week 2 OB 8/9

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.

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 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

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 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

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

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.

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 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.

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 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.

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 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

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 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

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 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

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 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."

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.

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.

he 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.

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

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."

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.

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."

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 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

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 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.

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.

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.

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

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.

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

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.

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

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.