Chapter 14: Preparing a Family for Childbirth and Parenting

25. A pregnant patient wants to use an alternative birthing center for the birth of her baby. Which information should the nurse provide the patient regarding this birthing approach? A) Birth is viewed as a wellness event. B) There are no physicians in attendance. C) Breastfeeding is not encouraged or supported. D) A birthing center has no advantages over a home birth.

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 310 Feedback: Alternative birthing centers are wellness-oriented childbirth facilities. These facilities are located near an acute care hospital in the event a physician is needed for the birthing process. Alternative birthing centers do not promote nor condone any specific action such as breastfeeding. Because a birthing center is located near a hospital, they are safer than home deliveries.

18. A pregnant patient tells the nurse about practicing different positions to use when labor begins. What should the nurse counsel the patient to avoid during these practice sessions? A) Pushing B) Bending over C) Pointing the toes D) Breathing normally

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 312 Feedback: Pregnant patients should not practice pushing during pregnancy because the possibility they could rupture membranes by doing this is too great. They can practice assuming a good position for pushing such as squatting, sitting upright, or leaning on a partner but should always be cautioned not to actually bear down and push. Bending over, pointing the toes, and breathing normally do not need to be avoided when practicing different positions to use when labor begins.

16. During prenatal classes, the nurse teaches pregnant patients how to perform pelvic rocking. What should the nurse explain to the class as being the purpose of this action? A) Helps to relieve backache B) Stretches perineal muscles C) Enhances respiratory excursion D) Improves abdominal muscle tone

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 314 Feedback: Pelvic rocking helps relieve backache during pregnancy and early labor by making the lumbar spine more flexible. This exercise does not stretch perineal muscles, enhance respiratory excursion, or improve abdominal muscle tone.

3. A nurse is teaching a pregnant woman how to perform Kegel exercises. The nurse determines that the teaching was effective based on which statement by the woman? A) "I'll squeeze my muscles around my vagina, as if I'm stopping my urine stream." B) "I should clasp my hands on my abdomen and push." C) "I need to tighten my perineal muscles and hold for 10 seconds." D) "I should tighten my abdominal muscles while whistling."

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 313 Feedback: Kegel exercises (tightening perineal muscles) are instrumental in preventing urinary incontinence following childbirth. They include starting and stopping a urine stream. The woman should squeeze the muscles surrounding the vagina as if stopping the flow of urine and hold for 3 seconds, not 10 seconds.

29. The nurse is assisting a pregnant patient learn gating control mechanisms to control pain during labor. Which techniques will the nurse teach the patient? (Select all that apply.) A) Distraction B) Reducing anxiety C) Receiving an epidural D) Cutaneous stimulation E) Use of patient-controlled analgesia

Ans: A, B, D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 315 Feedback: The gate control mechanisms of pain control are capable of halting an impulse at the level of the spinal cord so the impulse is never perceived at the brain level as pain. Techniques that can assist gating mechanisms are distraction, reduction of anxiety, and cutaneous stimulation. An epidural and use of patient-controlled analgesia are not techniques to assist the gating mechanism for pain control.

4. A woman wants to exercise during her pregnancy. After teaching the woman about maintaining safety when exercising, the nurse determines the need for additional teaching when the woman identifies which activity as appropriate to do? A) Pointing her toes while exercising. B) Engaging in pushing as an exercise. C) Using walking as an exercise. D) Performing abdominal strengthening exercises

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 318 Feedback: Women should not practice pushing during pregnancy or if in labor before the end of the first stage because the possibility they could rupture membranes by doing this is too great. They can practice assuming a good position for pushing (e.g., squatting, sitting upright, leaning on partner) but should always be cautioned not to actually bear down and push.

9. A woman is planning to take an expectant parents' class during pregnancy. Material you would expect her to learn in this type of course would include which of the following? A) Chest-breathing exercises to use in labor B) Beginning newborn care C) How to use a uterine monitor during labor D) Ways to use abdominal breathing

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Page: 311 Feedback: Expectant parents' classes are designed to teach about pregnancy as well as beginning child care.

28. The nurse reminds a patient in active labor to perform cleansing breaths. Why should the nurse encourage the patient to do this type of breathing? A) Ensures fetal perfusion B) Prevents hyperventilation C) Promotes hypoventilation D) Encourages cervical dilation

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 316 Feedback: Cleansing breaths are important because they limit the possibility of either hyperventilation or hypoventilation, both of which can happen with rapid breathing patterns. Cleansing breaths do not ensure fetal perfusion or promote cervical dilation.

