Chapter 8: Labor and Birth

The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate?

The nurse is counseling a 15-year-old pregnant patient at her first prenatal appointment. Which patient teaching by the nurse is appropriate?

A 40-year-old G5P1031 is attending a childbirth education class. During the class, the woman says, "The worst part of contractions with my last labor was when they were at the peak of intensity." The nurse educator correctly explains that the woman is identifying which part of a contraction?

The shortest part of the contraction

The nurse educator is teaching the nursing student the basic principles of using analgesia by using a patient, Christa, as an example. Which of the following demonstrates the basic principles of analgesia during Christa's labor and delivery? Select all that apply

- Christa has been in labor for 4 hours. She has been having contractions every 3 minutes. Contractions last a minute and are intense. She has had cervical change from 3 to 5 cm over the past 4 hours - The medication Christa wants is an epidural. After she receives the epidural, the fetal heart rate (FHR) tracing is within normal limits - Christa has a history of opiate abuse and therefore it was understood that she might require higher doses of medications to experience relief

The nurse educator is teaching about regional and local anesthesia in a childbirth education class. The nurse should teach that regional anesthesia is used for which of the following? Select all that apply.

- Epidural with lidocaine for pain in labor - Spinal block with lidocaine for a cesarean delivery - Lidocaine without epinephrine for forceps use

The obstetric nurse is assessing the laboring patient for pain. Which of the following should the nurse identify in a pain assessment? Select all that apply

- Intensity of contractions - Presence of pain in the neck or back - Signs of anxiety - Frequency and duration of contractions

The nurse is helping the patient assume a position for placement of an epidural. Which of the following positions are appropriate for placing an epidural? Select all that apply

- Lateral position with head flexed toward chest - Sitting position with elbows on knees

The nurse encourages the patient to bring loved ones to be with her during labor because the nurse knows that their presence does which of the following? Select all that apply.

- Reduces the likelihood that a patient will require an epidural - Shortens the length of labor - Increases patients' happiness and satisfaction with the outcome of their birth

The nurse is teaching the patient about the trends and risks of epidural anesthesia. Which of the following should the nurse relay about the risks of epidural anesthesia? Select all that apply

- There is a higher rate of instrumental vaginal delivery. - When using an epidural, women are less likely to sweat with a fever. - Labor may be longer with an epidural. - There is a higher rate of fever and sepsis.

The nurse is speaking with a pregnant patient who is asking what processes start labor. Which responses by the nurse are appropriate? Select all that apply.

- There is more pressure on the cervix, which causes the start of contractions by releasing oxytocin - Oxytocin stimulates uterine muscles to contract. - The fetus releases a stress hormone, cortisol, and this starts contractions. - The placenta begins to age and deteriorate and this triggers the start of contractions.

A patient is interested in a pain relief option that she can control during labor. The nurse explains to the patient what pain relief options are available that would meet her needs, and they mutually decide on nitrous oxide. Which of the following does the nurse describe to the patient about the use of nitrous oxide in labor? Select all that apply

- There is no effect on the labor progress from active labor to delivery, and therefore you do not need to worry about longer labors with the medication." - "The gas takes effect in about 50 seconds after the first breath, and the patient will feel calm."

The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: heart rate (HR) 120, respiratory rate (RR) 12, blood pressure (BP) 130/74, temperature (T) 98.8, and O2 sat 98%. Which action should the nurse take first?

Call the health-care provider (HCP) regarding the patient's pruritus to order an antipruritic medication.

The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with spontaneous rupture of membranes (SROM) and clear fluid 2 hours ago. What action should the nurse take?

Help the patient change her position from side to side every 30 minutes.

The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring (EFM) strip. How would the nurse assess this?

Palpate the maternal abdomen during a contraction.

The patient is having an unmedicated childbirth and has begun to bear down. She vocalizes, "The baby is coming!" Which action should the nurse take?

Have the patient assume a comfortable and upright position

The nurse is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacological methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient?

"We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes."

The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacological approaches will the nurse use to help illustrate its benefits?

Effleurage is performed in rhythm with breathing during a contraction

The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient?

Wider outlet

The primary factor that would allow the second stage of labor to continue beyond 2 hours is:

As the presenting part descends, the fetal heart rate (FHR) does not suggest fetal compromise

Ephedrine is used to correct which side effect of epidural anesthesia/analgesia?

Hypotension

The patient is a 26-year-old G1P0 at 38 weeks, 2 days of gestation. She is at her provider's office for a visit and complains to the nurse of wrist pain, fatigue, increased discharge, and "feeling heavy." Which complaint could be a sign of impending labor?

Increased discharge

An involuntary urge to push is most likely a sign of:

Low fetal station

The nurse is caring for a 34-year-old woman who is G2P1001 at 39 weeks and 1 day. The patient is an observant Muslim and is in active labor. Which outcome would be the most effective form of applying culturally sensitive communication?

Making sure that the patient's modesty is protected

The nurse is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days' gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs. and is in the left occiput anterior (LOA) position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history?

Passage

The most common cause of postpartum hemorrhage is:

Uterine atony