intrapartum

When assessing a woman in labor, the nurse is aware that the relationship of the fetal body parts to one another is called fetal: a. Lie. c. Attitude. b. Presentation. d. Position.

Attitude.

A woman has just arrived at the labor and delivery suite. To report the client's status to her primary healthcare practitioner, which of the following assessments should the nurse perform? Select all that apply. 1. Fetal heart rate. 2. Contraction pattern. 3. Urinalysis. 4. Vital signs. 5. Biophysical profile.

1. Fetal heart rate. 2. Contraction pattern. 4. Vital signs.

A client in labor is talkative and happy. How many centimeters dilated would a maternity nurse suspect that the client is at this time? 1.2 cm. 2.4 cm. 3.8 cm. 4.10 cm.

1.2 cm.

Which of the following actions would the nurse expect to perform immediately be-fore a woman is to have regional anesthesia? Select all that apply. 1.Assess fetal heart rate. 2.Infuse 1000 cc of Ringer's lactate. 3.Place woman in Trendelenburg position. 4.Monitor blood pressure every 5 minutes for 15 minutes. 5.Have woman empty her bladder

1.Assess fetal heart rate. 2.Infuse 1000 cc of Ringer's lactate. 5.Have woman empty her bladder

A nurse concludes that a woman is in the latent phase of labor. Which of the fol-lowing signs/symptoms would lead a nurse to that conclusion? 1.The woman talks and laughs during contractions. 2.The woman complains about severe back labor. 3.The woman performs effleurage during a contraction. 4.The woman asks to go to the bathroom to defecate

1.The woman talks and laughs during contractions.

The nurse is performing a vaginal examination on a client in labor. The client is found to be 5 cm dilated, 90% effaced, and station-2. Which of the following has the nurse palpated? 1.Thin cervix. 2.Bulging fetal membranes. 3.Head at the pelvic outlet. 4.Closed cervix.

1.Thin cervix.

Which of the following are signs of impending labor? 1. Weight gain 2. Surge of energy 3. Increase in urinary frequency 4. Dyspnea 5. Pain in lower back 6. Increase in bloody show

2. Surge of energy 3. Increase in urinary frequency 5. Pain in lower back 6. Increase in bloody show

A woman is in the transition phase of labor. Which of the following comments should the nurse expect to hear? 1."I am so excited to be in labor." 2."I can't stand this pain any longer!" 3."I need ice chips because I'm so hot." 4."I have to push the baby out right now!"

2."I can't stand this pain any longer!"

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for: 1.Complete bed rest for the remainder of the pregnancy 2.Delivery of the fetus 3.Strict monitoring of intake and output 4.The need for weekly monitoring of coagulation studies until the time of delivery

2.Delivery of the fetus

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order? 1.Prepare the client for an ultrasound 2.Obtain equipment for external electronic fetal heart monitoring 3.Obtain equipment for a manual pelvic examination 4.Prepare to draw a Hgb and Hct blood sample

2.Obtain equipment for external electronic fetal heart monitoringdiagnosis is with an US

A woman had a baby by normal spontaneous delivery 10 minutes ago. The nursenotes that a gush of blood was just expelled from the vagina and the umbilical cordlengthened. What should the nurse conclude? 1.The woman has an internal laceration. 2.The woman is about to deliver the placenta. 3.The woman has an atonic uterus. 4.The woman is ready to expel the cord bloods

2.The woman is about to deliver the placenta.

A client is in the third stage of labor. Which of the following assessments should the nurse make/observe for? Select all. 1.Fetal heart assessment after each contraction. 2.Uterus rising in the abdomen and feeling globular. 3.Rapid cervical dilation to ten centimeters. 4.Maternal complaints of intense rectal pressure. 5. Lengthening of the umbilical cord

2.Uterus rising in the abdomen and feeling globular. 5. Lengthening of the umbilical cord

When performing Leopold maneuvers, the nurse notes that the fetus is in the left occiput anterior position. Which is the best position for the nurse to place a fetoscope to hear the fetal heartbeat? 1. Left upper quadrant. 2. Right upper quadrant. 3. Left lower quadrant. 4. Right lower quadrant.

3. Left lower quadrant.

The nurse is performing an assessment on a client diagnosed with placenta previa. Which of these assessment findings would the nurse expect to note? Select all that apply. 1. Uterine rigidity 2. Uterine tenderness 3. Severe abdominal pain 4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age.

