Maternal Child Exam 3

A woman has just given birth to an infant weighing 9 lb, 15 oz (4,350 g) with the assistance of forceps and an episiotomy. The patient received a pudendal block 12 minutes before the birth. The perinatal nurse would expect which of the following responses to the block? A. Appropriate for adequate pain relief B. Too close to birth; causing fetal depression C. Too early and probably worn off D. Too late to provide anesthesia

A A pudendal nerve block provides pain relief in the lower vagina, vulva, and perineum. It should be administered 10 to 20 minutes before perineal anesthesia is needed and may be used late in the second stage of labor if an episiotomy is to be performed or if forceps or vacuum extraction will be used to facilitate birth.

A woman is 1 hour postpartum with an epidural block and wishes to get up to go to the bathroom. What action by the nurse is most appropriate? A. Assess sensation in the lower extremities. B. Check the maternal vital signs. C. Confer with the health-care provider. D. Offer the woman the bedpan first.

A After an epidural block, the nurse must assess for intact sensation in the woman's lower extremities prior to allowing ambulation. This action ensures patient safety. The other options are not related to ambulating after an epidural block.

The perinatal nurse explains to the new graduate nurse that fear and anxiety have physiological consequences in labor. The nurse is referring to what physiological process? A. Diminished effectiveness of contractions B. Faster, more intense labor and delivery C. Increased release of maternal endorphins D. More tissue trauma due to hurrying the delivery

A As muscle tension increases due to fear or anxiety, the effectiveness of uterine contractions decreases. Maternal pain is intensified. This leads to decreased labor progress.

The perinatal nurse is caring for a woman in early labor with a fetus in the occiput posterior position. What action should the nurse perform to increase the woman's comfort? A. Assist the woman into a hands-and-knees position. B. Encourage the woman to assume a sitting position. C. Have the woman walk to the bathroom and void. D. Provide soothing music as a distraction technique.

A Assuming a hands-and-knees position will help relieve the pressure on the woman's back when the fetus is in a posterior position. This also helps the fetus rotate to a more favorable position. The other interventions will not be as helpful.

The perinatal nurse providing care to a laboring woman recognizes a non-reassuring fetal heart rate tracing. Which of the following is the most appropriate initial action by the nurse? A. Assist the woman to a left lateral position. B. Decrease the rate of the intravenous solution. C. Document the fetal heart rate and variability. D. Request that the provider apply a fetal scalp electrode.

A Because nonreassuring fetal heart rate patterns constitute a risk indicator for cesarean birth, the nurse and all members of the health-care team must be ready for this outcome at all times. The nurse should change the woman's position to her side to increase oxygen flow to the fetus. The rate of the IV solution can be increased. Documentation should always be thorough. Fetal scalp electrodes may or may not need to be placed.

A woman is about to undergo an external version. What action by the nurse takes priority? A. Determine Rh status; give Rh immune globulin if needed. B. Explain the procedure to the woman and obtain consent. C. Offer emotional support to both the woman and her partner. D. Prepare to administer oxytocin (Pitocin) as per protocol.

A Because the version can cause feto-maternal bleeding, women who are Rh-negative should receive Rh immune globulin (RhoGAM). Offering emotional support is always important, but does not take priority over keeping the patient safe. The physician is responsible for explaining the procedure. Because uterine relaxation is important for a successful version, tocolytic medications may be given (not medications that increase uterine tone).

A woman received butorphanol (Stadol) IV for labor pain. Thirty minutes later, the patient's respiratory rate is 8 breaths/minute. What action by the nurse is best? A. Administer naloxone (Narcan) per protocol. B. Call the perinatal rapid response team. C. Reduce the next dose of Stadol by half. D. Hold the next dose of Stadol and notify the provider.

A Butorphanol can cause both maternal and fetal respiratory depression. Naloxone is an opioid antagonist and will reverse the effects of opioids. This woman's respiratory rate is too low, and the nurse needs to administer naloxone per protocol. There is no need to call a perinatal RRT prior to administering the medication. The patient's medication regime should then be discussed with the provider.

The perinatal nurse prepares the laboring woman for an epidural anesthesia insertion. What action is best to help prevent maternal hypotension? A. Administer an intravenous infusion of 500 mL of normal saline. B. Assess vital signs every 5 minutes after the epidural insertion. C. Assist the woman to lie down in a supine position. D. Encourage frequent cleansing breaths during the procedure.

A Complications that may occur with spinal anesthesia block include maternal hypotension, decreased placental perfusion, and an ineffective breathing pattern. Prior to administration, the patient's fluid balance is assessed, and IV fluids are administered to reduce the potential for sympathetic blockade (decreased cardiac output that results from vasodilation with pooling of blood in the lower extremities). Following administration of the anesthetic, the patient's blood pressure, pulse and respirations, and fetal heart rate must be taken and documented every 5 to 10 minutes; however, assessing vital signs will not prevent hypotension from occurring. The woman is helped to a sitting position on the side of the bed. Deep cleansing breaths may be helpful for relaxation, but will not help prevent hypotension.

The woman in labor is complaining of severe back pain. What action should the nurse suggest to the birth partner? A. Apply counterpressure B. Give a hand massage C. Perform effleurage D. Provide therapeutic touch

A Counterpressure is performed when the support person uses the fist or heel of the hand to apply steady pressure to the sacral area. This can be especially helpful when the woman is having back pain due to the pressure of the occiput against spinal nerves while the fetus is in a posterior position. Massage has demonstrated some usefulness, but more studies are needed. Effleurage is a gentle stroking technique performed in rhythm with contractions. Therapeutic touch is provided by trained personnel.

The nurse is caring for a woman with a placental abruption and suspects the patient has developed disseminated intravascular coagulation (DIC). What interventions does the nurse anticipate? A. Administering IV fibrinogen B. Performing hourly vaginal exams to assess for cervical dilation C. Performing blood pressure assessments every 4 hours D. Obtaining consent for a cesarean birth

A DIC is a severe complication of placental abruption. Interventions include administration of IV cryoprecipitate or fibrinogen. To avoid further tissue damage, pelvic and vaginal exams are not performed. The woman is critically ill, and vital signs need to be monitored more often than every 4 hours. Vaginal birth is desirable unless fetal distress is present or there are other indications. If a cesarean birth is necessary, the nurse will need to place the signed informed consent form on the chart.

The nurse is preparing to admit a diabetic woman who is in labor. The nurse plans care to assess carefully for which of the following conditions in this patient? A. Diminishing uterine contractions B. Need for an epidural block C. Onset of intrapartum hypertension D. Overly strong, painful contractions

A Diabetic women are at risk for having a macrosomic infant, which is a risk factor for hypotonic labor. For this patient, the nurse needs to be especially aware of this and assess for less frequent and less intense labor contractions. The other three conditions are not specifically related to diabetes.

