MCHN

A woman in active labor has requested a regional anesthetic. She is currently 5 cm dilated. The health care provider (HCP) has prescribed an epidural block. Which nursing intervention would be implemented after the epidural block has been placed? 1.Palpate the bladder at frequent intervals. 2.Encourage the woman to walk to progress the labor. 3.Assess the blood pressure frequently for hypertension. 4.Encourage the woman to assume a supine position after the epidural has been placed.

1 The effect of the epidural is that anesthesia is felt from the fifth lumbar space to the sacral region of the vertebral column. The woman loses sensation that she needs to urinate. The nurse must palpate the bladder frequently because a full bladder will impede progression of the fetus during the laboring process. Hypotension, not hypertension, is a concern. Ambulation is not allowed because of the anesthesia. The woman is encouraged to lie on her side to increase placental perfusion to the fetus.

The nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse should monitor the client closely for the risk of uterine rupture if which occurred? 1.Forceps delivery 2.Schultz presentation 3.Hypotonic contractions 4.Weak bearing-down efforts

1. Excessive fundal pressure, forceps delivery, violent bearing-down efforts, tumultuous labor, and shoulder dystocia can place a client at risk for traumatic uterine rupture. Schultz presentation is the expulsion of the placenta with the fetal side presenting first and is not associated with uterine rupture. Hypotonic contractions and weak bearing-down efforts do not add to the risk of rupture because they do not add to the stress on the uterine wall.

The nurse has been working with a laboring client and notes that she has been pushing effectively for 1 hour. What is the client's primary physiological need at this time? 1.Ambulation 2.Rest between contractions 3.Change positions frequently 4.Consume oral food and fluids

2 The birth process expends a great deal of energy, particularly during the transition stage. Encouraging rest between contractions conserves maternal energy, facilitating voluntary pushing efforts with contractions. Uteroplacental perfusion also is enhanced, which promotes fetal tolerance of the stress of labor. Changing positions frequently is not the primary physiological need. Ambulation is encouraged during early labor. Ice chips should be provided. Food and fluids are likely to be withheld at this time.

The nurse is assisting a client undergoing induction of labor at 41 weeks' gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. What is the priority nursing action? 1.Notify the health care provider. 2.Discontinue the infusion of oxytocin (Pitocin). 3.Place oxygen on at 8 to 10 L/minute via face mask. 4

2 The priority nursing action is to stop the infusion of oxytocin. Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. After stopping the oxytocin, the nurse should reposition the laboring mother. Applying oxygen, increasing the rate of the intravenous (IV) fluid (the solution without the oxytocin), and notifying the health care provider are also actions that are indicated in this situation. Contacting the client's primary support person(s) is not the priority action at this time.

The nurse is caring for a client in labor who is receiving oxytocin (Pitocin) by intravenous infusion to stimulate uterine contractions. Which assessment finding should indicate to the nurse that the infusion needs to be discontinued? 1.Increased urinary output 2.A fetal heart rate of 90 beats/min 3.Three contractions occurring within a 10-minute period 4.Adequate resting tone of the uterus palpated between contractions

2. A normal fetal heart rate is 110 to 160 beats/min. Bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin. Increased urinary output is unrelated to the use of oxytocin. The goal of labor augmentation is to achieve three good-quality contractions (appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress.

The goal for a woman with partial premature separation of the placenta is, "The woman will not exhibit signs of fetal distress." Which outcome, documented by the nurse, would indicate that this goal has been achieved?1.No accelerations of FHR 2.Short-term variability present 3.Variable decelerations present 4.Fetal heart rate (FHR) of 170 to 180 beats/min

2. Reassuring signs in the fetal heart tracing include an FHR of 120 to 160 beats/min, accelerations of the FHR, no variable decelerations, and the presence of short-term variability. The short-term variability indicates that the fetus is able to make the necessary adjustments to the stresses of the labor. Variable decelerations would indicate cord compression.

The nurse is reviewing the record of a client in the labor room and notes that the health care provider has documented that the fetal presenting part is at the -1 station. This documented finding indicates that the fetal presenting part is located at which area? 1.1 inch below the coccyx 2.1 inch below the iliac crest 3.1 cm above the ischial spine 4.1 fingerbreadth below the symphysis pubis

3 Station is the measurement of the progress of descent in centimeters above or below the midplane from the presenting part to the ischial spine. It is measured in centimeters, and noted as a negative number above the line and as a positive number below the line. At the negative 1 (-1) station, the fetal presenting part is 1 cm above the ischial spine.

