LABOR AND DELIVERY WEEK & POSTPARTUM

The nurse is caring for a client who is in the taking-in phase of the postpartum period. What area of health teaching will the client be most responsive to? Perineal care Infant feeding Infant hygiene Family planning

Perineal care - Because its about HER

What nursing action is the priority for a client in the second stage of labor? Check the fetus's position. Administer medication for pain. Promote effective pushing by the client. Explain that breastfeeding can start right after birth.

Promote effective pushing by the client.

A client who is 38 weeks pregnant presents to the labor unit for a nonstress test (NST). The resulting fetal monitor strip is shown. How does the nurse interpret this finding? Negative because of the lack of contractions Nonreassuring; fetal heart rate lacks variability Reassuring; fetal heart rate accelerates with movement Positive; demonstrates decelerations with fetal movement

Reassuring; fetal heart rate accelerates with movement

The nurse is instructing a primigravid client how to identify the onset of labor. Which clinical indicator of labor would necessitate the client to call her healthcare provider? Bloody show and back pressure occurring with no contractions Irregular contractions coming 10 minutes apart Rupture of membranes or contractions 5 minutes apart Contractions 12 minutes apart and lasting about 30 seconds

Rupture of membranes or contractions 5 minutes apart

A client in the active phase of the first stage of labor begins to tremble, becomes very tense during contractions, and is quite irritable. She frequently states, "I can't take this a minute longer." What does this behavior indicate to the nurse caring for her? There was no preparation for labor. She should receive an analgesic for pain. She is entering the transition phase of labor. Hypertonic uterine contractions are developing.

She is entering the transition phase of labor. The contractions become stronger, last longer, and occur erratically during the transition phase; the intervals between contractions become shorter than the contractions themselves; the client needs to apply a great deal of concentration and effort to pace her breathing with each contraction. Even clients who have been adequately prepared will experience these behaviors during the transition phase of the first stage of labor. Administration of an analgesic at this time may reduce the effectiveness of labor and depress the fetus. There is no indication that the contractions are hypertonic.

A woman in her first pregnancy is termed a a. Nullipara b. Multipara c. Nulligravida d. Para

a. Nullipara Multipara has previously given birth to a fetus that has been older than 20 weeks gestation. Nulligravida is a woman that has never been pregnant. Para is the term to define pregnancies that have gone past 20 weeks.

Which of the following, if found by the nurse would indicate a need for delivery by cesarean section? a. Positive herpes culture at the first prenatal visit, with client asymptomatic at the time of labor admission b. History of genital herpes lesions, at the time of delivery symptoms present but no lesion c. oral herpes lesion at the time of delivery d. Genital herpes lesion 1 month prior to delivery, no symptoms at present

b. History of genital herpes lesions, at the time of delivery symptoms present but no lesion

If the client's white blood cell (WBC) count is 25,000/mm on her second postpartum day, the nurse should: a. tell the physician immediately. b. have the laboratory draw blood for reanalysis. c. recognize that this is an acceptable range at this point postpartum. d. begin antibiotic therapy immediately.

c. recognize that this is an acceptable range at this point postpartum.

Twelve hours after a spontaneous birth a client's temperature is 100.4° F (38° C). What should the nurse suspect as the cause of this increase in temperature? Mastitis Dehydration Puerperal infection Urinary tract infection

Dehydration A client's temperature may increase to 100.4° F (38° C) during the first 24 postpartum hours as a result of dehydration and expenditure of energy during labor. Mastitis may develop after breastfeeding has been established and mature milk is present. A puerperal infection usually begins with a fever of 100.4° F (38° C) or more on 2 successive days, excluding the first 24 postpartum hours. Urinary tract infections usually become evident later in the postpartum period.