The perinatal nurse has administered a dose of dinoprostone (Cervidil) to a woman prior to a labor induction with oxytocin (Pitocin). The nurse then notices that the admission database is incomplete. What conditions should the nurse quickly question the patient about? A. Asthma B. Gallbladder disease C. IV drug use D. Penicillin allergy

A Dinoprostone is a prostaglandin E2 preparation for cervical ripening. It should be used cautiously in women with a history of asthma, glaucoma, and renal, hepatic, or cardiovascular disorders. Once the missing information is noticed, the nurse should assess for contraindications to using the medication, then for conditions that make it riskier. The other conditions are not related.

The perinatal nurse is aware that a 25-year-old woman with gestational hypertension in labor would benefit most from which pharmacological pain relief medication? A. Epidural bupivacaine B. Fentanyl intravenously C. Morphine intrathecally D. Secobarbital sodium per mouth

A Epidural blocks are advantageous for patients with diabetes, heart disease, pulmonary disease, and, in some cases, gestational hypertension, because they essentially eliminate the pain associated with labor and thus reduce the maternal stress associated with labor discomfort.

The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort? A. Amniotomy B. Correct use of breathing methods C. Fetus in an occiput anterior position D. Positional changes during active labor

A Labor induction and augmentation, amniotomy, and vaginal examinations may be associated with intensifying labor discomfort. Amniotomy, which is the artificial rupture of the fetal membranes, may be performed using a plastic amnihook or surgical clamp. The occiput anterior position is the optimal position for the fetus. Proper breathing exercises and positional changes during labor facilitate comfort for the laboring woman.

The perinatal nurse is providing care to a 32-year-old G1 TPAL 0000 at 34 weeks' gestation. Her blood pressure is 170/100 mm Hg, reflexes are +3, urine is 2+ for protein, and the patient is complaining of a headache. An intravenous solution of magnesium sulfate is begun with an hourly dose of 2 g. Which laboratory value would be assessed most carefully by the nurse? A. Aspartate aminotransferase (AST) B. Gamma-glutamyl transpeptidase C. Hematocrit D. Neutrophil count

A Laboratory tests include a complete blood count with platelets, coagulation profile to assess for disseminated intravascular coagulation, metabolic studies for determination of liver enzymes (aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase), and electrolyte studies to establish renal functioning. The other laboratory values are not as critical in this situation.

The perinatal nurse knows that one of the most severe complications for a patient with a diagnosis of abruptio placentae is which of the following? A. Couvelaire uterus B. Hydrops fetalis C. Hypertension D. Increased blood volume

A Maternal problems resulting from abruptio placentae include a couvelaire uterus (the accumulation of blood between the separated placenta and the uterine wall) and disseminated intravascular coagulation. Although a couvelaire uterus is rare, its implications are severe. The uterus takes on a bluish tinge as blood extravasates from the clot into the myometrium. Contractility is lost. The condition is so severe that a hysterectomy may be necessary to control the bleeding.

A woman has been diagnosed with hypertonic labor. She has an order for hydromorphone (Dilaudid). The student is preparing the medication and asks the labor nurse the rationale for using it. What response by the nurse is best? A. "It is to induce prescribed rest and relax the uterus." B. "It's for the pain associated with those strong contractions." C. "The patient must be allergic to other pain meds." D. "This is the best medication for labor and birth."

A Rest, hydration, and sedation often are prescribed in hypertonic labor to reduce the irritability of the uterus and help diminish the ineffective contractions. Medications given include hydromorphone (Dilaudid), meperidine (Demerol), and morphine sulfate (Morphine). The other answers are not accurate.

A woman is using a birth ball to promote comfort and fetal descent. The nurse observes the woman rocking back and forth while sitting on the ball. What action by the nurse is most appropriate? A. Assess her response to the birth ball and document. B. Document that she is using the modality. C. Explain that she should move the ball in a circle. D. Instruct her to only use the birth ball for 10 minutes.

A The birth ball helps with comfort and fetal descent during labor. The patient is using it correctly; the two methods are moving it in a circle and rocking back and forth. The nurse should assess her response to this modality and document it. There is no time restriction on using a birth ball.

The perinatal nurse is caring for a patient with preeclampsia. What intervention does the nurse include on this patient's care plan? A. Administer magnesium sulfate per agency policy. B. Assess the patient's blood pressure every 6 hours. C. Encourage the patient to rest on her back. D. Notify the physician of urine output greater than 30 mL/hr.

A The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion. Vital signs should be assessed more often than every 6 hours. The patient should be encouraged to maintain a left side-lying position. A urine output of greater than 30 mL/hour is normal.

A woman reports feeling uterine contractions that are strong, but on subsequent cervical checks, the nurse does not note any changes. What action by the nurse is most appropriate? A. Assess the woman for causes of anxiety. B. Attempt an external version of the fetus. C. Instruct the woman on nipple stimulation. D. Prepare to administer oxytoxin (Pitocin).

A This woman is experiencing hypertonic labor (strong but ineffective contractions). Because maternal anxiety is a major causative factor, the nurse should first assess for anxiety and help to relieve it. A fetal occiput-posterior malposition is also a cause of hypertonic labor, and the nurse should assess for this condition using Leopold maneuvers; however, the health-care provider would perform any attempt at version. Nipple stimulation and oxytocin would be used in hypotonic labor.

The perinatal nurse determines by vaginal examination that a patient's cervix is fully dilated and the fetal presenting part is descending rapidly with the patient's pushing efforts. The most appropriate nursing intervention at this time would be to do which of the following? A. Assist the patient with breathing patterns to slow down her pushing. B. Document the patient's progress and coping abilities in labor. C. Notify the health-care provider to come now for the birth. D. Provide information to the patient's partner about her stage of labor.

A This woman's labor is progressing precipitously. The nurse should instruct her to breathe through contractions to avoid pushing. Documentation should always be thorough, but further action is needed. The provider should be notified about a possible precipitous birth, but the woman needs assistance to control the bearing-down efforts. The nurse can delegate the notification task to someone else. Patients and their support persons always need information on their progress, but this is not the most important action.

A woman in labor receives a dose of hydromorphone hydrochloride (Dilaudid) at 11:30 a.m. She gives birth at 12:45 p.m. What action by the nurse takes priority? A. Assess the neonate frequently for respiratory depression. B. Encourage the woman to void every 2 hours postpartum. C. Perform a head-to-toe assessment on the neonate. D. Promote skin-to-skin contact and bonding as soon as possible.

A With Dilaudid, if birth occurs within 1 to 4 hours after administration, the nurse must assess the neonate frequently for respiratory depression. The other options are appropriate, but not the priority for this situation.