The nurse explains the purpose of effleurage to a client in early labor. Which statement should the nurse include in the explanation? 1."It is the application of pressure to the sacrum to relieve a backache." 2."It is a form of biofeedback to enhance bearing-down efforts during delivery." 3."It is light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus." 4."It is performed to stimulate uterine activity by contracting a specific muscle grou

3.

Which assessment finding following an amniotomy should be conducted first? 1.Cervical dilation 2.Bladder distention 3.Fetal heart rate pattern 4.Maternal blood pressure

3. Fetal heart rate is assessed immediately after amniotomy to detect any changes that may indicate cord compression or prolapse. Bladder distention or maternal blood pressure would not be the first things to check after an amniotomy. When the membranes are ruptured, minimal vaginal examinations would be done because of the risk of infection.

The nurse is reviewing the health care provider's (HCP's) prescriptions for a client admitted for premature rupture of the membranes. Gestational age of the fetus is determined to be 37 weeks. Which prescription should the nurse question? 1.Monitor fetal heart rate continuously. 2.Monitor maternal vital signs frequently. 3.Perform a vaginal examination every shift. 4.Administer ampicillin 1 g as an intravenous piggyback every 6 hours.v

3. Vaginal examinations should not be done routinely on a client with premature rupture of the membranes because of the risk of infection. The nurse would expect to monitor fetal heart rate, monitor maternal vital signs, and administer an antibiotic.

A client arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcome of the amniotomy? 1.Less pressure on her cervix 2.Decreased number of contractions 3.Increased efficiency of contractions 4.The need for increased maternal blood pressure monitoring

3. Amniotomy (artificial rupture of the membranes) can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the progress begins to slow. Rupturing of the membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions. Increased monitoring of maternal blood pressure is unnecessary following this procedure. The fetal heart rate needs to be monitored frequently, however.

The nurse is reviewing true and false labor signs with a multiparous client. The nurse determines that the client understands the signs of true labor if she makes which statement? 1."I won't be in labor until my baby drops." 2."My contractions will be felt in my abdominal area." 3."My contractions will not be as painful if I walk around." 4."My contractions will increase in duration and intensity."

4.

A pregnant client is admitted in labor. The nursing assessment reveals that the client's hemoglobin and hematocrit levels are low, indicating anemia. What should the nurse observe for throughout the client's labor? 1.Anxiety 2.Hemorrhage 3.Low self-esteem 4.Postpartum infection

4. Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage. Anxiety and low self-esteem are unrelated to physiological integrity.

A prenatal client with vaginal bleeding is being admitted to the labor unit. The labor room nurse is performing the admission assessment and would suspect a diagnosis of placenta previa if which finding is noted? 1.Back pain 2.Abdominal pain 3.Painful vaginal bleeding 4.Painless vaginal bleeding

4. The classic sign of placenta previa is the sudden onset of painless vaginal bleeding. Painful vaginal bleeding, abdominal pain, and back pain identify signs and symptoms of abruptio placentae.

On examination, it is noted that a full-term primipara in active labor is right occipitoanterior (ROA), 7 cm dilated, and 3+ station. Which of the following should the nurse report to the physician? a. descent is progressing well b. fetal head is not yet engaged c. vaginal delivery is imminent d. external rotation is complete

A.

TRUE OR FALSE Labor: A 37 week pregnant patient is having consistent contractions, the cervix is 90% effaced, and cervix is 6 cm dilated. The fetal station is +1. A. True labor B. False labor

A.

What anatomical part of the fetus is the BEST part to hear the fetal heart rate (FHR)? A. The back of the fetus B. The apical pulse located in the heart C. Brachial artery D. The popliteal

A.

Beth Ruiz had Apgar scores of 6 at 1 minute and 8 at 5 minutes after birth. Which of the following are the five areas assessed with Apgar scoring? a. Heart rate, respiratory effort, muscle tone, reflex irritability, and color b. Respiratory rate, abdominal tone, reflexes, color, and head circumference c. Color, breathing rate, cry, amount of brown fat, and response to loud noise d. Abdominal tone, persistence, reflexes, blood pressure, and response to pain

A. Using the apgar test, the nurse assesses heart rate, respiratory effort, muscle tone, reflex irritability, and color.

The cardinal movements of labor include which of the following? Select all that apply. A. Extension and rotation B. Descent and engagement C. Presentation and position D. Attitude and lie E. Flexion and expulsion

Answers A, B, and E are correct.. The cardinal movements of labor by the fetus include engagement, descent, flexion, international rotation, extension, external rotation, and expulsion only. The other choices describe the various fetal positions.

