Intrapartum

The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98%. Which action should the nurse take first? 1. Call the health care provider regarding the patient's pruritus to order an antipruritic medication. 2. Activate emergency response due to the patient's pruritus and tachycardia postepidural placement. 3. Call the anesthesiologist regarding the patient's oxygen saturation level. 4. Take no further action regarding the patient's complaints, as they are normal after epidural placement.

ANS: 1 1 This is correct. Ninety percent of women who receive opioids in epidural have itching, and the health care provider should be notified so the correct medications can be ordered and administered to treat the pruritus. 2 This is incorrect. The patient's vital signs do not indicate that she is having a critical response to the epidural placement. 3 This is incorrect. The patient's oxygen saturation is normal. 4 This is incorrect. The patient is tachycardic and pruritic. These symptoms require contacting a health care provider for further action.

The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development tier system, what category tracing does the patient's fall into? 1. A Category I tracing 2. A Category II tracing 3. A Category III tracing 4. A Category IV tracing

ANS: 1 1 This is correct. This is a normal tracing. 2 This is incorrect. A Category II is an indeterminate tracing, and the patient's tracing has normal components 3 This is incorrect. A Category III tracing is an abnormal tracing, and the patient's tracing has normal components 4 This is incorrect. There is no such category as a Category IV tracing.

The nurse is caring for a 30-year-old woman who is G4P2012 at 38 weeks and 5 days gestation. The nurse is watching her EFM strip and notices that for the past 10 minutes the fetus has shown minimal variability. Which actions should the nurse perform? Select all that apply. 1. Check to see if the patients' membranes have been ruptured, as there could be potential cord compression. 2. Look to see what the patient's position is and is she supine; change her to left side lying. 3. Continue to watch the strip, but know that this could be due to fetal sleep. 4. Recognize that the fetus is 38 weeks and therefore this could be due to fetal maturity. 5. Check the FHR and connect the minimal variability to fetal bradyasystole.

ANS: 1, 2, 3 1 This is correct. Minimal variability can be caused by cord compression. 2 This is correct. Minimal variability can be caused by maternal supine hypotension. 3 This is correct. Minimal variability can be caused by fetal sleep. 4 This is incorrect. Minimal variability can be caused by fetal prematurity. 5 This is incorrect. Minimal variability can be caused by tachysystole.

The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply. 1. Intensity of contractions 2. Presence of pain in the neck or back 3. Frequency and duration of contractions 4. Signs of anxiety 5. Presence of FHR with intermittent auscultation

ANS: 1, 2, 3, 4 1 This is correct. In a pain assessment, the nurse should assess for intensity. 2 This is correct. In a pain assessment, the nurse should assess for location. 3 This is correct. In a pain assessment, the nurse should assess for pattern. 4 This is correct. In a pain assessment, the nurse should assess for degree of distress. 5 This is incorrect. Fetal heart tones are not part of a pain assessment.

Which actions indicate the is assessing uterine activity? Select all that apply. 1. Feeling the maternal abdomen in between contractions 2. Checking the EFM strip to determine if contractions are either 2 or 3 minutes apart 3. Evaluating that the EFM strip shows 200 MVU every 10 minutes. 4. Checking the EFM strip to see if the fetus has an elevation of 15 bpm over baseline for 15 seconds twice in a 20-minute period 5. Evaluating that the EFM strip shows that each contraction lasts 1 minute

ANS: 1, 2, 3, 5 1 This is correct. Resting tone is an interpretation of uterine activity. 2 This is correct. Frequency is an interpretation of uterine activity. 3 This is correct. Intensity is an interpretation of uterine activity. 4 This is incorrect. Accelerations are an interpretation of periodic and episodic fetal changes. 5 This is correct. Duration of uterine contractions is an interpretation of uterine activity.

The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply. 1.There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin. 2. Oxytocin stimulates uterine muscles to contract. 3. The uterus begins to contract due to a decrease in estrogen. 4. The placenta begins to age and deteriorate and this triggers the start of contractions. 5. The fetus releases a stress hormone, cortisol, and this starts contractions.

