PrepU: Chapter 14: Nursing Management During Labor and Birth

A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first? Assist the client in ambulating to the bathroom. Instruct the client to do slow-paced breathing. Assess for labor progression. Prepare the client for an epidural.

Assess for labor progression.

Which statement is true regarding analgesia versus anesthesia? Analgesia and anesthesia perform the same function when it comes to blocking pain. Regional anesthesia should be given with caution close to the time of birth because it crosses the placenta and can cause respiratory depression in the newborn. Hypertension is the most common side effect when systemic analgesia is used. Increased FHR variability is a common side effect when regional anesthesia is used.

Regional anesthesia should be given with caution close to the time of birth because it crosses the placenta and can cause respiratory depression in the newborn.

There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain? Women report higher levels of satisfaction when regional anesthetics are used to control pain. Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience. Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use. Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain.

Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.

Touch and massage can be helpful during labor. Which touch and massage methods are used in labor? Select all that apply. patterned breathing effleurage counterpressure water therapy

effleurage counterpressure

The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best? "The analgesia will block pain sensation and limit your ability to push." "The analgesia will allow for a pain-free birth experience." "The analgesia will reduce the sensation of pain for a limited period of time." "The analgesia will limit your ability to be out of bed without assistance."

"The analgesia will reduce the sensation of pain for a limited period of time."

The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods? The gating mechanism opens so all the stimuli pass through to the brain. These methods are a technique to prevent the painful stimuli from entering the brain. Pain perception is decreased if anxiety is present. The gating mechanism is located at the pain site.

These methods are a technique to prevent the painful stimuli from entering the brain

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is: 7.21. 7.15 or less. 7.20. 7.25 or more.

7.15 or less.

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: patterned breathing. acupressure. therapeutic touch. effleurage.

effleurage

The nurse is analyzing the readout on the EFM and determines the FHR pattern is normal based on which recording? Increase in variability by 27 bpm Deceleration followed by acceleration of 15 bpm Decrease in variability for 15 seconds Acceleration of at least 15 bpm for 15 seconds

Acceleration of at least 15 bpm for 15 seconds

The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client? Prenatal classes Continuous labor support Massage therapy Pharmacologic pain management

Continuous labor support

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? FHR fluctuation range is undetectable. FHR fluctuates from 6 to 25 beats per minute. FHR fluctuates over 25 beats per minute. FHR fluctuates less than 5 beats per minute.

FHR fluctuates from 6 to 25 beats per minute

The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist? Inability to push Dry, cracked lips Rapid progress of labor Urinary retention

Inability to push

The client may spend the latent phase of the first stage of labor at home unless which occurs? The contractions vary in length and intensity The client begins back labor The client passes the bloody show The client experiences a rupture of membranes

The client experiences a rupture of membranes

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? acupuncture biofeedback acupressure effleurage

acupressure

A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency? every 20 minutes every 15 minutes every 10 minutes every 5 minutes

every 15 minutes

As a woman enters the second stage of labor, which would the nurse expect to assess? falling asleep from exhaustion reports of feeling hungry and unsatisfied expressions of satisfaction with her labor progress feelings of being frightened by the change in contractions

feelings of being frightened by the change in contractions

The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: right lower quadrant. right upper quadrant. left upper quadrant. left lower quadrant.

left lower quadrant.

While waiting for the placenta to deliver during the third stage of labor the nurse must assess the new mother's vital signs every 15 minutes. What sign would indicate impending shock? tachycardia and a falling blood pressure bradycardia and auscultation of fluid in the base of the lungs tachypnea and a widening pulse pressure bradypnea and hypertension

tachycardia and a falling blood pressure

The nurse is assessing a new client who presents in early labor. The nurse determines the fetus has an acceptable heart rate if found within which range? 110 to 160 bpm 90 to 140 bpm 120 to 170 bpm 100 to 150 bpm

110 to 160 bpm

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding? Rupture of amniotic membranes Dilation (dilatation) of cervix Bloody show Engagement of fetus

Dilation (dilatation) of cervix

How does a woman who feels in control of the situation during labor influence her pain? There is no association between the two factors. Feeling in control shortens the overall length of labor. Feelings of control are inversely related to the client's report of pain. Decreased feeling of control helps during the third stage.