A nurse is caring for a pregnant woman with diabetes mellitus. What assessment finding demonstrates that the patient has successfully met an important goal during pregnancy? A. Blood glucose consistently < 130 mg/dL B. Electrolyte levels remaining within normal limits C. Fetal weight > 4,500 g at birth D. Pregnancy weight gain of no more than 20 lb

A Women with diabetes should strive to maintain their blood glucose readings within normal parameters during pregnancy. Poor glycemic control contributes to fetal macrosomia (fetal weight > 500 g) and other complications. Weight gain should not be restricted to 20 lb, and electrolyte readings are not related to a major goal for this woman.

The perinatal nurse is caring for a woman with a postdural puncture headache. What interventions does the nurse include in this woman's care plan? (Select all that apply.) A. Bedrest B. Caffeine C. Decreased fluid intake D. Light therapy E. Position sitting upright

A, B Typically, the headache is intensified when the patient assumes an upright position and is relieved when she assumes a supine position. Interventions usually center on oral analgesics, bedrest in a darkened room, caffeine, and hydration. If these measures are not effective, an autologous epidural blood patch may be administered.

A nursing faculty member is explaining potential complications from epidural anesthesia to a class of nursing students. Which information does the nurse include? (Select all that apply.) A. Bizarre behavior B. Increased need for oxytocin (Pitocin) C. Lengthened duration of labor D. Shiver response E. Urinary incontinence

A, B, C, D Potential complications from epidural anesthesia include bizarre behavior (if the medication is injected into the circulation), increased length of labor, increased need for oxytocin, and shiver response. Urinary retention, not incontinence, is another possible complication.

The nurse explains to a class of nursing students that which of the following are the main predictors of medically indicated and elective cesarean birth? (Select all that apply.) A. Use of assisted reproductive technology B. Induced labor before 39 weeks of gestation C. Maternal age greater than 35 D. Multiple-gestation pregnancy E. Native American ethnicity

A, B, C, D The main predictors of elective or medically indicated cesarean births are assisted reproductive technology, induced labor prior to 39 weeks' gestation, maternal age older than 35, and multiple-gestation pregnancy (especially higher-order multiples). Native Americans have only a 28% rate of cesarean delivery, the lowest among major ethnic groups.

The perinatal nurse is explaining to a nursing student that which of the following are problems more frequently associated with twin gestation births? (Select all that apply.) A. Adherent placentas and bleeding B. Intrauterine growth restriction C. Long-term fetal disabilities D. Abnormal fetal presentations E. Requirement for cesarean delivery

A, B, C, D Twins and higher-order multiple-gestation births are associated with more maternal and fetal complications, including excessive bleeding from adherent placentas, intrauterine growth restriction, long-term fetal disabilities such as cerebral palsy, and multiple fetal presentations. A woman with twins who presents at 38 weeks' gestation or later may be a candidate for a vaginal delivery.

The perinatal nurse explains to the student nurse that the effects of the H1 receptor antagonists include which of the following? (Select all that apply.) A. Block histamine action at the receptor sites B. Decrease nausea and vomiting C. Decrease anxiety and promote sleep or rest D. Lead to more efficient contractions earlier in labor E. May decrease fetal heart rate variability

A, B, C, E H1 receptor antagonists are medications that block the action of histamines at the receptor sites. These medications produce sedative, antiparkinsonian, and antiemetic effects. They cause drowsiness and are often used during early labor to promote sleep and to decrease anxiety. Phenothiazines specifically cross the placenta readily and may produce decreased fetal heart rate beat-to-beat variability.

A woman is asking about a cesarean birth. The nurse explains that which of the following are appropriate indications for this type of birth? (Select all that apply.) A. Active genital herpes B. Certain fetal malpresentations C. Maternal request D. Some multiple gestations E. Umbilical cord prolapse

A, B, D, E Cesarean birth should be reserved for instances where the health of the mother or her fetus is jeopardized. Many conditions can lead to the need for a cesarean birth, but maternal request is not one of them.

What actions by the nursing staff would be beneficial for parents who have lost a newborn? (Select all that apply.) A. Ask the baby's name and use it. B. Clean the infant and wrap in a blanket. C. Encourage them not to see their baby. D. Explain how the infant will look. E. Take photographs to give the parents.

A, B, D, E Perinatal loss is difficult for all concerned. Some interventions that have been found to be helpful include acknowledging the baby as a person by using his or her name; cleaning the baby and wrapping him or her in a blanket or dressing the child appropriately (so the baby looks warm and tended to); explaining how the baby will look, especially if the child does not have normal features; and giving the parents photographs and other memorabilia of their child. If the child is not in a favorable condition for photographs, a professional photographer is important. The family should always be encouraged to hold, touch, and cuddle the baby after death.

A nurse is working with a nulliparous woman diagnosed with placenta previa. What interventions should the nurse plan to implement if necessary? (Select all that apply.) A. Educate the woman about prenatal iron supplements. B. Facilitate informed consent for blood. C. Educate the woman about the need for a forceps delivery. D. Explain that she will undergo a planned delivery at 34-35 weeks. E. Advise the woman that a vaginal birth may be possible.

A, B, E Interventions that are appropriate for women diagnosed with placenta previa include instruction about the need for prenatal iron and folic acid supplementation. Hemorrhage is possible, so a consent form for blood products may be needed. A forceps delivery is not indicated. Women with suspected placenta accreta should be delivered between 34 and 35 weeks; those with placenta previa should be delivered at 36 to 37 weeks. Women diagnosed with a partial or marginal placenta previa who have no bleeding or minimal bleeding may be allowed to attempt a vaginal birth.

The perinatal nurse is directing a student nurse in giving intravenous fentanyl citrate (Sublimaze) to a woman in labor. Which actions by the student would require the registered nurse to intervene? A. Administers the medication between contractions B. Administers the medication during a contraction C. Checks the three rights prior to administration D. Injects the medication rapidly E. Injects the medication slowly

A, C, D Sublimaze (and all opioid analgesics) should be administered during contractions so that the fetus has less exposure to the drug due to uterine vasoconstriction. There are five rights to medication administration (right patient, right drug, right dose, right route, right time). The medication should be injected slowly. The nurse should intervene if the student injects the medication between contractions, checks only three rights of medication administration, and injects the medication rapidly.

The nurse assesses a patient suspected of having disseminated intravascular coagulation (DIC) for which of the following symptoms? (Select all that apply.) A. Blood in the Foley catheter bag B. Slight oozing from an IV site C. Spontaneous nosebleed D. Tachycardia E. Widespread bruising

A, C, D, E DIC includes both bleeding and thrombotic manifestations. Blood in the urine, spontaneous nosebleeds, tachycardia, and widespread bruising are all manifestations that could signal DIC. Slight oozing from an IV site is a common finding, and without bleeding noted at multiple sites, it is probably insignificant.