A 39 week pregnant woman arrives to labor triage. The patient's prenatal history includes gravidity 3, parity 2. What signs and symptoms below indicate the patient is experiencing true labor? Select all that apply: A. The patient states the contractions are located above the umbilicus. B. Changing positions and walking does not decrease discomfort. C. The contractions are regular. D. The cervix is 90% effaced and dilated to 4 cm.

B, C, D

The nurse assesses Celeste Bailey9s uterine contractions and the FHR. Which of the following would the nurse document as a late deceleration? a. The FHR began increasing 45 seconds after the contraction was over. b. The FHR decreased in rate 30 seconds after the start of a contraction. c. The FHR decreased in strength after the 10th consecutive contraction. d. A decrease in FHR occurs but is totally unrelated to timing of contractions.

B. The nurse would document FHR decreasing in rate 30 seconds after the start of a contraction as a late deceleration. A late deceleration means the FHR decreases as a contraction ends, rather than at the beginning of a contraction, as is usual.

The nurse practitioner described to the patient that she is 3 cm effacement. The mother was shy to ask question to the nurse practitioner. When you went to the room and gave her towels, she asked you what effacement means. As an LPN you know that effacement means: A. "It is the degree of cervical dilation which is usually 0-10 centimeters " B. "It is the thinning or disappearance of the cervix during cervical dilation or labor" C. "The nurse practitioner is pertaining to the fetal location in re

B. This means that the nurse practitioner was explaining to the patient that her cervix is thinning and starting to open up, which is a normal part of the labor process.

The nurse is caring for a nulliparous client who attended Lamaze childbirth education classes. Which of the following techniques should the nurse include in her plan of care? Select all that apply. a. hypotonic suggestion b. rhythmic chanting c. muscle relaxation d. pelvic rocking e. abdominal massage

C, D, E

The contractions associated with true labor tend to have what type of characteristics: Select all that apply A. Located in the superior portion of the abdomen and radiate to the lower back B. Located in the abdomen superior to the navel C. Felt in the back and radiate to the abdomen D. Increase in intensity E. Stay the same with intensity but are regular F. Erratic G. Consistent

C, D, G

A client is complaining of severe back labor. Which of the following nursing interventions would be most effective? a. assist mother with childbirth breathing b. encourage mother to have an epidural c. provide direct sacral pressure d. move the woman to a hydrotherapy tub

C.

The shortest but most intense phase of labor is the: A. Latent phase B. Active phase C. Transition phase D. Placental expulsion phase

C.

Mrs. Ruiz is preparing to take her new daughter home and has asked an unlicensed care provider when Beth's dried umbilical cord will fall off. The nurse should confirm that the care provider has stated what time? a. Day 1 b. Days 2 to 3 c. Days 6 to 10 d. Day 30

C. The nurse would confirm that a week is an average time for a dried cord to detach.

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.

You're assessing a pregnant patient who is 38 weeks pregnant for signs of labor. The patient states she has been experiencing contractions that are 10-12 minutes apart. The contractions have decreased since she has been walking. The fetal station is -4. Based on these findings, is this TRUE or FALSE labor?

False Labor

Complete breech

In a complete breech presentation, the baby's buttocks are the presenting part, with both legs flexed at the hips and knees. The feet are close to the buttocks. This is different from a frank breech presentation, where the baby's buttocks are the presenting part, but the legs are extended straight up towards the head. It is also different from a single footling breech, where one foot is the presenting part, and a shoulder breech, where one or both shoulders are the presenting part.

Frank breech

In a frank breech presentation, the baby's buttocks are positioned to be delivered first, with the legs extended straight up towards the head. This can make delivery more challenging as the baby's head is less likely to engage in the pelvis. It is important for healthcare providers to be aware of the fetal presentation in order to determine the appropriate management and delivery method.

Shoulder presentation

In this case, the presence of a shoulder presentation suggests that the baby is positioned transversely, with its shoulder presenting first instead of the head or buttocks. This is a less common presentation and may require special medical attention during delivery.

Left occipitoposterior

This means that the baby's head is facing towards the mother's left side and towards the back of her pelvis.

Left occipitotransverse

This means that the fetus is in a position where the back of its head (occiput) is towards the left side of the mother's pelvis, and the baby is facing towards the mother's side (transverse position).

Single or (double) footling breech

This means that the fetus is positioned with one or both feet presenting first, instead of the head. This is a type of breech position, where the baby's bottom or feet are positioned to come out first during childbirth.