ANS: 1, 2, 4, 5 1 This is correct. Increased pressure on the cervix stimulates the nerve plexus, causing release of oxytocin by the maternal pituitary gland, which then stimulates contractions. 2 This is correct. Oxytocin stimulates uterine muscles to contract. 3 This is incorrect. It is an increase in estrogen that stimulates a uterine response. 4 This is correct. As the placenta ages, it begins to deteriorate, triggering initiation of contractions. 5 This is correct. Fetal cortisol rises and stimulates the uterus to contract.

The nurse-educator is preparing a presentation on fetal heart monitoring. Which of the following should be included? Select all that apply. 1. Intermittent auscultation should be performed every hour in the latent phase. 2. For Category I situations, intermittent electronic fetal monitoring (EFM) should be performed for 10 to 30 minutes every 1 to 2.5 hours. 3. A patient with a previous cesarean section should have EFM for 10 to 30 minutes every 1 to 2.5 hours. 4. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 5. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

ANS: 1, 2, 4, 5 1 This is correct. Intermittent auscultation should be done every hour in the latent phase. 2 This is correct. For Category I situations, intermittent EFM should be done for 10 to 30 minutes every 1 to 2.5 hours. 3 This is incorrect. A patient with a previous cesarean section should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 4 This is correct. A patient with membranes ruptured over 24 hours should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage. 5 This is correct. A patient with fever should be monitored during the latent phase every 30 minutes, every 15 minutes during the active phase, and every 5 minutes during the second stage.

The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply. 1. Shortens the length of labor 2. Reduces the likelihood that a patient will require an epidural 3. Reduces the risk of infection after birth 4. Lowers the chance that the patient will breastfeed 5. Increases patients' happiness and satisfaction with the outcome of their birth

ANS: 1, 2, 5 1 This is correct. In 2011, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) found that having support persons shortens labor. 2 This is correct. In 2011, the AWHONN found that having support persons decreases the use of analgesia. 3 This is incorrect. Having support persons has not been shown to have an effect on post-delivery infections. 4 This is incorrect. In 2011, the AWHONN found that having support persons increases the likelihood of breastfeeding. 5 This is correct. In 2011, the AWHONN found increased satisfaction with the birth experience in those with support persons.

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply. 1. Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours. 2. The medication Christa wants is an epidural. After she receives the epidural, the FHR tracing is within normal limits. 3. Christa received butorphanol (Stadol) within 3 hours of delivery and the infant experienced neonatal depression. 4. Local anesthesia in the perineal area was used in conjunction with the epidural throughout labor and delivery. 5. Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief.

ANS: 1, 2, 5 1 This is correct. Labor must be well established before administration of an analgesic is begun. 2 This is correct. Medication should provide relief to the mother with minimal risk to the baby. 3 This is incorrect. Neonatal depression may occur if medication is given within an hour before delivery. 4 This is incorrect. Local anesthesia is used at the time of delivery for episiotomy and repair. 5 This is correct. Women with a history of drug abuse may have a lessened effect from pain medication and require higher doses.

The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural? Select all that apply. 1. Lateral position with head flexed toward chest 2. Trendelenburg position 3. Lithotomy position 4. Sitting position with elbows on knees 5. Prone position

ANS: 1, 4 1 This is correct. The lateral position would give good access to the spine. 2 This is incorrect. This does not give access to the spine. 3 This is incorrect. This does not give access to the spine. 4 This is correct. The sitting position with head flexed would give good access to the spine. 5 This is incorrect. The mother will not be able to easily assume this position, and it will not give access to the spine.

The nurse is caring for a pregnant patient who expresses concern about the effects of electronic fetal monitoring (EFM) on her labor and delivery. Which responses by the nurse would be appropriate in this situation? Select all that apply. 1. "There is a reduced rate of seizures if a patient has EFM during labor." 2. "There is a decrease in the incidence of cerebral palsy if a patient has EFM during labor." 3. "There is a link between decreased infant mortality and EFM during delivery." 4. "There is a link between the rate of cesarean sections and continuous EFM." 5. "There is an increase in operative vaginal births and the use of continuous EFM."

