Test 3: IntraPartum Care

When educating a group of nursing students about the theories of onset of labor, the nurse identifies which factors as the possible causes for onset of labor? Select all that apply.

• release of oxytocin by the pituitary • increase in the fetal cortisol levels • prostaglandin production in the myometrium

A client is in the transitional phase of labor. Which findings would the nurse expect? Select all that apply.

• strong desire to push • irritability with restlessness

A primigravida is admitted to the labor-and-delivery suite for an elective induction with oxytocin. As the nurse caring for this client you know that one of the risks with oxytocin inductions is what?

Uterine hyperstimulation

Diagonal conjugate is

a measure of the pelvic inlet of the mother

Gynecoid pelvis

considered the true female pelvis and offers the optimal diameters in all three planes of the pelvic

A multigravid woman has been in labor for several hours and has dilated to 8 cm. Her fetal membranes have not yet ruptured and her contractions are not as strong as the birth attendant would like them to be. The decision is made to artificially rupture the woman's membranes. You are a new LPN/LVN on the unit. What is your role in this procedure?

Document fetal heart rate before and after the procedure

When reviewing the history of a woman in labor, the nurse notes that the client has a funnel-shaped pelvis. How would the nurse identify this pelvic shape?

Android

Major change during the third stage of labor

Placental separation

The nurse is assisting with a vaginal birth. The patient is fully dilated, 100% effaced and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus?

Shoulder dystocia

For which of the following fetal conditions is vaginal delivery contraindicated? Select all that apply.

• Hydrocephalus • Transverse lie

A nursing student is learning about fetal presentation. The nursing instructor realizes a need for further instruction when the student makes which of the following statements?

"Transverse lie is the same as when the fetal buttocks present to the birth canal."

Place the following events in order of occurrence for administration of spinal anesthesia before an elective primary cesarean delivery in a woman who is not in labor.

1. The woman enters the OR. 2. The nurse instructs the patient to sit and make a C-curve with her back. 3. The anesthesiologist cleanses the back. 4. Spinal anesthesia is administered. 5. The patient lies down on the delivery table, and a wedge is placed.

Assessment reveals that a woman's cervix is approximately 1 cm in length. The nurse would document this as:

50% effaced

When measuring the diagonal conjugate of a woman's pelvis, the distance between which of the following anatomic landmarks would be used?

Anterior surface of the sacral prominence and the anterior surface of the symphysis pubis

A woman has just entered the recovery room after cesarean birth of a baby weighing 9 lb 14 oz. She asks the nurse for a drink of water. The nurse notices that her pulse is 120 bpm and her blood pressure is 80/40. What should the nurse do first?

Assess the firmness of the fundus for involution) and the perineum for bleeding

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother?

Fetal lie

The obstetrician is examining a woman who is in early labor to determine the positioning of the fetus. The nurse knows that which of the following fetal attitudes would be the most advantageous for birth?

Head flexed forward so much that the chin touches the sternum A fetus in good attitude is in complete flexion: the spinal column is bowed forward, the head is flexed forward so much that the chin touches the sternum, the arms are flexed and folded on the chest, the thighs are flexed onto the abdomen, and the calves are pressed against the posterior aspect of the thighs.

A woman's body goes through many physiologic adaptations during the labor and delivery process. One of these adaptations is an increase in cardiac output. When is the cardiac output the highest?

Immediately after birth

It was once thought that an episiotomy made the birth less painful and healed faster than a spontaneous laceration of the perineum. Research has not shown these assumptions to be true. What is another finding in the research on episiotomies?

Increases risk of blood loss immediately after delivery

A woman is told she has an anthropoid pelvis. This means her pelvis:

Narrow transversely

When educating a group of nursing students about the different types of pelvis, the nurse describes one type as being flat, having a wider transverse diameter than anterior-posterior diameter, with ischial spines that are wide apart, and a short sacrum. The students are correct when they identify this description with which type?