4. Bright red vaginal bleeding 5. Soft, relaxed, nontender uterus 6. Fundal height may be greater than expected for gestational age.

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? 1.Disseminated intravascular coagulation 2.Chronic hypertension 3.Infection 4.Hemorrhage

4.Hemorrhage

A nurse determines that a client is carrying a fetus in the vertical lie. The nurse's judgment should be questioned if the fetal presenting part is which of the following? 1.Sacrum. 2.Occiput. 3.Mentum. 4.Scapula.

4.Scapula.

A woman has decided to hire a doula to work with her during labor and delivery. Which of the following actions would be appropriate for the nurse to delegate to the doula? (Select all that apply) A. Give the woman a back rub B. Assist the woman with her breathing C. Assess the fetal heart rate D. Check the woman's blood pressure E. Regulate the woman's intravenous infusion rate

A. Give the woman a back rub B. Assist the woman with her breathing

An obstetrician is performing an amniotomy on a gravid woman in transition. Which of the following assessments must the nurse make immediately following the procedure? A Maternal blood pressure B Maternal pulse C Fetal Heart Rate D Fetal fibronectin

C Fetal Heart Rate

A fetus is positioned in a longitudinal lie with its head in the fundus with both hips and knees flexed. Which presentation is this known as?

Complete breech

Upon examination, a nurse notes that a woman is 10 cm dilated, 100% effaced, and -3 station. Which of the following actions should the nurse perform during the next contraction? A. Encourage the woman to push B. Provide firm fundal pressure C. Move the client into a squat D. Monitor for signs of rectal pressure

D. Monitor for signs of rectal pressure

The slight overlapping of cranial bones or shaping of the fetal head during labor is called: a. Lightening. c. Ferguson reflex. b. Molding. d. Valsalva maneuver.

Molding.

A primigravida has just been examined. The examination revealed engagement of the fetal head. The nurse is aware that this means which of the following?

The biparietal diameter of the fetal head is at the level of the ischial spines

A fetus is positioned in the occiput anterior position. The nurse determines that the fetus is positioned in which way?

The fetal head is closest to the vaginal opening and the occiput is directed toward the maternal symphysis.

Which occurrence is associated with cervical dilation and effacement? a. Bloody show c. Lightening b. False labor d. Bladder distention

a. Bloody show

With regard to breathing techniques during labor, maternity nurses should understand that: a. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction. b. By the time labor has begun, it is too late for instruction in breathing and relaxation. c. Controlled breathing techniques are most difficult near the end of the second stage of labor. d. The patterned-paced breathing technique can help prevent hyperventilation.

a. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction.

Which presentation is described accurately in terms of both presenting part and frequency of occurrence? a. Cephalic: occiput; at least 95% c. Shoulder: scapula; 10% to 15% b. Breech: sacrum; 10% to 15% d. Cephalic: cranial; 80% to 85%

a. Cephalic: occiput; at least 95%breech - 3% shoulder - 1%

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use: a. Counterpressure against the sacrum. b. Pant-blow (breaths and puffs) breathing techniques. c. Effleurage. d. Conscious relaxation or guided imagery.

a. Counterpressure against the sacrum.

While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include (Select all that apply): a. Culture. b. Anxiety and fear. c. Previous experiences with pain. d. Intervention of caregivers. e. Support systems.

a. Culture . b. Anxiety and fear. c. Previous experiences with pain. e. Support systems.

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: a. Dilation of the cervix. c. Rupture of the amniotic membranes. b. Descent of the fetus. d. Increase in bloody show.

a. Dilation of the cervix.

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: a. Encouraging the woman to try various upright positions, including squatting and standing. b. Telling the woman to start pushing as soon as her cervix is fully dilated. c. Continuing an epidural anesthetic so pain is reduced and the woman can relax. d. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

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

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: a. Increase with activity such as ambulation. b. Decrease with activity. c. Are always accompanied by the rupture of the bag of waters. d. Alternate between a regular and an irregular pattern

a. Increase with activity such as ambulation.