Left occipitoanterior

This refers to the position of the baby's head in relation to the mother's pelvis. In the left occipitoanterior position, the baby's head is facing down and towards the mother's left side. This is considered the most favorable position for a vaginal delivery.

A client in labor is transported to the delivery room and prepared for a cesarean delivery. After the client is transferred to the delivery room table, the nurse should place the client in which position? 1.Supine position with a wedge under the right hip 2.Trendelenburg's position with the legs in stirrups 3.Prone position with the legs separated and elevated 4.Semi-Fowler's position with a pillow under the knees

1 Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and subsequently the fetus. The best position to prevent this would be side-lying, with the uterus displaced off the abdominal vessels. Positioning for abdominal surgery necessitates a supine position, however; a wedge placed under the right hip provides displacement of the uterus. Trendelenburg's position places pressure from the pregnant uterus on the diaphragm and lungs, decreasing respiratory capacity and oxygenation. A semi-Fowler's position or prone position is not practical for this type of abdominal surgery.

The nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. The nurse notes that the fetal heart rate between contractions is 100 beats/minute. Which nursing action is most appropriate? 1.Notify the health care provider (HCP). 2.Continue monitoring the fetal heart rate. 3.Encourage the client to continue pushing with each contraction. 4.Instruct the client's coach to continue to encourage breathing techniques.

1. A normal fetal heart rate is 110 to 160 beats/minute, and the fetal heart rate should be within this range between contractions. Fetal bradycardia between contractions may indicate the need for immediate medical management, and the HCP or nurse-midwife needs to be notified. Options 2, 3, and 4 are inappropriate nursing actions in this situation and delay necessary intervention.

The nurse is monitoring a client who is in the active stage of labor. The client has been experiencing contractions that are short, irregular, and weak. The nurse documents that the client is experiencing which type of labor dystocia? 1.Hypotonic 2.Precipitous 3.Hypertonic 4.Preterm labor

1. Hypotonic labor contractions are short, irregular, and weak and usually occur during the active phase of labor. Hypertonic dystocia usually occurs during the latent phase of labor, and contractions are painful, frequent, and usually uncoordinated. Precipitous labor is labor that lasts in its entirety for 3 hours or less. Preterm labor is the onset of labor after 20 weeks of gestation and before the thirty-seventh week of gestation.

The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1.Administer oxygen via face mask. 2.Place the mother in a supine position. 3.Increase the rate of the oxytocin (Pitocin) intravenous infusion. 4.Document the findings and continue to monitor the fetal patterns.

1. Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

A client in labor is dilated 10 cm. At this point in the labor process, at least how often should the nurse plan to assess and document the fetal heart rate? 1.Hourly 2.Every 15 minutes 3.Every 30 minutes 4.Before each contraction

2.

The nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate the need to contact the health care provider? 1.Hemoglobin of 11 g/dL 2.Fetal heart rate of 180 beats/minute 3.Maternal pulse rate of 85 beats/minute 4.White blood cell count of 12,000 cells/mm3

2.

A nurse performs a vaginal assessment on a pregnant client in labor. On assessment, the nurse notes the presence of the umbilical cord protruding from the vagina. Which is the initial nursing action? 1.Gently push the cord into the vagina. 2.Place the client in Trendelenburg's position. 3.Find the closest telephone and page the health care provider stat. 4.Call the delivery room to notify the staff that the client will be transported immediately.

2. When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with her hips higher than her head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the health care provider and notify the delivery room. If the cord is protruding from the vagina, no attempt should be made to replace it because that could traumatize it and further reduce blood flow. Oxygen at 8 to 10 L/min by face mask is administered to the mother to increase fetal oxygenation.

A pregnant 39-week-gestation client arrives at the labor and delivery unit in active labor. On confirmation of labor, the client reports a history of herpes simplex virus (HSV) to the nurse, who notes the presence of lesions on inspection of the client's perineum. Which should be the nurse's initial action?1.Perform an abdominal prep on the client. 2.Prepare the delivery room for a vaginal delivery. 3.Explain to the client why a cesarean delivery is necessary. 4.Call the health care provider to

3. Because neonatal infection of HSV is life threatening, prevention of neonatal infection is critical. Current recommendations state that a cesarean delivery within 4 hours after labor begins or membranes rupture is necessary if visible lesions are present on the woman's perineum. An abdominal prep will be necessary eventually for the cesarean delivery but should not be the nurse's initial action. Antiviral medications are used to control symptoms not eradicate the infection. At this phase in the client's pregnancy, the focus is on preventing transmission to the fetus rather than controlling the symptoms of HSV.

