OB Chapter 14
The maternal health nurse is caring for a woman in labor who is using a photo of a peaceful beach scene to focus during labor. Which action by the novice nurse will require intervention by the nurse preceptor? stepping in the line of vision of the image during a contraction moving the image to a different place in the room at the woman's request practicing silence during the woman's contraction encouraging the woman to focus on the image before a contraction
stepping in the line of vision of the image during a contraction A woman who is using imagery during labor may bring in a photo or object to focus on during contractions. The nurse should avoid stepping in the line of vision of the image during a contraction. The remaining answer choices are appropriate interventions and would not require the nurse preceptor to intervene.
A woman has informed the nurse that she plans to have a freebirth. Which statement indicates that the woman understands what freebirth entails? "I will not have to wear fetal monitors while in labor at the hospital." "I will be unlimited in the positions I am able to assume while in labor at the birthing center." "I will give birth at home under the care of a lay midwife." "I plan on giving birth at home without anyone around except my husband and my children."
"I plan on giving birth at home without anyone around except my husband and my children."
A couple is writing out the birth plan for their labor and delivery. They desire an atmosphere with a dark, warm room and soft music playing. They opt for delayed cord clamping and an immediate warm bath after the infant is born. What type of birth does the nurse understand the parents are requesting? A freebirth The Leboyer method The Bradley method The Lamaze method
The Leboyer method With the Leboyer method, the birthing room is darkened so there is no sudden contrast in light when the fetus is born. The room is kept pleasantly warm, not chilled. Soft music is played, or at least harsh noises are minimized. The infant is handled gently, the cord is cut late, and the infant is placed immediately after birth into a warm-water bath.
The maternal health nurse is caring for a pregnant client who is considering having a doula present at the birth. Which advantage does the nurse express to the client regarding a doula-assisted birth? The rate of maternal infection is lower. The overall cost of delivery is lower. The overall length of stay is lower. The rate of medical-assisted delivery is lower.
The rate of medical-assisted delivery is lower. A doula-assisted birth decreases the risk of a medical-assisted delivery. The remaining answer choices do not represent direct results of a doula-assisted birth.
The nurse is demonstrating tailor sitting to a group of pregnant clients as part of their exercises during pregnancy classes. During return demonstration of the position, which client is exhibiting proper positioning? client sitting back from a kneeling position with buttocks on legs client sitting with one leg in front of the other, bent at the knees but not crossing client sitting with the legs bent at the knees and crossed at the ankles client sitting with the legs straight and crossed at the ankles
client sitting with one leg in front of the other, bent at the knees but not crossing
A nursing student learning about childbirth preparation in a maternity course correctly identifies which of the following to be a major determinant of the plans women make for childbirth? culture religion social profession
culture Culture is a major determinant of the plans that women make for childbirth.
At a routine prenatal visit, a client asks the nurse for information on the Bradley method of childbirth. Which of the following would the nurse identify as an active participant during childbirth using the Bradley method? midwife nurse father doula
father The Bradley method advocates the continuous presence of the father as an active participant in labor and birth. The midwife, doula, and nurse are not involved in the Bradley method of childbirth.
A client is complaining of lower backache during her pregnancy. Which of the following exercises would best help her alleviate this pain? squatting pelvic floor contractions pelvic rocking tailor sitting
pelvic rocking Pelvic rocking helps relieve backache during pregnancy and early labor by making the lumbar spine more flexible. Pelvic floor contractions strengthen perineal muscles and reduce pain and promote perineal healing in the postpartum period. They also have long-term effects of increasing sexual responsiveness and helping prevent stress incontinence. Squatting and tailor sitting are primarily performed to stretch the perineal muscles.
A pregnant woman is taught many different types of exercises during pregnancy to help relieve pain, prevent complications, and facilitate an easier delivery. Which of the following exercises is taught to relieve backache during pregnancy? pelvic rocking abdominal muscle contractions pelvic floor exercises squatting
pelvic rocking Pelvic rocking helps to relieve backache during pregnancy and in early labor.
