women who are laboring in bed and changing positions every half hour or so." 2. "Unfortunately, you will not be able to use the shower while using telemetry." 3. "The nurses will need to come in and check your telemetry reading every half hour." 4. "We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery."

ANS 4 Telemetry can be used in all phases of labor. The patient can walk, bathe using telemetry. Nurses can assess the patient remotely.

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply. 1. Intermittent auscultation should be performed every hour in the latent phase. 2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. 3. A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours. 4. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 5. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

ANS: 1, 2, 4, 5 Intermittent auscultation should be done every hour in the latent phase. For Category I situations, intermittent EFM should be done for 10 to 30 minutes every 1 to 2.5 hours. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

. The nurse is providing care for a 45-year-old patient who has just learned she is in the second trimester of pregnancy. The patient thought she was experiencing manifestations of menopause until she recognized fetal movement. Which diagnostic test does the nurse expect to be prescribed for this patient?

Amniocentesis

A patient in the third trimester of pregnancy is instructed on how to perform daily fetal movement count. The nurse needs to inform the patient what to do if fetal movement is decreased. Which patient actions are appropriately recommended by the nurse? Select all that apply.

Eat something. Arrange for a period of rest. Focus on movement for 1 hour.

A patient is in her first trimester of her second pregnancy. The patient's first child was born with a trisomy 21 defect. The patient is requesting testing to determine whether the current fetus has the same defect. Which initial testing does the nurse expect the HCP to prescribe?

Fetal ultrasound

A patient in the second trimester of pregnancy is scheduled for a Doppler flow study because the health care provider (HCP) is concerned about an assessment finding during a routine prenatal visit. Which finding of concern does the nurse suspect?

Patient shows no weight gain in 2 weeks.

A patient who is at 30 weeks gestation is involved in a car crash. The nurse recognizes that which initial testing will be used to assess fetal well-being?

Nonstress testing

A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety?

"Screening tests are primarily to identify those without disease or abnormality."

The nurse is performing an NST along with a biophysical profile scoring (BPP) on a patient at 39 weeks gestation. The nurse determines the fetus has a nonreactive NST. The fetus has trunk or limb movement two times; is noted to be opening and closing hands; has a 45-second breathing episode; and has two 2-cm pockets of amniotic fluid. The nurse should assign a BPP score of ____________________/10.

6

The nurse is providing pre-amniocentesis teaching for a patient who is at 18 weeks gestation. Which information does the nurse provide? Select all that apply.

A full bladder will assist in ultrasound visualization. Discomfort will be minimized with a local anesthetic.

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept? 1. "Vagus nerve stimulation increases FHR and helps maintain variability." 2. "The sympathetic nervous system is responsible for heart rate variability." 3. "Action of the FHR occurs through the absence of norepinephrine." 4. "Baroreceptors are responsible for increasing FHR and fetal blood pressure."

ANS 2 The sympathetic nervous system is responsible for heart rate variability. Vagus nerve stimulation slows FHR and helps maintain variability.

The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system? 1. The baseline changes from 140 bpm to 150 bpm. 2. The change from moderate variability to minimal variability. 3. The consistent presence of accelerations. 4. The presence of 2 and then 3 decelerations

ANS 4 The parasympathetic nervous system is responsible for slowing the FHR and maintaining variability The sympathetic nervous system is responsible for increasing the FHR and FHR variability

The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority? 1. A patient with a previous cesarean section 2. A patient with an epidural in place 3. A patient with decreased fetal activity 4. A patient with Category I FHR tracings

ANS 4 This patient is low risk. The rest of the patients need monitoring every 30min or 15min.

15. The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply. 1. Intensity of contractions 2. Presence of pain in the neck or back 3. Frequency and duration of contractions 4. Signs of anxiety 5. Presence of FHR with intermittent auscultation

ANS: 1, 2, 3, 4 In a pain assessment, the nurse should assess for intensity, location, pattern, degree of distress. Fetal heart tones are not part of pain assessment

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply. 1. "There is a reduced rate of seizures if a patient has EFM during labor." 2. "There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor." 3. "There is a link between decreased infant mortality and EFM during delivery." 4. "There is a link between the rate of cesarean sections and continuous EFM." 5. "There is an increase in operative vaginal births and the use of continuous EFM."