11. A pregnant woman asks you about the advantages of an alternative birthing center. You would explain to her that A) no physicians will care for her. B) birth is viewed as a wellness event. C) she will not be encouraged to breastfeed her infant. D) a birthing center has no advantages over home birth.

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 321 Feedback: A birthing center admits only women who are at low risk for complications. At birthing centers, birth is viewed as a wellness event.

6. A pregnant woman has told you she is fearful of delivering in a hospital because of the possibility of infection. You would analyze her comment in relationship to which true statement below? A) Delivery at home avoids the possibility of infection for the mother or infant. B) Hospital births are conducted with more safeguards for sterility than home births tend to use. C) Hospitals today have eradicated nosocomial infections in nurseries. D) Since the turn of the century, hospitals have no longer worried about infection.

Ans: B Client Needs: Safe, Effective Care Environment: Safety and Infection Control Cognitive Level: Apply Page: 319 Feedback: The danger of infection is a great concern to hospitals. Maintaining standard precautions is a primary action to reduce this risk.

23. A pregnant patient enrolls in an expectant parents class during the second trimester of pregnancy. Which material should the nurse prepare to reinforce after these classes conclude? (Select all that apply.) A) Home safety B) The birth process C) Newborn nutrition D) Types of birth settings E) Infant immunization schedules

Ans: B, C, D Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 311 Feedback: Expectant parents classes provide content about the birth process, newborn nutrition, and types of birth settings. Home safety and infant immunization schedules are not a routine part of expectant parents classes.

19. A pregnant patient asks the nurse to explain the Lamaze philosophy of childbirth. What should the nurse include when responding to this patient's request? (Select all that apply.) A) Labor should be induced. B) Breathing patterns block pain sensations. C) It is based on the gating control theory of pain relief. D) Patients should be maintained on bed rest during labor. E) Actions that are not medically necessary should be avoided.

Ans: B, C, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 315 Feedback: The Lamaze philosophy of childbirth teaches that concentrating on breathing patterns can block incoming pain sensations. This philosophy is based on the gating control theory of pain relief. And any actions that are not medically necessary for the patient and fetus should be avoided. The Lamaze philosophy of childbirth believes that labor should not be induced and that patients should walk, move around, and change positions throughout labor.

14. A nurse is teaching a pregnant patient about the importance of practicing perineal exercises during pregnancy. The nurse determines that the teaching was successful based on which patient statement? A) "These exercises will help make my labor less painful." B) "I'll need less stitches with my episiotomy." C) "My muscles will get back into shape much more quickly." D) "My muscles will be able to stretch more easily during labor."

Ans: D Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 313 Feedback: Women can practice specific exercises to strengthen pelvic and abdominal muscles to make these muscles stronger and suppler for labor. If perineal muscles are supple, this allows for stretching during birth, reduces discomfort, and helps perineal muscles function more efficiently after childbirth, which helps reduce the possibility of urinary incontinence

17. The nurse identifies the diagnosis of "Anxiety related to absence of significant other" as appropriate for a pregnant patient. For which assessment finding is this diagnosis appropriate? A) Spouse works the night shift. B) Mother is recovering from a total hip replacement. C) Oldest daughter is preparing for a school dance recital. D) Spouse is in the military and is stationed in the Middle East.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 308 Feedback: The diagnosis "Anxiety related to absence of significant other" is appropriate for the spouse who is in the military and is stationed somewhere out of the country. The spouse working the night shift does not mean that the spouse is not available to help the patient. Other children are not typically identified as support people for a pregnant patient. The patient's mother is recovering from a surgical procedure and most likely is not identified as being a support person for the pregnant patient.

15. The nurse is instructing a pregnant patient on tailor sitting. What is the purpose of this exercise in pregnancy? A) Stretches perineal muscles B) Decreases respiratory effort C) Strengthens abdominal muscles D) Improves the blood supply to the uterus

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 313 Feedback: Tailor sitting stretches perineal muscles without occluding the blood supply to the lower legs. This exercise stretches perineal muscles to aid in the delivery process. Tailor sitting does not help with respiratory effort, strengthening abdominal muscles, or improving blood supply to the uterus.

