N306 Nursing Management of Labor PREPU

Which of the following supports why a preterm fetus usually is more affected by medication given at birth than a full-term fetus? - Affinity of the preterm fetus to drugs that are fat-soluble - Affinity of the preterm fetus to drugs that are strongly bound to protein - Inability of the preterm fetus to use drugs with a molecular weight over 1000 - Inability of the immature liver to metabolize or inactivate drugs

Inability of the immature liver to metabolize or inactivate drugs The liver of many full-term infants is not completely mature and is even less so in preterm infants.

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? - headache following anesthesia - increased frequency of micturition - excessive contractions of the uterus - passage of the drug to the fetus

headache following anesthesia The nurse should inform the client and her family about the possibility of headache after spinal anesthesia. The drug is retained in the mother's body and not passed to the fetus. There may be uterine atony, and not excessive uterine contractions, following spinal anesthesia. Spinal anesthesia may lead to bladder atony, and not an increased frequency of micturition.

In the labor and delivery unit, which is the best way to prevent the spread of infection? - Limit vaginal examinations - Provide clean gloves in the room - Use sterile gloving - Complete hand hygiene

Complete hand hygiene

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 difficulty working effectively with contractions. - The father's coaching role may be disrupted at times. - The mother may have continued memory loss postpartum.

The mother may have difficulty working effectively with contractions. Breathing and relaxation techniques can speed labor. An inability of the woman to do these as a result of pain relief measures can slow labor.

The client in labor at 3 cm dilation and 25% effaced is asking the nurse for analgesia. Which explanation should the nurse provide when explaining why it is too early to administer an analgesic? - This may prolong labor and increase complications. - This can lead to maternal hypertension. - This would cause fetal depression in utero. - The effects would wear off before delivery.

This may prolong labor and increase complications Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The client should be offered nonpharmacologic options at this point until she is in active labor. At this point in labor, the fetus would not be affected by analgesia. The effects would wear off and the drug would need to be re-administered, which would increase the risk to the fetus. There is no link between maternal hypertension and analgesia.

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? - 11:30 a.m. - 11:15 a.m. - 10:05 a.m. - 10:30 a.m.

10:30 Assess and document fetal status at least every 30 minutes. Record the baseline FHR every 30 minutes and evaluate the fetal monitor tracing for abnormal patterns. Variability should be present, except for brief periods of fetal sleep or when the mother receives narcotics or other selected medications, and no late decelerations should be present. Accelerations of the FHR are normal.

The nurse is assessing a woman at 37 weeks' gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the Nitrazine paper? - Yellow - Pink - White - Blue

Blue If the fluid in the vaginal canal is amniotic fluid, the Nitrazine paper will turn a dark blue, the color of an alkaline fluid, and this is a positive Nitrazine test for rupture of membranes.

When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful? - If the woman is in too much pain, a cesarean section is an option. - Women innately know how to deal with labor pain. - The characteristics of labor pain follow a pattern. - All pain is the same.

The characteristics of labor pain follow a pattern. While pain is individualized, labor pain is defined and follows a pattern. Since it follows a typical path, education and planning is completed. All pain is not the same. A primigravid needs education and guidance to best navigate the process. A cesarean section is not an option as a method of pain management.

The nursing instructor is teaching the students the basics of the labor and delivery process. The instructor determines the session is successful when the students correctly choose which action will best help to prevent infections in their clients? - Clean the woman's perineum with a Betadine scrub. - Strictly follow universal precautions. - Thoroughly wash the hands before and after client contact. - Replace soiled drapes and linen as needed.

Thoroughly wash the hands before and after client contact.

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? - tactile stimulation - administration of oxygen by mask - fetal scalp stimulation - application of vibroacoustic stimulation

administration of oxygen by mask The client should be administered oxygen by mask because the abnormal FHR pattern could be due to inadequate oxygen reserves in the fetus. Because the client is in preterm labor, it is not advisable to apply vibroacoustic stimulation, tactile stimulation, or fetal scalp stimulation.

The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? - fetal position - external electronic fetal monitoring - fetal oxygen saturation - fetal blood pH

external electronic fetal monitoring Analysis of the FHR using external electronic fetal monitoring is one of the primary evaluation tools used to determine fetal oxygen status indirectly. Fetal pulse oximetry measures fetal oxygen saturation directly and in real time. It is used with electronic fetal monitoring as an adjunct method of assessment when the FHR pattern is abnormal or inconclusive. Fetal scalp blood is obtained to measure the pH. The fetal position can be determined through ultrasonography or abdominal palpation but is not indicative of fetal oxygenation.

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? - prolonged decelerations - accelerations - variable decelerations - early decelerations

prolonged decelerations Prolonged decelerations are associated with prolonged cord compression, abruptio placentae, cord prolapse, supine maternal position, maternal seizures, regional anesthesia, or uterine rupture. Variable decelerations are the most common deceleration pattern found. They are usually transient and correctable. Early decelerations are thought to be the result of fetal head compression. They are not indicative of fetal distress and do not require intervention. Fetal accelerations are transitory increases in FHR and provide evidence of fetal well-being.

