Chapter 16: During Labor and Birth

A woman has decided to hire a doula to work with her during labor and delivery. Which of the following actions would be appropriate for the doula to perform? Select all that apply. a. Give the woman a back rub. b. Assist the woman with her breathing. c. Assess the fetal heart rate. d. Check the woman's blood pressure. e. Regulate the woman's intravenous.

a. Give the woman a back rub. b. Assist the woman with her breathing. Rational: 1. An appropriate action by the doula is giving the woman a back massage. 2. An appropriate action by the doula is to assist the laboring woman with her breathing. 3. The nurse, not the doula, should assess the fetal heart. 4. The nurse, not the doula, should assess the blood pressure. 5. The nurse, not the doula, should regulate the IV.

The labor and delivery nurse performs Leopold's maneuvers. A soft round mass is felt in the fundal region. A flat object is noted on the left and small objects are noted on the right of the uterus. A hard round mass is noted above the symphysis. Which of the following positions is consistent with these findings? a. Left occipital anterior (LOA). b. Left sacral posterior (LSP). c. Right mentum anterior (RMA). d. Right sacral posterior (RSP).

a. Left occipital anterior (LOA). Rational: The nurse's findings upon performing Leopold's maneuvers indicate that the fetus is in the left occiput anterior position (LOA)—that is, the fetal back is felt on the mother's left side, the small parts are felt on her right side, the buttocks are felt in the fundal region, and the head is felt above her symphysis.

A low-risk 38-week gestation woman calls the labor unit and says, "I have to come to the hospital right now. I just saw pink streaks on the toilet tissue when I went to the bathroom. I'm bleeding." Which of the following responses should the nurse make first? a. "Does it burn when you void?" b. "You sound frightened." c. "That is just the mucous plug." d. "How much blood is there?"

b. "You sound frightened." Rational: The nurse is using reflection to acknowledge the client's concerns.

A client is in the second stage of labor. She falls asleep immediately after a contraction. Which of the following actions should the nurse perform as a result? a. Awaken the woman and remind her to push. b. Cover the woman's perineum with a sheet. c. Assess the woman's blood pressure and pulse. d. Administer oxygen to the woman via face mask.

b. Cover the woman's perineum with a sheet. Rational: 1. The woman should not push until the next contraction. She should be allowed to sleep at this time. 2. The woman's privacy should be maintained while she is resting.3. The woman is in no apparent distress. Vital sign assessment is not indicated. 4. The woman is in no apparent distress. Oxygen is not indicated.

A woman is in the second stage of labor with a strong urge to push. Which of the following actions by the nurse is appropriate at this time? a. Assess the fetal heart rate between contractions every 60 minutes. b. Encourage the woman to grunt during contractions. c. Assess the pulse and respirations of the mother every 5 minutes. d. Position the woman on her back with her knees on her chest.

b. Encourage the woman to grunt during contractions. Rational: 1. The fetal heart should be assessed every 5 minutes during the second stage of labor. 2. The woman should be encouraged to grunt during contractions. 3. The pulse should be assessed, but it is unnecessary to do so every 5 minutes. 4. This position is not physiological.

During the third stage, the following physiological changes occur. Please place the changes in chronological order. a. Hematoma forms behind the placenta. b. Membranes separate from the uterine wall. c. The uterus contracts firmly. d. The uterine surface area dramatically decreases.

c, d, a, b Rational: 3. The contraction of the uterus after delivery of the baby is the first step in the third stage of labor. 4. As the uterus contracts, its surface area decreases more and more. 1. A hematoma forms behind the placenta as the placenta separates from the uterine wall after the uterus has contracted and its surface area has decreased. 2. The membranes separate from the uterine wall after the placenta separates and begins to be born.

A gravid client at term called the labor suite at 7:00 p.m. questioning whether she was in labor. The nurse determined that the client was likely in labor after the client stated: a. "At 5:00 p.m., the contractions were about 5 minutes apart. Now they're about 7 minutes apart." b. "I took a walk at 5:00 p.m., and now I talk through my contractions easier than I could then." c. "I took a shower about a half hour ago. The contractions seem to hurt more since I finished." d. "I had some tightening in my belly late this afternoon, and I still feel it after waking up from my 2-hour nap."

c. "I took a shower about a half hour ago. The contractions seem to hurt more since I finished." Rational: This response indicates that the labor contractions are increasing in intensity.

A nurse has just performed a vaginal examination on a client in labor. The nurse palpates the baby's buttocks as facing the mother's right side. Where should the nurse place the external fetal monitor electrode? a. Left upper quadrant (LUQ). b. Left lower quadrant (LLQ). c. Right upper quadrant (RUQ). d. Right lower quadrant (RLQ).

c. Right upper quadrant (RUQ). Rational: Because the baby's back is facing the mother's right side and the sacrum is presenting, the fetal monitor should be placed in her RUQ.

Upon examination, a nurse notes that a woman is 10 cm dilated, 100% effaced, and −3 station. Which of the following actions should the nurse perform during the next contraction? a. Encourage the woman to push. b. Provide firm fundal pressure. c. Move the client into a squat. d. Monitor for signs of rectal pressure.

d. Monitor for signs of rectal pressure.

A nurse is coaching a woman who is in the second stage of labor. Which of the following should the nurse encourage the woman to do? a. Hold her breath for twenty seconds during every contraction. b. Blow out forcefully during every contraction. c. Push between contractions until the fetal head is visible. d. Take a slow cleansing breath before bearing down.

d. Take a slow cleansing breath before bearing down. Rational: 1. Holding the breath for 20 seconds during each contraction can stimulate the Valsalva maneuver, which can lead to a sudden drop in blood pressure and fainting. 2. One cannot push and blow out at the same time. This will not facilitate the delivery of the baby. 3. Pushing should be done only during contractions, not between contractions. 4. By taking a slow, cleansing breath before pushing, the woman is waiting until the contraction builds to its peak. Her pushes will be more effective at this point in the contraction.