OB Chapter 14:Nursing Management during Labor and Birth Part 1

Following the birth, the nurse is responsible for assessing the cord pH. The nurse recognizes that which value would be considered a normal pH? 1) 7.2 2) 7.4 3) 6.8 4) 7.0

7.2 Explanation: Umbilical cord blood acid-base analysis is considered the most reliable indication of fetal oxygenation and acid-base condition at birth. The normal mean pH value range is 7.2 to 7.3.

A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first? 1) Determine if the client is in true or false labor. 2) Ask if this is the client's first pregnancy. 3) Notify the healthcare provider. 4) Assess to see if the client has any drug allergies.

Determine if the client is in true or false labor. Explanation: When a nurse first comes in contact with a pregnant client, it is important to first ascertain whether the woman is in true or false labor. Information regarding the number of pregnancies or history of drug allergy is not important criteria for admitting the client. The healthcare provider should be notified once the nurse knows the client's current status.

A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure? 1) To prevent supine hypotension syndrome 2) To aid the woman as she pushes during labor 3) To prevent the woman from falling out of bed 4) To decrease the heart rate of the fetus

To prevent supine hypotension syndrome Explanation: The term "rhythm strip testing" means assessment of the fetal heart rate for whether a good baseline rate and long- and short-term variability are present. For this, help a woman into a semi-Fowler's position (either in a comfortable lounge chair or on an examining table or bed with an elevated backrest) to prevent her uterus from compressing the vena cava and causing supine hypotension syndrome during the test. Placing her in this position does not decrease the heart rate of the fetus. It is not done to aid the woman as she pushes in labor, as she is not in labor yet. It is not done to prevent her from falling out of bed.

Which intervention would be least effective in caring for a woman who is in the transition phase of labor? 1) urging her to focus on one contraction at a time 2) encouraging the woman to ambulate 3) having the client breathe with contractions 4) providing one-to-one support

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

The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? 1) fetal position 2) fetal blood pH 3) external electronic fetal monitoring 4) fetal oxygen saturation

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

A woman presents in advanced labor, and birth appears imminent. What is the most important and appropriate aspect of admission for this woman? 1) taking her blood pressure and determining whether clonus or edema is present 2) assessing her use of drugs, alcohol, and tobacco during pregnancy 3) determining her plans for the newborn 4) obtaining a comprehensive obstetric and medical- surgical history

taking her blood pressure and determining whether clonus or edema is present Explanation: In advanced labor the most important assessments must be completed first. The assessment for signs or symptoms of preeclampsia must be assessed first. The history can be obtained after the birth of the baby or if labor slows down. Plans for the newborn can be figured out later. Blood tests can be run as soon as a sample can be taken from the mother.

The laboring client is on continuous fetal monitoring when the nurse notes a decrease in the fetal heart rate with variable deceleration to 75 bpm. What is the initial nursing intervention? 1) Change the position of the client. 2) Administer oxygen. 3) Notify the primary care provider. 4) Increase her IV fluids.

Change the position of the client. Explanation: Variable decelerations often indicate a type of cord compression. The initial response is to change the position and try to release the cord compression. If this does not work, apply oxygen while using the call light to alert others. If this continues, her fluid status needs to be assessed before increasing her IV rate

The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor? 1) Diffuse abdominal pain signals a complication with progression of labor. 2) It is reported as the worst pain a woman will ever feel. 3) Pain originates from the cervix and lower uterine segment. 4) Pain is focal in nature.

Pain originates from the cervix and lower uterine segment. Explanation: Pain sensations associated with labor originate from different places depending on the stage of labor. During the first stage of labor, the stretching required to efface and dilate the cervix stimulates pain receptors in the cervix and lower uterine segment.

If the monitor pattern of uteroplacental insufficiency were present, which action would the nurse do first? 1) Administer oxygen at 3 to 4 L by nasal cannula. 2) Help the woman to sit up in a semi-Fowler's position. 3) Ask her to pant with the next contraction. 4) Turn her or ask her to turn to her side.

Turn her or ask her to turn to her side. Explanation: Turn her or ask her to turn to her side.

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor? 1) a shallow deceleration occurring with the beginning of contractions 2) variable decelerations, too unpredictable to count 3) fetal baseline rate increasing at least 5 mm Hg with contractions 4) fetal heart rate declining late with contractions and remaining depressed

fetal heart rate declining late with contractions and remaining depressed Explanation: Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction.

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? 1) FHR fluctuates less than 5 beats per minute. 2) FHR fluctuation range is undetectable. 3) FHR fluctuates over 25 beats per minute. 4) FHR fluctuates from 6 to 25 beats per minute.

FHR fluctuates from 6 to 25 beats per minute. Explanation: Variability is described in four categories: absent, fluctuations range undetectable; minimal, fluctuations range observed at <5 beats per minute; moderate (normal), fluctuation range from 6 to 25 beats per minute; and marked, fluctuation range >25 beats per minute.

The laboring client who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? 1) This would cause fetal depression in utero. 2) This may prolong labor and increase complications. 3) The effects would wear off before birth. 4) This can lead to maternal hypertension.

This may prolong labor and increase complications. Explanation: Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The client should be offered nonpharmacologic options at this point until she is in active labor.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: 1) bloody show. 2) engagement of fetus. 3) dilatation of cervix. 4) rupture of amniotic membranes.

dilatation of cervix Explanation: The best determination of effective contractions is dilation of the cervix. Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.

To assess the frequency of a woman's labor contractions, the nurse would time: 1) the beginning of one contraction to the beginning of the next. 2) the end of one contraction to the beginning of the next. 3) the interval between the acme of two consecutive contractions. 4) how many contractions occur in 5 minutes.

the beginning of one contraction to the beginning of the next. Explanation: Measuring from the beginning of one contraction to the next marks the time between contractions.

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is: 1) 7.21. 2) 7.15 or less. 3) 7.25 or more. 4) 7.20.

7.15 or less. Explanation: In the hypoxic fetus, the pH will fall below 7.2, which is indicative of fetal distress.

A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? 1) Inhale slowly through nose and exhale through pursed lips. 2) Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. 3) Punctuated breathing by a forceful exhalation through pursed lips every few breaths. 4) Hold breath for 5 seconds after every 3 breaths.

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

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? 1) The client is more sensitive to preanesthetic medications. 2) Neonatal depression is possible. 3) Fetal hypersensitivity to anesthetic is possible. 4) The client is less sensitive to inhalation anesthetics.

Neonatal depression is possible. Explanation: General anesthesia is not used frequently in obstetrics because of the risks involved. The pregnant woman is at higher risk for aspiration. It requires more skill to intubate a pregnant woman because of physiologic changes in the trachea and thorax. In addition, general anesthetic agents cross the placenta and can result in the birth of a severely depressed neonate who requires full resuscitation.

A client has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help the client relax? 1) The client's anxiety will increase her blood pressure, increasing her risk with an epidural. 2) This is the time at which the nurse must establish that she is in control; she will be taking care of the client and the client needs to trust the nurse. 3) The client's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus. 4) The client needs to sleep now so that she can save her energy for the later stages of labor.

The client's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus. Explanation: Anxiety out of control can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and have a negative impact on the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural. It is premature to be stern with the client. While it is preferable that she save her energy, it is not damaging to her or to the fetus if she does not sleep.

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? 1) excessive contractions of the uterus 2) passage of the drug to the fetus 3) headache following anesthesia 4) increased frequency of micturition

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

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? 1) early decelerations 2) variable decelerations 3) accelerations 4) prolonged decelerations

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