The nurse is caring for a woman who is undergoing an induction with oxytocin (Pitocin). The nurse explains to a nursing student that contraindications to labor induction include which of the following? (Select all that apply.) A. Active genital herpes infection B. Breech presentation C. History of a myomectomy D. Severe hypertension E. Vasa previa or complete placenta previa

A, C, E Absolute contraindications for induction of labor include vasa previa or complete placenta previa, transverse fetal lie, umbilical cord prolapse, previous classical cesarean delivery, active genital herpes infection, and previous myomectomy. Breech presentation and severe hypertension are relative contraindications, meaning that induction is possible, but caution should be exercised.

A perinatal nurse is aware that which of the following fetal conditions places a woman at risk for oligohydramnios? (Select all that apply.) A. Fetal renal abnormalities B. Maternal diabetes C. Multiple gestations D. Poor placental perfusion E. Premature rupture of membranes

A, D, E Conditions that increase the risk of oligohydramnios include fetal renal abnormalities, poor placental perfusion, and premature rupture of membranes. Maternal diabetes and multiple gestation are risk factors for (poly)hydramnios.

A nurse is caring for a woman who gave birth to a term infant an hour ago. The chart notes that the baby was born after demonstrating a positive turtle sign. What assessment finding by the nurse warrants immediate action? A. Lochia rubra is noted an hour after birth. B. Maternal blood pressure is 90/42 mm Hg. C. Maternal heart rate is 68 beats/minute. D. Patient saturates one perineal pad in 2 hours.

B A turtle sign describes a situation where the fetal head retracts during contractions after crowning. This is a clinical indicator of possible shoulder dystocia. Maternal complications of shoulder dystocia include hemorrhage and soft tissue trauma. A blood pressure as low as this woman's blood pressure measurement could be an indicator of hemorrhage, and the nurse needs to assess the woman further. The finding of lochia rubra 1 hour after birth is normal, as is a maternal heart rate of 68 beats/ minute. The finding of one saturated perineal pad within 2 hours is also normal.

A nurse is caring for a woman who will be induced, but her cervix is not yet favorable for this intervention. The provider leaves an order for dinoprostone vaginal insert (Cervidil), which the nurse administers at 9:00 a.m. At what time does the nurse anticipate induction with oxytocin (Pitocin)? A. In 30 to 60 minutes after the last dose of dinoprostone B. In 30 to 60 minutes after the dinoprostone insert is removed C. In 5 to 7 hours or when contractions begin D. In 6 to 12 hours after the dinoprostone insert is removed

B After Cervidil administration, contractions usually begin within 5 to 7 hours. If further augmentation is needed with oxytocin, it can be administered 30 to 60 minutes after the dinoprostone vaginal insert is removed.

The perinatal nurse is asked to assess a 35-year-old woman who is a G1 TPAL 0000 at 34 weeks' gestation with a twin gestation. The patient complains of regular contractions with low abdominal pain that moves into the lumbar section of her back. The perinatal nurse's most appropriate initial nursing action is to do which of the following? A. Assess the patient's contractions. B. Initiate continuous fetal monitoring. C. Reassure the patient and her partner. D. Review the patient's birth plan.

B Electronic fetal monitoring is applied in the case of a multiple gestation. It is important to identify each of the individual fetal heart rates, and the use of a separate monitor for each fetus is preferable. The other interventions are also appropriate, but do not take priority over fetal monitoring.

A woman is preparing for whirlpool bath hydrotherapy. To ensure patient safety, what action by the nurse is best? A. Allow the woman to remain in the tub for no more than 20 minutes. B. Maintain water temperature no higher than 100.4°F (38°C). C. Obtain informed consent prior to allowing the woman in the tub. D. Use a wheelchair to transport the woman to the hydrotherapy tub.

B For safety, water temperature should remain between 96.8 and 100.4°F (36-38°C). The other actions are not necessary.

The perinatal nurse is providing care to a 25-year-old G1 TPAL 0000 woman hospitalized with severe hypertension at 33 weeks' gestation. The nurse is preparing to administer the second dose of betamethasone (Celestone), prescribed by the physician. The patient asks, "What is this injection for again?" Which of the following is the best response by the nurse? A. Helps your baby grow and develop B. Helps your baby's lungs to mature C. Prepares your body to begin labor D. Stabilizes your blood pressure

B Glucocorticoids such as betamethasone are given prior to 34 weeks' gestation to promote fetal lung maturity if delivery can be delayed for 48 hours.

A nurse is caring for a patient with abruptio placentae. What assessment findings would indicate that the woman is hemodynamically stable? A. Fetal heart rate: 108 beats/minute B. Hematocrit: 33% C. Oxygen saturation: 90% D. Urine output: 20 mL/hour

B Hemorrhage is a significant possibility with placental abruption. A hematocrit less than 30% is indicative of maternal hemodynamic stability; the presence of fetal bradycardia, maternal hypoxia, and urine output less than 30 mL/hour are indicative of an unstable state.

A woman is experiencing a long and painful labor and is becoming increasingly intolerant of the pain. She has been receiving frequent, small doses of IV hydromorphone (Dilaudid). The nurse suggests that she switch from medication to massage and water treatments. The patient is reluctant. What explanation by the nurse is best? A. "It's either this or you'll need an amniotomy." B. "Pain medicine sometimes slows labor down." C. "You are getting too much pain medication." D. "Your anxiety can cause labor to be slow."

B Pharmacological pain interventions can slow the progress of labor, especially if the labor pattern was not well established prior to initiating medication. In order to ease pain and discomfort, the nurse should suggest nonpharmacological measures that should help decrease the amount of pain medication the woman requires. The other statements are not accurate, and telling the woman she has to choose between relaxation techniques or amniotomy sounds vaguely threatening.

A post-anesthesia care nurse is receiving a report on a patient who was delivered under general anesthesia. The operating room nurse states that the patient received a dose of metoclopramide (Reglan) IV in the operating room. The nurse explains to a student nurse the purpose of giving this drug is to do which of the following? A. Allow rapid anesthetic induction B. Increase the speed of gastric emptying C. Promote muscle relaxation D. Reduce stomach acid production

B Reglan increases the speed of gastric emptying, which helps prevent the aspiration of gastric contents. Pregnant women are at a higher risk of gastric reflux than the general population. Rapid induction is facilitated with a short-acting barbiturate such as thiopental sodium (Pentothal). Muscle relaxation can be facilitated with succinylcholine (Anectine). Ranitidine hydrochloride (Zantac) or cimetidine (Tagamet) can be used to decrease gastric acid production.

A nursing instructor is explaining the differences between the somatic and visceral pain felt by women in labor to a class of nursing students. Which statement about these two types of pain is inconsistent with thorough knowledge of these two types of pain? A. Somatic pain is more intense, sharp, and burning. B. Somatic pain is usually only felt in the third stage. C. Visceral pain is most often felt during contractions. D. Visceral pain usually occurs in the first stage of labor.