ANS: 1, 4, 5 1 This is correct. EFM during labor is associated with reduced rates of neonatal seizures. 2 This is incorrect. EFM during labor has not been shown to reduce cerebral palsy. 3 This is incorrect. EFM during labor has not been shown to reduce infant mortality. 4 This is correct. Continuous EFM increases the rate of cesarean sections. 5 This is correct. Continuous EFM increases the rate of operative vaginal births.

The nurse is obtaining a baseline fetal heart rate (FHR). At 1:00 pm the baseline FHR was 130, at 1:20 pm FHR baseline was 166, and at 1:40 pm the baseline FHR was 204. What should the nurse assess from this trend of fetal baselines? Select all that apply. 1. The 1:00 pm FHR baseline warranted no further action. 2. The 1:20 pm FHR baseline warranted immediate fetal resuscitation. 3. The 1:00 pm FHR baseline warranted immediate maternal resuscitation 4. The 1:20 pm FHR baseline should be corrected immediately with delivery. 5. The 1:40 pm FHR baseline should be corrected immediately.

ANS: 1, 5 1This is correct. The normal range is 110 to 160 bpm. 2 This is incorrect. FHR baseline above 160 bpm for at least 10 minutes is tachycardic; however, maternal position change may correct the problem before fetal resuscitation. 3 This is incorrect. The normal range is 110 to 160 bpm and therefore no maternal resuscitation was needed at that time. 4 This is incorrect. An FHR that is tachycardic should be corrected but other measured should be performed before delivery. 5 This is correct. If tachycardia persists above 200 to 220 bpm, fetal demise may occur.

The nurse is looking at an EFM strip and sees that the patient is having contractions that are measuring 150 MVU every 10 minutes for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps? 1. The patients' contractions are adequate, so the main focus should be on resuscitating the fetus with maternal oxygen and maternal position change. 2. The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective. 3. The patients' contractions are adequate, so the main focus should be on determining her progress through cervical change. 4. The patients' contractions are inadequate; the provider could consider augmenting with Pitocin to be more effective.

ANS: 2 1 This is incorrect. Although the fetus should be resuscitated, the patients' contractions are inadequate. 2 This is correct. The patients' contractions are inadequate, so the provider could consider an amnioinfusion through the IUPC. Then, once the fetus has improved, contractions need to be augmented to be more effective. 3 This is incorrect. The patients' contractions are inadequate, and determining her progress through cervical change would not improve the mother's or fetus's condition. 4 This is incorrect. Although the patients' contractions are inadequate, augmenting the patients' contractions with Pitocin might put more undue stress on the fetus.

The nurse is using the Parer and Ikeda five-tier system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia and evidence of impending fetal asphyxia. What is the next best step for the nurse? 1. Perform conservative measures. 2. Prepare for urgent delivery. 3. Assist provider in immediate delivery. 4. Increase surveillance of patient.

ANS: 2 1 This is incorrect. Blue indicates a 0 risk of acidemia. In these cases, the nurse should inform the health care provider and perform conservative measures. 2 This is correct. Orange indicates an acceptably low risk of acidemia and preparation for possible urgent delivery. 3 This is incorrect. Red indicates an unacceptably high risk of acidemia and the need for immediate delivery. 4 This is incorrect. Yellow indicates 0 risk of acidemia. The recommendation is for increased surveillance and conservative measures.

While providing care for a patient, the nurse notices an erratic FHR recording. What action should the nurse take next? 1. Help the patient move around to help obtain the signal. 2. Place the transducer in a different position. 3. Check the mother's cervical progress to see if she is in the second stage of labor. 4. Remove some of the ultrasound gel from the transducer.

ANS: 2 1 This is incorrect. Fetal or maternal movement may cause erratic FHR recordings; increasing movement would not improve the recording. 2 This is correct. Fetal or maternal movement may cause erratic FHR recordings, and moving the transducer would help the recording if fetal movement causes it. 3 This is incorrect. Erratic FHR recordings are not usually due to moving into second stage. 4 This is incorrect. A lack of gel can cause the recording to be erratic, and if this is the case, more gel should be added, not less.