Which woman would be most likely to have severe afterbirth pains and request a narcotic analgesic? a. Gravida 5, para 5 b. Woman who is bottle-feeding her first child c. Primipara who delivered a 7-lb boy d. Woman who wishes to breastfeed as soon as her baby is out of the neonatal intensive care unit

a. Gravida 5, para 5

The nurse auscultates the fetal heart rate (FHR) and determines a rate of 152. Which nursing intervention is appropriate? a. Inform the family that the rate is normal b. Reassess the FHR in 10 minutes because the rate is outside normal parameters c. Report the FHR to the healthcare provider d. Tell the mother she is going to have a boy because the heart rate is fast

a. Inform the family that the rate is normal

A nonstress test (NST) is scheduled for a client with mild preeclampsia. During the test, the client asks the nurse what it means when the fetal heart rate goes up every time the fetus moves. How should the nurse respond? "These accelerations are a sign of fetal well-being." "These accelerations indicate fetal head compression." "Umbilical cord compression is causing these accelerations." "Uteroplacental insufficiency is causing these accelerations."

"These accelerations are a sign of fetal well-being."

A nurse is caring for a postpartum client. Where does the nurse expect the fundus to be located if involution is progressing as expected 12 hours after birth? 2 cm below the umbilicus 3 cm above the umbilicus 1 cm above the umbilicus 3 cm below the umbilicus

1 cm above the umbilicus Rationale: Twelve hours after birth the uterus is 1 cm above the umbilicus, and each succeeding day it descends one fingerbreadth. Therefore the uterus should be 2 cm below the umbilicus on the second postpartum day. A uterus 3 cm above the umbilicus indicates that the bladder is full. The uterus is 3 cm below the umbilicus on the fourth postpartum day because the uterus descends one fingerbreadth per day.

A nurse teaches a woman who is planning to breastfeed how to relieve breast engorgement. The nurse determines that further teaching is necessary when the woman states that she will do what? Manually express breast milk Breastfeed the infant less frequently Apply warm compresses to both breasts Place cold compresses on the breasts just after breastfeeding

Breastfeed the infant less frequently

A labor patient is admitted with complaint of leaking of vaginal fluid. The first action of the nurse should be to: a. Monitor the fetal heart rate b. Encourage the patient to ambulate c. Document the color, odor, and amount of amniotic fluid d. Prepare for imminent delivery of the newborn

a. Monitor the fetal heart rate

The nurse assists a client to the bathroom to void several times during the first stage of labor. Why is this is an important component of nursing? A full bladder is often injured during labor. A full bladder may inhibit the progress of labor. A full bladder jeopardizes the status of the fetus. A full bladder predisposes the client to urinary infection.

A full bladder may inhibit the progress of labor.

A nurse is caring for four mother-baby couplets on the postpartum unit. Which new mother is at the greatest risk for postpartum hemorrhage? A primipara who has given birth to an 8-lb baby A grand multipara who experienced a labor that lasted 1 hour A multipara whose placental separation occurred 10 minutes after she gave birth A primipara who received epidural anesthesia throughout the birthing experience

A grand multipara who experienced a labor that lasted 1 hour

A woman in active labor arrives at the birthing unit. She tells the nurse that she was told that she had a chlamydial infection the last time she visited the clinic; however, she stopped taking the antibiotic after 3 days because she "felt better." In light of this history what would the nurse anticipate as part of the plan of care? Administration of antibiotics before delivery Oxytocin infusion to augment labor Epidural anesthesia to relieve difficult labor discomfort Magnesium sulfate infusion to prevent a precipitous birth

Administration of antibiotics before delivery

A client in her 10th week of pregnancy exhibits presumptive signs of pregnancy. Which clinical findings may the nurse determine upon assessment? Amenorrhea Breast changes Urinary frequency Abdominal enlargement Positive urine pregnancy test

Amenorrhea Breast changes Urinary frequency

The nurse instructs a pregnant woman in labor that she must avoid lying on her back. The nurse bases this instruction on the information that the supine position is primarily avoided because it can do what? Prolong the course of labor Cause decreased placental perfusion Lead to transient episodes of hypertension Interfere with free movement of the coccyx