B Somatic pain is sharp, intense, well-localized, burning, or prickling pain felt during the second stage of labor. It is caused by stretching of the perineal body, distention and traction, and soft tissue lacerations. Visceral pain is predominant during the first stage of labor. This deep, dull and aching, poorly localized pain is usually felt only during contractions.

The perinatal nurse provides information to a laboring woman with twins that the second twin will normally be born within what time frame? A. Within 5 minutes of the first twin B. Within 15 minutes of the first twin C. Within 30 minutes of the first twin D. Within 60 minutes of the first twin

B The birth of the second twin normally occurs within 15 minutes of the first twin. Although there has been concern over complications associated with a longer time period between births, studies have shown that with proper fetal monitoring and maternal surveillance, a safe vaginal birth can take place in an indefinite amount of time.

The perinatal nurse observes a woman entering the transition phase of labor while she uses a patterned breathing method to cope with the increasing strength of contractions. She complains of light-headedness and tingling in her fingers. The most appropriate intervention by the nurse is to assist the patient in doing which of the following? A. Breathing more slowly and taking a cleansing breath B. Cupping her hands and breathing into them C. Putting her head between her knees D. Returning to bed and lying on her left side

B The symptoms of respiratory alkalosis are light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Strategies to eliminate respiratory alkalosis focus on replacement of the bicarbonate ion by rebreathing carbon dioxide. This can be accomplished by instructing the woman to breathe into a paper bag held tightly around the mouth and nose or, if no bag is available, instructing her to breathe into her cupped hands.

A woman has just given birth to an infant whose 1-minute Apgar score was 9. Meconium-stained amniotic fluid was noted upon rupture of the membranes. What action by the nurse is most appropriate? A. Apply oxygen at 0.5 L/minute via face mask. B. Assess and document the infant's 5-minute Apgar score. C. Transfer the neonate to the intensive care unit. D. Vigorously suction the infant's trachea.

B Vigorous infants born in the presence of meconium-stained amniotic fluid do not need routine tracheal suctioning after birth. An Apgar score of 9 indicates that this baby is not depressed, so the nurse should continue to provide routine care for the infant and assess the 5-minute Apgar score. The other interventions are not warranted.

The perinatal nurse is caring for a Native American woman in labor with her first baby. The patient asks about the possibility of burning sweet grass, a part of her cultural tradition, during labor. Which of the following is the best response by the nurse? A. "Burning any type of substance is not allowed by policy in the hospital. Is there something else that I can do that would be similar?" B. "Can you explain to me a bit more about this custom and what it means to you so that I can understand it better?" C. "I need to confer with the charge nurse. I want to know if this practice can be allowed so I will ask to see if it is possible." D. "I understand that this cultural practice is important to you; however, I am unable to accommodate your request at this time."

B When providing care, nurses must recognize that culture strongly influences how one perceives and copes with pain. Assessment of cultural beliefs and practices, questions to identify specific needs, and encouragement and support to use safe interventions is key in providing culturally sensitive care that empowers the patient to maintain her sense of control over her labor and childbirth experience. The nurse should make every attempt to accommodate this woman's request as long as safety is not compromised. If the ritual is not permitted, the nurse can work with the patient to find an acceptable alternative. Using open-ended questions is preferable to yes-no questions for gathering information.

A nurse is coaching a woman in labor in patterned breathing. To use the slow-paced breathing method, which instruction is best? A. "Blow like you are blowing out a candle at the end of your breath." B. "I will count to 4 while you inhale and again when you exhale." C. "Take a deep cleansing breath when the contraction ends." D. "You need to breathe at half of your normal rate in this pattern."

B With the slow-paced breathing pattern, the woman first takes a deep cleansing breath, then breathes slowly in and out of her mouth at about half her normal respiratory rate. Her coach counts slowly to 4 during inhalation and again during exhalation. Blowing out the candle is an instruction given during transition with the pattern-paced method. The woman should begin and end each contraction with a deep cleansing breath. Telling the woman that her respiratory rate will be half of the normal rate does not provide any specific instruction for her to follow.

A nurse is teaching a woman about pain management strategies during labor. The woman expresses great fear about the experience. Which of the following statements by the nurse would help to ease the woman's fears? (Select all that apply.) A. "Don't worry about the pain; at least it's not from illness." B. "Keep in mind there is an end to the pain with the birth." C. "Pain during labor is normal and expected, and helps you to give birth." D. "We can anticipate your labor pain and plan for it." E. "You have to expect some amount of pain during labor."

B, C, D Labor pain has some unique characteristics, including: (1) being part of a normal process, as opposed to being caused by illness or injury; (2) being anticipated, which allows for planning and preparation; and (3) having an end point with the birth of the baby. The nurse should inform the pregnant woman about these facts in a supportive, encouraging way. Stating "at least it's not from illness" is factual but dismissive of her fears. Stating that she has to expect some pain is also dismissive and gives the impression that wanting pain control is unreasonable.

The nurse is explaining dysfunctional labor patterns to a group of nursing students. Which of the following should the nurse include in the list of risk factors for hypotonic labor? (Select all that apply.) A. Anxiety and fear B. Fetal malpresentation C. Maternal obesity D. Multiple gestation E. Pain medication

B, C, D, E Many factors contribute to hypotonic labor, including fetal anomalies, malpresentation, and macrosomia; maternal diabetes and hypertension; multiple gestation; and hydramnios. Anxiety and fear are more likely contributing factors to hypertonic labor.

A nursing professor is describing placental abruption to a class of nursing students. What information is included? (Select all that apply.) A. Cesarean delivery is almost always needed. B. Complications include couvelaire uterus and DIC. C. Fetal and maternal death may occur. D. Hysterectomy may be necessary to control bleeding. E. Pelvic and vaginal exams are not performed.

B, C, D, E Placental abruption is a serious condition that can lead to both fetal and maternal death. Other complications include couvelaire uterus and DIC. Bleeding may be so severe that a hysterectomy is needed. To prevent further damage, vaginal and pelvic exams are not performed. Vaginal birth is desirable; cesarean birth is reserved for cases of fetal distress or other obstetric indications and should not be attempted if the woman has severe and uncorrected coagulopathy.

While providing a hospital tour, the perinatal nurse shows the compact disc player stored in the birthing room. The nurse explains that music is encouraged during labor because it does which of the following? (Select all that apply.) A. Decreases the production of catecholamines B. Increases maternal distraction C. Increases maternal oxygen demands D. Increases the production of endorphins E. Increases the woman's ability to focus

B, D, E Music can help create a relaxing environment and boost spirits. During labor, music provides comfort and decreases maternal anxiety by stimulating the release of endorphins. Comforting music during labor promotes maternal relaxation, thereby increasing oxygen intake. Some women find that music enhances their ability to remain focused during contractions. Decreasing anxiety and pain will decrease oxygen requirements.