The nurse is caring for a baby who is experiencing fetal tachycardia. Which action should the nurse take next? 1. Perform fetal scalp stimulation for 5 seconds. 2. Check maternal allergies in the patient chart. 3. Apply heat packs to the maternal chest and head. 4. Stimulate the fetus with a vibroacoustic device.

ANS: 2 1 This is incorrect. Fetal scalp stimulation should be used for fetal bradycardia. 2 This is correct. Fetal tachycardia can be caused by maternal or fetal infection and antibiotics may be administered; typically, penicillin is administered and a penicillin allergy would require a different medication. 3 This is incorrect. Fetal tachycardia can be caused by maternal fever. Heat application would increase maternal temperature. 4 This is incorrect. Fetal movement can cause fetal tachycardia; a vibroacoustic device would cause fetal movement and is therefore unnecessary.

The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient? 1. "We will inject 1 mL of sterile water intramuscularly, and it will last for about an hour." 2. "We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes." 3. "We will inject 1 mL of sterile water subcutaneously, and it will last for about a half hour." 4. "We will inject 0.5 mL of sterile water intramuscularly, and it will last for about 3 hours."

ANS: 2 1 This is incorrect. Sterile water injections are subcutaneous injections of 0.5 ml sterile water and provide 60 to 90 minutes of lower back pain relief. 2 This is correct. Sterile water injections are subcutaneous injections of 0.5 ml sterile water and provide 60 to 90 minutes of lower back pain relief. 3 This is incorrect. Sterile water injections are subcutaneous injections of 0.5 ml sterile water and provide 60 to 90 minutes of lower back pain relief. 4 This is incorrect. Sterile water injections are subcutaneous injections of 0.5 ml sterile water and provide 60 to 90 minutes of lower back pain relief.

The nurse preceptor is teaching a nursing student about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates successful teaching about this concept? 1. "Vagus nerve stimulation increases FHR and helps maintain variability." 2. "The sympathetic nervous system is responsible for heart rate variability." 3. "Action of the FHR occurs through the absence of norepinephrine." 4. "Baroreceptors are responsible for increasing FHR and fetal blood pressure."

ANS: 2 1 This is incorrect. Vagus nerve stimulation slows FHR and helps maintain variability. 2 This is correct. The sympathetic nervous system is responsible for heart rate variability. 3 This is incorrect. Action occurs through the release of norepinephrine. 4 This is incorrect. Baroreceptors are stretch receptors that protect homeostasis and regulate heart rate by stimulating a vagal response and decreasing FHR, fetal blood pressure, and cardiac output.

The nursing preceptor is teaching the nursing student about fetal bradycardia. Which is true of the maternal reasons for fetal bradycardia? Select all that apply. 1. A maternal fever in labor is usually due to dehydration and therefore should be treated with a fluid bolus. 2. Administering terbutaline to the mother for uterine tachysystole; this is self-limiting to when the drug is affecting the mother. 3. A urine toxicology screen may reveal recent cocaine use; the nurse should also monitor for placental abruption. 4. Check the chart for a history of maternal mental illness, particularly maternal anxiety; speak with the patient regarding her anxiety and take steps to ease her anxieties. 5. Check the maternal blood pressure, as hypertension is linked to fetal tachycardia; identify the on-call provider and correct with lisinopril as necessary.

ANS: 2, 3, 4, 5 1 This is incorrect. Maternal fever is usually caused by an infectious agent. Antibiotics, antipyretics, and ice packs should be used to combat it. 2 This is correct. Terbutaline is given to mothers for uterine tachysystole in labor, and its effect is limited to how quickly the drug is cleared from the maternal system. 3 This is correct. Illicit drugs such as cocaine can cause fetal tachycardia and additionally can cause placental abruption. 4 This is correct. Fetal tachycardia can be linked to maternal anxiety, and taking steps to reduce it can correct the FHR. 5 This is incorrect. There is no link between hypertension and fetal tachycardia. Additionally, lisinopril is an ACE inhibitor that is not recommended in pregnancy.