Cause decreased placental perfusion

A client in the birthing suite has spontaneous rupture of the membranes, after which a prolapsed cord is identified. The nurse calls for help and with a sterile gloved hand moves the fetal head off the cord. What should the nurse anticipate? Cesarean birth Prolonged labor Rapidly induced labor Vacuum extraction vaginal birth

Cesarean birth

The nurse admits a client in active labor to the birthing center. She is 100% effaced, dilated 3 cm, and at +1 station. What stage of labor has this client reached? First Latent Second Transitional

First

The nurse is caring for an assignment of postpartum clients. Which factor puts a client at increased risk for postpartum hemorrhage? Breastfeeding in the birthing room Receiving a pudendal block for the birth Having a third stage of labor that lasts 10 minutes Giving birth to a baby weighing 9 lb 8 oz (4309 g)

Giving birth to a baby weighing 9 lb 8 oz (4309 g) (uterine contractions may be impaired after the birth)

While caring for a client during labor, what does the nurse remember about the second stage of labor? It ends at the time of birth. It ends as the placenta is expelled. = It begins with the transition phase of labor. It begins with the onset of strong contractions.

It ends at the time of birth.

A woman at 40 weeks' gestation is admitted in active labor. When the client reaches 5 centimeters dilation, the woman asks for and receives epidural analgesia. Once the epidural catheter has been inserted, which assessments and interventions should be performed? Maintaining intravenous fluid administration Having oxygen available in case of hypotension Checking the bladder for distention every 2 hours Positioning the client supine for ease of monitoring Monitoring fetal heart rate and labor progress per hospital protocol Administering an oxytocin infusion to maintain the labor pattern

Maintaining intravenous fluid administration Having oxygen available in case of hypotension Checking the bladder for distention every 2 hours Monitoring fetal heart rate and labor progress per hospital protocol

The nurse is assessing the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? At the level of the umbilicus One fingerbreadth above the umbilicus Above and to the right of the umbilicus One or two fingerbreadths below the umbilicus

One or two fingerbreadths below the umbilicus

A client at 39 weeks' gestation is admitted for induction of labor. Knowing that several medications are used to induce labor, a nurse identifies those that may be prescribed. Oxytocin Misoprostol Ergonovine Carboprost Dinoprostone

Oxytocin Misoprostol Dinoprostone Oxytocin is an oxytocic that triggers or augments uterine contractions; it is used for labor induction. Misoprostol is a prostaglandin used for cervical ripening and labor induction. Dinoprostone is used for cervical ripening to induce labor. --Ergonovine is an oxytocic used for postpartum or postabortion hemorrhage. -- Carboprost is a prostaglandin used to treat postpartum hemorrhage.

A postpartum client is being prepared for discharge. The laboratory report indicates that she has a white blood cell (WBC) count of 16,000/mm 3. (16 X 10 9/L) What is the next nursing action? Checking with the nurse manager to see whether the client may go home Reassessing the client for signs of infection by taking her vital signs Delaying the client's discharge until the practitioner has conducted a complete examination Placing the report in the client's record because this is an expected postpartum finding

Placing the report in the client's record because this is an expected postpartum finding

A woman arrives for an appointment at an obstetrics clinic. During the visit the nurse records the following information. Which finding indicates a need for future intervention? Rubella titer less than 1:8 (nonimmune) No fetal heartbeat heard with fetoscope Hemoglobin 11 g/dL, hematocrit 31% Maternal blood type A-negative, father O-negative

Rubella titer less than 1:8 (nonimmune)

Oxytocin is prescribed for a client in labor after a period of ineffective uterine contractions. What nursing interventions are most important if strong contractions that last 90 seconds or longer occur? Stopping the infusion Turning the client on her side Notifying the primary healthcare provider Verifying the duration of contractions Administering magnesium sulfate

Stopping the infusion Turning the client on her side Notifying the primary healthcare provider Verifying the duration of contractions ----Magnesium sulfate is prescribed for preterm labor to inhibit contractions; this client needs to continue with labor. The goal is to decrease the length of contractions, not to stop them.