When developing a plan of care for a client in labor, which nursing intervention(s) reflects competency in managing pain throughout the first stage of labor? Select all that apply. providing nonpharmacologic measures throughout the labor assisting in measures to enhance client's endorphin release assisting to a supine position for laboring with a pillow behind the back asking the client for preferences in managing pain encouraging analgesia for relief of pain and quicker fetal descent
providing nonpharmacologic measures throughout the labor assisting in measures to enhance client's endorphin release asking the client for preferences in managing pain Appropriate actions for the client experiencing pain during labor include asking the client for preferences in managing pain, providing suggestions for nonpharmacologic measures, and assisting in measures to enhance the client's endorphin release. The supine position is not recommended to assist the client in pain relief and fetal descent. Providing analgesic choices does not mean quicker fetal descent and provides false reassurance.
A nursing instructor is teaching about the importance of childbirth classes for pregnant women. Which of the following statements made by a student indicates a need for further instruction? "Childbirth classes are informative for second-time mothers." "Childbirth classes are also available for siblings and grandparents." "Childbirth classes give information on how to prepare for childbirth and on how to parent." "Childbirth classes give information only on how to prepare for childbirth."
"Childbirth classes give information only on how to prepare for childbirth." Childbirth classes supply information on how not only to prepare for childbirth but also to parent. Individualized childbirth classes are also held for siblings and grandparents as well and are helpful for all mothers, no matter how many times they have been pregnant.
The maternal health nurse is caring for a woman in early labor with 3 cm cervical dilation. Which statement will the nurse use when teaching the client consciously controlled breathing during contractions at this stage of labor? "Take slow, deep, full breaths." "Keep the tip of your tongue on the roof of your mouth while breathing." "Take lighter and more rapid breaths." "Take three or four quick breaths (in and out), then a forceful exhalation."
"Take slow, deep, full breaths." Early in labor, the woman should be instructed to take slow, deep, full breaths during contractions. As the woman's labor progresses, the remaining answer choices may be used to instruct the woman on how to breathe during contractions.
A nurse is instructing a pregnant client on the benefits of squatting to stretch the perineal muscles. How many minutes a day should the client perform squatting? 5 15 10 20
15 Squatting stretches the perineal muscles and can be a useful position for second-stage labor as well, and like tailor-sitting, should be practiced for about 15 minutes a day.
The nurse is caring for a laboring woman who prefers to use the Leboyer method of childbirth. Which action will the nurse take to prepare the client's room? Darken the birthing room. Encourage the woman to use a birthing ball. Place a box fan in the birthing room. Encourage the woman to walk the halls.
Darken the birthing room. With the Leboyer method, the birthing room is darkened so there is no sudden contrast in light; the environment is kept pleasantly warm, not chilled; soft music is played, or at least harsh noises are kept to a minimum; the infant is handled gently; the cord is cut late; and the infant is placed immediately after birth into warm bath water. The remaining answers are incorrect and do not reflect the principles of the Leboyer method.
When a nurse is providing sibling education classes to children, what information can the nurse include that will address safety for the pregnant mother? The children will be provided a tour of the facility where the birth will take place. The children will continue to love them after the new baby arrives. The children should not leave toys on the floor. The children should eat healthy foods.
The children should not leave toys on the floor. Classes review how babies grow and things children can do to help their mothers during a pregnancy, such as eating healthy foods with her and not leaving toys on the floor that could create a risk for falling.
What does the nurse understand is the benefit of educating the pregnant mother about performing Kegel exercises during her pregnancy? The exercises can help reduce pain and promote perineal healing in the postpartum period. The exercises will help shorten the first stage of labor. The exercises will relieve the backache associated with the laboring process. The exercises can reduce the discomfort felt from the uterine contractions.
The exercises can help reduce pain and promote perineal healing in the postpartum period. Kegel exercises are helpful in the postpartum period to reduce pain and promote perineal healing.
The maternal health nurse is caring for a pregnant woman with a body mass index (BMI) of 31. Which childbirth technique will the nurse avoid when teaching the client? controlled breathing techniques tailor sitting perineal stretching methods abdominal strengthening exercises
tailor sitting Obese pregnant women should avoid tailor sitting because it requires balance and the woman may tire easily. However, women who are obese may still learn abdominal strengthening exercises, controlled breathing techniques, and perineal stretching methods.