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? - accidental intrathecal block - respiratory depression - a failed block - postdural puncture headache

respiratory depression

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: - 7.15 or less. - 7.20. - 7.21. - 7.25 or more.

7.15 or less.

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching? - "If you end up having a cesarean, the epidural can be used for anesthesia during surgery." - "You can continuously receive epidural anesthesia until you have the baby, and even afterward if you need it." - "You have no trouble walking around and using the bathroom after you receive the epidural." - "Epidural anesthesia is more effective than opioid analgesia in providing pain relief."

"You have no trouble walking around and using the bathroom after you receive the epidural." Epidural anesthesia impairs mobility; most clients are placed on bed rest after epidural anesthesia is given. Urinary catheterization is frequently required.

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next? - Test a sample of amniotic fluid for protein. - Ask her to bear down with the next contraction. - Elevate her hips to prevent cord prolapse. - Assess fetal heart rate for fetal safety.

Assess fetal heart rate for fetal safety.

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering? - Assess for dry mouth. - Assess for constipation. - Assess maternal blood pressure. - Assess fetal heart rate.

Assess fetal heart rate. After administering an opioid to a laboring mother, the priority is to assess the impact on the fetus. Opioid administration can cross the placental barrier with symptoms including assessing heart rate and variability. After birth, there may be a decrease in alertness. Maternal factors of a decreased blood pressure, constipation and dry month are of a lower priority.

The client and her partner have prepared for a natural birth and bring a picture of a sunset over the ocean with them. The nurse predicts they will be using which techniuqe during labor? - Patterned birthing - Hypnosis - Attention focusing - Water therapy

Attention focusing Attention focusing is the use of an object or picture or image for the woman to reflect and focus on (internally or externally) during labor to distract her from the labor pain. Hypnosis is a psychological state. Water therapy involves the woman sitting in water to relax. Patterned breathing involves the woman controlling her breathing patterns during contractions and "breathing through" them to help control the pain. The attention focusing, patterned breathing, water therapy, and hypnosis are all variations of relaxation which may be used by the client during the birthing process.

The nurse is preparing a birthing care plan for a pregnant client. Which factor should the nurse prioritize to achieve adequate pain relief during the birthing process? - The health care provider decides the best pain relief for the mother and family. - The nurse suggests alternative methods of pain relief. - The client has the baby without any analgesic or anesthetic. - Client priorities and preferences are incorporated into the plan.

Client priorities and preferences are incorporated into the plan.

During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used. A.+2 station B. 0 station C. -2 station D. +4 station E. -4 station

E C B A D Progressive fetal descent (-5 to +4) is the expected norm during labor, moving downward from the negative stations to zero station to the positive stations in a timely manner.

The nursing instructor is teaching a group of nursing students about the uniqueness of pain involved with the birthing process. The instructor determines the session is successful when the students correctly choose which pain factor to be related to psychosocial influences? - Pressure in the perineum - Stretching of cervix - Fear of pain during labor - Descent of fetus into birth canal

Fear of pain during labor Fear of pain during labor is a psychosocial factor. The stretching of the cervix, descent of the fetus into the birth canal, and pressure on the perineum are physical factors.

Why should a woman be cautioned against taking acetylsalicylic acid (aspirin) to relieve pain in labor? - Interference with the ability to concentrate on contractions - Competition with bilirubin-binding sites in fetal circulation increases risk of kernicterus - Interference with blood coagulation with increased risk of bleeding in mother or infant - Development of respiratory depression in the newborn

Interference with blood coagulation with increased risk of bleeding in mother or infant

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? - It is reported as the worst pain a woman will ever feel. - Pain is focal in nature. - Pain originates from the cervix and lower uterine segment. - Diffuse abdominal pain signals a complication with progression of labor.

Pain originates from the cervix and lower uterine segment.

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? - Help the woman to sit up in a semi-Fowler's position. - Turn her or ask her to turn to her side. - Administer oxygen at 3 to 4 L by nasal cannula. - Ask her to pant with the next contraction.

Turn her or ask her to turn to her side. The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression.

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 the primary care provider makes the decision on what type of pain control to use. - Women report higher levels of satisfaction when regional anesthetics are used to control pain. - 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.

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

A nurse is caring for woman in labor. The woman's membranes just ruptured. The nurse assesses the characteristics of the fluid. Which finding would the nurse identify as normal? - green - clear - malodorous - cloudy

clear Amniotic fluid should be clear when the membranes rupture. During an amniotomy, a disposable plastic hook (an amnihook) is used to perforate the amniotic sac. Cloudy or foul-smelling amniotic fluid indicates infection. Green fluid may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction (IUGR), maternal hypertension, diabetes, or chorioamnionitis.

A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will: - lead the client through a series of visualizations to aid in relaxation. - press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist. - instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale. - instruct the client or her partner to perform light fingertip repetitive abdominal massage.

instruct the client or her partner to perform light fingertip repetitive abdominal massage. The relaxation technique of visualization is used in hypnobirthing or focused meditation. Controlled chest breathing is a technique used in Lamaze breathing. Pressing on trigger points is an acupressure technique.