When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for _________________________ has increased. a. Intrauterine infection c. Precipitous labor b. Hemorrhage d. Supine hypotension

a. Intrauterine infection

The most critical nursing action in caring for the newborn immediately after birth is: a. Keeping the newborn's airway clear. b. Fostering parent-newborn attachment. c. Drying the newborn and wrapping the infant in a blanket . d. Administering eye drops and vitamin K.

a. Keeping the newborn's airway clear.

Signs that precede labor include (Select all that apply): a. Lightening. b. Exhaustion. c. Bloody show. d. Rupture of membranes. e. Decreased fetal movement.

a. Lightening . c. Bloody show . d. Rupture of membranes.

With regard to a woman's intake and output during labor, nurses should be aware that: a. 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. b. Intravenous (IV) fluids usually are necessary to ensure that the laboring woman stays hydrated. c. Routine use of an enema empties the rectum and is very helpful for producing a clean, clear delivery. d. When a nulliparous woman experiences the urge to defecate, it often means birth will follow quickly.

a. 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.

A woman's pelvis is described as long and narrow with an anteroposterior diameter greater than the transverse diameter. This is known as which type of pelvis?

anthropoid

secondary powers

are concerned with expulsion of the fetus

primary powers

are responsible for dilation and effacement

What is an expected characteristic of amniotic fluid? a. Deep yellow color b. Pale, straw color with small white particles c. Acidic result on a Nitrazine test d. Absence of ferning

b. Pale, straw color with small white particles

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: a. "Don't worry about it. You'll do fine." b. "Its normal to be anxious about labor. Let's discuss what makes you afraid." c. "Labor is scary to think about, but the actual experience isn't." d. "You can have an epidural. You won't feel anything."

b. "Its normal to be anxious about labor. Let's discuss what makes you afraid."

A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because: a. "The two together work the best for you and your baby." b. "Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea." c. "They work better together so you can sleep until you have the baby." d. "This is what the doctor has ordered for you."

b. "Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea."

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure (Select all that apply)? a. Place the woman in a supine position. b. Place the woman in a lateral position. c. Increase intravenous (IV) fluids. d. Administer oxygen. e. Perform a vaginal examination.

b. Place the woman in a lateral position. c. Increase intravenous (IV) fluids. d. Administer oxygen.

After change-of-shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: a. Visceral . c. Somatic . b. Referred. d. Afterpain.

b. Referred.

With regard to a pregnant woman's anxiety and pain experience, nurses should be aware that: a. Even mild anxiety must be treated. b. Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on . c. Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. d. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

b. Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.

After an emergency birth, the nurse encourages the woman to breastfeed her newborn. The primary purpose of this activity is to: a. Facilitate maternal-newborn interaction. b. Stimulate the uterus to contract. c. Prevent neonatal hypoglycemia. d. Initiate the lactation cycle.

b. 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: a. Relieve pain. c. Prevent infection. b. Stimulate uterine contraction. d. Facilitate rest and relaxation.

b. Stimulate uterine contraction.

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if: a. The mother gives birth without any analgesic or anesthetic. b. The mother and family's priorities and preferences are incorporated into the plan. c. The primary health care provider decides the best pain relief for the mother and family. d. The nurse informs the family of all alternative methods of pain relief available in the hospital setting.

b. The mother and family's priorities and preferences are incorporated into the plan.

The nurse recognizes that a woman is in true labor when she states: a. "I passed some thick, pink mucus when I urinated this morning." b. "My bag of waters just broke." c. "The contractions in my uterus are getting stronger and closer together." d. "My baby dropped, and I have to urinate more frequently now."

c. "The contractions in my uterus are getting stronger and closer together

At 1 minute after birth, the nurse assesses the newborn to assign an Apgar score. The apical heart rate is 110 bpm, and the infant is crying vigorously with the limbs flexed. The infant's trunk is pink, but the hands and feet are blue. What is the correct Apgar score for this infant? a. 7 c. 9 b. 8 d. 10

c. 9

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens, and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. This procedure is: a. Not used much anymore. b. Likely to be used in the second stage of labor but not in the first stage. c. An application of nitrous oxide. d. A prelude to cesarean birth.

c. An application of nitrous oxide.

The nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates the woman's understanding of the instructions when she states, "True labor contractions will: a. Subside when I walk around." b. Cause discomfort over the top of my uterus." c. Continue and get stronger even if I relax and take a shower." d. Remain irregular but become stronger."

c. Continue and get stronger even if I relax and take a shower."