A birth in which the lights are kept low, noise is kept to a minimum, and the newborn is placed into a warm bath immediately following delivery is called: the Leboyer method. water birth. the Dick-Read method. hydrotherapy.
the Leboyer method Frederick Leboyer, a French obstetrician, used this method (the Leboyer method) of placing the infant in a warm bath after birth and keeping the lights low and noise to a minimum.
A pregnant woman at the clinic tells the nurse that her goal is to not take any medications during labor. What is the nurse's best response to this client? "That will not be a problem if that is what you and your husband want." "If you end up taking any medication, then you will not achieve your goal." "If you absolutely do not want any medications, we will not give you any." "The ultimate goal of childbirth is a healthy baby and healthy parents. Sometimes medication is necessary."
"The ultimate goal of childbirth is a healthy baby and healthy parents. Sometimes medication is necessary." The nurse should explain to the client that the ultimate goal of childbirth is a healthy baby and healthy parents. If the pain gets too intense for a woman who has vowed not to have any medications during labor, she will consider herself a failure if she ends up taking an analgesic or having an epidural. She should be encouraged to be flexible in her decision and expectations.
A pregnant client informs the nurse, "I am not going to do those leg exercises anymore. Every time I do them, I get terrible leg cramps." How can the nurse educate the client to continue her exercise program and alleviate leg cramps? When you are doing your leg exercises, point the toes to prevent leg cramps." "If you are having leg cramps, it is likely you are deficient in potassium and should take a supplement." "When you are doing your leg exercises, you can prevent leg cramps by extending the heel and never pointing the toes." "Stop all leg exercises. Leg cramps could be a sign of a blood clot in your legs."
"When you are doing your leg exercises, you can prevent leg cramps by extending the heel and never pointing the toes." To prevent leg cramps when doing leg exercises, the woman should never point the toe, but should extend the heel instead.
The nurse is teaching pregnant women about breastfeeding. One woman tells the nurse, "I may breastfeed only for 6 weeks while I am on maternity leave. I don't see any other way except to give a bottle after that." What is the best response by the nurse? If you have to work, it will be impossible to try and breastfeed. Do you have to go back to work so soon?" "I understand how you feel. At least you are going to do it for 6 weeks." "Women should try and breastfeed exclusively for the first 6 months. We can talk about ways to fit it into your schedule." "If you are going to supplement, there is no reason to start breastfeeding at all. Your baby will get used to the formula and not take the breast."
"Women should try and breastfeed exclusively for the first 6 months. We can talk about ways to fit it into your schedule." Breastfeeding classes cover the physiology of breastfeeding as well as psychological aspects. They stress that women should try to breastfeed exclusively for the first 6 months and ways to fit breastfeeding into busy schedules so they can continue it for the full first year.
A nursing student correctly identifies the childbirth preparation method that focuses on the premise that fear leads to tension, which leads to pain, is known as which of the following? Dick-Read method Bradley method Lamaze method psychosexual method
Dick-Read method The method based on the premise that fear leads to tension and tension leads to pain is the Dick-Read method. The woman can achieve lack of fear through education about childbirth and relaxation and reduced pain by focusing on abdominal breathing during contractions.
Which statement best describes a doula? Doulas are midwives that do not practice midwifery. Doulas are birth coaches who perform minimal clinical procedures. Doulas provide continuous labor support but do not perform any clinical procedures. If a woman desires to avoid an epidural during labor, she will need a doula.
Doulas provide continuous labor support but do not perform any clinical procedures. A doula is a birth assistant or a birthing coach who provides continuous one-to-one labor support. A doula does not have any clinical responsibilities in a labor setting.
A client in the first trimester of pregnancy visits the health care facility for a tour. Which nursing instruction is most appropriate for the nurse to recommend to the client? Obtain a birthing assistant to help you through the labor. Have yourself and a support person participate in prenatal education classes. Read information on the labor process and vaginal birth. Have all members of the family prepare for the newborn's arrival.