The perinatal nurse suggests that a laboring woman may wish to use the birth ball. The patient questions the rationale for this suggestion. The best answer by the nurse is that use of the birth ball will facilitate what action? A. Decreased maternal anxiety B. Decreased transmission of pain C. Fetal descent D. Increased number of opioid receptors

C Assuming a sitting position on the birth ball facilitates a supported squatting position that opens the pelvis to allow fetal descent in preparation for birth.

What nursing intervention would be most important for a postpartum woman who received spinal anesthesia? A. Assess vital signs. B. Facilitate bonding. C. Monitor urine output. D. Promote breastfeeding.

C Because spinal anesthesia can cause bladder atony, it is important for the nurse to monitor the postpartum woman's urine output. Assessing vital signs and promoting bonding are important for all new mothers. Nurses should promote breastfeeding if this is the woman's preference.

A nurse is caring for a pregnant woman scheduled to have an epidural block. The nurse reviews the woman's admission laboratory results and finds the following: white blood count (WBC) 6,500/ mm3, hemoglobin 14 mg/dL, hematocrit 38%, platelet count 98,000, and international normalized ratio (INR) 4.2. What action by the nurse is best? A. Document the findings in the woman's chart. B. Ensure a signed consent form is in the chart. C. Notify the health-care provider immediately. D. Start a peripheral IV of normal saline (NS).

C Contraindications to spinal/epidural blocks include maternal refusal, local or systemic infection, coagulopathies, actual or anticipated maternal hemorrhage, allergy to a specific agent being used, or lack of trained staff. This woman's platelet count is low and her INR is high, leading to concern about coagulopathies. The nurse should notify the health-care provider immediately. Documentation should always be thorough, but further action is needed. A signed consent form should be in the chart for an invasive procedure; however, this is not the priority at this point. An IV will probably be needed prior to delivery (depending on institutional protocol), but, again, this is not the priority in the setting of a patient with abnormal laboratory results.

A new nurse is working with a patient undergoing an induction of labor. What action by the new nurse would prompt the preceptor to intervene? A. Assesses contractions every 5 minutes in the second stage of labor B. Calculates and charts the maternal total urine output every 4 hours C. Documents an IV intake of 1,500 mL in 8 hours D. Records the maternal vital signs a minimum of every 60 minutes

C During an induction of labor, the IV fluid intake should not exceed 1,000 mL in 8 hours to prevent fluid overload after the placenta is delivered. If the new nurse has documented a larger amount, the preceptor needs to intervene. The other options show proper care of this patient.

A nurse receives a handoff report on a newborn who is jaundiced. The off-going nurse states that the mother received some sort of sedative during the intrapartum period. The nurse should check the mother's chart for what medication? A. Diphenhydramine (Benadryl) B. Hydroxyzine (Vistaril) C. Promethazine (Phenergan) D. Secobarbital sodium (Seconal)

C H1 receptor antagonists are often used for sedation and relaxation in labor. Promethazine binds to bilirubin binding sites and may cause hyperbilirubinemia and jaundice in term infants exposed to the drug during the intrapartal period. The other medications do not cause this side effect.

A patient in labor has internal fetal monitoring and normal vital signs. All fetal signs are reassuring. She wishes to try whirlpool bath hydrotherapy as a comfort measure. Which action by the nurse is best? A. Assist the woman into the tub so she doesn't fall. B. Ensure the water temperature does not exceed 101°F (38.3°C). C. Inform her that she is not able to participate in this method. D. Remove the fetal monitor wires prior to the patient's getting in the tub.

C Hydrotherapy can provide excellent comfort for many women in labor; however, the presence of internal fetal monitoring electrodes is a contraindication to the use of whirlpool tubs or jet hydrotherapy. The nurse should inform her of this and explore other comfort measures. The other options are not appropriate.

A woman at 30 weeks' gestation is 80% effaced and 5 cm dilated. Which action by the nurse takes priority? A. Arrange a palliative care consult for probable fetal demise. B. Encourage the woman to attempt a trial of labor before undergoing a cesarean section. C. Ensure that informed consent for a cesarean birth is on the chart. D. Inform the woman that if the tocolytic therapy is successful, she will deliver.

C In preterm labor, if the woman's membranes have ruptured or if her cervix is more than 50% effaced and 3-4 cm dilated, it is not likely that the labor can be stopped. A cesarean birth is preferable to a vaginal delivery because it diminishes pressure on the fetal head and decreases the risk of intracranial hemorrhage. Because there is a high likelihood of cesarean birth, the nurse should ensure that consent for cesarean delivery is on the chart, in the event that the labor cannot be halted. Tocolytic medications are administered to halt contractions; if unsuccessful, the birth will occur.

The perinatal nurse is providing care to a multiparous woman in labor. Upon arrival to the birthing suite, the cervix is 5 cm dilated and the patient is experiencing contractions every 1 to 2 minutes that she describes as "strong." The patient states that she labored for 1 hour at home and is feeling some rectal pressure. The patient is most likely experiencing what condition? A. Hypertonic contractions B. Hypotonic contractions C. Precipitous labor D. Uterine hyperstimulation

C Precipitous labor contractions produce very rapid, intense contractions. A precipitous labor lasts less than 3 hours from the beginning of contractions to birth. Patients often progress through the first stage of labor with little or no pain and may present to the birth setting already advanced into the second stage.

A woman is having a planned cesarean birth. The nurse explains to the student that which of the following would not be an appropriate choice of anesthesia for this woman? A. Epidural block B. General anesthesia C. Pudendal block D. Spinal block

C Pudendal block is considered a local/regional anesthesia and would not provide sufficient anesthesia for an operative birth. The other options are all appropriate.

A nulliparous woman has been admitted to the labor and birth unit. Her Bishop score is 4. What medication does the nurse plan to administer? A. Betamethasone (Celestone) B. Hydromorphone (Dilaudid) C. Misoprostol (Cytotec) D. Oxytocin (Pitocin)

C The Bishop score is a rating system used to determine the level of cervical inducibility. Labor induction is more likely to be successful with a higher score (9 or more for nulliparous women; 5 for multiparous women). This woman's cervix is not favorable for induction, so a cervical ripening agent should be used. Cytotec is one such agent. Betamethasone is used to improve fetal lung maturity. Hydromorphone is a pain medication. Oxytocin would be used to augment labor once the cervix is favorable.

A labor and delivery nurse explains to the student that the most common complication following a spinal anesthesia block is which of the following? A. Fetal depression B. Hematoma C. Maternal hypotension D. Severe pruritus

C The most common complication seen with the use of spinal anesthesia blocks is maternal hypotension. The other options are less common complications.