Which description of the phases of the second stage of labor is accurate? a. Latent phase: Feeling sleepy, fetal station 2+ to 4+, duration 30 to 45 minutes b. Active phase: Overwhelmingly strong contractions, Ferguson reflux activated, duration 5 to 15 minutes c. Descent phase: Significant increase in contractions, Ferguson reflux activated, average duration varied d. Transitional phase: Woman "laboring down," fetal station 0, duration 15 minutes

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

Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? a. Place the hand on the abdomen below the umbilicus and palpate uterine tone with the fingertips. b. Determine the frequency by timing from the end of one contraction to the end of the next contraction. c. Evaluate the intensity by pressing the fingertips into the uterine fundus. d. Assess uterine contractions every 30 minutes throughout the first stage of labor.

c. Evaluate the intensity by pressing the fingertips into the uterine fundus.

A nulliparous woman who has just begun the second stage of her labor would most likely: a. Experience a strong urge to bear down. b. Show perineal bulging. c. Feel tired yet relieved that the worst is over. d. Show an increase in bright red bloody show.

c. Feel tired yet relieved that the worst is over.

While providing care to a patient in active labor, the nurse should instruct the woman that: a. The supine position commonly used in the United States increases blood flow. b. The "all fours" position, on her hands and knees, is hard on her back. c. Frequent changes in position will help relieve her fatigue and increase her comfort. d. In a sitting or squatting position, her abdominal muscles will have to work harder.

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

A woman in labor has just received an epidural block. The most important nursing intervention is to: a. Limit parenteral fluids. b. Monitor the fetus for possible tachycardia. c. Monitor the maternal blood pressure for possible hypotension. d. Monitor the maternal pulse for possible bradycardia.

c. Monitor the maternal blood pressure for possible hypotension.

A laboring woman received an opioid agonist (meperidine) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate? a. Fentanyl (Sublimaze) c. Naloxone (Narcan) b. Promethazine (Phenergan) d. Nalbuphine (Nubain)

c. Naloxone (Narcan)

Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. The fetal head is felt at 0 station during vaginal examination. b. Bloody mucus discharge increases. c. The vulva bulges and encircles the fetal head d. The membranes rupture during a contraction.

c. The vulva bulges and encircles the fetal head.

The nurse knows that the second stage of labor, the descent phase, has begun when: a. The amniotic membranes rupture. b. The cervix cannot be felt during a vaginal examination. c. The woman experiences a strong urge to bear down. d. The presenting part is below the ischial spines.

c. The woman experiences a strong urge to bear down.

A woman who is 39 weeks pregnant presents to the labor and delivery unit stating that she thinks she is in labor. Her contractions are irregular at 7 to 10 minutes apart. Which sign is definitive for true labor?

cervical dilation is occuring

A patient who is 8 cm dilated develops circumoral numbness and dizziness. What is the nurse's priority intervention?

have the pt slow down her breathing

When a nulliparous woman telephones the hospital to report that she is in labor, the nurse initially should: a. Tell the woman to stay home until her membranes rupture. b. Emphasize that food and fluid intake should stop. c. Arrange for the woman to come to the hospital for labor evaluation. d. Ask the woman to describe why she believes she is in labor.

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

The obstetric nurse is preparing the patient for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware and prepared for the greatest risk of administering general anesthesia to the patient. This risk is: a. Respiratory depression. c. Inadequate muscle relaxation. b. Uterine relaxation. d. Aspiration of stomach contents.

d. Aspiration of stomach contents.

A 40 year old G2, P1 woman is admitted to the labor and delivery unit with contractions 6 minutes apart. She is 36 weeks pregnant, has a history of placenta previa, and is currently experiencing moderate vaginal bleeding. What should the nurse be prepared to do?

initiate external fetal monitoring

On admission to the labor unit, a primigravid woman at 38 weeks gestation states, "I need to urinate more now but at least I can breathe easier." The nurse is aware that this is likely due to which physiological process?

lightening

A 28 year old woman without risk factors has now reached the second stage of labor. What is the optimal position for her at this point?

squatting

A nurse is caring for a laboring woman who is in transition. Which of the following signs/symptoms would indicate that the woman is progressing into the second stage of labor? Select all that apply. 1. Bulging perineum. 2. Increased bloody show. 3. Spontaneous rupture of the membranes. 4. Uncontrollable urge to push. 5. Inability to breathe through contractions.