The nurse is caring for a client in active labor. Which nursing intervention would be the best method to prevent fetal heart rate decelerations? 1.Prepare the client for a cesarean delivery. 2.Monitor the fetal heart rate every 30 minutes. 3.Encourage an upright or side-lying maternal position. 4.Increase the rate of the oxytocin (Pitocin) infusion every 10 minutes.

3. Side-lying and upright positions such as walking, standing, and squatting can improve venous return and encourage effective uterine activity. Many nursing actions are available to prevent fetal heart rate decelerations, without necessitating surgical intervention. Monitoring the fetal heart rate every 30 minutes will not prevent fetal heart rate decelerations. The nurse should discontinue an oxytocin infusion in the presence of fetal heart rate decelerations, thereby reducing uterine activity and increasing uteroplacental perfusion.

A nurse is caring for a client in labor. The nurse determines that the client is beginning the second stage of labor when which is documented in the client's record? 1.The contractions are regular. 2.The membranes have ruptured. 3.The cervix is completely dilated. 4.The client begins to expel clear vaginal fluid.

3. The second stage of labor begins when the cervix is completely dilated and ends with birth of the infant. The other options are not specific assessment findings of the second stage of labor.

The nurse is caring for a client in labor. Which assessment finding indicates to the nurse that the client is beginning the second stage of labor? 1.The contractions are regular. 2.The membranes have ruptured. 3.The cervix is dilated completely. 4.The client begins to expel clear vaginal fluid.

3. The second stage of labor begins when the cervix is dilated completely and ends with birth of the neonate. Options 1, 2, and 4 are not specific assessment findings of the second stage of labor and occur in stage 1.

The labor room nurse assists with the administration of a lumbar epidural block. How should the nurse check for the major side effect associated with this type of regional anesthesia? 1.Assessing the mother's reflexes 2.Taking the mother's temperature 3.Taking the mother's apical pulse 4.Monitoring the mother's blood pressure

4 A major side effect of regional anesthesia is hypotension, which results from vasodilation in the lower body and a reduction in venous return. After regional anesthesia, the blood pressure is taken every 1 to 2 minutes for 15 minutes and then every 10 to 15 minutes. Reflexes, temperature, and apical pulse are not specifically related to this type of anesthesia.

An amniotomy is performed on a client in labor. On the amniotic fluid examination, the delivery room nurse would identify which findings as normal? 1.Light green, with no odor 2.Clear and dark amber-colored 3.Thick and white, with no odor 4.Pale straw-colored, with flecks of vernix

4 Amniotic fluid normally is pale straw-colored and may contain flecks of vernix caseosa. Greenish fluid may indicate the presence of meconium and suggests fetal distress. Amber-colored fluid suggests the presence of bilirubin. The fluid should not be thick and white.

Shortly after receiving epidural anesthesia, a laboring woman's blood pressure drops to 95/43 mm Hg. Which immediate actions should the nurse take? Select all that apply. 1.Prepare for delivery. 2.Administer a tocolytic. 3.Administer an opioid antagonist. 4.Turn the woman to a lateral position. 5.Increase the rate of the intravenous infusion. 6.Administer oxygen by face mask at 10 L/minute.

4, 5, 6 Maternal hypotension results in decreased placental perfusion, so the focus of nursing care would be to initiate interventions that increase oxygen perfusion to the fetus. Turning the woman to left lateral position assists in deflecting the uterus off of the vena cava, thus improving maternal circulation. Increasing the rate of the intravenous infusion will increase blood volume, which will increase the maternal blood pressure. An increase in blood pressure would increase placental perfusion. Administering a high flow rate of oxygen will increase the oxygen levels in the maternal circulation and increase oxygen delivery to the fetus. The woman is not revealing any signs or symptoms of imminent delivery, so option 1 can be eliminated. Option 2 can be eliminated because the decrease in placental perfusion is the result of maternal hypotension, not uterine hyperstimulation. Option 3 can be eliminated because the client is not experiencing an ineffective breathing pattern caused b

The nurse is performing an assessment on a client diagnosed with placenta previa. Which of these assessment findings would the nurse expect to note? Select all that apply. 1.Uterine rigidity 2.Uterine tenderness 3.Severe abdominal pain 4.Bright red vaginal bleeding 5.Soft, relaxed, nontender uterus 6.Fundal height may be greater than expected for gestational age.