The perinatal nurse is providing care to a 17-year-old G2 TPAL 0010 patient at 32 weeks' gestation. An ultrasound examination confirms that she is experiencing an abruptio placentae. The patient's vital signs are as follows: BP: 110/66 mm Hg, P: 92 beats/minute, R: 18 breaths/minute, fetal heart rate: 156 beats/minute. What assessment should the nurse include in this patient's plan of care as a priority? A. Hourly vital signs B. Intake and output every 8 hours C. Blood draw for complete blood count (CBC), prothrombin time (PT), and electrolytes D. Checks for perineal bleeding every 15 minutes

C The nurse should review baseline and ongoing laboratory data, including complete blood count, clotting studies, serum electrolytes, and renal function tests. This baseline information is used to alert the care providers to changes in the patient's condition as additional laboratory tests are obtained. Assessment of vital signs is dependent on the patient's condition. Intake and output may need to be monitored more frequently. Checks for bleeding every 15 minutes are not necessary.

A nurse is assisting with a forceps delivery. After the forceps are applied, the nurse notes fetal bradycardia. What action by the nurse takes priority? A. Assess the fetal heart rate in 5 minutes. B. Document the findings in the chart. C. Inform the health-care provider immediately. D. Turn the woman on her left side.

C When the forceps are applied, umbilical cord compression can occur. Compression of the cord causes a decrease in the fetal heart rate. The nurse should immediately inform the provider so that the pressure can be released. The nurse is responsible for documenting the fetal heart rate before and immediately after forceps application, but relieving the pressure on the umbilical cord takes priority. The nurse should not wait 5 minutes for another assessment, nor should the nurse turn the patient on her side as a first action.

A nurse is caring for a woman who is going to have an epidural block. The physician orders that an IV be started. Which of the following solutions would be appropriate for the nurse to choose? (Select all that apply.) A. D5 (5% dextrose) with 0.45 normal saline (NS) B. D5 and water (D5W) C. Lactated Ringer's (LR) solution D. Normal saline (NS) E. Normal saline (NS) with 10% dextrose

C, D Most institutions use dextrose-free IV solutions for women in labor because dextrose can cause fetal hyperglycemia with rebound hypoglycemia in the few hours after birth. The other three options all contain dextrose.

The perinatal nurse is assessing a 36-year-old woman at term who is in early labor. The nurse assesses for findings that indicate pain, including which of the following? (Select all that apply.) A. Blood pressure: 100/64 mm Hg B. Frequent voiding in small amounts C. Increased irritability related to repeated questions D. Pulse rate of 106 beats per minute E. Verbalizing concern with coping ability

C, D, E During the assessment, the nurse may identify physiological and psychological changes that are indicative of maternal pain. These include an increased pulse rate and blood pressure, changes in mood, increased anxiety and stress, marked agitation, confusion, decreased urine output, decreased intestinal motility, and guarding of the target area of discomfort. Frequent voiding in small amounts and a normal blood pressure are not findings consistent with labor pain.

During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large amount of bright red vaginal bleeding. Her uterine fundus is firm. The most appropriate action by the nurse is to collaborate with the health-care provider in which activity? A. Bladder assessment and catheterization B. Preparing the woman for a hysterectomy C. Uterine massage and oxytocin infusion D. Vaginal assessment and repair

D A forceps-assisted birth is one in which a steel instrument with two curved blades is used to facilitate the birth of the infant's head. Perineal trauma is one of the major complications associated with the use of forceps. Because hemorrhage (bright red bleeding) may result from cervical lacerations and vaginal tearing, the woman requires close observation during the postpartum period. If this occurs, the care provider should be notified regarding a potential vaginal repair. The other actions are not warranted.

A nurse is caring for a patient who had a laminaria tent inserted 6 hours ago. What action by the nurse is most appropriate? A. Assess and record maternal temperature. B. Document fetal and maternal heart rate. C. Perform an amniotic membrane stripping. D. Remove the laminaria tent and assess cervical dilation.

D A laminaria tent is a hydroscopic cervical dilator made of seaweed, which swells as it absorbs moisture. Hydroscopic dilators remain in place for 6 to 12 hours, after which time they are removed and the woman is assessed for cervical dilation. The other interventions are not specific to this type of dilator.

A woman had an amniotomy 1 hour ago. Now she is complaining of uterine tenderness. What action by the nurse is most appropriate? A. Increase the IV infusion rate. B. Notify the health-care provider. C. Perform a vaginal examination. D. Take the woman's temperature.

D An amniotomy is an invasive procedure that carries the risk of infection. Maternal temperature should be assessed at least every 2 hours afterward. Other signs of infection include uterine tenderness, chills, foul-smelling vaginal discharge, and fetal tachycardia. The nurse should first assess the woman's temperature (and assess for other signs of infection) and then notify the health-care provider. The other two options would not be indicated at this time.

The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily for which of the following? A. Decrease the number of side effects B. Increase the intensity of the block C. Increase the total anesthetic volume D. Preserve more maternal motor function

D Combining an opioid with a local anesthetic agent reduces the total amount of anesthetic required and helps to preserve a greater amount of maternal motor function.

A nurse has administered dinoprostone gel (Prepidil) to a nulliparous woman whose Bishop score is 5. Fifteen minutes later the patient complains of intense itching, vaginal burning, and shortness of breath. What medication does the nurse anticipate giving? A. Epinephrine (Adrenalin) B. Hydromorphone (Dilaudid) C. Misoprostol (Cytotec) D. Terbutaline (no brand name)

D In case of adverse reactions to dinoprostone, the nurse will administer terbutaline, 0.25 mg intravenously or subcutaneously. The other medications are not indicated.

A woman is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions the patient in a supine position. The patient's blood pressure drops to 90/52 mm Hg and there is a decrease in the fetal heart rate to 110 beats/minute. Which response by the nurse is best? A. Administer naloxone (Narcan) per protocol. B. Discontinue the patient's intravenous infusion. C. Have ephedrine ready for administration. D. Place a wedge under the patient's left hip.

D In the event of severe maternal hypotension, the nurse should place the patient in a lateral position or use a wedge under the hip to displace the uterus, elevate the legs, maintain or increase the IV infusion rate, and administer oxygen by face mask at 10 to 12 L/min, or according to institution protocol. Narcan is used to reverse the effects of opioids. Ephedrine would be the drug of choice for refractory hypotension if other measures don't work. The IV would not be discontinued.

A nurse has instructed a woman on the procedure for nipple rolling. What action by the patient demonstrates good understanding of the teaching? A. Pinches and pulls the nipples on alternating sides B. Rolls both nipples together for 10 minutes C. Rolls one nipple at a time during a contraction D. Rolls one nipple at a time through her clothing

D Nipple rolling can stimulate uterine contractions after labor has begun. The technique is used when labor is not progressing satisfactorily. The nurse instructs the patient to roll one nipple at a time for 10 minutes through her clothing. Then she should switch to the other side. The woman should rest during contractions.