5. A nurse is teaching a group of pregnant women about different methods to manage pain during childbirth. The nurse determines that the teaching was successful when the group identifies which information as a principle underlying these methods? A) Abdominal breathing allows the uterus to expand freely. B) Distraction aids pain perception in the brain cortex. C) Chest breathing prevents the diaphragm from descending. D) Labor can be made pain free.

Ans: A Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 314 Feedback: Relaxation and breathing exercises allow the abdominal wall to relax and not interfere with uterine contractions. Prepared childbirth does not make labor pain free. It prepares women to manage the pain of contractions. Distraction alters how pain is perceived, such that if the cells of the brain that register the pain impulse are preoccupied with other stimuli, the pain impulse cannot register. Therefore distraction interferes with, not aids in, the perception of pain.

22. A patient who is newly pregnant and her spouse have decided to use the Bradley method of childbirth. Which outcome indicates that this couple is adhering to the principles of this birthing method? A) The patient performs muscle-toning exercises. B) The patient and spouse are ingesting a high-fat, low-carbohydrate diet. C) The patient identifies that lying in bed will be the position to use during labor. D) The spouse encourages the patient's mother to coach the patient during breathing exercises.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 314 Feedback: The Bradley method of childbirth is based on the premise that pregnancy and childbirth are joyful, natural processes and that a patient's partner should play an active role during pregnancy, labor, and the early newborn period. The patient's mother is not identified as being the partner in this method. During pregnancy, the patient performs muscle-toning exercises and limits or omits foods that contain preservatives, animal fat, or a high salt content. A high-fat, low-carbohydrate diet is not a part of this method. This method encourages walking and moving around while in labor and not lying in bed.

8. A pregnant woman's husband wants to act as her coach during labor. You would explain a coach's role to him as a(n) A) important participant in a successful labor. B) observer who must take careful notes. C) person convenient for furnishing supplies. D) auxiliary person to assist as necessary.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 310 Feedback: The presence of a coach in labor can help a great deal to make childbirth a positive event.

7. To teach a pregnant woman effleurage, which of the following would you include? A) Lightly tracing a pattern on her abdomen with her fingertips. B) Massaging the uterine fundus at the peak of each contraction. C) Holding her breath and pushing with contractions. D) Exhaling into a paper bag to prevent dizziness.

Ans: A Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 317 Feedback: Effleurage is light massage that helps offer pain relief in labor.

21. Which action should the nurse include when teaching a pregnant patient effleurage? A) Exhaling into a paper bag to prevent dizziness B) Holding the breath and pushing with contractions C) Lightly tracing a pattern on the abdomen with the fingertips D) Massaging the uterine fundus at the peak of each contraction

Ans: C Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 317 Feedback: A technique to encourage relaxation and displace pain in the Lamaze method is effleurage, which is French for "light abdominal massage." This action is done by tracing a pattern on the abdomen with the fingertips. Effleurage is not breathing into a paper bag to prevent dizziness, holding the breath and pushing with contractions, or massaging the uterine fundus at the peak of each contraction.

10. A pregnant woman is considering a home birth. Which statement by the woman would lead the nurse to determine that the woman is a good candidate for this birth setting? A) "I want to have a baby without having to endure boring prenatal care." B) "All women in my family have had easy labors, so I should, too." C) "I'm interested in learning as much as I can about birth and what I need to do." D) "I know nothing about birth so having a baby in a hospital intimidates me."

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 321 Feedback: Women who plan to deliver at home must be well informed about the process and what responsibility they must undertake to make home birth safe.

30. A nurse is working with a pregnant woman to develop a birth plan with her partner. The couple decides early in the pregnancy to give birth at home. Which information would be most important for the nurse to reinforce when discussing the birth plan with the couple to achieve a positive outcome? A) sticking with the plan as outlined B) ensuring adequate supplies are available C) being flexible with the plan's components D) focusing on a specific goal

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 310 Feedback: When talking to couples about their birth plan, the nurse should be certain that it includes flexibility as well as being centered on the ultimate goal of birth: a healthy baby and healthy parents rather than concentration on a limited goal, such as not having fetal monitoring or using a particular birthing position. This is because, in the event of a complication that requires an emergency cesarean birth, their preference may need to be modified or adjusted. Having adequate supplies available is important, but being flexible is essential to ensure a positive outcome.

2. Which of the following is true of pelvic rocking during pregnancy? A) It should hurt or it will be ineffective. B) It stretches perineal muscles. C) It helps to relieve backache. D) It may cause mild abdominal cramping.

