Maternity Chpt. 13 Labor and Birth Process 5-8

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Fetal heart rate at the peak of a contraction

In which manner is the fetal status best assessed during the active and transition stages of labor? Fetal movement on the tocometer Fetal heart rate between contractions Fetal heart rate at the peak of a contraction Fetal kicks over a 1-minute period

latent stage active stage transition stage second stage third stage

Place the following stages of labor in order from what occurs first to last. All options must be used. latent stage active stage second stage third stage transition stage

Flexion

Which cardinal movement allows the fetus to travel through the birth canal most efficiently? Extension External rotation Flexion Engagement

shoulder

Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation? cephalic vertex breech shoulder

second

The nurse is monitoring a client and notes: contractions causing urge to push, strong intensity, cervix 10 cm, 100% effaced, fetal head crowns when client pushes. The nurse determines the client is currently in which stage or phase of labor? transition second third active

at the level of the umbilicus

The nurse is assessing a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location? 2 cm above the umbilicus one fingerbreadth below the umbilicus at the level of the umbilicus between the umbilicus and symphysis pubis

strong desire to push irritability with restlessness

A nurse has been assisting a client who has been in labor. The nurse determines the client is moving into the transition phase based on which assessment findings? Select all that apply. cervical dilation (dilatation) of 6 cm cervical effacement of 70% strong desire to push apprehension mixed with excitement irritability with restlessness

"She is in active labor; she is progressing at this point and we will keep you posted."

The nurse determines a client is 7 cm dilated. What is the best response when asked by the client's partner how long will she be in labor? "She is in active labor; she is progressing at this point and we will keep you posted." "She is in the transition phase of labor, and it will be within 2 to 3 hours, though it might be sooner." "She is still in early latent labor and has much too long to go to tell when she will give birth." "She is doing well and is in the second stage; it could be anytime now."

increased white blood cell count

The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal? decreased plasma fibrinogen levels increased blood coagulation time increased blood glucose levels increased white blood cell count

powers passenger patience

After conducting a review class on the labor and birth process for a group of nurses working in the community clinic, the nurse determines that the teaching was successful when the group identifies which factors as affecting the labor process? Select all that apply. powers passenger patience place participation

to constrict the uterine blood vessels

A client in the third stage of labor has experienced placental separation and expulsion. Why is it necessary for a nurse to massage the woman's uterus briefly until it is firm? to remove pieces left attached to uterine wall to constrict the uterine blood vessels to lessen the chances of conducting an episiotomy to reduce boggy nature of the uterus

pain from the dilation (dilatation) or stretching of the cervix

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? distention of the vagina and perineum pain from the dilation (dilatation) or stretching of the cervix hypoxia of the contracting uterine muscles pressure on the lower back, buttocks, and thighs

transition phase

A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor? transition phase latent phase active phase early phase

cranial bones overlapping at the suture lines.

A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to: extreme pressure in the vaginal vault. a congenital defect. cranial bones overlapping at the suture lines. prolonged labor.

cannot be determined

A 28-year-old primigravida client presents to the unit in early labor. The record reveals the client is 5 ft (1.5 m) tall, 95 lb (43 kg), and has gained 25 lb (11.3 kg) over a normal, uneventful pregnancy. The nurse predicts this client will have which type of pelvis upon assessment? platypelloid android gynecoid cannot be determined

nesting

A 37-year-old primigravida client at 40 weeks' gestation is seen in the clinic for a scheduled prenatal visit. What report by the client would lead the nurse to predict the woman is close to labor? dilation (dilatation) effacement nesting ripening of the cervix

"It is a measurement to determine if the pelvis size is adequate for a vaginal birth."

A client at 9 weeks' gestation asks the nurse, "What is a diagonal conjugate?" What is the nurse's best response? "It is a measurement to determine if the pelvis size is adequate for a vaginal birth." "It is the largest diameter of the pelvic outlet." "It is the measurement between the ischial tuberosity and the pubis." "It is the smallest diameter of the pelvic outlet."