A woman is receiving oxytocin (Pitocin) via infusion. The nurse assesses the following: uterine contractions lasting 100 seconds every 1.5 minutes, uterine resting tone 36 mm Hg, baseline fetal heart rate (FHR) 108 beats/minute with absent variability. What action by the nurse takes priority? A. Document the findings. B. Notify the provider. C. Reassess the FHR in 10 minutes D. Stop the infusion.

D Oxytocin can cause uterine tachysystole, and the nurse's assessments are consistent with this condition. The priority action by the nurse is to stop the infusion. The nurse should notify the provider. Documentation should be thorough. Reassessment should be driven by a written protocol.

The perinatal nurse explains to a nursing student that the most appropriate patient for an amnioinfusion is a woman who has a fetal heart rate tracing that exhibits which pattern? A. Absent variability B. Early decelerations C. Late decelerations D. Variable decelerations

D Pregnancy outcome in patients experiencing variable fetal heart rate decelerations caused by cord compression is improved through the use of amnioinfusion, which is the instillation of normal saline or lactated Ringer's solution into the uterine cavity.

A patient in labor complains of a pain rating of 7 on a 1-to-10 scale. On assessing the patient further, the nurse finds her vital signs to be within normal limits, the patient is calm and cooperative, and she voided 400 mL 30 minutes ago. What action by the nurse is best? A. Delay treating the pain until physical signs are present. B. Reassess the woman in 1 hour for changes in vital signs. C. Tell her she can have medication when the pain is unbearable. D. Treat the woman's pain according to the treatment plan.

D Quite simply, pain is what the patient says it is, and the nurse should treat this patient according to the treatment plan. Although there are objective signs that can be assessed with pain (changes in vital signs, emotional changes, and decreased urinary output), their absence does not invalidate the woman's complaints.

The perinatal nurse prepares to assess the labor of a patient who is in the triage area with her partner. She is contracting every 5 to 7 minutes and is very fearful about going home due to extreme fatigue and the distance to her house. The perinatal nurse determines that the patient is a fingertip dilated and50% effaced, and the cervix is anterior. The nurse might anticipate an order for what medication? A. Diphenhydramine (Benadryl) B. Lorazepam (Ativan) C. Promethazine (Phenergan) D. Secobarbitol sodium (Seconal)

D Secobarbital is the most commonly used barbiturate in labor. It is a fast-acting oral agent that produces mild sedation within 15 minutes following administration, and its effects last for 3 to 4 hours. For this woman, who is not yet ready for admission and exhausted, prescribed rest would be of benefit.

A pregnant woman is asking about a combined spinal-epidural analgesia for labor pain. What information about this method of analgesia should the nurse provide? A. Cannot be used if a cesarean birth is required B. Causes a total loss of muscle control C. Associated with a delayed onset of good pain control D. Associated with an increased risk of infection and headache

D This method requires puncture of the dura and placement of a catheter in the epidural space, so it is associated with a higher incidence of infection and postprocedure headache than other methods. The other options are not associated with the combined analgesia.

The perinatal nurse is caring for a preeclamptic patient at 35 weeks' gestation. The patient's newest laboratory results include the following: platelet count 98,000/mm3 and RBC 3.1 million/µL. What action by the nurse is most appropriate? A. Administer betamethasone (Celestone). B. Increase the patient's IV fluids. C. Maintain the patient on bedrest. D. Notify the health-care provider immediately.

D This woman's laboratory values indicate the possible development of HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), which is a factor that may necessitate immediate interventions to facilitate birth. Betamethasone is not given after 34 weeks' gestation. Increasing the IV fluids is not warranted. The patient should be maintained on bedrest, but notifying the provider is a priority.

The perinatal nurse assesses a patient who is immersed in a water-filled tub during active labor. The assessments that indicate the hydrotherapy has been effective include which of the following? (Select all that apply.) A. Decreased fetal heart rate B. Increased maternal blood pressure C. Increased maternal temperature D. Increased uterine activity E. Patient's report of less pain

D, E Hydrotherapy is effective when it provides relief from labor discomfort and pain by decreasing maternal catecholamines, prompting an increase in the release of oxytocin (stimulates uterine contractions) and endorphins (reduce the perception of pain). With decreased catecholamine release, blood pressure should remain stable or decrease. Of course the patient's report of lessened pain is the most valuable assessment. During immersion, the maternal temperature and fetal heart rate should remain stable.

A nurse is caring for a woman who has an order for a high-dose oxytocin (Pitocin) regimen to stimulate uterine contractions. Which of the following actions are appropriate for the nurse to take? (Select all that apply.) A. Assess frequently for uterine tachysystole. B. Increase the infusion every 30 minutes as needed. C. Place to woman prone to prevent dizziness. D. Start the infusion at 2 mU/minute. E. Use an electronic infusion device.

A, B, E Oxytocin must be administered safely. The high-dose regimen begins with 4 mU/minute and is increased by the same amount every 30 minutes as needed. Uterine tachysystole can occur and the nurse must assess carefully for the development of this situation. The woman is placed sitting upright or in a side-lying position. Oxytocin should always be infused via an electronic infusion device.

The OB clinic nurse is giving a pregnant woman information on different types of anesthesia and pain control for use during labor. What information does the nurse provide about spinal anesthesia block? (Select all that apply.) A. Anesthesia occurs after only a 10- to 15-minute delay. B. It can be used for both vaginal and cesarean births. C. It causes decreased maternal level of consciousness. D. It may increase the chance of an operative birth. E. It provides excellent muscular relaxation.

B, D, E Benefits of spinal block anesthesia include: easy to administer, has immediate onset of action, requires a smaller volume of medication, produces excellent muscular relaxation, allows for maintenance of maternal consciousness, and is associated with minimal blood loss. However, because the woman will lose the ability to feel contractions, maternal pushing efforts are compromised, which increases the risk of an operative birth.

A laboring woman has the nursing diagnosis of fear related to incomplete childbirth education. What assessment would best indicate that actions to decrease fear have been successful? A. Better knowledge B. Chooses analgesia C. Decreased pain D. Increased pulse

C Anxiety and fear stimulate the release of catecholamines and heighten the sensation of pain. Decreased fear leads to relaxation and less pain. The other options do not show decreased fear.

The perinatal nurse notes a rapid decrease in the fetal heart rate (FHR) that does not recover immediately following an amniotomy. What action should the nurse perform first? A. Administer oxygen at 100%. B. Assess the maternal temperature. C. Perform a vaginal examination. D. Recheck the FHR in 30 minutes.

C The nurse needs to assess the fetal heart rate immediately before and after the artificial rupture of the membranes. Changes such as transient fetal tachycardia may occur and are common. However, other fetal heart rate patterns, such as bradycardia and variable decelerations, may be indicative of cord compression or prolapse. The nurse should perform a vaginal examination to assess for cord prolapse. Administering oxygen may or may not be needed. Maternal temperature is assessed every 2 hours after artificial rupture of membranes but is not related to this situation. The nurse should not wait 30 minutes prior to doing anything