Ch 14: Nursing Management During Labor and Birth

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse? A) "The injection is given in the space outside the spinal cord." B) "An injury is unlikely because of expert professional care given." C) "I have never read or heard of this happening." D) "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem."

A) "The injection is given in the space outside the spinal cord." An epidural block, as the name implies, does not enter the spinal cord but only the epidural space outside the cord.

A primigravida, who is 1 cm dilated, is in early latent labor. She has expressed a desire to avoid epidural anesthesia and asks about nonpharmacologic options for pain relief as her labor progresses. How could the nurse appropriately respond? Select all that apply. A) "The tub usually is not recommended when you are at such an early stage because it can cause your labor to slow down. Let's talk about using the tub as your labor progresses." B) "If you haven't already practiced these techniques, meditation and imagery won't work." C) "I can show you some simple breathing exercises that can help you relax." D) "You may want to go for a walk now. When you come back, I'll show you how to use the birthing ball." E) "If you are already asking about pain relief at this point in labor, you will most likely end up with an epidural anyway."

A) "The tub usually is not recommended when you are at such an early stage because it can cause your labor to slow down. Let's talk about using the tub as your labor progresses." C) "I can show you some simple breathing exercises that can help you relax." D) "You may want to go for a walk now. When you come back, I'll show you how to use the birthing ball." Hydrotherapy may slow labor if used too early. Although it is often more beneficial for the client to have practiced meditation, imagery, or breathing exercises before presenting in labor, the nurse can teach a laboring client simple exercises when she presents in labor. Position changes and ambulation can help ease labor pains. A birthing ball helps the patient continue to change positions while her weight is partially supported.

A nurse is preparing a patient for rhythm strip testing. She places the woman into a semi-Fowler's position. What is the appropriate rationale for this measure? A) To prevent supine hypotension syndrome B) To aid the woman as she pushes during labor C) To prevent the woman from falling out of bed D) To decrease the heart rate of the fetus

A) To prevent supine hypotension syndrome The term "rhythm strip testing" means assessment of the fetal heart rate for whether a good baseline rate and long- and short-term variability are present. For this, help a woman into a semi-Fowler's position (either in a comfortable lounge chair or on an examining table or bed with an elevated backrest) to prevent her uterus from compressing the vena cava and causing supine hypotension syndrome during the test. Placing her in this position does not decrease the heart rate of the fetus. It is not done to aid the woman as she pushes in labor, as she is not in labor yet. It is not done to prevent her from falling out of bed.

The nurse is monitoring a client's uterine contractions. Which factors should the nurse assess to monitor uterine contraction? Select all that apply. A) uterine resting tone B) frequency of contractions C) change in blood pressure D) change in temperature E) intensity of contractions

A) uterine resting tone B) frequency of contractions E) intensity of contractions The nurse should assess the frequency of contractions, intensity of contractions, and uterine resting tone to monitor uterine contractions. Monitoring changes in temperature and blood pressure is part of the general physical examination and does not help to monitor uterine contraction.

While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? A) FHR fluctuates less than 5 beats per minute. B) FHR fluctuates over 25 beats per minute. C) FHR fluctuates from 6 to 25 beats per minute. D) FHR fluctuation range is undetectable.

C) FHR fluctuates from 6 to 25 beats per minute.

A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? A) Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. B) Hold breath for 5 seconds after every 3 breaths. C) Inhale slowly through nose and exhale through pursed lips. D) Punctuated breathing by a forceful exhalation through pursed lips every few breaths.

C) Inhale slowly through nose and exhale through pursed lips. For slow-paced breathing, the nurse should instruct the woman to inhale slowly through her nose and exhale through pursed lips. In shallow or modified-pace breathing, the woman should inhale and exhale through her mouth at a rate of 4 breaths every 5 seconds. In pattern-paced breathing, the breathing is punctuated every few breaths by a forceful exhalation through pursed lips. Holding the breath for 5 seconds after every three breaths is not recommended in any of the three levels of patterned breathing.

What is the most important thing a nurse can do during labor and birth to prevent maternal and fetal infection? A) Strictly follow universal precautions. B) Clean the woman's perineum with a Betadine scrub. C) Thoroughly wash the hands before and after client contact. D) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum.

C) Thoroughly wash the hands before and after client contact.

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client? A) administrating IV naloxone B) administrating IV ephedrine C) starting an IV and hanging IV fluids D) maintaining the client in a supine position

C) starting an IV and hanging IV fluids Prehydration with IV fluids helps to prevent the most common side effect of epidural anesthesia, which is hypotension (20%). If the client develops hypotension or respiratory depression, then IV ephedrine or IV naloxone, respectively, can be administered, but neither is preventative. Maintaining the client in a supine position is recommended for a spinal headache, which can be a side effect of epidural anesthesia but is not the most common side effect and is not preventative.

A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? A) Explain to the client that narcotics should only be administered an hour or less before birth. B) Agree with the client, and administer the drug immediately to keep the pain manageable. C) Refuse to administer narcotics because they can develop dependency in the client and the fetus. D) Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.

D) Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. The timing of administration of narcotics in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, narcotics are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as: A) short-term variability. B) fetal bradycardia. C) baseline variability. D) baseline FHR.

D) baseline FHR.