A woman at 40 weeks' gestation is having contractions. Wondering whether she is in true labor, she asks, "How will you know if I'm really in labor?" Which information should the nurse provide to the patient at this time? The cervix dilates and becomes effaced in true labor. Bloody show is the first sign of true labor. The membranes rupture at the beginning of true labor. Fetal movements lessen and become weaker in true labor.

The cervix dilates and becomes effaced in true labor.

SELECT ALL The nurse is assessing her assignment of four postpartum clients. Which conditions increase the risk for postpartum hemorrhage? Twin birth Overdistended bladder Hypertonic uterine dystocia Retained placental fragments Mild gestational hypertension

Twin birth Overdistended bladder Retained placental fragments

What is the nurse's most critical assessment for a client with preeclampsia during the immediate postpartum period? Vital signs Emotional status Signs of hemorrhage Signs of hypovolemic shock

Vital Signs

Which of the following occurrences is associated with cervical dilation and effacement? a. Bloody show b. False labor c. Lightening d. Bladder distention

a. Bloody show Lightening is the descent of the fetus toward the pelvic inlet before labor. Bladder distention occurs when the bladder is not empted frequently. It may slow down the decent of the fetus during labor.

Which of the following is a high priority for the nurse caring for a patient in early labor a. Cultural beliefs and practices b. Maternal nutrition status c. Reasons for selecting a certain health care practitioner d. Names the family has chosen for the infant

a. Cultural beliefs and practices

Which finding 12 hours after birth would require further assessment? a. The fundus is palpable two fingerbreadths above the umbilicus. b. The fundus is palpable at the level of the umbilicus. c. The fundus is palpable one fingerbreadth below the umbilicus. d. The fundus is palpable two fingerbreadths below the umbilicus.

a. The fundus is palpable two fingerbreadths above the umbilicus.

A cesarean section patient has recently had an intrathecal narcotic adminsterd for relief of post operative pain. The nurse determines that teaching has been effective when the client makes the statement: a. "If I stay on the bedpan a little longer, I think I can urinate." b. "I know my face is itching form the intrathecal medication." c. "I won't be nauseated now." d. "I will have to lie flat on my back for a few hours."

b. "I know my face is itching form the intrathecal medication."

The nurse should plan for Group B streptococcus screening if the pregnant client meets which of the following criteria? a. History of a sexually transmitted infection b. 36-37 weeks gestation c. Has come for her initial prenatal visit d. Rash noted in the genital area

b. 36-37 weeks gestation

A client whose cervix is dilated to 6 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Second stage d. Third stage

b. Active phase

Which event is the best indicator of true labor? a. Bloody show b. Cervical dilation and effacement c. Fetal descent in the pelvic inlet d. Uterine contractions every seven minutes

b. Cervical dilation and effacement

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are a. Contraction pattern, amount of discomfort, and pregnancy history b. Fetal heart rate, maternal vital signs, and the woman's nearness to birth c. Identification of ruptured membranes, the woman's gravida and para, and her support person d. last food intake, when labor began, and cultural practices the couple desires

b. Fetal heart rate, maternal vital signs, and the woman's nearness to birth

Pregnant woman can tolerate the normal blood loss associated with childbirth because they have a. a higher hematocrit b. increased blood volume c. a low fibrinogen level d. Increased leukocytes

b. increased blood volume

Which of the following results from the adaptation of the fetus to the size and shape of the pelvis a. Lightening b. Lie c. Molding d. Presentation

c. Molding

Postpartal overdistention of the bladder and urinary retention can lead to which complication? a. Postpartum hemorrhage and eclampsia b. Fever and increased blood pressure c. Postpartum hemorrhage and urinary tract infection d. Urinary tract infection and uterine rupture

c. Postpartum hemorrhage and urinary tract infection

After administration of an epidural block for labor analgesia, the client's blood pressure decreases from 130/75 to 90/50. The nurse should assit the woman to do which of the following first? a. Lie in a supine position b. Assume a semi-fowler"s position c. Empty her bladder d. Turn to the side in a left lateral position

d. Turn to the side in a left lateral position Vasodilation occurs with epidural analgesia and anesthesia which can results in hypotension. the client should be turned to the left lateral position and the IV should be increased to assist with fluid volume load to bring the blood pressure up to normal range

