210 OB Unit 5

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? Dilation less than 3 cm -2 station Cephalic presentation Right occiput posterior position

-2 station (The dilation of the cervix must be great enough to determine labor. The presenting part of the fetus should be engaged and well applied to the cervix before the procedure in order to prevent cord prolapse. Amniotomy is deferred if the presenting part is higher in the pelvis. ROP indicates a cephalic presentation, which is appropriate for an amniotomy.)

The least common cause of long, difficult, or abnormal labor (dystocia) is: Midplane contracture of the pelvis. Compromised bearing-down efforts as a result of pain medication. Disproportion of the pelvis. Low-lying placenta.

Disproportion of the pelvis. (The least common cause of dystocia is disproportion of the pelvis.)

A woman in labor and delivery is being given subcutaneous terbutaline for preterm labor. Which of the following common medication effects would the nurse expect to see in the mother? a. Serum potassium level increases b. Diarrhea c. Urticaria d. Complaints of nervousness

d. Complaints of nervousness (d. Complaints of nervousness are commonly made by women receiving subcutaneous beta agonists.)

When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to: maternal hyperthyroidism. initiation of epidural anesthesia that resulted in maternal hypotension. maternal infection accompanied by fever. alteration in maternal position from semirecumbent to lateral.

initiation of epidural anesthesia that resulted in maternal hypotension. (Hyperthyroidism would result in baseline tachycardia. Fetal bradycardia is the pattern described and results from the hypoxia that would occur when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. A maternal fever could cause fetal tachycardia. Assumption of a lateral position enhances placental perfusion and should result in a reassuring fetal heart rate (FHR) pattern.)

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's IMMEDIATE action would be to: change the woman's position. stop the Pitocin. elevate the woman's legs. administer oxygen via a tight mask at 8 to 10 L/min.

stop the Pitocin. (The woman is already in an appropriate position for uteroplacental perfusion. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic that stimulates the uterus to contract. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.)

Fetal well-being during labor is assessed by: the response of the fetal heart rate (FHR) to uterine contractions (UCs). maternal pain control. accelerations in the FHR. an FHR greater than 110 beats/min.

the response of the fetal heart rate (FHR) to uterine contractions (UCs). (Fetal well-being during labor can be measured by the response of fetal heart rate (FHR) to uterine contractions (UCs). In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.)

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information? "Because this is a repeat procedure, you are at the lowest risk for complications." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Because this is your second cesarean birth, you will recover faster." "You will not need preoperative teaching because this is your second cesarean birth."

"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." (This statement is not accurate. Maternal and fetal risks are associated with every cesarean section. This statement is the most appropriate. This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.)

A new client and her partner arrive on the labor, delivery, recovery, and postpartum unit for the birth of their first child. You apply the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. Your best response is: "Don't worry about that machine; that's my job." "The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor." "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are." "Your doctor will explain all of that later."

"The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor." ("The top line graphs the baby's heart rate. Generally the heart rate is between 110 and 160. The heart rate will fluctuate in response to what is happening during labor" educates the partner about fetal monitoring and provides support and information to alleviate his fears. "Don't worry about that machine; that's my job" discredits the partner's feelings and does not provide the teaching he is requesting. "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are" provides inaccurate information and does not address the partner's concerns about the fetal heart rate. The EFM graphs the frequency and duration of the contractions, not the intensity. Nurses should take every opportunity to provide client and family teaching, especially when information is requested.)

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate? "After the baby is born." "When we can stabilize your preterm labor and arrange home health visits." "Whenever the doctor says that it is okay." "It depends on what kind of insurance coverage you have."

"When we can stabilize your preterm labor and arrange home health visits." (The client's preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a woman with preterm labor is multifactorial; the goal is to prevent delivery. In many cases this may be achieved at home. Care of the preterm client is multidisciplinary and multifactorial. Managed care may dictate earlier hospital discharges or a shift from hospital to home care. Insurance coverage may be one factor in the care of clients, but ultimately client safety remains the most important factor.)

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: A gravida 3 who has had two low-segment transverse cesarean births. A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. A gravida 5 who had two vaginal births and two cesarean births. A gravida 4 who has had all cesarean births.

A gravida 4 who has had all cesarean births. (The risk of uterine rupture increases for the patient who has had multiple prior births with no vaginal births. As the number of prior uterine incisions increases, so does the risk for uterine rupture. Low-segment transverse cesarean scars do not predispose the patient to uterine rupture.)