ANS: 1, 4, 5 EFM during labor is associated with reduced rates of neonatal seizures. Continuous EFM increases the rate of cesarean sections. Continuous EFM increases the rate of operative vaginal births

The nurse is looking at an EFM strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps? 1. The patients' contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change. 2. The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective. 3. The patients' contractions are adequate, so the main focus should be on determining her progress through cervical change. 4. The patients' contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective.

ANS: 2 The patients' contractions are inadequate, so the provider could consider an amnio infusion through the IUPC. Then, once the fetus has improved, contractions need to be augmented to be more effective

18. The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply. 1. Lidocaine 1% for episiotomy 2. Epidural with lidocaine for pain in labor 3. Spinal block with lidocaine for a cesarean delivery 4. Lidocaine 1% for episiotomy repair 5. Lidocaine without epinephrine for forceps use

ANS: 2, 3, 5 Regional anesthesia can be used for labor pain in the form of a pudendal block, epidural block, or spinal block. Regional anesthesia can be used for surgical pain in cesarean section. A pudendal block (which is regional anesthesia) is used for forceps use

A patient is scheduled for transvaginal ultrasound testing. Which preparation by the nurse is appropriate?

Ascertain whether the patient has a latex or banana allergy.

An adolescent patient who is 15 weeks pregnant refuses to have an alpha-fetoprotein test performed because, "I don't like needles." Which initial approach does the nurse take to achieve the testing?

Explain the testing is important in detecting serious birth defects.

The nurse is assisting a patient who is pregnant to prepare for an MRI scheduled to assess fetal brain development. Which situation causes the nurse to notify the radiology department personnel?

The patient has a permanent body piercing.

The nurse is assessing a patient who just received confirmation of pregnancy. While collecting information about the patient's medical history, which information alerts the nurse to biophysical risk factors? Select all that apply.

The patient has been a strict vegetarian for 25 years. The patient is medically treated for rheumatoid arthritis.

A patient is scheduled for a contraction stress test (CST) at 36 weeks gestation. The nurse is aware that a successful testing is dependent on which factor?

Whether uterine contractions can be stimulated

The ____________________ in conjunction with NST is a strong indicator of fetal status, as it is accurate in detecting fetal hypoxia.

amniotic fluid index

The nurse is aware that some ____________________ tests, such as multiple marker screening and ultrasound, are offered to all pregnant women.

screening

13. The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply. 1. There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. 2. Oxytocin stimulates uterine muscles to contract. 3. The uterus begins to contract due to a decrease in estrogen. 4. The placenta begins to age and deteriorate and this triggers the start of contractions. 5. The fetus releases a stress hormone, cortisol, and this starts contractions

ANS: 1, 2, 4, 5 Increased pressure on the cervix stimulates the nerve plexus, causing release of oxytocin by the maternal pituitary gland, which then stimulates contractions. Oxytocin stimulates uterine muscles to contract. As the placenta ages, it begins to deteriorate, triggering initiation of contractions. Fetal cortisol rises and stimulates the uterus to contract

16. The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply. 1. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. 2. The medication Christa wants is an epidural. After she receives the epidural, the FHR tracing is within normal limits. 3. Christa received butorphanol (Stadol) within 3 hours of delivery and the infant experienced neonatal depression. 4. Local anesthesia in the perineal area was used in conjunction with the epidural throughout labor and delivery. 5. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief.

ANS: 1, 2, 5 Labor must be well established before administration of an analgesic is begun. Medication should provide relief to the mother with minimal risk to the baby. Women with a history of drug abuse may have a lessened effect from pain medication and require higher doses.

19. The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply. 1. There is a higher rate of instrumental vaginal delivery. 2. When using an epidural, women are less likely to sweat with a fever. 3. There is a higher rate of spontaneous vaginal delivery. 4. Labor may be longer with an epidural. 5. There is a higher rate of fever and sepsis.

ANS: 1, 4, 5 Epidurals are associated with higher rates of forceps and vacuum suction rates as well as longer labor and higher rates of fever and sepsis. An elevation in maternal temperature is associated with regional anesthesia, and it is also associated with reduced perspiration.

