OB Chapter 7 NCLEX ?

The nurse would coach the laboring woman with a fully dilated cervix to push by saying:

"At the beginning of a contraction, take two deep breaths and push with the second exhalation." Rationale: When the cervix is fully dilated, the woman should take a deep breath and exhale at the beginning of a contraction, then take another deep breath and push while exhaling.

A woman requests a pudendal block to manage her labor pain. The nurse realizes that the woman needs further explanation about the pudendal block when she says:

"I'm having a contraction. Can I get the pudendal block now?"

The nurse coaches the primigravida not to bear down until the cervix is completely dilated because premature bearing down can cause:

Cervical laceration

A narcotic antagonist used to reverse narcotic-induced respiratory depression is:

Naloxone (Narcan)

A nurse instructs a woman's labor coach to comfort her by firmly pressing on her lower back. This technique is called:

Sacral pressure

A potential adverse effect of pudendal block is:

Vaginal hematoma

The nurse who is instructing a Lamaze class on abdominal breathing tells a patient that because her baseline respiratory rate is 22, her rate while performing slow breathing should be no lower than:

10

When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. The nurse is aware that the factor that would be a contraindication to an epidural block is:

A low platelet count

The nurse observes on the fetal monitor a pattern of a 15-beat increase in the fetal heart rate that lasts 15 to 20 seconds. The nurse knows that this pattern is indicative of:

A well-oxygenated fetus Rationale: Accelerations in the fetal heart rate suggest that the fetus is well oxygenated.

5. Several hours into labor, a woman complains of blurred vision, numbness, and tingling of her hands and mouth. The nurse recognizes these as symptoms of:

Hyperventilation

Which technique is likely to be most effective for "back labor?"

Applying firm pressure in the sacral area

While teaching the child birth preparation class, the nurse explains to the class that labor pains:

Are influenced by cultural factions

The most important nursing activity during the fourth stage of labor is to:

Assess for hemorrhage Rationale: Immediately after giving birth, every woman is assessed for signs of hemorrhage.

What is the most important nursing assessment immediately after a woman receives an epidural block?

Blood Pressure

A woman who is 6 cm dilated has the urge to push. The nurse would instruct the woman to:

Blow in short breaths during the contraction

The childbirth method that was originally called "husband-coached childbirth" and was the first to include the father as an integral part of labor is called:

Bradley

A registered nurse who has advanced training in anesthetic administration is known as:

Certified Registered Nurse Anesthetist

One hour postdelivery the nurse notes the new mother has saturated three perineal pads. The nurse should

Check the fundus for position and firmness Rationale: Increased lochia may indicate hemorrhage. The fundus should be assessed for firmness. One pad an hour is an acceptable rate for immediate postdelivery.

What is a blood patch and when is it used?

Correct Answer(s): A blood patch is a procedure performed by the nurse anesthetist or anesthesiologist. The patient's blood (10 to 15 mL) is withdrawn from her vein and injected into the epidural space in the area of the subarachnoid puncture. The blood clots and forms a gelatinous seal that stops spinal fluid leakage. The clot later breaks down and is reabsorbed by the body. It is done to provide relief from postspinal headache.

Under what conditions would an epidural block not be used?

Correct Answer(s): An epidural block is not used if the woman has any of the following: abnormal blood clotting, an infection in the area of injection or a systemic infection, and hypovolemia.

Why are there limitations of pharmacological methods of pain management in the birthing process?

Correct Answer(s): Any drug given to the mother can affect the fetus, and the effects may be prolonged in the infant after birth. The drug may directly affect the fetus, or it may indirectly affect the fetus because of effects in the mother. Also, several pharmacological methods may slow labor's progress if used early in labor.

How does childbirth pain differ from other types of pain?

Correct Answer(s): Childbirth pain is part of a normal birth process; the woman has several months to prepare for pain management, and it is self-limiting and rapidly declines after birth.

Identify the important admission assessments related to pharmacological pain management.