Platypelloid

A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus?

ROA

The physician has just examined the patient and determined that she needs to have a cesarean section. He notifies the nurse that he will be doing a low cervical vertical incision into the uterus. The nurse knows that the physician has chosen this type of incision over the classical incision because the low cervical vertical incision:

Reduces the risk of uterine rupture *** ASK TEACHER: The incision in the low cervical vertical incision is smaller than a classical incision. The lower cervical vertical incision is more complicated to perform and has a higher risk of maternal injury. The lower cervical vertical incision reduces the risk of uterine rupture

A nurse is caring for a client in labor, who has been diagnosed with placental problems. Which of the following is indicative of placenta succenturiata?

Small accessory lobes develop in the membranes at a distance from the main placenta

The Bishop score is calculated using which factors?

The Bishop score is based on 5 factors: dilatation, cervical position, station, effacement, and cervical consistency.

A woman having a cesarean birth will have a low cervical incision. Which of the following would you cite as an advantage?

The skin incision will be just above her pubic hair.

A woman is in the second stage of labor and is crowning. Which diameter of the fetal skull, which is the smallest, should align with the anteroposterior diameter of the mother's pelvis, which is the narrowest diameter at the pelvic inlet?

Transverse (bipartietal)

Your patient is in active labor. You do a Leopold Manuever and notify the RN that there is a fetal malpresentation. The infant is in a breech position. The physician is notified and it is ascertained that the infant is in a frank breech presentation. What type of delivery does this presentation call for?

Vaginal delivery

There is much discussion in the medical community about vaginal birth after a cesarean delivery (VBAC). When a woman has had a previous emergency cesarean delivery, she is at high risk for a ruptured uterus. When is VBAC contraindicated? a) When a vertical abdominal incision has been made previously b) When a transverse abdominal incision has been made previously c) When a classical uterine incision has been made previously d) When a low cervical uterine incision has been made previously

When a classical uterine incision has been made previously

The anteroposterior diameter of the pelvis

a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet so the best presentation for birth is when the fetus presents a transverse (biparietal) diameter to this

Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client?

amniotic fluid embolism

A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage?

cervical dilation

When assisting with amniotomy, what is the LPN/LVN role?

document the fetal heart rate before and after the procedure. Notify the RN or birth attendant if the rate drops precipitously. Sometimes the birth attendant will ask for suprapubic or fundal pressure during the procedure.

major change during second stage of labor

fetal movement through the birth canal

Platypelloid Pelvis

flat pelvis has a shallow pelvic cavity that widens at the pelvic outlet

A nurse is teaching a group of nursing students about the mechanism of labor when the fetus is in a cephalic presentation. Given in random order are a series of events that take place in a cascade to finally deliver the baby. Arrange the series of events in the most likely sequence they occur.

flexion internal rotation extension restitution external rotation

The lethicin/sphingomyelin (L/S) ratio results indicate fetal lung maturity. What ratio results indicate lung maturity?

greater than 2

Android pelvis

is considered the male-shaped pelvis and is characterized by a funnel or heart shape.

This usual "fetal position" is advantageous for birth because

it helps a fetus present the smallest anteroposterior diameter of the skull to the pelvis and also because it puts the whole body into an ovoid shape, occupying the smallest space possible.

A nurse is reading a journal article about cesarean births and the indications for them. Place the indications for cesarean birth below in the proper sequence from most frequent to least frequent. All options must be used.

labor dystocia abnormal fetal heart rate tracing fetal malpresentation multiple gestation suspected macrosomia

The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding?

lie

Any presentation other than __________ or a slight variation of the fetal position or size increases the probability of dystocia.

occiput anterior

Anthropoid Pelvis

oval pelvic inlet and long sacrum, producing a deep pelvis that is wider front to back than side to side

A client in labor has been admitted to the labor and birth suite. The nurse assessing her notes that the fetus is in a cephalic presentation. Which description should the nurse identify by the term presentation?

part of the fetal body entering the maternal pelvis first

One of the theories about the onset of labor is the prostaglandin theory. While not being conclusively proven that the action of prostaglandins initiate labor, it is known that prostaglandins do play a role in labor. What is an action of prostaglandins?

softens cervix

The two most important diameters that can affect the birth process are

suboccipitobregmatic (approximately 9.5 cm at term) and the biparietal (approximately 9.25 cm at term) diameters.