4, 5, 6 Placenta previa is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os. Painless, bright red vaginal bleeding in the second or third trimester of pregnancy is a sign of placenta previa. The client has a soft, relaxed, nontender uterus, and fundal height may be more than expected for gestational age. In abruptio placentae, severe abdominal pain is present. Uterine tenderness accompanies placental abruption. In addition, in abruptio placentae, the abdomen feels hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability.

The nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of which condition? 1.Hematoma 2.Uterine atony 3.Placenta previa 4.Placental separation

4.

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.

When caring for a client during the active phase of labor without continuous electronic fetal monitoring, the nurse would intermittently assess FHR every: A. 15 to 30 minutes B. 5 to 10 minutes C. 45 to 60 minutes D. 60 to 75 minutes

A.

When determining the frequency of contractions, the nurse would measure which of the following? A. Start of one contraction to the start of the next contraction B. Beginning of one contraction to the end of the same contraction C. Peak of one contraction to the peak of the next contraction D. End of one contraction to the beginning of the next contraction

A.

The nurse is collaborating with Celeste Bailey9s obstetrician and is planning possible interventions in light of fetal position. Which of the following fetal positions is considered ideal and is most conducive to a birth that requires few interventions by the obstetrician? a. Right occipitoanterior with full flexion b. Left transverse anterior in moderate flexion c. Right occipitoposterior with no flexion d. Left sacroanterior with full flexion

A. The nurse is aware that an occipitoanterior position means the lie is cephalic— the back of the baby's head is facing the right anterior quadrant of the mother's pelvis. Full flexion means the smallest diameter of the fetal head is presenting to the cervix. This position is considered to be ideal and is most conducive to a healthy delivery that requires fewer interventions.

Labor and birth can be such overwhelming events that between 1% and 6% of women develop PTSD after childbirth. <Hotspots= are moments of extreme distress that strongly influence the development of PTSD. To find what are the hotspots in labor, researchers asked 675 women who experienced a difficult or traumatic birth to complete a questionnaire describing their labor and birth experience. Of the women, 67% reported at least one hotspot during birth and 52.9% had reexperiencing anxiety of these ho

A. The nurse should be most concerned that Celeste is <losing a grasp on things.= In the study, a feeling of loss of control severely affected women9s impressions of whether labor was traumatic or not

Jonny has chosen to have epidural anesthesia, and the nurse has consequently informed the anesthesiologist. What are two risks that are potentially associated with this form of anesthesia? a. Hypotension and a prolonged second stage of labor can occur. b. Severe headache and peripheral cyanosis can occur. c. Women have increased back pain and abrupt transitions between stages of labor. d. Maternal hypertension and a reduced red blood cell count can occur.

A. The nurse should inform Jonny that peripheral relaxation can lead to systemic hypotension with epidural anesthesia. A slowed second stage of labor also may occur.

What are some characteristics of contractions associated with false labor? Select all that apply: A. Contractions are 5 minutes apart that last for 1 minute and have been occurring for 1 hour B. Changing positions help alleviate contraction pain C. Cervix dilates from 2-5 cm D. Fetal station is +1 E. Fetal station is -5 F. Contractions are unpredictable

B, E, F

A laboring woman is admitted to the labor and birth suite at 6 cm dilation. She would be in which phase of the first stage of labor? A. Latent B. Active C. Transition D. Early

B.

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is: A. Discomfort level is greater with false labor. B. Progressive cervical changes occur in true labor. C. There is a feeling of nausea with false labor. D. There is more fetal movement with true labor.

B.

TRUE OR FALSE Labor: A 40 week pregnant patient is experiencing some contractions that are weak, while others are strong in intensity. When she walks or lies down it helps decrease the contraction pain. She states the contractions are hard to predict. A. True labor B. False labor

B.

The nurse is assessing the fetal station during a vaginal examination. Which of the following structures should the nurse palpate? a. sacral promontory b. ischial spines c. cervix d. symphysis pubis

B.

Which fetal lie is most conducive to a spontaneous vaginal birth? A. Transverse B. Longitudinal C. Perpendicular D. Oblique

B.

When should we administer a pudendal block? A. First stage of labor B. Second stage of labor C. Third stage of labor D. Fourth stage of labor

B. A pudendal block is a local anesthetic injection given to numb the perineum and vaginal area during childbirth. It is typically administered during the second stage of labor, which is the pushing stage. This is because the block takes effect quickly and provides pain relief specifically in the lower part of the birth canal, allowing the mother to push effectively without experiencing excessive pain. Administering the block too early in the first stage may result in the medication wearing off before the actual delivery, while administering it in the later stages may not be necessary as the baby's head is already descending and providing some relief.

