MC Ch7

The urge to push will usually occur when the presenting part is at what station in the pelvis?

+3

Which of the following statements are true about postpartum administration of oxytocin? Select all that apply.

- It can be given IV or IM -It will induce breast milk letdown

Which of the following statements about labor and delivery are true? Select all that apply.

-Every labor and delivery is different -If the fetus is not in a favorable position, the provider may attempt to turn them externally - True labor can be defined as cervical change

Which of the following statements are true about intermittent auscultation (IA)?

-IA results in fewer C-sections -IA allows for increased freedom of movement -IA should be started right after a uterine contraction has ended -IA requires 1:1 care

Anna is a patient who just ambulated to OB triage for labor assessment. She is a 37 week 5 day G3P0111. As the nurse working in triage, which of the following statements from Anna would indicate she should be evaluated? Select all that apply.

-The bed was wet when I woke up this morning -There was a pinkish, thick discharge on the toilet paper when I wiped this morning

Which of the following are expected findings for a patient who has received an epidural? Select all that apply.

-The patient may need help holding her legs and being directed when to push -The patient may develop intense pruritus -Urinary retention and stress incontinence may occur immediately postpartum

Place the maternal structures based on the cardinal movements of labor in the order in which they are reached.

1.Entering the maternal inlet 2. Pelvic floor and cervix 3. Levator ani muscles 4.Under the pubic symphysis

Teresa's placenta has just been delivered and is putting her newborn to breast. What stage of labor is Teresa in?

4th stage

When assisting a hypotensive patient receiving an epidural, which of the following situations is the most concerning?

A drop >20 mm Hg in BP

A common way to prevent maternal hypotension in a patient receiving an epidural is which of the following?

Administer a bolus of IV fluids before epidural placement

Marcella is a G3P2002 who has arrived at the hospital in active labor at 38 weeks 2 days. FHTs are 145, she's contracting every 3 to 5 minutes, and she is rating her contraction pain at a 6 on a scale of 1 to 10. On sterile vaginal exam, her cervix is dilated to 6 cm, effaced 80%, the infant is at +1 station, and the position is RSA. With this information, what orders should you anticipate next?

Admit to L&D, place an IV, collect type and screen, and a CBC. Notify the OR team of the need for a C-section

Once the infant reaches +4 station, it is at what maternal landmark?

At the pelvic outlet

When taking a medical history for a newly admitted patient in labor, which of the following statements or questions is phrased appropriately?

Can you tell me about any medication or drugs you took during your pregnancy and how much?

While assessing the tracing of a term laboring patient on continuous fetal monitoring, the nurse notes the fetal heart rate is 115 bpm with moderate variability. There are several early decelerations, along with a few accelerations that last 30 seconds and increase the heart rate by 20 bpm. What category of fetal heart tracing is this?

Category 1

Julia, a G3P1011 at term, was admitted in active labor 6 hours ago. On admittance, she was dilated 5 cm, 70% effaced, and at 0 station. The nurse just checked her cervix and she was 7 cm, 80% effaced, and at 0 station. What is the suspected complication at this time?

Cephalopelvic disproportion

The nurse is palpating the uterus of a patient who has been in active labor for several hours. The nurse knows the contractions are of moderate intensity when they feel like a

Chin

Susan is 40 weeks 3 days pregnant and has come to OB triage for an assessment of labor. On the monitor, FHR is 145 with moderate variability, and contractions are every 2 to 3 minutes lasting 60 to 90 seconds. Her abdomen palpates as mild to moderate during contractions. Her cervix is 2 cm dilated, 50% effaced, and the fetus is at -2 station. Which part of this assessment is not an expected finding for this stage of labor?

Contractions every 2-3 mins lasting 60-90 secs

Which of the following statements about electronic fetal monitoring (EFM) is not true?

EFM has reduced the cesarean rate in healthy pregnancies since its introduction

Shelley is a term G3P1102 who has been admitted to labor and delivery in labor. She's breathing deeply with her contractions with eyes closed. She's contracting every 3 to 6 minutes lasting 60 to 80 seconds. What stage and phase of labor is Shelley in?

First stage, active phase

Heather, a term G2P1001, has been actively laboring and progressing through an unmedicated labor for the past 7 hours. She has remained calm and is using breathing techniques with her partner. After a particularly strong contraction, Heather begins to cry and states, "I just wants it done, I can't do much more, how much longer will it take?" What stage and phase of labor is Heather in?

First stage, transition phase

When counting contractions, which of the following is true?

