Ch 7 Davis Advantage Maternity Nursing

As you care for a laboring patient at 5 cm, between contractions she asks why her thighs hurt. What is your best response? "The radiating pain is passing from your lumbosacral area into your thighs and is called referred pain." "This is called referred pain. It's your contraction pain moving through your body and sometimes happens." "This is somatic pain and is caused by your body stretching to accommodate the baby." "You are going to hurt all over; that's why this is called labor."

"This is called referred pain. It's your contraction pain moving through your body and sometimes happens."

A new nurse on the floor is describing the need for internal fetal monitoring to the nurse educator during a simulation drill. Which of the following statements made by the new nurse indicates a need for further education? "I should request orders for internal monitoring if the FHR is nonreassuring." "Because of my patient's risk factors, I need an accurate measure of contraction intensity." "Internal monitors can be placed in my patient any time there is a concern for fetal well-being." "I'll need to assess my patient frequently for complications from placing internal monitoring because it is an invasive procedure."

"Internal monitors can be placed in my patient any time there is a concern for fetal well-being."

Cary has just delivered a healthy baby boy, and the midwife remains at the perineum to assess any damage that may have occurred. The nurse knows the patient has a 2nd-degree laceration when the midwife states which of the following to the patient? "You'll have several stitches on your perineum, but I don't have to place any near your rectum." "You'll have several stitches on your vulva." "You'll have several stitches between your vaginal opening and your rectum." "You'll have just one or two stitches right below your vaginal opening."

"You'll have several stitches on your perineum, but I don't have to place any near your rectum."

A common way to prevent maternal hypotension in a patient receiving an epidural is which of the following? Keep the patient NPO to avoid aspiration. Administer a bolus of IV fluids before epidural placement. Administer thiopental sodium to the patient as ordered. Administer dextrose fluid to ensure the patient doesn't become hypoglycemic, resulting in hypotension.

Administer a bolus of IV fluids before epidural placement.

Fetal presentation

Fetal part that leads through the birth canal first, cephalic, breech, or shoulder

Teresa's placenta has just been delivered and is putting her newborn to breast. What stage of labor is Teresa in? 4th stage 3rd stage 5th stage 2nd stage

4th stage

When assisting a hypotensive patient receiving an epidural, which of the following situations is the most concerning? A drop ≥ 20 mm Hg in blood pressure. Increased need for oxytocin in labor. A maternal shiver response. An inability to void leading to urinary catheterization.

A drop ≥ 20 mm Hg in blood pressure.

Shelley is a term G3P1102 who has been admitted to labor and delivery in labor. She's breathing deeply with her contractions with eyes closed. She's contracting every 3 to 6 minutes lasting 60 to 80 seconds. What stage and phase of labor is Shelley in? First stage, active phase First stage, latent phase Second stage Second stage, delivery phase

First stage, active phase

Heather, a term G2P1001, has been actively laboring and progressing through an unmedicated labor for the past 7 hours. She has remained calm and is using breathing techniques with her partner. After a particularly strong contraction, Heather begins to cry and states, "I just wants it done, I can't do much more, how much longer will it take?" What stage and phase of labor is Heather in? First stage, latent phase First stage, transition phase Second stage, active phase Third stage, fourth phase

First stage, transition phase

Anna is a patient who just ambulated to OB triage for labor assessment. She is a 37 week 5 day G3P0111. As the nurse working in triage, which of the following statements from Anna would indicate she should be evaluated? Select all that apply. "My contractions spaced out and got better when I walked in from the parking lot." "The bed was wet when I woke up this morning." "There was a pinkish, thick discharge on the toilet paper when I wiped this morning." "The baby has been playing soccer in there today!" "I feel like the baby is lower this week because I've been having to pee so much."

The bed was wet when I woke up this morning." "There was a pinkish, thick discharge on the toilet paper when I wiped this morning."

Describe onset of labor cervix and uterus

The cervix softens or ripens, the uterus becomes excitable and the muscles stretch

The urge to push will usually occur when the presenting part is at what station in the pelvis? -2 0 +2 +3

+3

Which of the following statements about electronic fetal monitoring (EFM) is not true? EFM has reduced the cesarean rate in healthy pregnancies since its introduction. EFM can indicate the beginning of the second stage of labor. EFM can indicate fetal sleep/wake cycles. EFM can indicate a tight nuchal cord (cord wrapped around the fetal neck).

EFM has reduced the cesarean rate in healthy pregnancies since its introduction.