During labor a fetus with an average heart rate of 135 beats/min over a 10-minute period would be considered to have: Bradycardia. Tachycardia. A normal baseline heart rate. Hypoxia.

A normal baseline heart rate. (The baseline heart rate is measured over 10 minutes; a normal range is 110 to 160 beats/min. Bradycardia is a fetal heart rate (FHR) below 110 beats/min for 10 minutes or longer. Tachycardia is an FHR over 160 beats/min for 10 minutes or longer. Hypoxia is an inadequate supply of oxygen; no indication of this condition exists with a baseline heart rate in the normal range.)

The nurse caring for the laboring woman should understand that early decelerations are caused by: Altered fetal cerebral blood flow. Uteroplacental insufficiency. Umbilical cord compression. Spontaneous rupture of membranes.

Altered fetal cerebral blood flow. (Early decelerations are the fetus's response to fetal head compression. Variable decelerations are associated with umbilical cord compression. Late decelerations are associated with uteroplacental insufficiency. Spontaneous rupture of membranes has no bearing on the fetal heart rate unless the umbilical cord prolapses, which would result in variable or prolonged bradycardia.)

The nurse providing care for the laboring woman comprehends that accelerations with fetal movement: Are reassuring. Are caused by umbilical cord compression. Warrant close observation. Are caused by uteroplacental insufficiency.

Are reassuring. (Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being. Umbilical cord compression results in variable decelerations in the FHR. Accelerations in the FHR are an indication of fetal well-being and do not warrant close observation. Uteroplacental insufficiency would result in late decelerations in the FHR.)

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? Prolonged latent phase Arrest of active phase Protracted active phase Protracted descent

Arrest of active phase (With an arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.)

The priority nursing intervention after an amniotomy should be to: Assess the color of the amniotic fluid. Change the patient's gown. Estimate the amount of amniotic fluid. Assess the fetal heart rate.

Assess the fetal heart rate. (The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Secondary to FHR assessment, amniotic fluid amount, color, odor, and consistency is assessed. Dry clothing is important for patient comfort; however, it is not the top priority.)

Immediately after the forceps-assisted birth of an infant, the nurse should: Assess the infant for signs of trauma. Give the infant prophylactic antibiotics. Apply a cold pack to the infant's scalp. Measure the circumference of the infant's head.

Assess the infant for signs of trauma. (The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would put the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.)

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? Assessing deep tendon reflexes (DTRs) Assessing for chest discomfort and palpitations Assessing for bradycardia Assessing for hypoglycemia

Assessing for chest discomfort and palpitations (Terbutaline is a β₂-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations. Assessing DTRs would not address these concerns. β₂-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.)

A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor. Orders include bedrest with continuous fetal monitoring, administration of magnesium sulfate (Sulfamag) and betamethasone (Celestone), and laboratory work. In reviewing the patient's record, the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia) and diet-controlled diabetes mellitus type 2. Which action by the nurse is best? A. Assist the woman to choose appropriate food items from the menu. B. Call the physician to question the orders and document the conversation. C. Order a pressure-relieving mattress overlay and perform a skin assessment. D. Prepare to give the magnesium sulfate and betamethasone as ordered.

B. Call the physician to question the orders and document the conversation. (The combination of nifedipine and magnesium sulfate can cause sudden cardiac death. The nurse should contact the health-care provider to question the orders. The nurse should also document all aspects of this communication clearly. The woman may or may not need assistance in choosing food items appropriate for her diabetes. All patients need a full skin assessment and, depending on how long bedrest is anticipated, a pressure-relieving mattress overlay might be appropriate. The nurse should not give the medications without further clarification.)

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: Change in position. Regional anesthesia. Oxytocin administration. Intravenous analgesic.

Change in position. (Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration, regional anesthesia, and intravenous analgesic may reduce maternal cardiac output.)

While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. The nurse's first priority is to: Change the woman's position. Assist with amnioinfusion. Notify the care provider. Insert a scalp electrode.

Change the woman's position. (Late decelerations may be caused by maternal supine hypotension syndrome. They usually are corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava. If the fetus does not respond to primary nursing interventions for late decelerations, the nurse would continue with subsequent intrauterine resuscitation measures, including notifying the care provider. An amnioinfusion may be used to relieve pressure on an umbilical cord that has not prolapsed. The FHR pattern associated with this situation most likely reveals variable deceleration. A fetal scalp electrode would provide accurate data for evaluating the well-being of the fetus; however, this is not a nursing intervention that would alleviate late decelerations, nor is it the nurse's first priority.)