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Page: 314 Feedback: Backache is a frequent symptom of pregnancy. Pelvic rocking can help to relieve this.

27. The nurse assessing a patient in active labor notes that the patient's respiratory rate is 36 breaths/min and shallow. From this information, what should the nurse determine as being the status of the patient's cervical dilation? A) 0 to 1 cm B) 2 to 3 cm C) 4 to 6 cm D) 7 to 10 cm

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 316 Feedback: Respirations up to 40 breaths/min and shallow is a level of breathing when cervical dilation is between 4 and 6 cm. Slow deep chest breathing of comfortable but full respirations at a rate of 6 to 12 breaths/min is used for early contractions in labor when the cervical dilation is between 0 and 3 cm. More rapid breathing at a rate of 50 to 70 breaths/min is used when cervical dilation is between 7 and 10 cm.

20. The nurse working in the maternity care area is planning actions to support the 2020 National Health Goals regarding the preparation of patients for childbirth. Which action should the nurse select to support these goals? A) Attend pediatric advanced life support training. B) Request to be scheduled to work in the labor suite. C) Enroll in classes to become a childbirth instructor. D) Become certified in infant cardiopulmonary resuscitation.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 308 Feedback: Nurses have a direct role in helping the nation achieve the 2020 National Health Goals regarding the preparation of patients for childbirth by participating as childbirth instructors. Attending pediatric advanced life support training, working in the labor suite, and certification in infant cardiopulmonary resuscitation will not support the 2020 National Health Goals for childbirth.

13. A pregnant woman confides to you, "I want to deliver at home because our car is in bad shape and might break down on the way to the hospital." Her comment is likely to reflect which of the following? A) An indication that the couple has been living beyond their means B) Being afraid to deliver in a hospital setting C) Fear of having an emergency delivery before reaching the hospital D) Having an excessive reaction related to pregnancy

Ans: C Client Needs: Psychosocial Integrity Cognitive Level: Apply Page: 321 Feedback: Women's reasons for wanting home birth vary. If a reason is because of inadequate transportation, a solution that provides transportation will often convert them to planning birth in a more structured setting.

26. A pregnant patient has chosen to give birth in a hospital that is designated as mother friendly. What information should the nurse teach the patient to expect when admitted for the birth of her baby? (Select all that apply.) A) Application of continuous fetal monitoring prior to delivery B) Routine policies for perineal shaving and admission enemas C) Accurate information about procedures, drugs, and tests D) Algorithm to determine when to artificially rupture the membranes E) Support for making informed choices about what is best for the baby

Ans: C, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 319 Feedback: Mother-friendly hospitals approach birth as a healthy and joyous experience. The patient should expect to receive accurate information about procedures, drugs, and tests and receive support for making informed choices about what is best for the baby. To qualify as a mother-friendly hospital, there should not be routine policies for fetal monitoring, perineal shaving, admission enemas, or artificial rupturing of the membranes.

1. A woman you meet is interested in childbirth preparation. She asks why tailor sitting is recommended as an exercise for pregnancy. Your response would be that it A) improves the blood supply to the uterus. B) strengthens abdominal muscles. C) decreases respiratory effort. D) stretches perineal muscles.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 313 Feedback: Supple perineal muscles allow the opening to the vagina to expand for childbirth without tearing. Tailor sitting is an exercise that helps accomplish this.

24. A pregnant patient is planning to give birth to the baby at home. Which patient statement indicates to the nurse that this patient is a good candidate for this birthing option? A) "All women in my family have had easy labors." B) "I want to have a baby without boring prenatal care." C) "I know nothing about birth so a hospital intimidates me." D) "I have no health problems and follow good self-care practices."

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 321 Feedback: To be a candidate for a home birth, a woman should be in good overall health. A family history of easy labor is not a criterion for a home birth. Avoiding prenatal care might jeopardize the patient's health status, leading to her not being a candidate for a home birth. Being intimidated by hospitals is not a criterion for a home birth.

12. A pregnant woman asks about the advantages of a hospital birth. Which information would the nurse most likely include in the response? A) What was right for her mother will surely be right for her. B) A hospital's primary function is promotion of health. C) Having anesthesia administered in a hospital setting will shorten labor. D) Security of knowing emergency equipment is on hand.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Cognitive Level: Apply Page: 319 Feedback: A major advantage of hospital birth is that emergency equipment and personnel both are readily available.