The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply. 1. Lidocaine 1% for episiotomy 2. Epidural with lidocaine for pain in labor 3. Spinal block with lidocaine for a cesarean delivery 4. Lidocaine 1% for episiotomy repair 5. Lidocaine without epinephrine for forceps use

ANS: 2, 3, 5 1 This is incorrect. A local anesthesia can be used for episiotomy. 2 This is correct. Regional anesthesia can be used for labor pain in the form of a pudendal block, epidural block, or spinal block. 3 This is correct. Regional anesthesia can be used for surgical pain in cesarean section. 4 This is incorrect. A local anesthesia is used for episiotomy repair. 5 This is correct. A pudendal block (which is regional anesthesia) is used for forceps use.

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply. 1. There is a higher rate of instrumental vaginal delivery. 2. When using an epidural, women are less likely to sweat with a fever. 3. There is a higher rate of spontaneous vaginal delivery. 4. Labor may be longer with an epidural. 5. There is a higher rate of fever and sepsis.

ANS: 2, 4, 5 1 This is correct. Epidurals are associated with higher rates of forceps and vacuum suction rates. 2 This in correct. An elevation in maternal temperature is associated with regional anesthesia, and it is also associated with reduced perspiration. 3 This is incorrect. Epidurals are associated with lower rates of spontaneous vaginal delivery. 4 This is correct. Epidurals are associated with longer labor. 5 This is correct. Epidurals are associated with higher rates of fever and sepsis.

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient? 1. Narrower pubic arch 2. Shorter diameter between her coccyx and ischium 3. Wider outlet 4. Smaller inlet

ANS: 3 1 This is incorrect. A gynecoid pelvis has a wider pubic arch than an android pelvis. 2 This is incorrect. A gynecoid pelvis has a longer diameter between the coccyx and the ischium than an android pelvis 3 This is correct. A gynecoid pelvis has a wider outlet than an android pelvis. 4 This is incorrect. A gynecoid pelvis has a larger inlet than an android pelvis

The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take? 1. Help the patient in a lithotomy position. 2. Help the patient onto all fours. 3. Have the patient assume a comfortable and upright position. 4. Help the patient into a knee-chest position.

ANS: 3 1 This is incorrect. Although regularly used, evidence has shown the lithotomy position is not the best position. 2 This is incorrect. Although sometimes used, recent research has shown that being on all fours is not the best position 3 This is correct. An upright position allows gravity to assist with the descent of the baby. 4 This is incorrect. A knee-chest position does not facilitate birth.

While reviewing the birth plan of an uncomplicated and healthy patient in active labor, the nurse notices that she would like to have a natural labor and potentially experience hydrotherapy. Which option should the nurse suggest for the patient? 1. IUPC to make sure that her contractions are adequate to keep labor progressing 2. FSE to make sure that her fetus is tolerating the hydrotherapy 3. Telemetry to allow for the patient to accomplish her birth plan 4. External EFM to make sure that there is continuous monitoring

ANS: 3 1 This is incorrect. An intrauterine pressure catheter (IUPC) is only used in a patient who is bed bound, which would not allow for a patient to move around or use hydrotherapy. 2 This is incorrect. A fetal scalp electrode (FSE) is only used in a patient who is bed bound, which would not allow for a patient to move around or use hydrotherapy. 3 This is correct. Telemetry would allow for continuous monitoring while allowing patients free movement and the ability to use hydrotherapy. 4 This is incorrect. External EFM is best used in a patient who is bed bound, which would not allow for a patient to move around or use hydrotherapy.

A nurse-preceptor is explaining to a new nurse about the tocodynamometer. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s; she is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first? 1. Give the mother oxygen to increase the fetal heart rate. 2. Immediately call the provider into the room. 3. Check to make sure that the maternal radial pulse is being recorded correctly. 4. Adjust the monitor on the maternal abdomen.