A normal uterine activity pattern in labor is characterized by: Contractions every 2 to 5 minutes. Contractions lasting about 2 minutes. Contractions about 1 minute apart. A contraction intensity of about 1000 mm Hg with relaxation at 50 mm Hg.

Contractions every 2 to 5 minutes. (Contractions normally occur every 2 to 5 minutes and last less than 90 seconds (intensity 800 mm Hg) with about 30 seconds in between (20 mm Hg or less).)

In evaluating the effectiveness of oxytocin induction, the nurse would expect: Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. The intensity of contractions to be at least 110 to 130 mm Hg. Labor to progress at least 2 cm/hr dilation. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. (The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.)

Which deceleration of the fetal heart rate would not require the nurse to change the maternal position? Early decelerations Late decelerations Variable decelerations It is always a good idea to change the woman's position.

Early decelerations (Early decelerations (and accelerations) generally do not need any nursing intervention. Late decelerations suggest that the nurse should change the maternal position (lateral); variable decelerations also require a maternal position change (side to side). Although changing positions throughout labor is recommended, it is not required in response to early decelerations.)

Increasing the infusion rate of nonadditive intravenous fluids can increase fetal oxygenation primarily by: Maintaining normal maternal temperature. Preventing normal maternal hypoglycemia. Increasing the oxygen-carrying capacity of the maternal blood. Expanding maternal blood volume.

Expanding maternal blood volume. (Filling the mother's vascular system makes more blood available to perfuse the placenta and may correct hypotension. Increasing fluid volume may alter the maternal temperature only if she is dehydrated. Most intravenous fluids for laboring women are isotonic and do not provide extra glucose. Oxygen-carrying capacity is increased by adding more red blood cells.)

The most common cause of decreased variability in the fetal heart rate (FHR) that lasts 30 minutes or less is: Altered cerebral blood flow. Umbilical cord compression. Fetal hypoxemia. Fetal sleep cycles.

Fetal sleep cycles. (A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Fetal hypoxemia would be evidenced by tachycardia initially and then bradycardia. A persistent decrease or loss of FHR variability may be seen. Umbilical cord compression would result in variable decelerations in the FHR.)

Which statement is most likely to be associated with a breech presentation? Least common malpresentation Descent is rapid Diagnosis by ultrasound only High rate of neuromuscular disorders

High rate of neuromuscular disorders (Breech is the most common malpresentation affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound. Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus.)

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring? Select all that apply. History of preterm labor experience with a prior pregnancy. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm. Fetal heart rate of 150 beats/minute

History of preterm labor experience with a prior pregnancy. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm. (A significant risk factor for preterm birth is a preterm birth experience with a prior pregnancy. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Fetal heart rate is normal.)

As a perinatal nurse you realize that a fetal heart rate that is tachycardic, is bradycardic, or has late decelerations or loss of variability is nonreassuring and is associated with: Hypotension. Maternal drug use. Cord compression. Hypoxemia.

Hypoxemia. (Nonreassuring heart rate patterns are associated with fetal hypoxemia. Fetal bradycardia may be associated with maternal hypotension. Fetal variable decelerations are associated with cord compression. Maternal drug use is associated with fetal tachycardia.)

With regard to the process of augmentation of labor, the nurse should be aware that it: Is part of the active management of labor that is instituted when the labor process is unsatisfactory. Relies on more invasive methods when oxytocin and amniotomy have failed. Is a modern management term to cover up the negative connotations of forceps-assisted birth. Uses vacuum cups.

Is part of the active management of labor that is instituted when the labor process is unsatisfactory. (Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods. Forceps-assisted births and vacuum-assisted births are appropriately used at the end of labor and are not part of augmentation.)

The nurse providing care to a woman in labor should understand that cesarean birth: Is declining in frequency in the twenty-first century in the United States. Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients. Is performed primarily for the benefit of the fetus. Can be either elected or refused by women as their absolute legal right.

Is performed primarily for the benefit of the fetus. (The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States in this century. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.)

Nurses should be aware that the induction of labor: Can be achieved by external and internal version techniques. Is also known as a trial of labor (TOL). Is almost always done for medical reasons. Is rated for viability by a Bishop score.