4. The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient? 1. Narrower pubic arch 2. Shorter diameter between her coccyx and ischium 3. Wider outlet 4. Smaller inlet

ANS: 3 A gynecoid pelvis has a wider outlet than an android pelvis.

3. The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take? 1. Help the patient in a lithotomy position. 2. Help the patient onto all fours. 3. Have the patient assume a comfortable and upright position. 4. Help the patient into a knee-chest position

ANS: 3 An upright position allows gravity to assist with the descent of the baby. Although regularly used, evidence has shown the lithotomy position is not the best position. A knee-chest position does not facilitate birth

12. The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM clear fluid 2 hours ago. What action should the nurse take? 1. Monitor the patient's blood pressure, temperature, and respirations every 2 hours. 2. Have the patient rate her pain on a scale from 1-10 roughly every hour. 3. Help the patient change her position from side to side every 30 minutes. 4. Monitor the fetal heart tones every hour.

ANS: 3 When the patient is in active labor, the nurse should help the woman change position every 30 minutes and as needed. Once rupture of the membranes has occurred, the nurse should monitor the patient's VS, and temperature every hour. When the patient is in active labor, the nurse should monitor FHR every 15 to 30 minutes.

8. The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor? 1. Wrist pain 2. Fatigue 3. Increased discharge 4. Heavy feeling

ANS: 3 When labor is impending, the patient may lose her mucous plug or have a change in discharge. Fatigue, wrist pain, heavy feeling is common in pregnancy but is not a sign of impending

9. The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacologic approaches will the nurse use to help illustrate its benefits? 1. Using peppermint aromatherapy oils will help promote relaxation. 2. The client can achieve self-hypnosis with the Bradley Method. 3. Sterile water injections can be very useful for pelvic pain. 4. Effleurage is performed in rhythm with breathing during a contraction

ANS: 4 Effleurage is cutaneous stimulation by lightly stroking the maternal abdomen in rhythm with breathing during contractions. Although aromatherapy is a nonpharmacologic method of promoting relaxation and decreasing pain perception, peppermint is used to help with nausea, not to enhance labor and spontaneous vaginal delivery. Sterile water injections are used for lower back pain relief.

17. A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply. 1. "If started, it should be used throughout the entire labor." 2. "It has no trade name and is only available in generic forms." 3. "The nurses will administer it to you during every contraction so we will need to be with you during the entire labor." 4. "The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm." 5. "There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication

ANS: 4, 5 It takes effect in about 50 seconds after the first breath, and the effect is transient. It has no adverse effects on the normal physiology and progress of labor. It is self-administered by the patient, it is called Nitronox, and can be started and stopped.

____________________ stimulation may be effective in eliciting a change in fetal behavior, fetal startle movements, and increased FHR variability.

Vibroacoustic

An Eastern European Jewish couple had two children who died from Tay-Sachs disease. The couple is currently pregnant and have asked for genetic confirmation about this fetus with the intention of early termination if the fetus tests positively. For which reason does the nurse expect chorionic villa sampling to be prescribed?

The test is performed as early as 10 weeks gestation.

A patient has experienced an uneventful pregnancy but begins to have vaginal spotting at 38 weeks gestation. The health care provider (HCP) suspects placenta previa initiated by cervical thinning. Which testing does the nurse expect the HCP to schedule?

Ultrasonography studies

11. The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98%. Which action should the nurse take first? 1. Call the health care provider regarding the patient's pruritus to order an antipruritic medication. 2. Activate emergency response due to the patient's pruritus and tachycardia postepidural placement. 3. Call the anesthesiologist regarding the patient's oxygen saturation level. 4. Take no further action regarding the patient's complaints, as they are normal after epidural placement.

ANS 1 Ninety percent of women who receive opioids in epidural have itching, and the health care provider should be notified so the correct medications can be ordered and administered to treat the pruritus.

7. The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history? 1. Passenger 2. Position 3. Passage 4. Psyche

ANS 3 A platypelloid pelvis is found in only 3% of women and is not an optimal pelvis for the passage of a vaginal delivery

14. The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply. 1. Shortens the length of labor 2. Reduces the likelihood that a patient will require an epidural 3. Reduces the risk of infection after birth 4. Lowers the chance that the patient will breastfeed 5. Increases patients' happiness and satisfaction with the outcome of their birth

ANS: 1, 2, 5 In 2011, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) found that having support persons shortens labor, found that having support persons decreases the use of analgesia. increased satisfaction with the birth experience in those with support persons. Havin a support person does not have an effect of post-delivery infections, having a support person does increase likelihood of breastfeeding.