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: - left upper quadrant. - right upper quadrant. - left lower quadrant. - right lower quadrant.

left lower quadrant The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant.

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

the beginning of one contraction to the beginning of the next.

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 blocks the transmission of nerve messages of pain at the receptors." - "It causes the release of endorphins." - "It disrupts the nerve signal of pain via mechanical irritation of the nerves." - "It distracts your brain from the sensations of pain."

"It distracts your brain from the sensations of pain." Concentrating intently on an object is another method of distraction, or another method of keeping sensory input from reaching the cortex of the brain. The other answers refer to other means of pain management.

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse? - "An injury is unlikely because of expert professional care given." - "I have never read or heard of this happening." - "The injection is given in the space outside the spinal cord." - "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem."

"The injection is given in the space outside the spinal cord."

The nursing instructor is preparing a presentation which will explore the various sources of pain during the labor process. Which source should the instructor emphasize as the main source of pain during the first stage? - Back - Birth canal - Cervix - Perineum

Cervix The first stage of labor is when the cervix is dilating. The woman in labor will have pain from the stretching and dilation of the cervix. Stretching of the perineum and birth canal is associated with the second stage of labor. Not all women have back pain, and typically when they do it is referred pain from the lower abdomen and can happen in both the first and second stage of labor.

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

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

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

The woman is prepared for labor and birth. The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared.

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 gate control mechanism is located at the pain site. - The gate control mechanism opens so all the stimuli pass through to the brain. - This is a technique to prevent the painful stimuli from entering the brain. - Pain perception is decreased if anxiety is present.

This is a technique to prevent the painful stimuli from entering the brain. Gate control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location.

Which intervention would be least effective in caring for a woman who is in the transition phase of labor? - encouraging the woman to ambulate - 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 Although ambulating is beneficial during early and possibly even active labor, the strong and frequent contractions experienced and the urge to bear down may make ambulating quite difficult. During transition, women should continue to breathe with contractions and focus on one contraction at a time. Providing one-to-one support at this time helps the woman cope with the events of this phase, as well as help her maintain a sense of control over the situation.

A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? - Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. - Inhale slowly through nose and exhale through pursed lips. - Punctuated breathing by a forceful exhalation through pursed lips every few breaths. - Hold breath for 5 seconds after every 3 breaths.

inhale slowly through nose and exhale through pursed lips For slow-paced breathing, the nurse should instruct the woman to inhale slowly through her nose and exhale through pursed lips. In shallow or modified-pace breathing, the woman should inhale and exhale through her mouth at a rate of 4 breaths every 5 seconds. In pattern-paced breathing, the breathing is punctuated every few breaths by a forceful exhalation through pursed lips. Holding the breath for 5 seconds after every three breaths is not recommended in any of the three levels of patterned breathing.

A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? - indomethacin - epinephrine - naloxone - ampicillin

naloxone Naloxone is the drug used for reversal of opioids' adverse effects. If a narcotic is given too close to birth, the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered (respiratory depression, sleepiness) in the fetus for 2 to 3 hours after birth. Indomethacin is an analgesic and NSAID; ampicillin is an antibiotic; and epinephrine is a vasopressor.

A nurse notes the digital readings of the electronic fetal monitor shows decreased beat-to-beat variability in a client who was just admitted to the unit. The nurse interprets this as indicating which system is mainly being affected in the fetus? - Genitourinary system - Gastrointestinal system - Central nervous system - Musculoskeletal system

Central nervous system The nurse should identify that the decreased variability is associated with the fetal central nervous system (sympathetic and parasympathetic). Baseline variability is the beat-to-beat variations in the fetal heart rate (FHR), which is a normal FHR finding. Decreased beat-to-beat variability indicates CNS involvement. Other systems, such as gastrointestinal, genitourinary, and musculoskeletal, are not associated with decreased beat-to-beat variability in the FHR.

A nurse is auscultating the fetal heart rate of a woman in labor. To ensure that the nurse is assessing the FHR and not the mother's heart rate, which action would be most appropriate for the nurse to do? - Have the woman lie completely flat on her back while auscultating. - Instruct the woman to bend her knees and flex her hips. - Ask the woman to hold her breath while assessing the FHR. - Palpate the mother's radial pulse at the same time.

Palpate the mother's radial pulse at the same time.

The nurse is assessing the read-out of the external fetal monitor and notes late decelerations. Which action should the nurse prioritize at this time? - palpate for bladder fullness - reposition the client on either side - notify the health care provider - do nothing, this is benign

reposition the client on either side Deceleration may be related to compression on the maternal abdominal aorta and inferior vena cava and repositioning the woman to either her right or left side will remove the pressure and allow the blood flow to resume. If this is not effective then the nurse would look for other potential causes such as an infusion of oxytocics. If this is unsuccessful the RN and health care provider needs to be notified immediately. The fetus is not getting enough oxygen and needs intervention. Palpating for bladder fullness would not be appropriate at this time. This is a serious situation developing and needs prompt intervention.