ANS: 3 1 This is incorrect. The maternal heart rate is usually significantly lower than the fetal heart rate and is therefore tracked underneath the fetal heart rate. It is therefore important to check and make sure that the maternal heart rate is being tracked correctly before beginning oxygen. 2 This is incorrect. The maternal heart rate is usually significantly lower than the fetal heart rate and is therefore tracked underneath the fetal heart rate. It is therefore important to check and make sure that the maternal heart rate is being tracked correctly before calling in the provider. 3 This is correct. The maternal heart rate is usually significantly lower than the fetal heart rate and is therefore tracked underneath the fetal heart rate. It is therefore important to check and make sure that the maternal heart rate is being tracked correctly before initiating any efforts for the fetus. 4 This is incorrect. The maternal heart rate is usually significantly lower than the fetal heart rate and is therefore tracked underneath the fetal heart rate. It is therefore important to check and make sure that the maternal heart rate is being tracked correctly before adjusting the fetal monitor.

The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history? 1. Passenger 2. Position 3. Passage 4. Psyche

ANS: 3 1 This is incorrect. The passenger is the fetus; the patient's fetus is of average estimated fetal weight and in an optimal position for labor. 2 This is incorrect. This patient is on the birth ball, which is an excellent laboring position. 3 This is correct. A platypelloid pelvis is found in only 3% of women and is not an optimal pelvis for the passage of a vaginal delivery. 4 This is incorrect. Having a support person during labor has been shown to improve a woman's psyche during labor.

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring strip. How would the nurse assess this? 1. Time the amount of time in between the ending of one contraction and the beginning of another. 2. Palpate the maternal abdomen right after a contraction ceases. 3. Palpate the maternal abdomen during a contraction. 4. Monitor the patients' vocalizations and facial expressions.

ANS: 3 1 This is incorrect. Timing the amount of time between the ending of one contraction and the beginning of another would determine frequency. 2 This is incorrect. Palpating the maternal abdomen right after a contraction ceases would determine resting tone. 3 This is correct. Intensity is evaluated by palpating the fingertips on the maternal abdomen. 4 This is incorrect. Depending on the patients' pain tolerance and cultural background, each patient will have different vocalizations and facial expressions that do not necessarily correlate to the intensity of the contraction.

A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction? 1. When the uterine wall is resistant to indentation 2. The longest part of the contraction 3. The shortest part of the contraction 4. Descending of contraction

ANS: 3 1 This is incorrect. When a nurse palpates moderate contractions, they are resistant to indentation; the acme of a contraction should ideally be strong to palpation. 2 This is incorrect. The longest part of the contraction is the increment, which is the buildup of the contraction. 3 This is correct. The acme is the peak of the contraction's intensity but also is the shortest part of the contraction. 4 This is incorrect. The decrement is the relaxation of the uterine muscle and the end of the intensity of the contraction.

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM clear fluid 2 hours ago. What action should the nurse take? 1. Monitor the patient's blood pressure, temperature, and respirations every 2 hours. 2. Have the patient rate her pain on a scale from 1-10 roughly every hour. 3. Help the patient change her position from side to side every 30 minutes. 4. Monitor the fetal heart tones every hour.

ANS: 3 1 This is incorrect. When the patient is in active labor, the nurse should monitor the patient's vital signs every hour. Once rupture of the membranes has occurred, the nurse should monitor the patient's temperature every hour. 2 This is incorrect. When the patient is in active labor, the nurse should assess the patient's pain status every 30 minutes and as needed. 3 This is correct. When the patient is in active labor, the nurse should help the woman change position every 30 minutes and as needed. 4 This is incorrect. When the patient is in active labor, the nurse should monitor FHR every 15 to 30 minutes.

The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor? 1. Wrist pain 2. Fatigue 3. Increased discharge 4. Heavy feeling

ANS: 3 1 This is incorrect. Wrist pain is common in pregnancy but is not a sign of impending labor. 2 This is incorrect. Fatigue is common in pregnancy but is not a sign of impending labor. 3 This is correct. When labor is impending, the patient may lose her mucous plug or have a change in discharge. 4 This is incorrect. Although a heavy feeling is common in pregnancy, it is not a sign of impending labor.

