Chapter 13: Labor and Birth Process
The first stage of labor is often a time of introspection. In light of this, which information would guide the nurse's planning of nursing care? A) A woman should be left entirely alone during this period. B) A woman will rarely speak or laugh during this period. C) A woman may spend time thinking about what is happening to her. D) No nursing care is needed to be done during this time.
C) A woman may spend time thinking about what is happening to her. Women need a support person with them during all stages of labor.
A pregnant woman, multipara, has been in labor for several hours. She cries out that her contractions are getting harder and that she cannot do this. The client is really irritable, nauseated, annoyed, and fearful of being left alone. Considering the client's behavior, the nurse would expect the cervix to be dilated how many centimeters? A) 3 to 5 B) 0 to 2 C) 5 to 6 D) 8 to 10
D) 8 to 10 The reaction of the client is indicative of entering or being in the transition phase of labor, stage 1. The dilation would be 8-10 cm. Before that, when dilation is 0 to 7 cm, the client has an easier time using positive coping skills.
A nurse is caring for a client in her third stage of labor. Which findings would the nurse assess as indicating placental separation? Select all that apply. A) fresh gushing of blood from the vagina B) a relaxed and distended uterus C) umbilical cord descending lower down D) renewed bearing down efforts by client E) falling downward of uterus in the abdomen
A) fresh gushing of blood from the vagina C) umbilical cord descending lower down D) renewed bearing down efforts by client The signs of placental separation include a fresh gush of blood from the vagina, lengthening of the umbilical cord, and renewed bearing-down efforts by the client. When the client is in her third stage of labor, these indicate placental separation. A rising upwards of the uterus and a well-contracted globular uterus are the other signs of placental separation. Falling downward of the uterus in the abdomen and a relaxed uterus are the signs of uterine atony.
The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as: A) duration. B) peak. C) frequency. D) intensity.
C) frequency. Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. The peak or acme of a contraction is the highest intensity of a contraction.
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting? A) shoulders B) buttocks C) brow D) occiput
D) occiput With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. The shoulders are the presenting part when the fetus is in a shoulder presentation. The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation.
A nurse is caring for a pregnant client at her 34-week checkup. The client has chosen the Lamaze method for her birthing plan but states that her partner does not agree. The client says she will just change her plan. Which response by the nurse would be appropriate to support the female client? A) "Have you and your partner discussed what his / her role will be in the birth?" B) "Just wait until the birth; your partner's mind could change." C) "Preparing for the birth works for some clients, but not for all." D) "Maybe you should choose a different support person."
A) "Have you and your partner discussed what his / her role will be in the birth?" The nurse should explain to the client the different roles the partner can take in the birth process. The nurse should encourage the client to discuss both her feelings and her partner's feelings to better understand the partner's disapproval of Lamaze. This could help improve family communication. The other three answers are not therapeutic because they ignore the client's concern and do not help to prepare the client.
A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure? A) allowing the woman time to be alone B) promoting the woman's feelings of control C) providing clear information about procedures D) encouraging the woman to use relaxation techniques
A) allowing the woman time to be alone Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor.
A pregnant client has come to the labor and birth suite in labor. The nurse reviews the client's medical record and determines that a vaginal birth is favorable based on which finding related to the client's pelvic shape? A) gynecoid B) platypelloid C) anthropoid D) android
A) gynecoid Vaginal birth is most favorable with a gynecoid pelvis because the inlet is round and the outlet is roomy. This shape offers the optimal diameters in all three planes of the pelvis. This type of pelvis allows early and complete fetal internal rotation during labor. Although vaginal birth is favorable with an anthropoid pelvis, it is less favorable than a gynecoid pelvis. However, vaginal birth is more favorable with an anthropoid pelvic shape compared with the android or platypelloid shape.
A nurse is caring for a pregnant client with rhythmic uterine contractions. Which feature should the nurse identify as associated with true labor? A) increase in frequency of the contractions B) irregularity in the duration of the contractions C) lessening of the contractions with position change D) decrease in the intensity of the contractions
A) increase in frequency of the contractions The nurse should identify that there is an increase in the duration of the contractions associated with true labor. In true labor, the duration, frequency, and intensity of uterine contractions increase. Position change does not reduce the uterine contractions. In false labor, the uterine contractions often disappear with ambulation and sleep. Also, there is no increase in frequency, duration, or intensity of the contractions, and the cervix fails to dilate any further.
A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? A) increased risk of infection B) increased risk of breech presentation C) potential placenta previa D) potential rapid birth of fetus
A) increased risk of infection After the amniotic sac has ruptured, the barrier to infection is gone, and an ascending infection is possible. In addition, there is a danger of cord prolapse. The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.
