OB Silvestri Labor and Delivery

A client in labor is transported to the delivery room and is prepared for a cesarean delivery. The client is transferred to the delivery room table, and the nurse places the client in the: 1. Trendelenburg's position with the legs in stirrups 2. Semi-Fowler position with a pillow under the knees 3. Prone position with the legs separated and elevated 4. Supine position with a wedge under the right hip

4. Supine position with a wedge under the right hip Rationale: Compression of blood vessels from uterus leads to decreasing cardiac return, cardiac output and blood flow to the uterus and subsequently the fetus. Side lying is the best position.

Which assessment finding after an amniotomy should be conducted first? 1. Cervical dilation 2. Bladder distention 3. Fetal heart rate pattern 4. Maternal blood pressure

3. Fetal heart rate pattern. Rationale: Fetal heart rate is assess immediately after amniotomy to detect any changes that may indicate cord compression or prolapse.

The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement? 1. "I won't be in labor until my baby drops." 2. "My contractions will be felt in my abdominal area." 3. "My contractions will not be as painful if I walk around." 4. "My contractions will increase in duration and intensity."

4. "My contractions will increase in duration and intensity." Rationale: true labor is present when contractions increase in duration and intensity. ** Connect the word true to increase in duration and intensity.**

A nurse in the labor room is caring for a client in the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1. Administer oxygen via face mask. 2. Place the mother in a supine position 3. Increase the rate of the oxytocin intravenous infusion. 4. Document the findings and continue to monitor the fetal patterns.

1. Administer oxygen via face mask. Rationale: Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions.

The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 beats per minute. Which nursing action is most appropriate? 1. Notify the PHCP 2. Continue monitoring the fetal heart rate 3. Encourage the client to continue pushing with each contraction 4. Instruct the client's coach to continue to encourage breathing techniques.

1. Notify the PCHP Rationale: A normal FHR is 110 to 160 beats/minute. Fetal bradycardia between contractions may indicate the need for immediate medical management and the PCHP should be notified. ** Note strategic words and focus on the data in the question. Recognize fetal bradycardia is present.**

The nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client's abdomen. After attachment of the electronic fetal monitor to the client's abdomen what is the next nursing action? 1. Identify the types of accelerations 2. Assess the baseline fetal heart rate 3. Determine the intensity of the contractions 4. Determine the frequency of contraction

2. Assess the baseline fetal heart rate Rationale: Assess the baseline fetal heart rate is important so that abnormal variations of the baseline rate can be identified if they occur. ** Use ABCs. Fetal heart rate reflects the ABCs.**

The nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats per minute for the past hour. What is the priority nursing action? 1. Notify the health care provider 2. Discontinue the infusion of oxytocin 3. Place oxygen on at 8 to 10 L/minute via face mask 4. Contact the client's primary support person(s) if not currently present.

2. Discontinue the infusion of oxytocin Rationale: Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. **Relationship of the words undergoing induction and the correct option**

The nurse is performing an assessment of a client who is scheduled for a C-Section at 39 weeks gestation. Which assessment finding indicates the need to contact the primary healthcare provider? 1. Hemoglobin of 11 g/dL (110 mol/L) 2. Fetal heart rate of 180 beats per minute 3. Maternal pulse rate of 85 beats per minute 4. White blood cell count of 12x10^9/L

2. Fetal heart rate of 180 beats per minute Rationale: a normal fetal heart rate is 110 to 160 beats per minute. A FHR of 180 could indicate fetal distress and warrant immediate notification to PHCP

The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primary physiological need at this time? 1. Ambulation 2. Rest between contractions 3. Change positions frequently 4. Consume oral food and fluids

2. Rest between contractions Rationale: The birth process expends a great deal of energy, particularly during the transition stage. Encouraging rest between contractions conserves maternal energy, facilitating voluntary pushing efforts with contractions

A client arrives at a birthing center in active labor. After examination, it is determined that her membranes are still intact and she is at a -2 station. The primary health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcomes of the amniotomy? SELECT ALL THAT APPLY 1. Less pressure on her cervix 2. Decreased number of contractions 3. Increased efficiency for increased maternal blood pressure monitoring 4. The need for increased maternal blood pressure monitoring. 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord.

3, 5 3. Increased efficiency for increased maternal blood pressure monitoring 5. The need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord. Rationale: Amniotomy can be used to induce labor when the condition of the cervix is favorable or to augment labor if the progress begins to slow. Rupturing the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary after this procedure. The fetal heart rate needs to be monitored frequently, as there is an increased likelihood of a prolapsed core with ruptured membranes and thigh presenting part.

The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? SELECT ALL THAT APPLY 1. The contractions are regular 2. The membranes have been ruptured 3. The cervix is dilated completely 4. The begins to expel clear vaginal fluid 5. The Ferguson reflex is initiated from perineal pressure

3, 5 Rationale: The second stage of labor begins when the cervix is dilated completely and ends with birth of neonate. The woman has a strong urge to push in stage 2 when Ferguson is activated. Options 1,2 & 4 occur in stage 1.

The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction? 1. Variability 2. Accelerations 3. Early decelerations 4. Variable decelerations

4. Variable decelerations Rationale: Variable decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and the fetus.