If rubella vaccine is indicated for a postpartum client, instructions to the client should include: a. drinking plenty of fluids to prevent fever. b. no specific instructions. c. the recommendation to stop breastfeeding for 24 hours after injection. d. an explanation of the risks of becoming pregnant within 3 months after injection.

d. an explanation of the risks of becoming pregnant within 3 months after injection.

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should: a. report the incident to the social services department. b. advise the parents that the toddler needs to be reprimanded. c. Report to oncoming staff tht the family needs teaching regarding discipline. d. realize that this is a normal family adjusting to change.

d. realize that this is a normal family adjusting to change.

A nurse is giving discharge instructions to a new mother. What is the most important instruction to address the prevention of postpartum infection? "Don't take tub baths for at least 6 weeks." "Wash your hands before and after changing your sanitary napkins." "Douche with a dilute antiseptic solution twice a day and continue for a week." "Tampons are better than sanitary napkins for inhibiting bacteria in the postpartum period."

"Wash your hands before and after changing your sanitary napkins."

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of what possible complication related to a prolonged pregnancy? Polyhydramnios Placental insufficiency Postpartum infection Subclinical gestational diabetes

Placental insufficiency

To assess the duration of labor contractions, the nurse determines the time a. From the beginning of one contraction to the beginning of the next contraction b. From the beginning to the end of each contraction c. From the acme of one contraction to the acme of the next contraction d. From the end of one contraction to the beginning of the next contraction

b. From the beginning to the end of each contraction

An increase in urinary frequency and leg cramps after the 36th week of pregnancy most likely indicates that which of the following has occurred? a. Braxton-Hicks contractions b. Lightening c. Breech presentation d. Urinary tract infection

b. Lightening

Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis? a. Desent b. Engagement c. Flexion d. Station

c. Flexion Descent is the moving of the fetus through the birth canal. Engagement occurs when the largest diameter of the fetal presenting part has passed the pelvic inlet. The station is the relationship of the fetal presenting part to the level of the ischial spines.

Which of the following clients at term should go to the hospital or birth center the soonest after labor begins? a. Gravida 2 para 1 who lives 10 minutes away b. Gravida 1 para 0 who lives 40 minutes away c. Gravida 3 para 2 whose longest previous labor was 4 hours d. Gravida 2 para 1 whose first labor lasted 16hrs

c. Gravida 3 para 2 whose longest previous labor was 4 hours

The best way for the nurse to promote and support the maternal-infant bonding process is to: a. Help the mother express identify postive feelings toward the newborn b. Encourage the mother to provide all newborn care c. assist the family with rooming in d. return the newborn to the nursery during sleep periods

c. assist the family with rooming in

As the uterus contracts during labor, maternal-fetal exchange of oxygen and waste a. Continues except when placental functions are reduced b. Increases as blood pressure decreases c. diminishes as the spiral arteries are compressed d. Is not significantly affected

c. diminishes as the spiral arteries are compressed

On observing a woman on her first postpartum day sitting in bed while her newborn lies awake in the bassinet, the nurse should: a. realize that this situation is perfectly acceptable. b. offer to hand the baby to the woman. c. hand the baby to the woman. d. explain "taking in" to the woman.

c. hand the baby to the woman.

The nurse would use which of the following as the most accurate method to collect data about the frequency, dudration, and strength of contractions of a woman in labor? a. abdominal palpation b. Tocodynamometer c. Intrauterine pressure catheter d. The patients description of contractions.

c. Intrauterine pressure catheter