2410 intrapartum

Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination?

When accelerations of the fetal heart rate (FHR) are noted

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate?

When we can stabilize your preterm labor and arrange home health visits

With regard to dysfunctional labor, nurses should be aware that:

Women experiencing precipitous labor are about the only dysfunctionals not to be exhausted

Complications and risks associated with cesarean births include (Select all that apply)

Wound dehiscence. Hemorrhage. Urinary tract infections. Fetal injuries

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have:

a normal baseline heart rate

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor

active phase

The nurse caring for the laboring woman should understand that early decelerations are caused b

altered fetal cerebral blood flow

In documenting labor experiences, nurses should know that a uterine contraction is described according to all these characteristics except

apperance

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement:

are reassuring

A laboring woman is lying in the supine position. The most appropriate nursing action at this time is to

ask her to turn to one side

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal

attitude

The nurse providing care for the laboring woman should understand that amnioinfusion is used to treat

Variable decelerations

Which collection of risk factors most likely would result in damaging lacerations (including episiotomies)

A first-time mother with reddish hair whose rapid labor was overseen by an obstetrician

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is

A gravida 4 who has had all cesarean births

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurses initial response would be to

Assess the fetal heart rate and pattern

Immediately after the forceps-assisted birth of an infant, the nurse should

Assess the infant for signs of trauma

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug

Assessing for chest discomfort and palpitations

According to standard professional thinking, nurses should auscultate the fetal heart rate (FHR

Before and after ambulation and rupture of membranes

As relates to fetal positioning during labor, nurses should be aware that:

Birth is imminent when the presenting part is at +4 to +5 cm below the spine

Which occurrence is associated with cervical dilation and effacement

Bloody show

When assessing the relative advantages and disadvantages of internal and external electronic fetal monitoring, nurses comprehend that both:

Can be used during the antepartum and intrapartum period

Which presentation is described accurately in terms of both presenting part and frequency of occurrence

Cephalic: occiput; at least 95

To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor?

Cervical dilation and effacement

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by:

Change in position.

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the womans understanding of the instructions when she states, True labor contractions will

Continue and get stronger even if I relax and take a shower

A normal uterine activity pattern in labor is characterized by

Contractions every 2 to 5 minutes

In evaluating the effectiveness of oxytocin induction, the nurse would expect

Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart

Perinatal nurses are legally responsible for

Correctly interpreting fetal heart rate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes

Which description of the phases of the second stage of labor is accurate?

Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive sign that uterine contractions are effective would be

Dilation of the cervix

The maternity nurse understands that as the uterus contracts during labor, maternal-fetal exchange of oxygen and waste products

Diminishes as the spiral arteries are compressed

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance:

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

In relation to primary and secondary powers, the maternity nurse comprehends that

Primary powers are responsible for effacement and dilation of the cervix

In planning for home care of a woman with preterm labor, which concern must the nurse address

Prolonged bed rest may cause negative physiologic effects.

Fetal bradycardia is most common during

Prolonged umbilical cord compression

In order to care for obstetric patients adequately, the nurse understands that labor contractions facilitate cervical dilation by

Pulling the cervix over the fetus and amniotic sac

When assessing the fetus using Leopold maneuvers, the nurse feels a round, firm, movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mothers right side close to midline. What is the likely position of the fetus?

RSA

The nurse thoroughly dries the infant immediately after birth primarily

Reduce heat loss from evaporation.

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when

The nurse is unable to feel the cervix during a vaginal examination

It is paramount for the obstetric nurse to understand the regulatory procedures and criteria for admitting a woman to the hospital labor unit. Which guideline is an important legal requirement of maternity care

The patients weight gain is calculated to determine whether she is at greater risk for cephalopelvic disproportion (CPD) and cesarean birth

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the womans fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that

The placenta has separated.

Fetal well-being during labor is assessed by:

The response of the fetal heart rate to uterine contractions

What is an advantage of external electronic fetal monitoring?

The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. Your best response is:

The top line graphs the babys heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor.

With regard to a womans intake and output during labor, nurses should be aware that

The tradition of restricting the laboring woman to clear liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth

The vulva bulges and encircles the fetal head

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth?

The vulva bulges and encircles the fetal head

The nurse knows that the second stage of labor, the descent phase, has begun when

The woman experiences a strong urge to bear down

A nurse may be called on to stimulate the fetal scalp

To elicit an acceleration in the fetal heart rate (FHR

When using intermittent auscultation (IA) for fetal heart rate, nurses should be aware that

Ultrasound can be used to find the fetal heartbeat and reassure the mother if initial difficulty was a factor.

Which maternal condition is considered a contraindication for the application of internal monitoring devices?