Correct Answer(s): Important admission assessments include the time and type of last oral intake, adverse reactions to drugs especially dental anesthetics, other medications taken, and any food or latex allergies.

Why do laboring women often tolerate more pain than they would otherwise?

Correct Answer(s): Laboring women often tolerate more pain than usual because they have high levels of endorphins and are concerned about the infant's well-being.

List and describe the types of anesthesia for childbirth.

Correct Answer(s): Local infiltration: injection of the perineum with a local anesthetic just before vaginal birth. Pudendal block: injection of pudendal nerves with a local anesthetic just before vaginal birth. Epidural block: injection of a local anesthetic into the epidural space, which blocks the transmission of pain impulses to the brain. Subarachnoid (spinal) block: injection of a local anesthetic under the dura and arachnoid membranes to block transmission of pain impulses to the brain. It is used primarily for cesarean birth. General anesthesia: uses a combination of intravenous and inhalational drugs to produce a loss of consciousness, and it is rarely used for vaginal births.

Explain the difference between pain threshold and pain tolerance.

Correct Answer(s): Pain threshold, or the perception of pain, is the least amount of sensation that a person perceives as painful. Pain threshold is fairly constant, and it varies little under different conditions. Pain tolerance is the amount of pain one is willing to endure. Unlike the pain threshold, one's pain tolerance can change under different conditions.

What topics would you expect to cover in a childbirth preparation class?

Correct Answer(s): The topics in a childbirth preparation class may include changes of pregnancy, fetal development, prenatal care, hazardous substances to avoid, good nutrition, relieving common discomforts of pregnancy, working during pregnancy and parenthood, coping with labor and delivery, infant care, and early growth and development.

Describe the positioning of the woman and the administration of a subarachnoid (spinal) block.

Correct Answer(s): The woman's position for a subarachnoid block is similar to that for the epidural block except her back is curled around her uterus in a C shape. The dura is punctured with a thin (25- to 27-gauge) spinal needle. A local anesthetic is then injected. A much smaller amount of the drug is needed to achieve anesthesia using the subarachnoid block than with the epidural block.

The nurse, while caring for a woman in the first stage of labor, reminds the patient that contractions during this stage of labor:

Dilate and efface the cervix Rationale: The first stage of labor describes the time from the onset of labor until full dilation of the cervix.

To comfort a woman who is tensing her muscles with contractions, the nurse would guide the labor coach to:

Direct the patient in progressive relaxation

Which are nonpharmacological forms of pain control? Select all that apply.

Diversion Breathing techniques Effleurage Sacral pressure

The nurse recognizes the contraction duration and interval that could result in fetal compromise is:

Duration longer than 90 seconds, interval shorter than 60 seconds Rationale: Persistent contraction durations longer than 90 seconds or contraction intervals less than 60 seconds many reduce fetal oxygen supply

Chemical substance produced in the body that act as natural pain relievers are:

Endorphins

Spinal headache after epidural anesthesia may be relieved by?

Epidural injection of a blood patch at the puncture site

The nurse explains that the third stage of labor ends with:

Expulsion of the placenta and membranes Rationale: The third stage of labor extends from the birth of the infant until the placenta is detached and expelled.

When the infant is in a vertex presentation, meconium-stained amniotic fluid indicates:

Fetal Distress Rationale: Green-stained amniotic fluid means that the fetus passed the first stool before birth and is an indicator of fetal compromise.

It is determined that the presenting part of the fetus is the buttocks. At delivery the fetus's hips are flexed and the knees are extended. The nurse would record this presentation as:

Frank breech Rationale: When a fetus presents in a frank breech position, the legs are flexed at the hips and extend toward the shoulders.

The appropriate nursing action to take when a laboring woman hyperventilates is to:

Help her breathe into her cupped hands

A woman is 7 cm dilated and her contractions are 3 minutes apart. When she begins cursing at her birthing coach and the nurse, the nurse assesses the most likely explanation for the woman's change in behavior is that:

Labor has progressed to the transition phase. Rationale: If a woman suddenly loses control and becomes irritable, suspect that she has progressed to the transition stage of labor.