8 to 12 weeks

A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanel (fontanelle). The client is anxious to know when the posterior fontanel (fontanelle) will close. Which time span is the normal duration for the closure of the posterior fontanel (fontanelle)? 4 to 6 weeks 8 to 12 weeks 12 to 14 weeks 14 to 18 weeks

catecholamines

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? prostaglandins catecholamines oxytocin relaxin

need for someone to control the situation

A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared? less likely to need analgesia less likely to need anesthesia need for someone to control the situation unlikely to require cesarean birth

bloody show lightening backache

A nurse is meeting with a group of pregnant clients who are in their last trimester to teach them the signs that may indicate they are going into labor. The nurse determines the session is successful after the clients correctly choose which signs as an indication of starting labor? Select all that apply. bloody show constipation lightening weight gain backache

first, active

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? second first, latent first, active third

increased risk of infection

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? potential rapid birth of fetus potential placenta previa increased risk of infection increased risk of breech presentation

fetal anomalies

A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with shoulder presentation during a vaginal birth should the nurse assess? uterine abnormalities fetal anomalies congenital anomalies birth after due date

begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity

A pregnant client is being discharged from the labor and birth suite because of false labor. The client asks the nurse how to tell whether the contractions are true contractions or Braxton Hicks contractions. Which description(s) will the nurse mention as characteristic of true contractions? Select all that apply. begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity begin and remain irregular felt first abdominally and remain confined to the abdomen and groin often disappear with ambulation or sleep

The cervix takes around 12 to 16 hours to dilate during first pregnancy.

A pregnant client wants to know why the labor of a primigravida usually lasts longer than that of a woman who has already given birth once and is pregnant a second time. What explanation should the nurse offer the client? Contractions are stronger during the first pregnancy than the second. Braxton Hicks contractions are not strong enough during first pregnancy. Spontaneous rupture of membranes occurs during first pregnancy. The cervix takes around 12 to 16 hours to dilate during first pregnancy.

gross proteinuria

The nurse is caring for a client in active labor. Which assessment finding requires health care provider notification? hyperventilation elevated WBC count gross proteinuria nausea

The cervix is softening

The nurse is caring for a client who is late in her pregnancy. What assessment finding should the nurse attribute to the role of prostaglandins? The cervix is softening The uterus is relaxing The cervix is dilating The perineum is relaxing

The primigravida who has a thinning cervix and a dilation of 3 cm

The nurse is caring for four clients within the labor and delivery unit. Which client does the nurse anticipate will be sent home? The primigravida who is effaced, having intense contractions but at irregular intervals and dilation (dilatation) is 6 cm The multipara who just experienced lightening and is having contractions 7 minutes apart. The primigravida who has a thinning cervix and a dilation of 3 cm The multipara who is effaced with dilation of 4 cm.

Oxytocin Progesterone Prostaglandins

The nurse is instructing on maternal hormones which may impact the onset of labor. Which hormones are included in the discussion? Select all that apply. Testosterone Oxytocin Thyroxine Progesterone Prostaglandins Insulin

The fetal head is not descending as expected.

The nurse is preparing to perform a straight catheterization on a client in labor. What assessment data support this nursing action? The urine-specific gravity tests at as higher than expected. The fetal head is not descending as expected. Trace amounts of protein are found in the urine. The fetus is noted to be a breech presentation.

1 cm above the ischial spines.

The nurse is providing care to a client in labor. On examination, the nurse determines the fetus is at -1 station. The nurse interprets this as indicating that the fetus is: 1 cm above the ischial spines. 1 cm below the ischial spines. 1 cm below the pubic bone. 1 cm above the pubic bone.

descent, flexion, internal rotation, extension, external rotation, expulsion

The student nurse is learning about normal labor. The teacher reviews the cardinal movements of labor and determines the instruction has been effective when the student correctly states the order of the cardinal movements as follows: internal rotation, descent, extension, flexion, external rotation, expulsion descent, flexion, external rotation, extension, internal rotation, expulsion descent, flexion, internal rotation, extension, external rotation, expulsion internal rotation, flexion, descent, extension, external rotation, expulsion

head elevated, grasping knees, breathing out

To give birth to her infant, a woman is asked to push with contractions. Which pushing technique is the most effective and safest? lying supine with legs in lithotomy stirrups squatting while holding her breath head elevated, grasping knees, breathing out lying on side, arms grasped on abdomen

platypelloid

When educating a group of nursing students about the different types of pelves, the nurse describes one type as being flat, having a wider transverse diameter than anterior-posterior diameter, with ischial spines that are wide apart, and a short sacrum. The students are correct when they identify this description with which type? gynecoid android anthropoid platypelloid

change in estrogen-to-progesterone ratio

When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories? decrease in number of oxytocin receptors decrease in the level of estrogen change in estrogen-to-progesterone ratio decrease in prostaglandins, leading to myometrium contractions

Descent

Which cardinal movement of delivery is the nurse correct to document by station? Descent Flexion Extension Internal rotation