S/S of impending labor

Energy spurt - Nesting phase True labor pains start in lower back and radiate to abdomen and becomes more intense with walking (false labor pain is relived by walking) Lightening occurs at the beginning of engagement Bloody show is when the cervical blood mixes with plug mucus and means labor will start in 24-48 hours Others: Braxton Hicks contractions, cervical ripening, and rupture of membranes

Marna is a term G3P1102 patient who was admitted to labor and delivery in active labor a few hours ago. Her NST in OB triage before admittance showed a FHR of 150 with moderate variability and an occasional early deceleration. Her contractions are lasting 40 to 60 seconds every 2 to 4 minutes. Her membranes ruptured 16 hours ago at home, and she didn't begin to contract until an hour ago. Otherwise, her labor has been uncomplicated. Why is the provider ordering continuous fetal monitoring and not intermittent auscultation for Marna? She has a history of a preterm delivery according to her GTPAL. FHR 150 with moderate variability and an occasional early deceleration. Her membranes ruptured 16 hours ago before the onset of labor. Her contractions are lasting 40 to 60 seconds every 2 to 4 minutes.

Her membranes ruptured 16 hours ago before the onset of labor.

Which nonpharmacological pain relief measure emphasizes mental and physical relaxation while promoting a sense of safety? Aromatherapy Hydrotherapy Hypnotherapy Biofeedback

Hypnotherapy

Which of the following statements are true about intermittent auscultation (IA)? IA results in fewer cesarean sections. Documentation is required hourly through delivery. IA allows for increased freedom of movement. IA should be started right after a uterine contraction has ended. IA requires 1:1 care.

IA results in fewer cesarean sections. IA allows for increased freedom of movement. IA should be started right after a uterine contraction has ended. IA requires 1:1 care.

Teasha is 38 weeks 4 days and is in the office for a routine checkup. She tells the provider she's been breathing easier, but now her feet are starting to swell and she woke up with a leg cramp this morning. What normal physiological finding is Teasha experiencing? Lightening Braxton Hicks Nesting Pre-eclampsia

Lightening

Position

Location of a fixed reference point on the fetal presenting part in relation to a specific quadrant of maternal pelvis Best quadrant for birth is ROA (right occiput-anterior)

The baseline FHR on a patient on admittance was 130 to 140 with moderate variability. Over the course of the last 5 hours, the FHR has risen to a baseline of 155 to 170. What does this most likely indicate? Uterine tachysystole Supine Hypotension Maternal dehydration Maternal infection

Maternal infection

Marcella is a G3P2002 who has arrived at the hospital in active labor at 38 weeks 2 days. FHTs are 145, she's contracting every 3 to 5 minutes, and she is rating her contraction pain at a 6 on a scale of 1 to 10. On sterile vaginal exam, her cervix is dilated to 6 cm, effaced 80%, the infant is at +1 station, and the position is RSA. With this information, what orders should you anticipate next? Admit to labor and delivery on intermittent auscultation, place an IV, collect type and screen, and a CBC. Pitocin at the bedside for immediate postpartum IV administration. Obtain an NST and discharge home. She is in latent labor and should be educated on when to return to the unit once labor is well established. Admit to labor and delivery, place an IV, collect type and screen, and a CBC. Notify the OR team of the need for a cesarean section. Admit to labor and delivery for an emergent cesarean section, place an IV, collect a type and cross with 2 units of PRBC on standby, and notify the NICU of the delivery of an infant in distress.

Admit to labor and delivery, place an IV, collect type and screen, and a CBC. Notify the OR team of the need for a cesarean section.

Which of the following statements about labor and delivery are true? Select all that apply. Every labor and delivery is different. Once labor starts, the uterus does not completely relax again until after delivery. If the fetus is not in a favorable position, the provider may attempt to turn them externally. True labor can be defined as cervical change. Spontaneous rupture of membranes (SROM) does not occur until the fetus is about to be delivered.

Every labor and delivery is different. If the fetus is not in a favorable position, the provider may attempt to turn them externally. True labor can be defined as cervical change.

Once the infant reaches +4 station, it is at what maternal landmark? The ischial spines At the pelvic inlet At the pelvic outlet The maternal pelvis

At the pelvic outlet

When taking a medical history for a newly admitted patient in labor, which of the following statements or questions is phrased appropriately? Drugs are very bad for you and your baby; tell us how much you did. Did you do any drugs while you were pregnant? Can you tell me about any medications or drugs you took during your pregnancy and how much? I can't give you any pain medicine until you tell me what drugs you are on.

Can you tell me about any medications or drugs you took during your pregnancy and how much?