Beverly's husband drove her to the emergency room because she was having symptoms of preterm labor. The admitting nurse in the emergency department identifies which action as the priority? a. Encourage her to carefully walk so the fetal head maintains pressure on her cervix. b. Position her in a side-lying position and assess fetal heart rate and contractions. c. Obtain blood for an hCG hormone assessment. d. Ensure no one initiates intravenous fluid infusion because hypervolemia exacerbates pre

B. The nurse identifies assessing FHR and whether she is having contractions as the best first actions. Walking stimulates contractions. Hydration, not dehydration, may reduce contractions

Suppose Celeste is having long and hard uterine contractions. What length of contraction would the nurse report as indicative of a potential safety risk? a. Any length of contraction over 30 seconds b. A contraction over 70 seconds in length c. A contraction that peaks at 20 seconds d. A contraction that appears intensely painful

B. The nurse should report a contraction 70 seconds long as it is long enough to compromise fetal oxygenation. In the context of labor, pain is not necessarily indicative of pathophysiology.

Jonny asks the nurse if she could safely use warm water tub bathing during labor. Which answer by the nurse would be best? a. No. The chilling that sometimes results can lead to hypothermia. b. Yes, as long as your membranes are not ruptured. c. No. This technique will separate you from your partner. d. Yes, as long as you know warm water has no significant effect.

B. The nurse should state that warm water is comforting during labor; it may be contraindicated if membranes are ruptured because of the increased risk of infection.

The childbirth educator is teaching a class of pregnant couples the breathing technique that is most appropriate during the second stage of labor. Which of the following techniques did the nurse teach the women to do? a. alternately pant and blow b. take rhythmic, shallow breaths c. push down with an open glottis d. do slow chest breathing

C.

The nurse enters a laboring client's room. The client is complaining of intense back pain with each contraction. The nurse conludes that the fetus is likely in which of the following positions? a. mentum anterior b. sacrum posterior c. occiput posterior d. scapula anterior

C.

When performing Leopold's maneuvers, the nurse notes that the fetus is in the left occiput anterior position. Which is the best position for the nurse to place a fetoscope to hear the fetal heartbeats. a. left upper quadrant b. right upper quadrant c. left lower quadrant d. right lower quadrant

C.

Which of the following observations would suggest that placental separation is occurring? A. Uterus stops contracting altogether. B. Umbilical cord pulsations stop. C. Uterine shape changes to globular. D. Maternal blood pressure drops.

C.

While performing Leopold's maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundal area, a flat surface on the left side, small objects on the right side, and a soft round mass just above the symphysis. Which of the following is a reasonable conclusion by the nurse? a. the fetal position is transverse b. the fetal presentation is vertex c. the fetal lie is vertical d. the fetal attitude is flexed

C.

Suppose Moja had an amniotomy during her labor. Immediately after this procedure, which nursing assessment would be most important for the nurse to make? a. Ask her to rate her pain level after the procedure. b. Assess maternal heart rate to detect possible bleeding. c. Assess FHR to detect possible cord prolapse. d. Document the amount of amniotic fluid that has been los

C. A danger of amniotomy is that the fetal cord can prolapse which will interfere with fetal circulation. This makes the nurse's immediate assessment of the fetal heart rate important.

The nurse offers to teach Jonny controlled breathing to help with pain management until she can receive her epidural. Which instruction by the nurse would be best? a. Lie on your back and breathe in slowly while repeating, I can do this. b. Hold your breath as long as you possibly can before exhaling. c. Breathe in as slowly as you can and then breathe out just as slowly. d. Pant rapidly as this best lifts your abdominal wall off your expanding uterus.

C. The nurse should recommend slow breathing. Slow breathing calls for concentration. Consequently, it can be used as a distraction technique. Women should not lie on their back during labor in order to prevent hypotension. Women should not hold their breath as long as possible, and rapid breathing should not be encouraged.

Suppose a sonogram shows Beverly, who is beginning preterm labor, has a placenta previa. The nurse identifies which measure as the priority to ensure her safety? a. Keep her physically active to avoid a deep vein thrombosis. b. Perform a daily vaginal exam to assess the extent of the previa. c. Assess for vaginal bleeding and clear fluid leakage every shift. d. Keep her nothing by mouth (NPO) as she will need an emergency cesarean birth

C. It is important for the nurse to assess for vaginal bleeding and clear fluid leakage every shift. Vaginal examinations are contraindicated as this procedure may cause bleeding. If the previa is not total, a cesarean birth may not be necessary.

