OB Chapter 15

During the labor process, the patient's membranes rupture. Select all the assessments that are necessary for the nurse to carry out at this time. (Select all that apply.) A. Color of amniotic fluid B. Odor of amniotic fluid C. Fetal heart rate D. Cervical dilation E. Cervical effacement F. Time the membranes ruptured

A, B, C, F The time of rupture of membranes, fetal heart rate, color, odor, and quantity of the amniotic fluid are noted and charted.

Which one of the following findings during the fourth stage would require immediate interventions by the nurse? A. Fundus firm and at midline B. Fundus firm, deviated to the right, with slight distention over the symphysis pubis C. Blood pressure and pulse slightly lower than reading during second stage of labor D. Lochia is bright red, with a few small clots

B. Fundus firm, deviated to the right, with slight distention over the symphysis pubis Even though the fundus is firm, it is not midline and the bladder is filling. A full bladder will interfere with contraction of the uterus and lead to increased bleeding. The rest of the answer choices are within normal limits for this stage.

A 39-week primigravida calls the birthing center and tells the nurse she has contractions that are 10 to 15 minutes apart and had a small gush of fluid about 1 hour ago. The nurse should tell her to A. wait until the contractions are about 5 minutes apart and come to the center. B. come to the birthing center now. C. come to the birthing center in about an hour if she lives farther than 1 hour away. D. come to the birthing center if the baby stops moving.

B. come to the birthing center now. A gush or trickle of fluid from the vagina should be evaluated as soon as possible. Waiting until the contractions are 5 minutes apart is appropriate for a primigravida if the membranes have not ruptured.

In caring for a low-risk woman in the active phase of labor, the nurse realizes the assessment of fetal well-being should occur A. every 15 minutes. B. every 30 minutes. C. every 5 minutes. D. every hour.

B. every 30 minutes For low-risk women, the nurse should evaluate the fetal monitoring strip or assessment fetal well-being at least every 30 minutes during the active phase of labor and every 15 minutes during the second stage. For the high-risk woman, monitoring should occur every 15 minutes during the active phase and every 5 minutes during the second stage.

The nurse is preparing to auscultate the fetal heart rate using a Doppler transducer. When performing the Leopold maneuver, the nurse felt the buttocks near the fundus and the back along the left side of the mother. The best position for the Doppler would be in the mother's A. left upper quadrant. B. left lower quadrant. C. right upper quadrant. D. right lower quadrant.

B. left lower quadrant. The fetal heart is best heard through the fetus's upper back. Because this fetus is in a cephalic position, with the back toward the mother's left side, the Doppler should be placed in the left lower quadrant of the mother's abdomen.

Which one(s) of the following would be an indication for a cesarean birth? (Select all that apply.) A. Maternal coagulation defects B. Fetal death C. Cephalopelvic disproportion D. Active genital herpes E. Persistent nonreassuring FHR patters

C, D, E Possible indications for cesarean birth include, but are not limited to, the following: dystocia; cephalopelvic disproportion; hypertension, if prompt delivery is necessary; maternal diseases such as diabetes, heart disease, or cervical cancer, if labor is not advisable; active genital herpes; some previous uterine surgical procedures such as a classic cesarean incision or removal of fibroid tumors; persistent indeterminate or abnormal FHR patterns; prolapsed umbilical cord; fetal malpresentations such as breech or transverse lie; hemorrhagic conditions such as abruptio placentae or placenta previa; and maternal request.

A pregnant patient walks into the birthing center complaining of contractions. After getting her to bed, the first thing the nurse should do is A. assess the mother's pulse and respirations. B. gather information about her medical history. C. assess the fetal heart rate. D. start an intravenous line.

C. assess the fetal heart rate. Assessment priorities on admission of a labor patient are to determine the condition of the mother and fetus and whether birth is imminent. Checking the fetal heart rate is one of the first assessments that should be carried out. Along with assessing the fetus, the nurse should also check the maternal blood pressure and temperature.

Misoprostol (Cytotec), 50 mcg, has been ordered for a woman to assist with the ripening of the cervix. The nurse's action should be to A. administer the medication vaginally. B. administer the medication orally. C. question the dosage amount. D. monitor for contractions before administering the medication.

C. question the dosage amount. The normal dose of misoprostol for cervical ripening is 25 mcg. A 50-mcg dose is associated with hypertonic contractions.

On admission to the labor suite, a woman begins to cry out loudly, "Lord help me, I am going to die." She repeats this phrase loudly with each contraction. The nurse's best response would be to A. explain to the woman that she is disturbing other patients. B. praise her between contractions when she is quiet. C. understand that this may be a cultural mannerism and accept her individual response to labor. D. understand that this may be a cultural mannerism and do patient teaching to help her understand other ways of expressing her fear and pain.

C. understand that this may be a cultural mannerism and accept her individual response to labor. Women should be encouraged to express themselves in any way they find comforting. The cultural diversity of their expressions must be respected. Accepting a woman's individual response to labor and pain promotes a therapeutic relationship. Belittling her, praising her falsely, or trying to show her a "better way" of dealing with the pain will interfere with the therapeutic relationship and lower the woman's self-esteem.

A vaginal birth after cesarean is often abbreviated __________.

VBAC

The technique of delaying pushing until the reflex urge to push occurs may be called _____________________.

delayed pushing, laboring down, rest and descend, or passive pushing

Which one(s) of the following are important points when teaching a patient the proper method for pushing during the second stage of labor? (Select all that apply.) A. Begin and end by taking a deep breath and exhaling. B. Push for 4 to 6 seconds at a time. C. Take a deep breath and then push while holding her breath. D. Push at least five or six times with each contraction.