Is rated for viability by a Bishop score. (Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.)

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: Ripening the cervix usually results in a decreased success rate for induction. Labor sometimes can be induced with balloon catheters or laminaria tents. Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. Amniotomy can be used to make the cervix more favorable for labor.

Labor sometimes can be induced with balloon catheters or laminaria tents. (Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.)

Which fetal heart rate (FHR) finding would concern the nurse during labor? Accelerations with fetal movement An average FHR of 126 beats/min Early decelerations Late decelerations

Late decelerations (Late decelerations are caused by uteroplacental insufficiency and are associated with fetal hypoxemia. They are considered ominous if persistent and uncorrected. Accelerations in the FHR are an indication of fetal well-being. Early decelerations in the FHR are associated with head compression as the fetus descends into the maternal pelvic outlet; they generally are not a concern during normal labor.)

What correctly matches the type of deceleration with its likely cause? Early deceleration—umbilical cord compression Late deceleration—uteroplacental inefficiency Variable deceleration—head compression Prolonged deceleration—cause unknown

Late deceleration—uteroplacental inefficiency (Late deceleration is caused by uteroplacental inefficiency. Early deceleration is caused by head compression. Variable deceleration is caused by umbilical cord compression. Prolonged deceleration has a variety of either benign or critical causes.)

A maternal indication for the use of vacuum extraction is: A wide pelvic outlet. A history of rapid deliveries. Maternal exhaustion. Failure to progress past 0 station.

Maternal exhaustion. (A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.)

The priority nursing care associated with an oxytocin (Pitocin) infusion is: Measuring urinary output. Increasing infusion rate every 30 minutes. Monitoring uterine response. Evaluating cervical dilation.

Monitoring uterine response. (Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is also important; however, it is not the top priority during the administration of Pitocin. The infusion rate may be increased after proper assessment that it is an appropriate interval to do so. Monitoring labor progression is the standard of care for all labor patients.)

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase intravenous (IV) fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? Notify nursery nurse of imminent delivery. Perform a straight cath at this time. Start oxytocin (Pitocin). Notify the primary health care provider immediately (HCP).

Notify the primary health care provider immediately (HCP). (Although delivery is a priority, notification of the nursery nurse is not the most important nursing measure at this time. The patient needs to be evaluated by the HCP immediately to determine whether delivery is warranted at this time. If the FHR were to continue in an abnormal or nonreassuring pattern, a cesarean section may be warranted. Performing a straight cath at this time would not be prudent as it is more likely that a foley catheter will have to be inserted if a cesarean section becomes the mode of delivery. Oxytocin may put additional stress on the fetus. To relieve an FHR deceleration, the nurse can reposition the mother, increase intravenous (IV) fluid, and provide oxygen. Also, if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.)

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? Fetal heart rate of 116 beats/min Cervix dilated 2 cm and 50% effaced Score of 8 on the biophysical profile One fetal movement noted in 1 hour of assessment by the mother

One fetal movement noted in 1 hour of assessment by the mother (A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. A score of 8 on the biophysical profile (BPP) is a normal finding in a 42-week gestation pregnancy. Self-care in a postterm pregnancy should include performing daily fetal kick counts 3 times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation.)

Which patient status is an acceptable indication for serial oxytocin induction of labor? Past 42 weeks' gestation Polyhydramnios Multiple fetuses History of long labors

Past 42 weeks' gestation (Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus and make induction of labor high risk. Polyhydramnios overdistends the uterus, again making induction of labor high risk. History of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.)

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? Place the woman in the knee-chest position. Cover the cord in a sterile towel saturated with warm normal saline. Prepare the woman for a cesarean birth. Start oxygen by face mask.

Place the woman in the knee-chest position. (A. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord.B. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although this is an appropriate intervention, relieving pressure on the cord is the nursing priority.C. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete. D. The nurse should administer O₂ by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.)