Have yourself and a support person participate in prenatal education classes. The nurse should suggest to the client in the first trimester of pregnancy that the client and support person attend prenatal education classes. These classes help the client understand the changes in the body during pregnancy and throughout the labor process. A birthing assistant or doula is an option for the client to have during labor. All family members do not need preparation for the arrival of the newborn. The birthing education classes lead by a nurse are a better option than reading information.
The nurse is caring for a client in the first trimester of pregnancy. The client states self doubt in the ability to tolerate the pain of labor and extreme fear of needles. The client asks if there is someone who can stay with them during the labor process. What will the nurse suggest as the best option for this client? Ask your support person to come to prenatal classes with you. A private duty nurse can provide you emotional support. Bring a Lamaze coach to the birth with you. Hire a doula to work with you throughout the labor and birth.
Hire a doula to work with you throughout the labor and birth. A doula is someone experienced in childbirth who provides continuous emotional and physical support. The doula will meet the client toward the end of pregnancy and develop a birth plan in conjunction with the client and health care provider. The other suggestions are able to provide emotional support but do not have the training and knowledge base of the labor and delivery process that the doula provides.
The maternal health nurse is discussing the birth plan with a pregnant woman. The woman asks for the baby to be placed in a warm bath at birth. Which statement(s) represent potential results of this request? Select all that apply. It decreases spontaneous breathing in the infant. It decreases the infant's ability to thermoregulate. It increases the risk of metabolic alkalosis. It stimulates the production of red blood cells. It promotes an acidotic state in the infant.
It decreases spontaneous breathing in the infant. It promotes an acidotic state in the infant. Some neonatologists question placing a baby in a warm bath because this may decrease spontaneous breathing in the infant and may promote an acidotic state in the infant. This does not stimulate the production of red blood cells, nor does it decrease the infant's ability to thermoregulate. The risk of respiratory acidosis increases, not the risk for metabolic alkalosis.
A nurse observes a woman in labor and her spouse as they practice breathing exercises to manage the client's pain. Before each contraction, she takes a deep, cleansing breath and then breathes at a controlled pace. During each contraction, she gradually shifts from slow, deep breaths to shallow, rapid ones and then back to slow, deep ones. Her spouse coaches her and performs effleurage on her abdomen. The nurse recognizes that this couple is using which method of pain management? Dick-Read psychosexual Bradley Lamaze
Lamaze A cleansing breath before each contraction, controlled breathing as described, and effleurage are all hallmarks of the Lamaze method. The Bradley method is characterized by abdominal breathing, walking, and using an internal focal point as a disassociation technique during labor. The psychosexual method includes a program of conscious relaxation and levels of progressive breathing that encourage a woman to "flow with" rather than struggle against contractions. In the Dick-Read method, a woman achieves a lack of fear through education about childbirth; she achieves reduced pain by focusing on abdominal breathing during contractions. Although all of the methods involve breathing, the specific approach outlined above corresponds with Lamaze.
A nurse is instructing a pregnant client on putting together a childbirth plan. Which of the following recommendations should the nurse give her? Avoid including the desired birth attendant in the plan. Make decisions about the birth plan about 1 week before the expected day of birth. Make the birth plan in a group setting, if possible. Focus on a limited goal, such as not having an epidural.
Make the birth plan in a group setting, if possible. Most classes for expectant parents urge couples to make a written childbirth plan to include information, such as their choice of setting, birth attendant, special needs such as the extent of family participation they wish during labor, birthing positions, medication options, plans for the immediate postpartum period and baby care, and family visitation; all measures to give them a better sense of control. Making a birth plan in a group setting has the advantage of allowing a couple to sort out their questions and feelings about what they want to consider in their plan as they share information with others. When talking to couples about their birth plan, be certain it includes flexibility as well as is centered on the ultimate goal of childbirth: a healthy baby and healthy parents rather than concentration on a limited goal, such as not having fetal monitoring or using a particular birthing position. Urge couples to make these decisions at least 1 month before the expected day of birth.
The nurse is caring for a client in the last trimester of pregnancy. The client states having chronic back pain which disrupts each day. What action will the nurse suggest? Pelvic rocking may soothe the back pain. Tailor sitting when at work may provide relief. Squatting once per hour may be helpful. Kegel exercises during voiding may lessen the pressure.