A & B Support the woman's spontaneous pushing techniques if they are effective. The woman should push with her abdominal muscles while relaxing her perineum. If she needs coaching, teach her to begin by taking a breath and exhaling and then to take another breath and exhale while pushing for 6 seconds at a time. Sustained pushing while holding a breath (Valsalva maneuver or "purple pushing") or pushing more than four times per contraction reduces blood flow to the placenta, increases intrathoracic pressure, is fatiguing and should be discouraged.

An intravenous access is started in most labor patients because of which one(s) of the following? (Select all that apply.) A. To have quick access if drugs are needed B. To provide fluids to prevent dehydration C. In case an epidural block is administered D. To provide a route for pain medications for the 48-hour postpartum period

A, B, C An IV line provides quick access if fluids or medications are needed. Continuous fluid infusion prevents and reduces dehydration and is necessary if epidural analgesia is used. By 48 hours postpartum, mothers are expected to be on oral pain medication.

Labor pain management may include which one(s) of the following interventions? (Select all that apply.) A. Cool, damp washcloths on the face and neck B. Decreasing bright lights in the room C. Keeping the woman clean and dry D. Administering pain medication as ordered E. Offering simple snacks every 2 hours

A, B, C, D Providing comfort measures are important during labor. A laboring woman may have clear liquids by mouth but no solid food during active labor.

Which one(s) of the following are used to assist with the cervical ripening process prior to induction of labor? (Select all that apply.) A. Prostaglandin B. Oxytocin C. Misoprostol (Cytotec) D. Laminaria tents E. Terbutaline

A, C, D Prostaglandin E2 (PGE2) preparations may be given as an intravaginal gel, an intracervical gel, or a timed-release vaginal insert to ripen the cervix. Misoprostol can be used for both cervical ripening and induction of labor. Mechanical methods for cervical ripening are efficacious and have decreased risk of excessive uterine activity. These methods include placement of a transcervical balloon catheter, membrane stripping, or placement of hydroscopic inserts (i.e., Laminaria—sterile cone-shaped preparations of dried seaweed).

A multigravida at 37 weeks of gestation is admitted to the labor room. She has contractions every 3 to 4 minutes lasting 40 to 50 seconds and no history of clear fluid leakage from the vagina, but complains of bright red bleeding for the past hour. The fetal heart rate is 145 beats/minute (bpm). What should be the nurse's next intervention? A. Call the physician promptly. B. Perform a vaginal exam to determine imminence of birth. C. Continue to monitor contractions and fetal heart rate. D. Administer an enema according to protocol of the agency.

A. Call the physician promptly. Bright red bleeding is a sign of complications, and the physician or primary health care provider should be notified immediately. Vaginal exams or enemas are contraindicated in the presence of bleeding. Continuing to monitor the mother and fetus is important after notifying the health care provider.

After birth, the nurse assesses the newborn. The heart rate is 90 bpm, the body is flexed, there is vigorous movement, the newborn is actively crying when stimulated, and has bluish coloration in the feet and hands. The proper Apgar score for this newborn should be A. 7. B. 8. C. 9. D. 10.

B. 8. The heart rate less than 100 bpm gets a score of 1, a lusty cry will give a score of 2 for both respiratory effort and reflex response, the flexed posture and vigorous movements give a score of 2, and the bluish coloration of the hands and feet will give a score of 1.

Which one of the following women can the nurse anticipate having difficulty dealing with labor pain? A. Primigravida who has attended childbirth preparation classes B. A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. C. A woman having her sixth child and who has not attended any prenatal teaching classes D. Primigravida who has her mother as her birth support person. The mother is encouraging her with every contraction.

B. A woman having her second baby; the first child was in a posterior position and the labor lasted 18 hours. Previous experiences with pain can alter a woman's perception of labor pain. The woman with a prolonged labor and posterior position with the last birth will come to this labor anxious about the outcome and amount of pain. Preparation for labor and previous positive experiences will help the woman tolerate the pain. A support person who has been through the process and is encouraging can also assist the woman in a positive way.

Which one of the following measures will help prevent complications from an episiotomy? A. Pain medication every 3 to 4 hours as needed B. Cold applications after birth D. Warm applications after birth E. Early ambulation

B. Cold applications after birth Cold applications for the first 12 hours after birth may help prevent hematomas and edema. Pain medication helps treat, not prevent, the complication of pain. Early ambulation helps prevent other complications. Warm applications are contraindicated after birth; they may be used after 12 hours.

A patient is being discharged, having been diagnosed with false labor. The nursing diagnosis for her is Deficient Knowledge: characteristics of true labor. An appropriate expected outcome for this diagnosis is that the A. Patient will return to the hospital when she is in true labor. B. Patient will define true labor. C. Patient will describe reasons for returning to the hospital for evaluation. D. Patient will be able to determine false from true labor.

C. Patient will describe reasons for returning to the hospital for evaluation. The patient may not be able to determine true from false labor; however, she should be made aware of what signs to look for that may indicate the need for evaluation.

A primigravida is admitted in early labor. The nurse notices on the prenatal record that the position of the fetus is left occiput posterior. Because of this information, the nurse can anticipate A. a cesarean section. B. a short labor and birth process. C. increased back pain with labor. D. a short labor with a prolonged birth process.

C. increased back pain with labor. When the fetus is in the posterior position, the labor may be longer and more uncomfortable. Back discomfort increases with contractions and will continue between contractions. The fetus may not be able to deliver until it rotates into the anterior position.

When pressure is applied to the fetal chin through the perineum at the same time pressure is applied to the occiput of the fetal head, it is termed the _______________.

Ritgen maneuver