While assessing the tracing of a term laboring patient on continuous fetal monitoring, the nurse notes the fetal heart rate is 115 bpm with moderate variability. There are several early decelerations, along with a few accelerations that last 30 seconds and increase the heart rate by 20 bpm. What category of fetal heart tracing is this? Category I Category II Category III Category IIII

Category I

Julia, a G3P1011 at term, was admitted in active labor 6 hours ago. On admittance, she was dilated 5 cm, 70% effaced, and at 0 station. The nurse just checked her cervix and she was 7 cm, 80% effaced, and at 0 station. What is the suspected complication at this time? Cephalopelvic disproportion Breech presentation Uterine tachysystole Transition phase

Cephalopelvic disproportion

The nurse is palpating the uterus of a patient who has been in active labor for several hours. The nurse knows the contractions are of moderate intensity when they feel like a ______________. Nose Chin Forehead Cervix

Chin

Susan is 40 weeks 3 days pregnant and has come to OB triage for an assessment of labor. On the monitor, FHR is 145 with moderate variability, and contractions are every 2 to 3 minutes lasting 60 to 90 seconds. Her abdomen palpates as mild to moderate during contractions. Her cervix is 2 cm dilated, 50% effaced, and the fetus is at -2 station. Which part of this assessment is not an expected finding for this stage of labor? FHR 145 with moderate variability. Contractions every 2 to 3 minutes lasting 60 to 90 seconds. 2 cm dilated, 50% effaced, -2 station. Abdomen palpates as mild to moderate during contractions.

Contractions every 2 to 3 minutes lasting 60 to 90 seconds.

Place the maternal structures based on the cardinal movements of labor in the order in which they are reached. Levator ani muscles Pelvic floor and cervix Under the pubic symphysis Entering the maternal inlet

Entering the maternal inlet Pelvic floor and cervix Levator ani muscles Under the pubic symphysis

When counting contractions, which of the following is true? Frequency is counted from the beginning of one acceleration to the beginning of the next acceleration. Frequency is counted as the beginning of one contraction to the beginning of the next contraction. Frequency is counted as the end of one contraction to the end of the next contraction. Frequency is counted as the end of one contraction to the beginning of the next contraction.

Frequency is counted as the beginning of one contraction to the beginning of the next contraction.

Frequency, duration, and intensity definition

Frequency measured from beginning of one to beginning of the next Duration is from start of one to end of the same one Intensity is measured with uterine palpation and can be mild (nose) moderate (chin) or strong (forehead)

Benefits of delayed cord clamping include all of the following except what? Increased chance of maternal hemorrhage. Increased circulatory function in the preterm infant. Reduction in the risk of intraventricular hemorrhage. Increased chance of hyperbilirubinemia.

Increased chance of maternal hemorrhage.

Which of the following statements are true about postpartum administration of oxytocin? Select all that apply. It can be given IV or IM. If excessive blood loss is occurring, an additional 80 units may be given IV. It is administered to reduce bleeding at the perineum and for cervical lacerations. It will induce breast milk letdown. It can cause hypernatremia due to dehydration.

It can be given IV or IM. It will induce breast milk letdown.

The nurse knows if, while doing a vaginal exam, the fetus' occiput is located to the maternal anterior left, she will chart the position as which of the following? ROA LOP ROP LOA

LOA

Counterpressure over the sacral area will be most beneficial to which of the following patients? Sarah, at 9 cm an hour ago, who received her epidural 3 hours ago and is now feeling pressure and the urge to push. Madison, at 6 cm with her baby ROP, kneeling on her bed rating her pain as a 7 on a 1 to 10 scale during contractions and a 5/10 between them. Zina, at 4 cm with her baby LOA, ambulating and contracting every 4 to 8 minutes rating her pain as a 6 on a scale of 1 to 10 during contractions, and a 0/10 between them. Raida, at 3 cm with her baby LSA, who arrived in OB triage for labor evaluation rating her pain as a 5 on a scale of 1 to 10 with contractions, and 1/10 between them.

Madison, at 6 cm with her baby ROP, kneeling on her bed rating her pain as a 7 on a 1 to 10 scale during contractions and a 5/10 between them.

Aimee is a G1P001 at 38 weeks 3 days who has been in labor for 23 hours. She is now 7 cm dilated, 80% effaced, and the infant is at zero station. Over the last 2 hours, her strip has begun to resemble this FHR pattern. What orders should the nurse anticipate? (Strip has many decelerations) Orders for an emergency cesarean section. This is a normal labor pattern, and no new orders would be needed. Orders for an amnioinfusion. Orders to discontinue continuous EFM and begin IA so patient can ambulate.