The baseline fetal heart rate (FHR) is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. This is likely to be caused by which physiologic alteration? (Select all that apply) Spontaneous fetal movement Compression of the fetal head Placental abruption Cord around the baby's neck Maternal supine hypotension

Placental abruption Maternal supine hypotension (Late decelerations are almost always caused by uteroplacental insufficiency. Insufficiency is caused by uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, IUGR, intraamniotic infection, or placental abruption. Spontaneous fetal movement, vaginal examination, fetal scalp stimulation, fetal reaction to external sounds, uterine contractions, fundal pressure and abdominal palpation are all likely to cause accelerations of the FHR. Early decelerations are most often the result of fetal head compression and may be caused by uterine contractions, fundal pressure, vaginal examination, and placement of an internal electrode. A variable deceleration is likely caused by umbilical cord compression. This may happen when the umbilical cord is around the baby's neck, arm, leg, or other body part or when there is a short cord, a knot in the cord, or a prolapsed cord.)

Which assessment is least likely to be associated with a breech presentation? Meconium-stained amniotic fluid Fetal heart tones heard at or above the maternal umbilicus Preterm labor and birth Post-term gestation

Post-term gestation (Post-term gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.)

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: The terms preterm birth and low birth weight can be used interchangeably. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. Low birth weight is anything below 3.7 pounds. In the United States early in this century, preterm birth accounted for 18% to 20% of all births.

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. (Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.)

In planning for home care of a woman with preterm labor, which concern must the nurse address? Nursing assessments will be different from those done in the hospital setting. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. Prolonged bed rest may cause negative physiologic effects. Home health care providers will be necessary.

Prolonged bed rest may cause negative physiologic effects. (Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.)

What three measures should the nurse implement to provide intrauterine resuscitation? Select the response that best indicates the priority of actions that should be taken. Call the provider, reposition the mother, and perform a vaginal examination. Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. Administer oxygen to the mother, increase IV fluid, and notify the care provider. Perform a vaginal examination, reposition the mother, and provide oxygen via face mask.

Reposition the mother, increase intravenous (IV) fluid, and provide oxygen via face mask. (Repositioning the mother, increasing intravenous (IV) fluid, and providing oxygen via face mask are correct nursing actions for intrauterine resuscitation. The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion. The second priority is to increase blood volume by increasing the IV fluid. The third priority is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. If these interventions do not resolve the fetal heart rate issue quickly, the primary provider should be notified immediately.)

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: Enhance uteroplacental perfusion in an aging placenta. Increase amniotic fluid volume. Ripen the cervix in preparation for labor induction. Stimulate the amniotic membranes to rupture.

Ripen the cervix in preparation for labor induction. (It is accurate to state that Prepidil will be administered to ripen the cervix in preparation for labor induction. It is not administered to enhance uteroplacental perfusion in an aging placenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.)

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include: (Select all that apply) Rupture of membranes at or near term. Convenience of the woman or her physician. Chorioamnionitis (inflammation of the amniotic sac). Post-term pregnancy. Fetal death.

Rupture of membranes at or near term. Chorioamnionitis (inflammation of the amniotic sac). Post-term pregnancy. Fetal death. (These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation.)

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: Fetus from a breech to a cephalic presentation before labor begins. Fetus from a transverse lie to a longitudinal lie before cesarean birth. Second twin from an oblique lie to a transverse lie before labor begins. Second twin from a transverse lie to a breech presentation during vaginal birth.

Second twin from a transverse lie to a breech presentation during vaginal birth. (Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.)

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? Urine output of 160 mL in 4 hours Deep tendon reflexes 2+ and no clonus Respiratory rate of 16 breaths/min Serum magnesium level of 10 mg/dL

Serum magnesium level of 10 mg/dL (The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.)

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? She is exhibiting hypotonic uterine dysfunction. She is experiencing a normal latent stage. She is exhibiting hypertonic uterine dysfunction. She is experiencing pelvic dystocia.

She is exhibiting hypertonic uterine dysfunction. (Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.)

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: Stimulate fetal surfactant production. Reduce maternal and fetal tachycardia associated with ritodrine administration. Suppress uterine contractions. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

Stimulate fetal surfactant production. (Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.)

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? Estriol is not found in maternal saliva. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. Fetal fibronectin is present in vaginal secretions. The cervix is effacing and dilated to 2 cm.

The cervix is effacing and dilated to 2 cm. (Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.)

With regard to the care management of preterm labor, nurses should be aware that: Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. Braxton Hicks contractions often signal the onset of preterm labor. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. (Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor.)

Before the physician performs an external version, the nurse should expect an order for a: Tocolytic drug. Local anesthetic. Contraction stress test (CST). Foley catheter.

Tocolytic drug. (A tocolytic drug will relax the uterus before and during version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. The bladder should be emptied; however, catheterization is not necessary.)

