OB test 2
Which statement, if made by the laboring client, most likely indicates that the client is in the second stage of labor? 1."I feel like I need to push." 2."My contractions seem to be getting stronger." 3."I am glad that I have several minutes to rest between contractions." 4."Warm fluid is running down my legs each time I have a contraction."
1."I feel like I need to push." Rationale: The second stage of labor begins when the cervix is completely dilated and ends with birth of the infant. At this time, the laboring woman typically experiences the desire to push. Contractions becoming stronger are experienced throughout labor and do not indicate that she has reached stage 2. Having several minutes to rest between contractions does not describe the end of transition. Leaking of amniotic fluid does not mean that she is completely dilated.
A nonstress test is performed on a client who is pregnant, and the results of the test indicate nonreactive findings. The primary health care provider prescribes a contraction stress test, and the results are documented as negative. How should the nurse document this finding? 1.A normal test result 2.An abnormal test result 3.A high risk for fetal demise 4.The need for a cesarean section
1.A normal test result
The nurse should make which statement to a pregnant client found to have a gynecoid pelvis? 1."Your type of pelvis has a narrow pubic arch." 2."Your type of pelvis is the most favorable for labor and birth." 3."Your type of pelvis is a wide pelvis, but it has a short diameter." 4."You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery."
2."Your type of pelvis is the most favorable for labor and birth."
After the spontaneous rupture of a laboring woman's membranes, the fetal heart rate drops to 85 beats/minute. Which should be the nurse's priority action? 1.Reposition the laboring woman to knee-chest. 2.Assess the vagina and cervix with a gloved hand. 3.Notify the primary health care provider of the need for an amnioinfusion. 4.Document the description of the fetal bradycardia in the nursing notes.
2.Assess the vagina and cervix with a gloved hand Rationale: It is most common to see an umbilical cord prolapsed directly after the rupture of membranes, when gravity washes the cord in front of the presenting part. A cord prolapse can be evidenced by fetal bradycardia with variable decelerations occurring with uterine contractions. Because the fetal heart rate became bradycardic immediately following the spontaneous rupture of the client's membranes, the nurse's initial action should be to glove the examining hand and insert 2 fingers into the vagina to assess for the presence of a prolapsed cord and then to relieve compression of the cord by exerting upward pressure on the presenting part. Repositioning the woman to a knee-chest position is a correct intervention for prolapsed cord, but confirmation of the prolapsed cord and relieving compression is the first intervention that should be implemented; therefore, option 1 can be eliminated. An amnioinfusion may be used to minimize the effects of cord compression in utero, not a prolapsed cord, so option 3 can be eliminated. Although documentation of this occurrence is important, it is not the priority in this situation, so option 4 can also be eliminated
Which purposes of placental functioning should the nurse include in a prenatal class? Select all that apply. 1.It cushions and protects the baby. 2.It maintains the temperature of the baby. 3.It is the way the baby gets food and oxygen. 4.It prevents all antibodies and viruses from passing to the baby. 5.It provides an exchange of nutrients and waste products between the mother and developing fetus.
3.It is the way the baby gets food and oxygen. 5.It provides an exchange of nutrients and waste products between the mother and developing fetus.
The nurse is caring for a client in labor. Which assessment findings indicate to the nurse that the client is beginning the second stage of labor? Select all that apply. 1.The contractions are regular. 2.The membranes have ruptured. 3.The cervix is dilated completely. 4.The client begins to expel clear vaginal fluid. 5.The spontaneous urge to push is initiated from perineal pressure.
3.The cervix is dilated completely. 5.The spontaneous urge to push is initiated from perineal pressure.
