Nursing management during labor and birth: chapter 14

A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first? A. Determine if the client is in true or false labor B. ask if this is the clients first pregnancy C. notify the healthcare provider D. assess to see if the client has any drug allergies

A

A client in labor is administered lorazepam to relax her enough so that she can participate effectively during her labor process rather than fighting against it. For which adverse affects of the drug should the nurse monitor? A. Increased sedation B. newborn respiratory depression C. Nervous system depression D. Decreased alertness

A

A nurse is caring for a client administered generals anesthesia for an emergency cesarean birth. The nurse notes the client uterus is relaxed upon a massage. What would the nurse do next? A. continue to monitor the client B. Continue to massage the clients fundus C.Administer oxygen to the client D. Assess the clients vaginal bleeding

A

A nurse is caring for a client who has been administered by an epidural block. Which should the nurse assess next? A. Respiratory rate B. Temperature C. pulse D. Uterine contractions

A

A nurse is required to obtain the fetal heart rate for a pregnant client. If their presentation is cephalic which maternal side should the nurse monitor to hear the FHR clearly? A. Lower quadrant of the maternal abdomen B. at the level of the maternal umbilicus C. above the level of the maternal umbilicus D. Just below the maternal umbilicus

A

___________ describes the irregular variations or absence of fetal heart rate due to erroneous causes on the fetal monitor record

Artifact

Fetal________are transitory increases in the FHR above the baseline that are associated with sympathetic nervous stimulation

Excellerations

A pregnant client has opt for Hydro therapy for pain management during labor. Which should the nurse consider when assisting the client during the birthing process? A. initiate the technique only when a client is an active labor B. do not allow the client to stay in the bath for long C. Ensure that the water temperature exceeds body temperature D. allow the client into the water only if her membrane have rupture

A

The nurse is assessing the laboring client to determine fetal oxygen status. What indirect assessment method will the nurse likely use? A. external electronic fetal monitoring B. fetal blood pH C. fetal oxygen saturation D. Fetal position

A

The nurse explains Leopold maneuvers to a pregnant client. For which purpose are these maneuvers performed? Select all that apply A.Determining the presentation of the fetus B.Determining the position of the fetus C. Determining the lie of the fetus D. Determining the weight of a fetus E. Determining the size of the fetus

A, B, C

A pregnant client requires administration of an epidural block for management of pain during labor. For which condition should the nurse check the client before administrating the epidural block? Select all that apply A. spinal abnormality B. hypovolemia C. Varicose veins D. Coagulation defects E. Skin rashes or bruises

A, B, D

The nurses moderating a clients uterine contractions. Which factor should the nurse assess to monitor uterine contraction? Select all that apply. A. uterine resting tone B. frequency of contractions C. Change in temperature D. Change in blood pressure E. intensity of contractions

A, B, E

A nurse is assigned to conduct an admission assessment on the phone for a pregnant client. Which information should the nurse obtain from the client? Select all that apply A. estimated due date B. history of drug abuse C. Characteristics of contractions D. appearance of vaginal blood E. history of drug allergy

A, C, D

A nurse is caring for a pregnant client in labor observes that the fetal heart rate is below 120 bpm. Which intervention should be a nurse perform? Select all that apply. A. Turn the client on her left side B. Reduce iv fluid rate C. Administer oxygen by mask D. Assess client for underlying causes E. Ignore questions for the client

A, C, D

If the nitrazine test is inconclusive, an additional test, called the ________________ test, can be used to confirm rupture of membranes

AFP

A client administered combine spinal epidural and Analgesia showing signs of hypotension and associated fetal heart rate changes. What intervention should nurse perform to manage the changes? A. Assist client to A supine position B. Provide supplemental oxygen C. discontinue IV fluid D turn client to her right side

B

A nurse is caring for a pregnant client who is in the active phase of labor. At what interval should the nurse monitor the clients vital signs? A. Every 15 minutes B. every 30 minutes C. Every 45 minutes D. Every 1 hour

B

A nurse is teaching a couple about pattern breathing during their birth education. Which technique should the nurse suggest for slow paced breathing? A. Inhale and exhale through the mouth at a rate of 4 breaths every 5seconds B. Inhale slowly through nose and exhale through pursed lips C. Punctuated breathing by a force for exhalation through pursed lips every few breaths D. Hold breath for 5seconds after every 3 breath

B

During an admission assessment of a client in labor the nurse observe that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is an early stage of labor? A. Monitor vital signs B. assess amount of cervical dilation C. Obtain urine specimen for urinalysis D. Monitor hydration status

B

The nurse is monitoring a pregnant client admitted to a healthcare center who is in the Latent phase of labor. The nurse demonstrates appropriate nursing care by moderating the fetal heart rate with the Doppler at least how often? A. every 15 to 30 minutes B. every 30 minutes C. Every hour D.Continuously

B

A 29 weeks gestation client is admitted with moderate vaginal discharge. The nurse performs a nitrozine test to determine if the membranes have ruptured. The nitrozine tape remains yellow to olive green, with pH between five and six. What should the nurse do next? A. prepare the client for birth B. assess the clients cervical status C. Notify the healthcare provider D. Perform Leopold maneuver

C

The nurse caring for a client in preterm labor observes abnormal Fetal heart rate patterns. Which nursing intervention should the nurse perform next? A. Application of Vibroacoustic stimulation B. tactile stimulation C. administration of oxygen by mask D. Fetal scalp stimulation

C

A pregnant client with a history of spinal injury is being prepared for a cesarean birth. Which method of anesthesia is to be administered to the client? A.Local infiltration B. epidural block C. regional anesthesia D General anesthesia

D

The _______ spines serve as landmarks for estimating the decent of the fetal presenting part and have been designated as zero station

Ishial

_________ comfort measures are usually simple ,safe ,effective , and inexpensive to use

Nonpharmacologic

baseline variability represents the interplay between the ________and sympathetic nervous systems

Parasympathetic

Third-degree laceration

Through the anal sphincter muscle

Fourth-degree laceration

Through the interior rectal wall

Second-degree laceration

Through the muscles of the perineal body

First-degree laceration

Through the skin

The nurse reviews the prenatal record to identify risk factors that may contribute to a decrease in ___________circulation during pregnancy and/or labor

Unoplacen

The primary power of labor is/are __________contractions, which are involuntary

Uterine

If the woman is a diabetic, it is critical to alert the newborn nursery of potential __________________ in the newborn.

hypoglycemia

The ______ is placed over the uterine Fundus in the area of greatest contractility to electronically monitor uterine contractions

tocotransducer