There is no reason to think Jonny will need a general anesthetic. But if she did, what type of drug would the nurse want to ensure is readily available on a birthing unit to help minimize the risk of aspiration of vomitus? a. An anticonvulsant such as diazepam (Valium) b. A nerve relaxant such as phenobarbital c. Metoclopramide (Reglan) to speed gastric emptying d. Oxytocin to increase the effectiveness of labor

C. The nurse should have a drug to speed gastric emptying on hand in case of general anesthesia use. A drug to increase gastric emptying helps to avoid vomiting. The other listed drugs do not have this therapeutic effect.

Jonny Baranca is having a painful labor. She asks the nurse if she should have hired a doula. The nurse identifies which answer as best? a. Definitely. Doulas time contractions and perform many tasks, taking the burden off you. b. Maybe. Doulas are good at telling you if you are doing everything correctly. c. That's an individual choice, but a doula can serve as an important support person. d. No. A second person giving advice is apt to cause conflict.

C. The nurse's best answer would be that a doula is a second support person in labor. She doesn't replace a woman's partner and does much more than time contractions. The use of a doula is an individual choice.

Perineal care is an important infection control measure. When evaluating a postpartum woman's perineal care technique, the nurse would recognize the need for further instruction if the woman: A. Uses soap and warm water to wash the vulva and perineum. B. Washes from symphysis pubis back to episiotomy. C. Changes her perineal pad every 2 - 3 hours. D. Uses the peri bottle to rinse upward into her vagina.

D. The peri bottle should be used in a backward direction over the perineum. The flow should never be directed upward into the vagina since debris would be forced upward into the uterus through the still-open cervix.

Rosann's baby is not only large but also in an occipitoposterior position. The nurse would want the team members to know which position is best for a woman whose baby is in the occipitoposterior position during labor? a. On her right side to stretch the pelvic inlet b. Walking about to encourage fetal descent c. Sitting in a rocking chair to aid presentation d. On her hands and knees to help fetal rotation

D. Although not evidence based, the nurse would want team members to know a hands-and-knees position appears to aid fetal occipital rotation more than the other listed positions.

Celeste Bailey didn9t recognize for over an hour that she was in labor. During her prenatal education, Celeste should have been taught to recognize which sign of true labor? a. Sudden loss of energy from epinephrine release b. Nagging= but constant pain in the lower back c. Urinary urgency from increased bladder pressure d. Show= or release of the cervical mucus plug

D. An important teaching point for Celeste would have been that cervical dilation is a mark of true labor. For the mucus plug to be loosened, cervical dilatation must be occurring.

To investigate if listening to music can help women feel less pain and anxiety in labor, researchers assigned 30 primiparas expected to have normal spontaneous births to either an experimental group that received routine labor care or a control group that received routine care plus music therapy. Both women and their nurses assessed the degree of pain experienced during labor. Results of the study revealed women who listened to music had significantly lower pain during the latent phase of labor

D. Based on the study, the nurse could confirm that music is best used in early labor to help a woman relax.

Rosann Bigalow states that her contractions are irregular in frequency and short in duration. She screams in pain, however, every time she has a contraction. What action by the nurse would be best? a. Recognize that this is a usual response to labor and offer her a back rub. b. Notify the anesthesiologist that Rosann needs to have epidural anesthesia. c. Obtain a prescription from her primary care provider for an analgesic. d. Document/report frequency and duration of contractions plus facilitat

D. It would be important for the nurse to document the characteristics of Rosann9s contractions to see if they are irregular; even though ineffective, they are still painful so she needs pain relief.

Celeste is anxious for her placenta to deliver so she can move to a rocking chair and help relieve her back pain. To best facilitate Celeste9s wishes, which action is best? a. Tug gently on the umbilical cord until the placenta comes loose. b. Ask Celeste to continue hard pushing as she did to birth her baby. c. Push on the lax fundus of her uterus to cause the placenta to loosen. d. Assure her that a placenta loosens quickly so the waiting time will not be long.

D. The nurse should assure her that a placenta loosens quickly so waiting time will not be long. Pulling on the cord, pushing on the uterine fundus, or hard pushing could all cause additional bleeding. The placenta must normally be delivered spontaneously.

Right occipitoposterior

Right occipitoposterior refers to the position of the baby's head in the mother's pelvis during childbirth. In this position, the back of the baby's head is towards the mother's right side and towards the back of her pelvis. This position can make labor more difficult and may require additional interventions or techniques to assist with delivery.