Pelvic rocking may soothe the back pain. Pelvic rocking is a technique that can be used to reduce backache in pregnancy, improve posture and also improve flexibility. Squatting and tailor sitting are stretches for the pelvic floor muscles. Kegel exercises strengthen the pelvic floor.
A nurse is working to increase participation in childbirth education classes for pregnant clients who are receiving care at the clinic. To achieve this goal, which objective will the nurse include in the advertisement? The classes will provide information on breastfeeding the infant. The classes will provide a certificate of completion at the end. The classes will include a narrated video of a client giving birth. The classes will include pharmacologic and nonpharmacologic methods of pain relief.
The classes will include pharmacologic and nonpharmacologic methods of pain relief. Childbirth classes provide important information regarding the birthing process. It is important that pregnant client understand the benefits of attendance as related to the client's needs and experience. Some clients are reluctant to sign up for childbirth classes, because they fear that doing so commits them to a medication-free birth. The management of pain is a primary concern of childbirth. The client need to be instructed that this is not true and both pharmacologic and nonpharmacologic strategies for pain relief will be addressed. Not all clients want to watch a birthing video; however, others feel it to be beneficial. Breastfeeding is important but not as important in the childbirth curriculum as pain management. It is nice to have a certificate of completion but not necessary.
The maternal health nurse cares for several pregnant women. Which woman does the nurse identify as using the Bradley method? The pregnant woman attends a childbirth and breastfeeding education class. The laboring woman uses conscious relaxation during a contraction. The laboring woman's partner assists the woman in breathing exercises. The pregnant woman decides she does not want her labor medically induced.
The laboring woman's partner assists the woman in breathing exercises. The Bradley (partner-coached) method of childbirth is based on the premise that pregnancy and childbirth are joyful, natural processes and that a woman's partner should play an active role during pregnancy, labor, and the early newborn period. The remaining answer choices are methods of childbirth; however, these do not represent the Bradley method.
A nurse is reading a journal article about childbirth and the role of doulas in childbirth. The nurse demonstrates understanding of the article when the nurse identifies which activity as a function of a doula? educating the woman about awareness of her breathing and relaxation Teaching partners how to do massage techniques providing health promotion and illness prevention caring for the mother's emotional needs
caring for the mother's emotional needs A doula is a woman experienced in childbirth who provides continuous emotional and physical support. A doula takes care of the mother's emotional needs throughout childbirth and the postpartum period. A doula also provides support and suggestions for partners that can enhance their experiences of birth. A postpartum doula continues that valuable emotional support and guidance, helping a family make a smooth transition into new family dynamics. A midwife teaches health promotion and illness prevention; awareness of breathing; relaxation; and partner massage techniques.
What type of common nonpharmacologic methods of pain relief can the nurse offer the client in labor? Select all that apply. epidural anesthesia consciously controlled breathing hydrotherapy effleurage guided imagery
consciously controlled breathing hydrotherapy effleurage guided imagery Commonly used nonpharmacologic techniques for pain relief in labor are conscious relaxation, consciously controlled breathing, effleurage, focusing, imagery, and hydrotherapy.
A pregnant client informs the nurse that she is considering a "water birth" for the labor and delivery of her child. What does the nurse anticipate as potential complications for this type of birth? Select all that apply. premature rupture of membranes contamination of the bath water with feces as the mother pushes during labor uterine infection prolonged second stage of labor
contamination of the bath water with feces as the mother pushes during labor uterine infection A potential complication of a water birth is contamination of the bath water, with feces expelled during the pushing efforts of the second stage of labor. This could lead to uterine infection in the mother or aspiration of contaminated bath water by the newborn, which could lead to pneumonia.
The maternal health nurse is caring for a pregnant woman who expresses a desire to have a water birth. When discussing this option with the client, which disadvantage will the nurse identify? decreased relief of pain absence of the health care provider inability to move freely contamination of the water
contamination of the water Contamination of the water with feces during labor is the major disadvantage of a water birth. The remaining answer choices are not true regarding water births and would not be discussed with the client considering this option.