In placenta circumvallata...

the membranes are folded back on the fetal surface of the placenta, exposing part of the umbilical cord. With a velamentous placenta, umbilical blood vessels course unprotected for long distances through the membranes to insert into the margin of the placenta.

Presentation is

the portion of the fetus that overlies the maternal pelvic inlet.

Attitude is

the relationship of the different fetal parts to one another

Position is

the relationship of the fetal denominator to the different sides of the maternal pelvis.

In a battledore placenta...

the umbilical cord inserts at the placental margin rather than in the center

In vasa previa,

the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.

A patient who comes to the emergency department states that she has not felt any fetal movement for several days. The physician who cannot hear a heartbeat suspects fetal death. Once fetal death is confirmed by ultrasound, the physician immediately induces labor. Why is it important in this case to induce labor as soon as possible?

to prevent coagulopathy

The national rise in cesarean birth can be attributed to what? Select all that apply

• Concerns about malpractice litigation • Increased incidence of multiple gestations • Increase in labor inductions • Increase in consumer demand for primary cesarean • Trend toward delivering breech presentations by cesarean

The nurse is monitoring the labor of a woman attempting a vaginal birth after cesarean (VBAC) delivery. The nurse correctly suspects a uterine rupture when which of the following occur? (Select all that apply.)

• Excessive maternal pain • Increased vaginal bleeding • Unrelenting uterine contraction • Signs of maternal shock

A nurse is conducting a class for a group of nurses new to the labor and birth unit about labor and the passage of the fetus through the birth canal. As part of the class, the nurse explains that specific diameters of the fetal skull can affect the birth process. Which diameter would the nurse identify as being most important? Select all that apply.

• Suboccipitobregmatic • Biparietal

A patient arrives at the birthing suite and tells the nurse that she is in labor. Which of the following should the nurse immediately assess at this time? (Select all that apply.)

• birth imminence • fetal status • risk factors • maternal status

A woman has been in labor for some time, but her membranes have not yet ruptured. Artificial rupture of membranes is being considered. Which assessment findings would support the decision to perform the procedure? Select all that apply.

• cervical dilation of 4 cm • fetal head at -2 station

A nurse is caring for a client in her third stage of labor. Which findings would the nurse assess as indicating placental separation? Select all that apply.

• fresh gushing of blood from the vagina • umbilical cord descending lower down • renewed bearing down efforts by client

The nursing instructor is teaching about cesarean birth and informs the students that the main reasons for this procedure include which of the following? (Select all that apply.)

• history of previous cesarean birth • fetal malpresentation • non-reassuring fetal status • labor dystocia

After teaching a pregnant client who is in her last weeks of pregnancy about the signs and symptoms of approaching labor, which signs or symptoms if identified by the client would indicate effective teaching? Select all that apply.

• lightening • bloody show • backache

A patient is admitted with a post-delivery date pregnancy. Her cervix is not ready so the nurse anticipates the cervix will have to be "ripened." Which methods are commonly used to do this? (Select all that apply.)

• membrane stripping • mechanical dilation • locally applied prostaglandins • artificial rupture of membranes • oxytocin induction

A patient whose labor is advancing informs the nurse that she does not want an episiotomy. The nurse should inform her that there are things that can minimize a need for episiotomy, such as which of the following? (Select all that apply.) You selected: • patience with the delivery process

• prenatal perineal massage • using natural pushing techniques • patience with the delivery process • delivering the fetal head between contractions • protecting the perineum immediately before birth