A woman received a subarachnoid block before delivery. In order to prevent the associated side effect of this type of anesthesia, the nurse would include in the teaching plan that the patient should:

Lie flat on her back for several hours.

A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for the associated side effect of:

Marked hypotension

The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management?

Massage

The initial nursing action immediately after an epidural block is initiated for a laboring woman would be to

Measure the woman's blood pressure

Spinal headache after epidural anesthesia may be relieved by?

Meperidine

An 18-year-ld primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care. She had no childbirth preparation. She is crying loudly and shouting, "Please give me something for the pain. I can't take the pain." What is the priority nursing diagnosis?

Pain related to uterine contractions

To relieve perineal bruising and edema following delivery the nurse should:

Place an ice pack on the area for 12 hours. Rationale: An ice pack can be placed on the mother's perineum to reduce bruising and edema for 12 hours followed by a warm pack after the first 12 to 24 hours following delivery.

During the fourth stage of labor, the nurse encourages the mother to void, because a full bladder may:

Predispose the mother to uterine hemorrhage Rationale: A full bladder immediately after birth can cause excessive bleeding because it pushes the uterus upward and interferes with contractions.

The nurse explains that the function of contractions during the second stage of labor is to:

Push the baby out of the mother's body Rationale: The contractions push the baby out the mother's body as the second stage of labor ends with the birth of the baby.

At a prenatal visit, a primigravida asks the nurse how she will know her labor has started. The nurse instructs the woman that the beginning of true labor is indicated by:

Regular contractions becoming more frequent and intense Rationale: In true labor, contractions gradually develop a regular pattern and become more frequent, longer, and more intense

The nurse explains that the Dick-Read method of childbirth preparation is based on:

Relaxation techniques

While caring for a laboring woman, the nurse notices a pattern of variable decelerations in the fetal heart rate with uterine contractions. The nurse's initial action is:

Reposition the woman to her side Rationale: Repositioning the woman is the first response to a pattern of variable decelerations. If the decelerations continue, then oxygen should be administered and/or the flow rate of oxygen should be increased.

A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. The nurse explains that giving a narcotic analgesic medication at this stage of labor will:

Results in respiratory depression to the newborn

When the nurse observes the patient bearing down with contractions and crying out, "The baby is coming!" the nurse should:

Stay with the woman and use the call bell to get help Rationale: If birth appears to be imminent, the nurse should not leave the woman and should summon help with the call bell

The relaxation phase between contractions is important because:

The contractions can interfere with fetal oxygenation Rationale: Blood flow from the mother into the placenta gradually decreases during contractions. During the interval between contractions, the placenta refills with oxygenated blood for the fetus

The nurse measures the frequency of a laboring woman's contractions by noting:

The time between the beginning of once contraction and the beginning of the next Rationale: The frequency of contractions is the elapsed time from the beginning of one contraction to be the beginning of the next contraction

While discussing labor and delivery during a prenatal visit, a primigravida asks the nurse when she should go to the hospital. The nurse's most informative response would be that the woman should come when she:

Thinks her membranes has ruptured Rationale: Ruptured membranes are an indication that the woman should go to the hospital or birthing center.

Vaginal examination reveals the presenting part is the infant's head, which is well flexed on his/her chest. This presentation is referred to as:

Vertex Rationale: In the vertex presentation, the fetal head is the presenting part. The head is fully flexed on the chest.

After the physician discussed general anesthesia with a woman in labor, the nurse determines the woman understood the explanation when she says food and fluids are restricted for several hours prior to delivery to prevent:

Vomiting and aspiration

The release of ______________ during labor may explain why women often need smaller doses of an analgesic or anesthetic than might be expected in a similarly painful experience.

endorphins

What drug should be immediately available for emergency use when a woman receives narcotics during labor?

naloxone (Narcan