1. Bulging perineum. 2. Increased bloody show. 4. Uncontrollable urge to push.

Which of the following nonpharmacological interventions recommended by nurse midwives may help a client at full term to go into labor? Select all that apply. 1.Engage in sexual intercourse. 2.Ingest evening primrose oil. 3.Perform yoga exercises. 4.Eat raw spinach. 5.Massage the breast and nipples.

1.Engage in sexual intercourse. 2.Ingest evening primrose oil 5.Massage the breast and nipples.

A client in labor, G2 P1001, was admitted 1 hour ago at 2 cm dilated and 50% effaced. She was talkative and excited at that time. During the past 10 minutes she has become serious, closing her eyes and breathing rapidly with each contraction. Which of the following is an accurate nursing assessment of the situation? 1. The client had poor childbirth education prior to labor. 2. The client is exhibiting an expected behavior for labor. 3. The client is becoming hypoxic and hypercapnic. 4. The client needs her alpha-fetoprotein levels checked.

2. The client is exhibiting an expected behavior for labor.

The nurse is assessing a client who states, "I think I'm in labor." Which of the fol-lowing findings would positively confirm the client's belief? 1.She is contracting q 5 minx60 sec. 2.Her cervix has dilated from 2 to 4 cm. 3.Her membranes have ruptured. 4.The fetal head is engaged

2.Her cervix has dilated from 2 to 4 cm.

A 35-year old gravida 1, para 0 is admitted to the labor and delivery unit. She reports intense rectal pressure. Which stage of labor is probable?

2nd stage

The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse concludes that the fetus is likely in which of the following positions? 1. Mentum anterior. 2. Sacrum posterior. 3. Occiput posterior. 4. Scapula anterior.

3. Occiput posterior.

A woman who states that she "thinks" she is in labor enters the labor suite. Which of the following assessments will provide the nurse with the most valuable information regarding the client's labor status? 1. Leopold maneuvers. 2. Fundal contractility. 3. Fetal heart assessment. 4. Vaginal examination.

4. Vaginal examination.

A woman, 40 weeks' gestation, calls the labor unit to see whether or not she should go to hospital to be evaluated. Which of the following statements by the woman indicates that she is probably in labor and should proceed to the hospital? 1."The contractions are 5 to 20 minutes apart." 2."I saw a pink discharge on the toilet tissue when I went to the bathroom." 3."I have had cramping for the past 3 or 4 hours." 4."The contractions are about a minute long and I am unable to talk through them."

4."The contractions are about a minute long and I am unable to talk through them."

To care for a laboring woman adequately, the nurse understands that the __________ stage of labor varies the most in length? a. First c. Third b. Second d. Fourth

First

Which factors influence cervical dilation (Select all that apply) a. Strong uterine contractions b. The force of the presenting fetal part against the cervix c. The size of the female pelvis d. The pressure applied by the amniotic sac e. Scarring of the cervix

a. Strong uterine contractions b. The force of the presenting fetal part against the cervix d. The pressure applied by the amniotic sac e. Scarring of the cervix

Which description of the four stages of labor is correct for both definition and duration? a. First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours b. Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours c. Third state: active pushing to birth; 20 minutes (multiparous women), 50 minutes (first-timer) d. Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour

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

What is an essential part of nursing care for the laboring woman? a. Helping the woman manage the pain b. Eliminating the pain associated with labor c. Sharing personal experiences regarding labor and delivery to decrease her anxiety d. Feeling comfortable with the predictable nature of intrapartum care

a. Helping the woman manage the pain

Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory? a. Massaging the woman's back b. Changing the woman's position c. Giving the prescribed medication d. Encouraging the woman to rest between contractions

a. Massaging the woman's back

A woman in active labor receives an analgesic opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease? a. Meperidine (Demerol) c.Butorphanol tartrate (Stadol) b.Promethazine (Phenergan) d.Nalbuphine (Nubain)

a. Meperidine (Demerol)

With regard to nerve block analgesia and anesthesia, nurses should be aware that: a. Most local agents are related chemically to cocaine and end in the suffix -caine. b.Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once. c.A pudendal nerve block is designed to relieve the pain from uterine contractions. d.A pudendal nerve block, if done correctly, does not significantly lessen the bearing-down reflex.

a. Most local agents are related chemically to cocaine and end in the suffix -caine.