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? Amniotomy Transcervical catheter Intravenous Pitocin Vaginal insertion of prostaglandins

Transcervical catheter (Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.)

The nurse providing care for the laboring woman realizes that variable fetal heart rate (FHR) decelerations are caused by: Altered fetal cerebral blood flow. Uteroplacental insufficiency. Umbilical cord compression. Fetal hypoxemia.

Umbilical cord compression. (Variable decelerations can occur any time during the uterine contracting phase and are caused by compression of the umbilical cord. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Uteroplacental insufficiency would result in late decelerations in the FHR. Fetal hypoxemia would result in tachycardia initially and then bradycardia if hypoxia continues.)

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? Select all that apply. Unstable coronary artery disease Previous cesarean birth Placenta previa Initial blood pressure of 132/87 History of three spontaneous abortions

Unstable coronary artery disease Previous cesarean birth Placenta previa (Indications for cesarean birth include: maternal specific cardiac disease, (e.g., Marfan syndrome, unstable coronary artery disease) respiratory disease, (e.g., Guillain-Barré syndrome) conditions associated with increased intracranial pressure, mechanical obstruction of the lower uterine segment (tumors, fibroids) mechanical vulvar obstruction, (e.g., extensive condylomata) history of previous cesarean birth, fetal abnormal fetal heart rate (FHR) or pattern, malpresentation (e.g., breech or transverse lie) active maternal herpes lesions, maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL, congenital anomalies, maternal-fetal dysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor), placental abruption, placenta previa, and elective cesarean birth (cesarean on maternal request). The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth.)

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation? (Select all that apply) Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency Uterine tone <20 mm Hg Uterine tone >20 mm Hg Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency Uterine tone >20 mm Hg Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern (Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.)

Why is continuous electronic fetal monitoring usually used when oxytocin is administered? The mother may become hypotensive. Uteroplacental exchange may be compromised. Maternal fluid volume deficit may occur. Fetal chemoreceptors are stimulated.

Uteroplacental exchange may be compromised. (The uterus may contract more firmly, and the resting tone may be increased with oxytocin use. This response reduces entrance of freshly oxygenated maternal blood into the intervillous spaces, thus depleting fetal oxygen reserves. Hypotension is not a common side effect of oxytocin. All laboring women are at risk for fluid volume deficit; oxytocin administration does not increase the risk. Oxytocin affects the uterine muscles.)

The nurse caring for the woman in labor should understand that maternal hypotension can result in: Early decelerations. Uteroplacental insufficiency. Fetal dysrhythmias. Spontaneous rupture of membranes.

Uteroplacental insufficiency. (Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia. Maternal hypotension is not associated with early decelerations, fetal dysrhythmias, or spontaneous rupture of membranes.)

The nurse providing care for the laboring woman should understand that late fetal heart rate (FHR) decelerations are the result of: Altered cerebral blood flow. Uteroplacental insufficiency. Umbilical cord compression. Meconium fluid.

Uteroplacental insufficiency. (Uteroplacental insufficiency would result in late decelerations in the FHR. Altered fetal cerebral blood flow would result in early decelerations in the FHR. Umbilical cord compression would result in variable decelerations in the FHR. Meconium-stained fluid may or may not produce changes in the fetal heart rate, depending on the gestational age of the fetus and whether other causative factors associated with fetal distress are present.)

Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? FHR does not change as a result of fetal activity. Average baseline rate ranges between 100 and 140 beats/min. Mild late deceleration patterns occur with some contractions. Variability averages between 6 and 10 beats/min.

Variability averages between 6 and 10 beats/min. (Fetal heart rate (FHR) should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats/min. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings. Variability indicates a well oxygenated fetus with a functioning autonomic nervous system.)

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. Viral Cervical Periodontal Urinary tract

Viral (The infections that increase the risk of preterm labor and birth are all bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, it is important for the client to participate in early, continual, and comprehensive prenatal care. Evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent infection. Cervical infections of a bacterial nature have been linked to preterm labor and birth. The presence of urinary tract infections increases the risk of preterm labor and birth.)

With regard to dysfunctional labor, nurses should be aware that: Women who are underweight are more at risk. Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. Hypertonic uterine dysfunction is more common than hypotonic dysfunction. Abnormal labor patterns are most common in older women.

Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. (Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women less than 20 years of age.)