Unruptured membranes

The nurse caring for a woman in labor understands that prolonged deceleration

Usually are isolated events that end spontaneously

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)

Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency Uterine tone >20 mm Hg Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and patter

Why is continuous electronic fetal monitoring usually used when oxytocin is administered

Uteroplacental exchange may be compromised.

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of

Uteroplacental insufficiency

The nurse caring for the woman in labor should understand that maternal hypotension can result in

Uteroplacental insufficiency.

A maternal indication for the use of vacuum extraction is

maternal exhaustion

The nurse caring for the woman in labor should understand that increased variability of the fetal heart rate may be caused by

methampetamines

As the United States and Canada continue to become more culturally diverse, it is increasingly important for the nursing staff to recognize a wide range of varying cultural beliefs and practices. Nurses need to develop respect for these culturally diverse practices and learn to incorporate these into a mutually agreed on plan of care. Although it is common practice in the United States for the father of the baby to be present at the birth, in many societies this is not the case. When implementing care, the nurse would anticipate that a woman from which country would have the father of the baby in attendance

mexico

The slight overlapping of cranial bones or shaping of the fetal head during labor is called

molding

The priority nursing care associated with an oxytocin (Pitocin) infusion is

monitoring uterine response

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patients most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration (Select all that apply) ?

placental abruption, maternal supine hypotension

The factors that affect the process of labor and birth, known commonly as the five Ps, include all except

pressure

Women who have participated in childbirth education classes often bring a birth bag or Lamaze bag with them to the hospital. These items often assist in reducing stress and providing comfort measures. The nurse caring for women in labor should be aware of common items that a client may bring, including (Select all that apply)

rolling pin, tennis ball, pillow, stuffed animal

a means of controlling the birth of the fetal head with a vertex presentation

the ritgen maneuver

Before the physician performs an external version, the nurse should expect an order for a

tocolytic drug

The primary difference between the labor of a nullipara and that of a multipara is the

total duration of labor

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered

transcervical catheter

The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by

umbilical cord compression

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm birth

viral

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy?

-2 station

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken

Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask

With regard to the care management of preterm labor, nurses should be aware that:

The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change

A new mother asks the nurse when the soft spot on her sons head will go away. The nurses answer is based on the knowledge that the anterior fontanel closes after birth by _____ month

18

The priority nursing intervention after an amniotomy should be to

Assess the fetal heart rate

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate 110 bpm, and the infant is crying vigorously with the limbs flexed. The infants trunk is pink, but the hands and feet are blue. What is the correct Apgar score for this infant

9

The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence

A fetal heart rate (FHR) of 180 with absence of variability

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hour

Concerning the third stage of labor, nurses should be aware that:

An expectant or active approach to managing this stage of labor reduces the risk of complications

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description?

Arrest of active phase

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should

Ask the woman to describe why she believes she is in labor

A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The fetal heart rate has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. The nurse should expect the woman to be:

Discharged home to await the onset of true labor

The nurse who performs vaginal examinations to assess a womans progress in labor should

Discuss the findings with the woman and her partner

The least common cause of long, difficult, or abnormal labor (dystocia) is

Disproportion of the pelvis

While evaluating an external monitor tracing of a woman in active labor whose labor is being induced, the nurse notes that the fetal heart rate (FHR) begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should

Document the finding in the clients record

The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The nurse notes that the intrauterine pressure at the peak of the contraction ranges from 65 to 70 mm Hg and the resting tone range is 6 to 10 mm Hg. The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. On the basis of this information, the nurse should:

Document the findings because they reflect the expected contraction pattern for the active phase of labor

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position

Early decelerations

In assisting with the two factors that have an effect on fetal status (i.e., pushing and positioning), nurses should:

Encourage the womans cooperation in avoiding the supine position.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include

Encouraging the woman to try various upright positions, including squatting and standing

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions?

Evaluate the intensity by pressing the fingertips into the uterine fundus

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include

Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures.

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by

Expanding maternal blood volume

. For women who have a history of sexual abuse, a number of traumatic memories may be triggered during labor. The woman may fight the labor process and react with pain or anger. Alternately, she may become a passive player and emotionally absent herself from the process. The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse. The nurse can implement a number of care measures to help the client view the childbirth experience in a positive manner. Which intervention would be key for the nurse to use while providing care

Limiting the number of procedures that invade her body

While providing care to a patient in active labor, the nurse should instruct the woman that

Frequent changes in position will help relieve her fatigue and increase her comfort

A nulliparous woman who has just begun the second stage of her labor would most likely:

Feel tired yet relieved that the worst is over

A woman who is gravida 3 para 2 enters the intrapartum unit. The most important nursing assessments are

Fetal heart rate, maternal vital signs, and the womans nearness to birth

The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is

Fetal sleep cycle

Through vaginal examination the nurse determines that a woman is 4 cm dilated, and the external fetal monitor shows uterine contractions every 3.5 to 4 minutes. The nurse would report this as

First stage, active phase

For the labor nurse, care of the expectant mother begins with any or all of these situations, with the exception of:

Formulation of the womans plan of care for labor

What is an essential part of nursing care for the laboring woman?