In relation to primary and secondary powers, the maternity nurse comprehends that: a. Primary powers are responsible for effacement and dilation of the cervix. b. Effacement generally is well ahead of dilation in women giving birth for the first time; they are closer together in subsequent pregnancies. c. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. d. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.

a. Primary powers are responsible for effacement and dilation of the cervix.

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is: a. Respiratory depression. c. Acrocyanosis. b. Bradycardia. d. Tachypnea.

a. Respiratory depression.

Nurses should be aware of the differences experience can make in labor pain such as: a. Sensory pain for nulliparous women often is greater than for multiparous women during early labor. b. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. c. Women with a history of substance abuse experience more pain during labor. d. Multiparous women have more fatigue from labor and therefore experience more pain.

a. Sensory pain for nulliparous women often is greater than for multiparous women during early labor.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. The nurse concludes that: a. The placenta has separated. b. A cervical tear occurred during the birth. c. The woman is beginning to hemorrhage. d. Clots have formed in the upper uterine segment

a. The placenta has separated.

To help clients manage discomfort and pain during labor, nurses should be aware that: a. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. b. Referred pain is the extreme discomfort between contractions. c. The somatic pain of the second stage of labor is more generalized and related to fatigue. d. Pain during the third stage is a somewhat milder version of the second stage.

a. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.

With regard to spinal and epidural (block) anesthesia, nurses should know that: a. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births. b. A high incidence of after-birth headache is seen with spinal blocks. c. Epidural blocks allow the woman to move freely. d. Spinal and epidural blocks are never used together.

b. A high incidence of after-birth headache is seen with spinal blocks.

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called: a. An epidural. c. A local. b. A pudendal. d. A spinal block.

b. A pudendal.

The role of the nurse with regard to informed consent is to: a. Inform the client about the procedure and have her sign the consent form b. Act as a client advocate and help clarify the procedure and the options. c. Call the physician to see the client. d. Witness the signing of the consent form.

b. Act as a client advocate and help clarify the procedure and the options.

A patient whose cervix is dilated to 5 cm is considered to be in which phase of labor? a. Latent phase c. Second stage b. Active phase d. Third stage

b. Active phase

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? a. Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours c. Lull: No contractions; dilation stable; duration of 20 to 60 minutes d. Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2 hours

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

Concerning the third stage of labor, nurses should be aware that: a. The placenta eventually detaches itself from a flaccid uterus. b. An expectant or active approach to managing this stage of labor reduces the risk of complications. c. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface. d. The major risk for women during the third stage is a rapid heart rate.

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

To teach patients about the process of labor adequately, the nurse knows that which event is the best indicator of true labor? a. Bloody show c. Fetal descent into the pelvic inlet b. Cervical dilation and effacement d. Uterine contractions every 7 minutes

b. Cervical dilation and effacement

With regard to systemic analgesics administered during labor, nurses should be aware that: a. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. b. Effects on the fetus and newborn can include decreased alertness and delayed sucking. c. Intramuscular administration (IM) is preferred over intravenous (IV) administration. d. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

b. Effects on the fetus and newborn can include decreased alertness and delayed sucking.

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: a. First stage, latent phase. c. First stage, transition phase. b. First stage, active phase. d. Second stage, latent phase.

b. First stage, active phase.

To assist the woman after delivery of the infant, the nurse knows that the blood patch is used after spinal anesthesia to relieve: a. Hypotension. c. Neonatal respiratory depression. b. Headache. d. Loss of movement.

b. Headache.

If an opioid antagonist is administered to a laboring woman, she should be told that: a. Her pain will decrease. b. Her pain will return. c. She will feel less anxious. d. She will no longer feel the urge to push.

b. Her pain will return.

It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care. The nurse can explain that a major advantage of nonpharmacologic pain management is: a. Greater and more complete pain relief is possible. b. No side effects or risks to the fetus are involved. c. The woman remains fully alert at all times. d. A more rapid labor is likely.

b. No side effects or risks to the fetus are involved.