Complications and risks associated with cesarean births include: (Select all that apply) Placental abruption. Wound dehiscence. Hemorrhage. Urinary tract infections. Fetal injuries.

Wound dehiscence. Hemorrhage. Urinary tract infections. Fetal injuries. (Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section.)

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: uterine contractions occurring every 8 to 10 minutes a fetal heart rate (FHR) of 180 with absence of variability. the client needing to void. rupture of the client's amniotic membranes.

a fetal heart rate (FHR) of 180 with absence of variability. (The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. This fetal heart rate (FHR) is nonreassuring. The oxytocin should be immediately discontinued and the physician should be notified. This is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.)

The nurse is administering terbutaline (Brethine) to a pregnant woman to prevent preterm labor. The nurse would assess for which adverse effect? a. Maternal tachycardia b. Maternal hypertension c. Fetal bradycardia d. Fetal hypokalemia

a. Maternal tachycardia (Maternal tachycardia is the common negative side effect of terbutaline, which should be corrected with a dose of propranolol.)

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse would be to: assess the fetal heart rate (FHR) pattern. perform a vaginal examination. inspect the characteristics of the fluid. assess maternal temperature.

assess the fetal heart rate (FHR) pattern. (The first nursing action after the membranes are ruptured is to check fetal heart rate (FHR). Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). These are all important and should be done after the FHR and pattern are assessed.)

On review of a fetal monitor tracing, the nurse notes that for several contractions, the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: describe the finding in the nurse's notes. reposition the woman onto her side. call the physician for instructions. administer oxygen at 8 to 10 L/min with a tight face mask.

describe the finding in the nurse's notes. (An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix. These actions would be implemented when nonreassuring or ominous changes are noted.)

A nurse providing care to a woman in labor should be aware that a clinical indication for a cesarean birth: is preference of the mother who may not want to go through the labor experience. is a shorter recovery time compared with vaginal deliveries. is performed primarily for the benefit of the fetus and/or mother in the context of clinical conditions. is an alternative birth method option if there is increased pain experienced by the mother during labor.

is performed primarily for the benefit of the fetus and/or mother in the context of clinical conditions. (Clinical indication for a cesarean section is based on preventing complications that would impact either the fetus or the mother leading to adverse outcomes. Preference of the patient is not a clinical indication for this type of surgery. Recovery time is increased relative to vaginal delivery as a cesarean section is considered to be a major abdominal surgery. Increased pain is not a clinical indication for a cesarean section. Pain management can be implemented through various strategies including but not limited to nonpharmacologic and pharmacologic methods.)

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. there are no important maternal (as opposed to fetal) contraindications. its most important function is to afford the opportunity to administer antenatal glucocorticoids. if the client develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given.

its most important function is to afford the opportunity to administer antenatal glucocorticoids. (Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Administering intravenous fluids in the presence of pulmonary edema (regardless of origin) is contraindicated as it will lead to fluid overload.)

A woman is evaluated to be using an effective bearing-down effort if she: begins pushing as soon as she is told that her cervix is fully dilated and effaced. takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. uses the Valsalva maneuver by holding her breath and pushing vigorously for a count of 12. continues to push for short periods between uterine contractions throughout the second stage of labor.

takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. (Bearing-down efforts should begin during the active-descent phase of the second stage of labor when the urge to bear down (Fresno reflex) is perceived. Cleansing breaths at the onset of a contraction allow it to build to a peak before pushing begins. They also enhance gas exchange in the alveoli and help the woman relax after the uterine contraction subsides. Women should avoid closed-glottis pushing (Valsalva maneuver) since uteroplacental perfusion is usually reduced. Open-glottis pushing is recommended. The woman should push with contractions to combine the force of both powers of labor: uterine and abdominal. Pushing gently between contractions is only advised when the fetal head is being delivered.)

With regard to dysfunctional labor, nurses should be aware that: dysfunctional labor typically occurs in women who have a gynecoid pelvis. women who have dysfunctional labor are more likely to deliver via cesarean section. hypertonic uterine dysfunction is more common than hypotonic dysfunction. abnormal labor patterns are most common in older women.

women who have dysfunctional labor are more likely to deliver via cesarean section. (Dysfunctional labor is more likely to occur as a result of a structural (pelvic) abnormality. A gynecoid pelvis is considered to be a normal pelvic structure. Women who have dysfunctional labor are more likely to deliver via cesarean section as compared to vaginal delivery. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years of age.)