An internal fetal monitor has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next? 1. Prepare Chrissy for the placement of an internal monitor. 2. Take the required two blood pressure readings every 15 minutes prior to insertion of the internal fetal monitor due to her pregnancy-induced hypertension. 3. Discuss with the health care provider the fact that Chrissy's blood type is O negative and she should therefore receive Rhogam before insertion of an internal monitor. 4. Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor.

ANS: 4 1 This in incorrect. Chrissy is GBS positive and therefore cannot receive an internal monitor. 2 This is incorrect. There are no required blood pressure readings for a pregnancy-induced hypertensive patient prior to the insertion of an internal monitor. 3 This is incorrect. Chrissy does not need to receive Rhogam prior to the insertion of an internal monitor. She should have received it earlier in the pregnancy, but it should have no effect on an internal monitor. 4 This is correct. GBS positivity is a contraindication to the placement of an internal monitor.

The obstetric nurse is managing her patients while covering for another nurse who is on a break. Which patient is the lowest priority? 1. A patient with a previous cesarean section 2. A patient with an epidural in place 3. A patient with decreased fetal activity 4. A patient with Category I FHR tracings

ANS: 4 1 This is incorrect. A patient with a previous cesarean section needs to be monitored every 30 minutes during the latent phase, every 15 minutes during the active phase, and every 5 minutes during the second stage. 2 This is incorrect. A patient with an epidural in place needs to be monitored every 30 minutes during the latent phase, every 15 minutes during the active phase, and every 5 minutes during the second stage. 3 This is incorrect. A patient with decreased fetal activity needs to be monitored every 30 minutes during the latent phase, every 15 minutes during the active phase, and every 5 minutes during the second stage. 4 This is correct. This patient is low risk.

The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate? 1. "Adolescents usually have very effective coping mechanisms." 2. "Teenagers always have larger babies than older patients." 3. "Adolescents' ego integrity is less easily threatened by stress and pain." 4."Your response to pregnancy, labor, and delivery will differ from that of an adult because your cognitive development is not yet complete."

ANS: 4 1 This is incorrect. According to AWHONN, adolescents tend to have fewer coping mechanisms than adults. 2 This is incorrect. There is no evidence that teenagers have larger babies. 3 This is incorrect. According to AWHONN, ego integrity of adolescents is more easily threatened by stress and pain. 4 This is correct. According to AWHONN, teenagers have incomplete cognitive development.

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacologic approaches will the nurse use to help illustrate its benefits? 1. Using peppermint aromatherapy oils will help promote relaxation. 2. The client can achieve self-hypnosis with the Bradley Method. 3. Sterile water injections can be very useful for pelvic pain. 4. Effleurage is performed in rhythm with breathing during a contraction.

ANS: 4 1 This is incorrect. Although aromatherapy is a nonpharmacologic method of promoting relaxation and decreasing pain perception, peppermint is used to help with nausea, not to enhance labor and spontaneous vaginal delivery. 2 This is incorrect. Although the Bradley Method is a nonpharmacologic way to help manage labor pain; it is husband-coached. 3 This is incorrect. Sterile water injections are used for lower back pain relief. 4 This is correct. Effleurage is cutaneous stimulation by lightly stroking the maternal abdomen in rhythm with breathing during contractions.

The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing? 1. Green: very low risk of evolution, no action 2. Red: unacceptably high risk of acidemia, deliver 3. Yellow: moderate risk of evolution, increase surveillance 4. Orange: acceptable low risk of acidemia, prepare for possible urgent delivery

ANS: 4 1 This is incorrect. Based on the five-tier FHR interpretation system, this tracing is classified as orange, which means there is an acceptable low risk of acidemia and the nurse should prepare for possible urgent delivery. 2 This is incorrect. Based on the five-tier FHR interpretation system, this tracing is classified as orange, which means there is an acceptable low risk of acidemia and the nurse should prepare for possible urgent delivery. 3 This is incorrect. Based on the five-tier FHR interpretation system, this tracing is classified as orange, which means there is an acceptable low risk of acidemia and the nurse should prepare for possible urgent delivery. 4 This is correct. Based on the five-tier FHR interpretation system, this tracing is classified as orange, which means there is an acceptable low risk of acidemia and the nurse should prepare for possible urgent delivery.