Orders for an amnioinfusion. An amnioinfusion witll help to reduce the cord compression

5Ps and how they influence labor/birth

Powers (physiological forces of uterine contractions and maternal pushing efforts) The uterus contracts in three components: The increment -building of the contraction The acme - peak of the contraction The decrement - decrease in contraction In between contractions the uterus completely relaxes to give mom a break and give baby O2 flow Passageway (maternal pelvis and soft tissues) Passenger (fetus and placenta) Molding or overlapping of the cranial bones Passageway + Passenger and their relationship (engagement, attitude, position) Psychosocial influences (previous experiences, emotional status)

Mariah is in active labor and being continuously monitored. FHR is 120 with moderate variability and contractions every 3 to 5 minutes. The nurse also notes decelerations that begin and end with the contractions. What is the appropriate nursing action to address these decelerations? Turn the patient left lateral and apply oxygen via facemask at 10 L/min to improve the variability. Notify the provider the patient has a category III strip and needs an emergency cesarean section. Reassure the patient and her support persons that she and the baby are doing well. Perform full intrauterine resuscitation by turning patient to the side, applying oxygen at 8 to 10 L/min, bolusing 500 mL IV fluid, and stopping any oxytocin infusion.

Reassure the patient and her support persons that she and the baby are doing well.

Stacey is a new nurse on this unit but an experienced labor and delivery nurse. She just received a reprimand for placing internal fetal monitors on her patient, a task she performed routinely at her previous unit in another state but is only done by the provider on this unit. What should Stacey have done to prevent this reprimand? Informed her manager of her skill set. Shown the provider she knew what she was doing to then receive orders to place them in the future. Reviewed the institutional policies for differences in practice between her two places of work. Reviewed the institutional policies for differences between units to organize a change project for the institution.

Reviewed the institutional policies for differences in practice between her two places of work.

Syrah received an epidural an hour ago. Upon re-entering the room, the nurse notes that Syrah is sleeping soundly. Assessing her vitals, the nurse realizes Syrah is not sleeping soundly and may need Naloxone. What in her assessment findings would indicate this to the nurse? Syrah's blood pressure is 110/68 mm Hg, pulse is 63. Syrah's respiratory rate is 14, pain is a 0/10 on a scale of 1 to 10. Syrah's oxygen saturation is 88%, and respirations are 8. Syrah's oxygen saturation is 93% and pulse is 60.

Syrah's oxygen saturation is 88%, and respirations are 8.

The monitor in a laboring patient's room has shown a category II strip for the past hour. Variability has ranged between minimal and moderate with no accelerations and an occasional variable deceleration. In the past 15 minutes, subtle late decelerations have begun to appear repetitively, and the variability has remained minimal and at times absent. What should be assumed by this assessment? The fetus is compressing the cord. This fetus is about to deliver and is experiencing head compression. The fetus is experiencing uteroplacental insufficiency and possibly beginning to suffer hypoxemia. This fetus is in a sleep cycle, and the strip will resolve to a category I when it wakes up.

The fetus is experiencing uteroplacental insufficiency and possibly beginning to suffer hypoxemia.

A nurse is calling report to the provider of a patient who just came into OB triage actively laboring with delivery imminent. On the phone, the nurse states, "Erika Jones, a 26-year-old G5P3104, is in triage contracting every 2 to 3 minutes with a reactive NST. Her cervix is 9 cm dilated, 100% effaced, and the baby is ROA at +2 station. Her membranes are intact, and vital signs are all within normal limits. She's had a normal healthy pregnancy and is stating she needs to push." What priority information is missing from this report? The gestational age and EDD. The gender of the fetus. Who the support person is. The patient has requested an epidural.

The gestational age and EDD.

Which of the following are expected findings for a patient who has received an epidural? Select all that apply. The patient will be unable to walk for up to 24 hours after receiving an epidural. The patient may need help holding her legs and being directed when to push. The patient may develop intense pruritus. The patient may have a decrease in temperature immediately following the placement. Urinary retention and stress incontinence may occur immediately postpartum.

The patient may need help holding her legs and being directed when to push. The patient may develop intense pruritus. Urinary retention and stress incontinence may occur immediately postpartum.

Fetal attitude is _________________________. The relationship of fetal body parts to each other. The relationship of the fetal long axis, or spine, to the maternal long axis, or spine. The fetal part that that enters the birth canal first. The level of the presenting part in relation to the maternal pelvis.

The relationship of fetal body parts to each other.

A new nurse has placed a laboring patient on the external monitor for EFM. When the provider comes into the room and notes the location of the ultrasound transducer and the category I strip, they ask for the ultrasound machine and to contact the OR to prepare for a nonemergent cesarean section. What has the provider seen that would prompt this action? The patient's abdomen is too large to be able to deliver vaginally. The EFM strip is showing the fetus is in distress. The transducer is 1 cm below and to the right of the umbilicus. The transducer is 1 cm above and to the left of the umbilicus.

The transducer is 1 cm above and to the left of the umbilicus.

Engagement

Widest diameter of fetal presenting part has passed through the pelvic inlet

Station

level of presenting part in relation to maternal ischial spines -3 to +3

Fetal altitude

relation of fetal body parts to one another Usually flexion (fetal position)

Fetal lie

relationship of the long axis of the fetus to the long axis of the mother