Feelings of control are inversely related to the client's report of pain.

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client? postdural puncture (spinal) headache accidental intrathecal block respiratory depression a failed block

respiratory depression

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? Fetal hypersensitivity to anesthetic is possible. Neonatal depression is possible. The client is less sensitive to inhalation anesthetics. The client is more sensitive to preanesthetic medications.

Neonatal depression is possible.

The nurse has been monitoring the progression of labor for a primipara. At which time is the nurse most correct to prepare for delivery? When the fetus is crowning When the health care provider arrives When the client begins pushing When full dilation (dilatation) is reached

When the fetus is crowning

The pain of labor is influenced by many factors. What is one of these factors? The woman has a high threshold for pain. The woman has a high tolerance for pain. The woman is prepared for labor and birth. The woman has lots of visitors during labor.

The woman is prepared for labor and birth

To assess the frequency of a woman's labor contractions, the nurse would time: the beginning of one contraction to the beginning of the next. the interval between the acme of two consecutive contractions. how many contractions occur in 5 minutes. the end of one contraction to the beginning of the next.

the beginning of one contraction to the beginning of the next

During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? Obtain urine specimen for urinalysis. Monitor hydration status. Assess the amount of cervical dilation (dilatation). Monitor vital signs.

Assess the amount of cervical dilation (dilatation).

Which intervention would be least effective in caring for a woman who is in the transition phase of labor? providing one-to-one support urging her to focus on one contraction at a time having the client breathe with contractions encouraging the woman to ambulate

encouraging the woman to ambulate

Which possible outcome would be a major disadvantage of any pain relief method that also affects awareness of the mother? The infant may show increased drowsiness. The mother may have continued memory loss postpartum. The mother may have difficulty working effectively with contractions. The father's coaching role may be disrupted at times.

The mother may have difficulty working effectively with contractions.

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states: "Breathing patterns are distraction techniques taught to decrease pain in labor." "Breathing patterns cannot be taught while in labor." "Breathing patterns help a woman concentrate on pain." "Breathing patterns must be used with a coach."

"Breathing patterns are distraction techniques taught to decrease pain in labor."

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give? "It distracts your brain from the sensations of pain." "It causes the release of endorphins." "It disrupts the nerve signal of pain via mechanical irritation of the nerves." "It blocks the transmission of nerve messages of pain at the receptors."

"It distracts your brain from the sensations of pain."

A labor nurse is caring for a client who is 7 cm dilated, 100% effaced, at a +1 station, and has a face presentation on examination. The nurse knows that teaching was understood when the birth partner makes which statement? "Our baby will come out facing the hip." "Our baby will come out face first." "Our baby will come out with the buttocks first." "Our baby will come out with the back of the head first."

"Our baby will come out face first."

A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR? 10:30 a.m. 11:15 a.m. 11:30 a.m. 10:05 a.m.

10:30 a.m.

A client in labor has requested the administration of opioids to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? Agree with the client, and administer the drug immediately to keep the pain manageable. Refuse to administer opioids because they can develop dependency in the client and the fetus. Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. Explain to the client that opioids should only be administered an hour or less before birth.

Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor? Pain is focal in nature. Diffuse abdominal pain signals a complication with progression of labor. It is reported as the worst pain a woman will ever feel. Pain originates from the cervix and lower uterine segment

Pain originates from the cervix and lower uterine segment

A primigravida is 1 cm dilated, in early latent labor, and interested in avoiding epidural anesthesia. After asking about which nonpharmacologic options for pain relief she can use at this time, which option(s) should the nurse point out to the client? Select all that apply. Effleurage Walking and then using a birthing ball Simple breathing exercises Sitting in a tub of warm water It is too late for nonpharmacologic measures.

Simple breathing exercises Effleurage Walking and then using a birthing ball

A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply. Reduce intravenous (IV) fluid rate. Ignore questions from the client. Assess client for underlying causes. Turn the client on her left side. Administer oxygen by mask.

Turn the client on her left side. Administer oxygen by mask. Assess client for underlying causes.