ob Chapter 8 & 9

What should the nurse's best response be to help the patient remain calm and cooperative during delivery?

The baby is coming. I'll explain what's happening and guide you

What is the primary role of the nurse in pain management for a nurse working with labor patients?

Work with the labor patient to plan pain management options

Opiods are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request?

"Pain medication given now might cause the baby to have slow respirations and is not recommended, lets try to focus and breathe."

A woman is documented on the labor and delivery board to be 7cm dilated. Her family wants to know how long she will be in labor. The nurse should provide which information to the family?

"She is in active labor, she is progressing at this point and we will keep you posted."

A patient, 38 weeks gestation, pregnant with her first child calls the clinic and states "my baby is lower and it is more difficult to walk" and ask if she should come to the hospital to be checked. How should the nurse respond?

"The baby has dropped into the pelvis, this is called lightening, your body and baby are getting ready for labor in the next few weeks."

The patient is having a routine prenatal visit and asks the nurse what the childbirth education teacher meant when she used the term zero station. What is the best response by the nurse?

"The presenting part is at the true pelvis and is engaged."

After administration of epidural anesthesia during labor, the patient develops a temperature of 100.1F. The patient's husband is asking if she is "getting sick". How should the nurse respond to the patient and her husband?

"This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour."

In a woman who measures 13 centimeters from the symphysis pubis to the sacral promontory, what would you estimate the obstetric conjugate to measure?

11 centimeters

A pregnant woman, multipara, has been in labor for several hours. She cries out that her contractions are getting harder and that she can't do this. The patient is really irritable, nauseated, annoyed, and fearful of being left alone. Considering the client's behavior, the nurse would expect the cervix to be dilated how many centimeters?

8-10

The nurse instructs the client about skin massage and the gate control theory of pain. Which of the following statements would be appropriate for the nurse to include for patient understanding of the nonpharmacological pain relief methods?

A technique to prevent the painful stimuli from entering the brain

Susan is in labor with her second child. She knows that she will want epidural anesthesia and she has already signed her consent form. What must the nurse do before Susan receives the epidural?

Administer a fluid bolus through the IV line to reduce the risk of hypotension

Jennifer has just received IV sedation. What must the nurse tell Jennifer to do?

Ambulate only with assistance from the nurse or caregiver

A patient of 41 weeks gestation has been in labor for 18 hours and the fetus is now showing signs of distress. The anesthesiologist has recommended a general anesthetic, the patient cannot have an epidural due to prior back surgery. The nurse should plan to administer which medication prior to taking the patient to the operating room?

Antacid

Marie, a 21-year-old first-time mother in the second stage of labor, has been moaning and screaming and generally vocal throughout her labor. Her husband is distraught seeing his wife this way and comes to the nurse asking that his wife receive more pain medication. How should the nurse respond?

Ask Marie to describe the intensity of her pain on a scale of 0 to 10

The nurse should initially implement which intervention when a nulliparous woman telephones the hospital to report that she is in labor.

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

Betsy is recovering from a standard delivery. The nurse has just removed Betsy's epidural catheter and applied a sterile pressure dressing. What is it important for the nurse to do now?

Assess return of sensory and motor functions to the lower extremities

The labor patient is prepared for natural childbirth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacological pain management is this considered?

Attention focusing

Erin, a 19-year-old first-time mother in the second stage of labor who has been given an epidural, reports severe, unrelenting abdominal pain and rates it as 10 on a scale of 0 to 10. As the nurse, what should you do?

Call the obstetrician; severe unrelenting abdominal pain could indicate placental abruption, uterine rupture, or other undiagnosed complication.

A petite, 5-foot tall, 95-pound woman who is 28 years old is about to deliver her first child and would like to have a vaginal delivery. She has two sisters, both of whom have given birth vaginally. She has gained 25 pounds during a normal, uneventful pregnancy. What type of pelvis would a nurse expect this woman to have upon assessment of the patient?

Cannot be determined

Your patient, a 29-year-old woman, was driven to the hospital after awakening with labor pains at 5:30 AM. She has not eaten since dinner the night before, which was at 5:00 PM. She has a gynecoid pelvis, and this will be her fourth child; the first three were delivered vaginally. It is now 9:00 AM. and she is 80 percent effaced and dilated 3 centimeters. What nourishment would you allow her upon request ?

Clear liquids but no solid food

Which of the following would be the best way the nurse can facilitate an effective birth plan for the patient to achieve adequate pain relief?

Client priorities and preferences are incorporated into the plan

When documenting the fetus is at "zero station", the nurse knows this is where in relation to the pelvic structure?

Pelvic Crest

At 37 weeks gestation a patient calls the labor and delivery floor and thinks she is in labor. What statement should the nurse recognize as an assessment finding for true labor?

Contraction, regular and lasting longer and stronger

A woman is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain?

Counter pressure against the sacrum

An infant, who was ROA in labor, has delivered and noted to have edema on his scalp along with ecchymosis. How does the nurse explain this to the parents?

Ecchymosis with edema on the scalp is where the infant was pushed out of the canal

13. The patient is G1 P0, in the second stage of labor and is at 2+ station and in anticipation of delivery within the hour. Her epidural did not work and she is begging for Demerol. Which is the most appropriate action by the nurse?