The nurse has received report regarding her patient in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and ?2-2. The nurse's interpretation of this assessment is that: a. The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm above the ischial spines . b. The cervix is 3 cm dilated, it is effaced 30%, and the presenting part is 2 cm above the ischial spines. c. The cervix is effaced 3 cm, it is dilated 30%, and the presenting part is 2 cm below the ischial spines. d. The cervix is dilated 3 cm, it is effaced 30%, and the presenting part is 2 cm below the ischial spines.

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

Nurses alert to signs of the onset of the second stage of labor can be certain that this stage has begun when: a. The woman has a sudden episode of vomiting. b. The nurse is unable to feel the cervix during a vaginal examination. c. Bloody show increases. d. The woman involuntarily bears down.

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

The primary difference between the labor of a nullipara and that of a multipara is the: a. Amount of cervical dilation. c. Level of pain experienced . b. Total duration of labor . d. Sequence of labor mechanisms.

b. Total duration of labor.

The primary difference between the labor of a nullipara and that of a multipara is the: a. Amount of cervical dilation. c. Level of pain experienced. b. Total duration of labor. d. Sequence of labor mechanisms.

b. Total duration of labor.

The nurse has just performed a sterile vaginal examination on her patient and reports the examination as 4 cm, 50%, -1. What does this represent?

dilation, effacement, and station

A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. The nurse's initial response would be to: a. Prepare the woman for imminent birth. b. Notify the woman's primary health care provider. c. Document the characteristics of the fluid. d. Assess the fetal heart rate and pattern.

d. Assess the fetal heart rate and pattern.

Which method of pain management is safest for a gravida 3 para 2 admitted at 8 cm cervical dilation? a. Epidural anesthesia c. Spinal block b. Narcotics d. Breathing and relaxation techniques

d. Breathing and relaxation techniques

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: a. Admitted and prepared for a cesarean birth. b. Admitted for extended observation. c. Discharged home with a sedative. d. Discharged home to await the onset of true labor.

d. Discharged home to await the onset of true labor.

The nurse who performs vaginal examinations to assess a woman's progress in labor should: a. Perform an examination at least once every hour during the active phase of labor. b. Perform the examination with the woman in the supine position. c. Wear two clean gloves for each examination. d. Discuss the findings with the woman and her partner.

d. Discuss the findings with the woman and her partner.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: a. Notify the woman's physician. b. Tell the woman to slow the pace of her breathing. c. Administer oxygen via a mask or nasal cannula. d. Help her breathe into a paper bag

d. Help her breathe into a paper bag

If a woman complains of back labor pain, the nurse could best suggest that she: a. Lie on her back for a while with her knees bent. b. Do less walking around. c. Take some deep, cleansing breaths. d. Lean over a birth ball with her knees on the floor.

d. Lean over a birth ball with her knees on the floor.

Which statement correctly describes the effects of various pain factors? a. Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth. b. Upright positions in labor increase the pain factor because they cause greater fatigue. c. Women who move around trying different positions are experiencing more pain. d. Levels of pain-mitigating b-endorphins are higher during a spontaneous, natural childbirth.

d. Levels of pain-mitigating b-endorphins are higher during a spontaneous, natural childbirth.

Which basic type of pelvis includes the correct description and percentage of occurrence in women? a. Gynecoid: classic female; heart shaped; 75% b. Android: resembling the male; wider oval; 15% c. Anthropoid: resembling the ape; narrower; 10% d. Platypelloid: flattened, wide, shallow; 3%

d. Platypelloid: flattened, wide, shallow; 3%gynecoid - 50% andriod - 23% anthropoid - 24%platypelloid - 3%

An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, "My contractions are so strong that I don't know what to do with myself." The nurse should: a. Assess for fetal well-being. b. Encourage the woman to lie on her side. c. Disturb the woman as little as possible. d. Recognize that pain is personalized for each individual.

d. Recognize that pain is personalized for each individual.

In order to evaluate the condition of the patient accurately during labor, the nurse should be aware that: a. The woman's blood pressure will increase during contractions and fall back to prelabor normal between contractions. b. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. c. Having the woman point her toes will reduce leg cramps. d. The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

d. The endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.

A new mother asks the nurse when the "soft spot" on her son's head will go away. The nurse's answer is based on the knowledge that the anterior fontanel closes after birth by _____ months. a. 2 c. 12 b. 8 d. 18

d.18

A patient sustained a third degree perineal laceration during a vaginal delivery. Which is this associated with?

extension through involving the anal sphincter