The nurse is monitoring a patient when the EFM strip conveys fetal bradycardia. Which action would be the most urgent for the nurse to take? 1. Check the patient's input and output. 2. Take a blood pressure to determine if the mother has hypotension. 3. Change the mother's position from supine to left lateral. 4. Check the mother for vaginal bleeding and severe abdominal pain.

ANS: 4 1 This is incorrect. Dehydration is a possible cause of fetal bradycardia but is not the most urgent action. 2 This is incorrect. Hypotension is a possible cause of fetal bradycardia but is not the most urgent action. 3 This is incorrect. Supine position is a possible cause of fetal bradycardia, so it may help to place the patient in a left lateral position, but it is not the most urgent action. 4 This is correct. Placental abruption is a possible cause of fetal bradycardia and is an emergency.

The nurse is caring for a 34-year-old woman who is G2P1001 at 39 weeks and 1 day. The patient is an observant Muslim and is in active labor. Which outcome would be the most effective form of applying culturally sensitive communication? 1. Ensuring that the health care provider is present every 2 hours to examine labor progress 2. Making sure that the patient has Kosher meat for her postpartum meal 3. Making sure that the patient's hair is covered constantly 4. Assuring the patient that her baby is less than 9 lbs

ANS: 4 1 This is incorrect. The health care providers' presence influences the women's psyche but is not culturally sensitive communication, which acknowledges the nurse is willing to learn. 2 This is incorrect. Eating affects energy in labor, but it is not usually psyche, and Kosher meat is appropriate for an observant Jewish patient. Muslim patients eat Halal meat. 3 This is correct. Modesty is influenced by culture. 4 This is incorrect. The estimated size of the baby may affect the psyche of the patient, but it is not usually related specifically to culture.

The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate? 1. "Telemetry is used mostly for women who are laboring in bed and changing positions every half hour or so." 2. "Unfortunately, you will not be able to use the shower while using telemetry." 3. "The nurses will need to come in and check your telemetry reading every half hour." 4. "We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery."

ANS: 4 1 This is incorrect. The patient will be able to walk while using telemetry. 2 This is incorrect. The patient will be able to bathe while using telemetry. 3 This is incorrect. Nurses can assess the patient remotely. 4 This is correct. Telemetry can be used in all phases of labor.

The nurse-educator is instructing on the physiology of fetal heart rate (FHR) patterns. He is showing the students an EFM strip, and there is a tracing that is classified as baseline 140 bpm, moderate variability, accelerations, and 2 decelerations. A half hour later the baseline is 150 bpm, there is minimal variability, accelerations, and 3 decelerations. Which of these findings would the nurse attribute to the parasympathetic nervous system? 1. The baseline changes from 140 bpm to 150 bpm. 2. The change from moderate variability to minimal variability. 3. The consistent presence of accelerations. 4. The presence of 2 and then 3 decelerations.

ANS: 4 1 This is incorrect. The sympathetic nervous system is responsible for increasing the FHR and FHR variability. 2 This is incorrect. The central nervous system is responsible for variations in FHR and variability related to fetal activity. 3 This is incorrect. The sympathetic nervous system is responsible for increasing FHR. 4 This is correct. The parasympathetic nervous system is responsible for slowing the FHR and maintaining variability.

A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply. 1. "If started, it should be used throughout the entire labor." 2. "It has no trade name and is only available in generic forms." 3. "The nurses will administer it to you during every contraction so we will need to be with you during the entire labor." 4. "The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm." 5. "There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication."

ANS: 4, 5 1 This is incorrect. It can be started and stopped at any point in labor. 2 This is incorrect. It is called by the trade name Nitronox. 3 This is incorrect. It is self-administered by the patient. 4 This is correct. It takes effect in about 50 seconds after the first breath, and the effect is transient. 5 This is correct. It has no adverse effects on the normal physiology and progress of labor.