Encourage her through the contractions and explain not giving the Demerol

The initial descent of the fetus into the pelvis to zero station is which one of the cardinal movements of labor?

Engagement

The RN in labor and delivery documents the fetus as ROA. To what does this documentation refer for a fetus?

Fetal position

A new OB/GYN physician has just finished evaluating her one hundredth patient. In reviewing the documentation from all patients thus far, which types of pelvis would you assume the physician has seen the most and the least?

Gynecoid and platypelloid, respectively

You are preparing an injection of a narcotic to relieve a pregnant woman's pain. As you are about to give it, she asks you for a bedpan because she has to move her bowels. Your best action would be to

Hold the injection until you evaluate her labor progress

4. During which part of the birth process does the cardiac output increase to 80 percent above the pre-labor level?

Immediately after birth

If a fetus is in an ROA position during labor, you would interpret this to mean the fetus is

In a longitudinal lie facing the left posterior

The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist?

Inability to push

At which time during a woman's labor might the nurse assist with a pudendal block?

Just before delivery

The nurse is working with a patient in labor. She is happy and cheerful, and states she is "ready to see her baby." What stage or phase of labor would she anticipate the patient to be in right now?

Latent Phase

Newer methods of pain control are under investigation, one under study is the use of intradermal water injection. Where is the water injected for pain control in a labor patient?

Lower back

The following are nursing measures commonly offered to women in labor. Which nursing intervention would probably be most effective in applying the gate control theory for relief of labor pain?

Massage for the woman's back

A 37-year-old woman in the final weeks of her first pregnancy visits the doctor's office for a scheduled check-up. What might a nurse note as a sign of labor in speaking with the woman prior to the examination?

Nesting

The patient is 5 cm dilated, 80 percent effaced, and 0 station. Her contractions are increasing to every 2-3 minutes, lasting 50 seconds. The client is increasingly uncomfortable. She is apprehensive but appropriate and focused on her breathing and relaxation. Select the most appropriate nursing diagnosis for the client.

Pain related to increasing frequency and intensity of contractions

The four essential components of labor are known as the "four P's". Which of the four P's involves the pelvis?

Passageway

Nancy has presented in the early phase of labor. She's experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage?

Practicing effleurage on the abdomen

A client you care for in labor asks you what causes labor to begin. Which of the following statements is a possible explanation?

Prostaglandins may be the causative factor of labor

A woman in labor at the hospital has just received an epidural block. Which intervention is priority before and during epidural placement?

Provide adequate IV fluids to maintain her blood pressure

A woman dilated to 10 centimeters and feeling the urge to "have a bowel movement" is refusing to push, she is screaming "it hurts down there too much to push." What is the option the nurse should suggest at this point for pain management to facilitate pushing?

Pudendal block

The physician is worried about the condition of the fetus during an unusually long labor for a 33-year-old woman. The fetal scalp pH is 7.26. What does this result say about the fetal status?

Reassuring; it is associated with normal acid-base balance.

Which phase of the involuntary uterine contraction pattern should the nurse be observing that is beneficial to the pH of the fetal scalp?

Relaxation

Sara 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 Sarah relax?

Sara's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus

A woman in latent labor for the past 12 hours is requesting medication to help her rest. What medication should the provider prescribe?

Secobarbital (Seconal)

In preparing for the actual birth, which fetal presentation would a nurse be least likely to find?

Shoulder

Which type of pain is always associated with the first stage of labor

Stretching of the cervix

Jane and her husband have attended childbirth preparation classes and they feel very hopeful and optimistic about having a natural childbirth. As Jane progresses to 8cm dilation, she can no longer endure the pain at the peak of each contraction and she begs the nurse for an epidural. How can the nurse best help Jane?

Support Jane's decision and call the obstetrician to discuss the epidural with Jane

A vaginal exam on a laboring woman is recorded by the nurse as 10 cm, 100 percent, and -1. Which of the following is the correct interpretation of this data to share with the patient?

The fetal descent is 1cm below the ischial spines

A pregnant woman calls her provider's office to report she thinks she is in labor. The patient reports contractions have been at these times: 12:05, 12:10, 12:15, and 12:20. What information is gathered based on this data?

The frequency of the contractions is every 5 minutes

Labor can be indicated by which of the following?

The patient complains of back pain and the cervix is effacing and dilating.

A post delivery CBC has noted an elevated WBC count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count ?

This is a normal variation due to stress of labor

19. The laboring patient who is at 3cm dilation and 25 percent effaced is asking for analgesia. The nurse explains the analgesia is usually not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice.

This may prolong labor and increase complications

The laboring patient is having contractions every 2-3 minutes, lasting 45-60 seconds and of strong intensity. The fetal head crowns when the client pushes. The cervix is completely dilated (10 centimeters) and 100 percent effaced. The nurse assesses the patient to be in what stage or phase of labor?

Transition

Which instructions should be given by the nurse to the patient in the second stage of labor to facilitate natural childbirth?

Use a squatting position and use the squat bar for support

Pain is multi-factorial for women in labor. Which of the following is a psychosocial influence for a woman in labor?

fear of pain during labor