2. A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction? 1. When the uterine wall is resistant to indentation 2. The longest part of the contraction 3. The shortest part of the contraction 4. Descending of contraction

ANS: 3 The acme is the peak of the contraction's intensity but also is the shortest part of the contraction. The longest part of the contraction is the increment, which is the buildup of the contraction. When a nurse palpates moderate contractions, they are resistant to indentation; the acme of a contraction should ideally be strong to palpation.

5. The nurse is caring for a 34-year-old woman who is G2P1001 at 39 weeks and 1 day. The patient is an observant Muslim and is in active labor. Which outcome would be the most effective form of applying culturally sensitive communication? 1. Ensuring that the health care provider is present every 2 hours to examine labor progress 2. Making sure that the patient has Kosher meat for her postpartum meal 3. Making sure that the patient's hair is covered constantly 4. Assuring the patient that her baby is less than 9 lbs

ANS: 3 Modesty is influenced by culture. The others may affect the psyche of the patient, but it is not usually related specifically to culture.

20. The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural? Select all that apply. 1. Lateral position with head flexed toward chest 2. Trendelenburg position 3. Lithotomy position 4. Sitting position with elbows on knees 5. Prone position

ANS 1,4 The lateral position would give good access to the spine. The sitting position with head flexed would give good access to the spine

The nurse is reviewing the purpose of a modified BPP for a patient at 38 weeks gestation. The nurse recognizes which determinations can be made through a modified BPP regarding fetal well-being? Select all that apply.

The NST is an indicator of short-term fetal well-being. The test is considered most predictive for perinatal outcomes. The AFI is an indicator of long-term placental function. An AFI of 5 cm is indicative of fetal asphyxia.

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient's fall into? 1. A Category I tracing 2. A Category II tracing 3. A Category III tracing 4. A Category IV tracing

ANS 1 This is a normal tracing. No such thing as a category IV, Category II is an indeterminate tracing, and Category III is an abnormal tracing

A patient who is at 20 weeks gestation is being prepared for an MRI after a nonconclusive ultrasound testing for suspected brain abnormality related to possible zika virus exposure. Which nursing actions are appropriate for this patient? Select all that apply.

Provide information regarding the test. Allow patient to express feelings about her high-risk pregnancy. Promote open communication with her primary health care providers. Provide psychological support to the patient and her partner.

The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation. The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply. 1. Check to see if the patients' membranes have been ruptured, as there could be potential cord compression. 2. Look to see what the patient's position is and is she supine; change her to left side lying. 3. Continue to watch the strip, but know that this could be due to fetal sleep. 4. Recognize that the fetus is 38 weeks and therefore this could be due to fetal maturity. 5. Check the FHR and connect the minimal variability to fetal bradyasystole

ANS 1,2,3 Minimal variability can be caused by cord compression. Minimal variability can be caused by maternal supine hypotension. Minimal variability can be caused by fetal sleep

The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 pm the baseline FHR was 130, at 1:20 pm FHR baseline was 166, and at 1:40 pm the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply. 1. The 1:00 pm FHR baseline warranted no further action. 2. The 1:20 pm FHR baseline warranted immediate fetal resuscitation. 3. The 1:00 pm FHR baseline warranted immediate maternal resuscitation 4. The 1:20 pm FHR baseline should be corrected immediately with delivery. 5. The 1:40 pm FHR baseline should be corrected immediately

ANS 1,5 The normal range is 110 to 160 bpm. If tachycardia persists above 200 to 220 bpm, fetal demise may occur

2. While providing care for a patient, the nurse notices an erratic FHR recording. What action should the nurse take next? 1. Help the patient move around to help obtain the signal. 2. Place the transducer in a different position. 3. Check the mother's cervical progress to see if she is in the second stage of labor. 4. Remove some of the ultrasound gel from the transducer

ANS 2 Fetal or maternal movement may cause erratic FHR recordings, and moving the transducer would help the recording if fetal movement causes it