After teaching a group of students about Grantley Dick-Read and his view of childbirth, which of the following if identified by the students as an activity advocated by Dick-Read indicates that the teaching was successful? controlled breathing abdominal stroking physical exercises pressure point application
controlled breathing Prenatal education advocated by Dick-Read focuses on health promotion activities like physical exercise, relaxation, and breathing. The Russian activist Nikolayev emphasized controlled breathing, abdominal stroking, and applying pressure on the hip and back in his psychoprophylaxis training method.
The nurse is educating a pregnant woman and her partner to trace a pattern on her abdomen with her fingertips as a distraction method during contractions. What type of distraction method is this considered? effleurage psychoprophylaxis conditioned reflexes deep abdominal massage
effleurage In effleurage, a woman or her partner traces a pattern on her abdomen with her fingertips. The rate of effleurage should remain constant even though breathing rates change. Effleurage serves as a distraction technique and decreases sensory stimuli transmission from the abdominal wall, helping limit local discomfort.
A pregnant woman and her partner are reviewing information about a local hospital as a possible birth setting. The couple determine that the hospital is a mother-friendly facility based on which information? promotes the use of repeat cesarean births over VBACs demonstrates high rates for episiotomies encourages a woman to assume the positions of her choice during labor and birth encourages use of constant fetal monitoring
encourages a woman to assume the positions of her choice during labor and birth To qualify as a mother-friendly hospital, a hospital should allow the woman to give birth as she wishes in an environment in which she feels nurtured and secure. A mother-friendly hospital should not have routine policies that include practices for such things as perineal shaving, admission enemas, withholding food or fluid during labor, rupturing membranes to hurry labor, or the use of continuous intravenous lines or constant fetal monitoring. It also should have low rates of episiotomies, induction for labor, and cesarean births. In contrast, it should also have a high VBAC rate (60% or more).
A client in labor stares at a silver locket that her partner holds in front of her during a contraction. What type of distraction technique is the client using? effleurage focusing guided imagery conscious relaxation
focusing Focusing intently on an object is a method of keeping sensory input from reaching the cortex of the brain.
A nurse suggests to a client planning to start a family that she and her partner should attend childbirth education classes. Which of the following are taught in childbirth classes? Select all that apply. healthy relationships stress management day nursery facilities Crèche facilities nutritional needs in pregnancy
healthy relationships stress management nutritional needs in pregnancy Childbirth classes provide information on nutritional needs in pregnancy, stress management, and healthy relationships. These classes provide information that help parents take the initiative in changing risky lifestyles. Childbirth classes do not provide information on crèche and day nursery facilities.
A client in the third trimester comes to the clinic for a follow-up visit complaining of a backache. Which activity would the nurse include when teaching the client how to relieve her backache? taking hot water baths performing pelvic rocking exercises using a soft mattress using warm tub baths
performing pelvic rocking exercises The nurse should teach the client to perform pelvic rocking exercises. Use of soft mattress, hot water baths, and warm tub baths are not advisable for backaches.
A nurse recommends to soon-to-be parents that they attend early prenatal classes. Which of the following topics would be covered in an early prenatal class? anatomy and physiology of childbirth and choices physical and emotional changes of pregnancy desire for and confidence in vaginal birth and risks of cesarean supply list and information on nutrition to prevent anemia
physical and emotional changes of pregnancy Early prenatal classes cover topics like physical and emotional changes of pregnancy, minor discomforts of pregnancy, danger signs, and nutrition. Anatomy and physiology of childbirth and choices are the topics covered in prenatal classes. Supply lists and information on nutrition to prevent anemia is covered in homebirth preparation classes. The VBAC classes for parents who have had a previous cesarean birth covers topics that include desire/confidence for vaginal birth, risks of cesarean, and a comparison of labors for primiparous and multiparous clients.
A nurse is providing care to a couple who is planning to get pregnant within a short time and who need proactive nutritional strategies prior to conceiving. The nurse would most likely recommend which type of care? Lamaze classes prenatal classes preconception visits a childbirth plan
preconception visits Preconception visits are held for couples planning to get pregnant within a short time who want to know more about what pregnancy is like and birth setting/procedure choices. These visits stress that pregnancy brings psychological as well as physical changes and include recommended preconception nutrition modifications, such as good intake of folic acid and protein during the time trying to conceive.