Frequency is counted as the beginning of one contraction to the beginning of the next contraction

Marna is a term G3P1102 patient who was admitted to labor and delivery in active labor a few hours ago. Her NST in OB triage before admittance showed a FHR of 150 with moderate variability and an occasional early deceleration. Her contractions are lasting 40 to 60 seconds every 2 to 4 minutes. Her membranes ruptured 16 hours ago at home, and she didn't begin to contract until an hour ago. Otherwise, her labor has been uncomplicated. Why is the provider ordering continuous fetal monitoring and not intermittent auscultation for Marna?

Her membranes ruptured 16 hours ago before the onset of labor

Which nonpharmacological pain relief measure emphasizes mental and physical relaxation while promoting a sense of safety?

Hypnotherapy

Effects of delayed cord clamping include all of the following except what?

Increased chance of maternal hemorrhage

A new nurse on the floor is describing the need for internal fetal monitoring to the nurse educator during a simulation drill. Which of the following statements made by the new nurse indicates a need for further education?

Internal monitors can be placed in my patient any time there is a concern for fetal well-being

The nurse knows if, while doing a vaginal exam, the fetus' occiput is located to the maternal anterior left, she will chart the position as which of the following?

LOA

Teasha is 38 weeks 4 days and is in the office for a routine checkup. She tells the provider she's been breathing easier, but now her feet are starting to swell and she woke up with a leg cramp this morning. What normal physiological finding is Teasha experiencing?

Lightening

Counterpressure over the sacral area will be most beneficial to which of the following patients?

Madison, at 6 cm with her baby ROP, kneeling on her bed rating her pain as a 7 on a 1 to 10 scale during contractions and a 5/10 between them

The baseline FHR on a patient on admittance was 130 to 140 with moderate variability. Over the course of the last 5 hours, the FHR has risen to a baseline of 155 to 170. What should be the nurses' priority assessment focus for this?

Maternal infection

Aimee is a G1P001 at 38 weeks 3 days who has been in labor for 23 hours. She is now 7 cm dilated, 80% effaced, and the infant is at zero station. Over the last 2 hours, her strip has begun to resemble this FHR pattern. What orders should the nurse anticipate? Help reduce the cord compression that variable declarations typically indicate

Order for an amnioinfusion

Mariah is in active labor and being continuously monitored. FHR is 120 with moderate variability and contractions every 3 to 5 minutes. The nurse also notes decelerations that begin and end with the contractions. What is the appropriate nursing action to address these decelerations?

Reassure the patient and her support persons that she and the baby are doing well

Stacey is a new nurse on this unit but an experienced labor and delivery nurse. She just received a reprimand for placing internal fetal monitors on her patient, a task she performed routinely at her previous unit in another state but is only done by the provider on this unit. What should Stacey have done to prevent this reprimand?

Reviewed the institutional policies for differences in practice between her two places of work

Syrah received an epidural an hour ago. Upon re-entering the room, the nurse notes that Syrah is sleeping soundly. Assessing her vitals, the nurse realizes Syrah is not sleeping soundly and may need Naloxone. What in her assessment findings would indicate this to the nurse?

Syrah's O2 sat is 88% and respirations are 8

The monitor in a laboring patient's room has shown a category II strip for the past hour. Variability has ranged between minimal and moderate with no accelerations and an occasional variable deceleration. In the past 15 minutes, subtle late decelerations have begun to appear repetitively, and the variability has remained minimal and at times absent. What should be assumed by this assessment?

The fetus is experiencing uteroplacental insufficiency and possibly beginning to suffer hypoxemia

A nurse is calling report to the provider of a patient who just came into OB triage actively laboring with delivery imminent. On the phone, the nurse states, "Erika Jones, a 26-year-old G5P3104, is in triage contracting every 2 to 3 minutes with a reactive NST. Her cervix is 9 cm dilated, 100% effaced, and the baby is ROA at +2 station. Her membranes are intact, and vital signs are all within normal limits. She's had a normal healthy pregnancy and is stating she needs to push." What priority information is missing from this report?

The gestational age and EDD

Fetal attitude is

The relationship of fetal body parts to each other.

A new nurse has placed a laboring patient on the external monitor for EFM. When the provider comes into the room and notes the location of the ultrasound transducer and the category I strip, they ask for the ultrasound machine and to contact the OR to prepare for a nonemergent cesarean section. What has the provider seen that would prompt this action?

The transducer is 1 cm above and to the left of the umbilicus

As you care for a laboring patient at 5 cm, between contractions she asks why her thighs hurt. What is your best response?

This is called referred pain. It's your contraction pain moving through your body and sometimes happens

Cary has just delivered a healthy baby boy, and the midwife remains at the perineum to assess any damage that may have occurred. The nurse knows the patient has a 2nd-degree laceration when the midwife states which of the following to the patient?

You'll have several stitches on your perineum, but I don't have to place any near your rectum