Helping the woman manage the pain

A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would explain that true labor contractions

Increase with activity such as ambulation.

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the womans risk for _________________________ has increased

Intrauterine infection

With regard to the process of augmentation of labor, the nurse should be aware that it

Is part of the active management of labor that is instituted when the labor process is unsatisfactoy

The nurse providing care to a woman in labor should understand that cesarean birth

Is performed primarily for the benefit of the fetus

Nurses should be aware that the induction of labor

Is rated for viability by a bishop score

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that

Its most important function is to afford the opportunity to administer antenatal glucocorticoid

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurses best response is

Its normal to be anxious about labor. Lets discuss what makes you afraid

The most critical nursing action in caring for the newborn immediately after birth is

Keeping the newborns airway clear

While caring for the patient who requires an induction of labor, the nurse should be cognizant that

Labor sometimes can be induced with balloon catheters or laminaria tents

Which fetal heart rate (FHR) finding would concern the nurse during labor?

Late decelerations

If a woman complains of back labor pain, the nurse could best suggest that she:

Lean over a birth ball with her knees on the floor

Which statement is the best rationale for assessing maternal vital signs between contraction

Maternal circulating blood volume increases temporarily during contraction

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the fetal heart rate remains in the 80s. What additional nursing measures should you take

Notify the care provider immediately

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse

One fetal movement noted in 1 hour of assessment by the mother

The nurse knows that proper placement of the tocotransducer for electronic fetal monitoring is located:

Over the uterine fundus.

What is an expected characteristic of amniotic fluid?

Pale, straw color with small white particles

Which patient status is an acceptable indication for serial oxytocin induction of labor

Past 42 weeks gestation

With regard to the turns and other adjustments of the fetus during the birth process, known as the mechanism of labor, nurses should be aware that

The effects of the forces determining descent are modified by the shape of the womans pelvis and the size of the fetal head

a pregnant womans amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority

Placing the woman in the knee-chest position

which basic type of pelvis includes the correct description and percentage of occurrence in women

Platypelloid: flattened, wide, shallow; 3

Which assessment is least likely to be associated with a breech presentation

Post-term gestation

. In order to evaluate the condition of the patient accurately during labor, the nurse should be aware that

The endogenous endorphins released during labor will raise the womans pain threshold and produce sedation.

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to:

Ripen the cervix in preparation for labor induction

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply) :

Rupture of membranes at or near term Chorioamnionitis (inflammation of the amniotic sac). Post-term pregnancy. Fetal death

The standard of care for obstetrics dictates that an internal version may be used to manipulate the

Second twin from a transverse lie to a breech presentation during vaginal birth

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects

Serum magnesium level of 10 mg/dL

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this womans labor

She is exhibiting hypertonic uterine dysfunction

When using intermittent auscultation (IA) to assess uterine activity, the nurse should be cognizant that

The examiners hand should be placed over the fundus before, during, and after contraction

With regard to factors that affect how the fetus moves through the birth canal, nurses should be aware that

The normal attitude of the fetus is called general flexion.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to

Stimulate fetal surfactant production.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to

Stimulate the uterus to contract

The nurse expects to administer an oxytocic (e.g., Pitocin, Methergine) to a woman after expulsion of her placenta to

Stimulate uterine contraction

Which factors influence cervical dilation (Select all that apply)

Strong uterine contractions The force of the presenting fetal part against the cervix The pressure applied by the amniotic sac Scarring of the cervix

The nurse has received report regarding her patient in labor. The womans last vaginal examination was recorded as 3 cm, 30%, and ?2-2. The nurses interpretation of this assessment is that:

The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring?

The cervix is effacing and dilated to 2 cm

The nurse recognizes that a woman is in true labor when she states

The contractions in my uterus are getting stronger and closer together

A tiered system of categorizing FHR has been recommended by regulatory agencies. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. These categories include (Select all that apply) :

catergory I, catergory II, catergory III

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurses first priority is t

change the womans position

To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length?

first

Which description of the four stages of labor is correct for both definition and duration

first stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours

Leopold maneuvers would be an inappropriate method of assessment to determine

gender of the fetus

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with

hypoxemia

The nurse would expect which maternal cardiovascular finding during labor

increased cardiac output

What correctly matches the type of deceleration with its likely cause

late decelerationuteroplacental inefficienc

signs that precede labor include (Select all that apply) :

lightening, bloody show, rupture of membranes