Nursing OB Exam 2

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A) Semirecumbent B) Sitting C) Squatting D) Side-lying

C) Squatting A semirecumbent position does not assist in increasing the size of the pelvic outlet. Although sitting may assist with fetal descent, this position does not increase the size of the pelvic outlet. Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. A side-lying position is unlikely to assist in increasing the size of the pelvic outlet.

The fourth stage of labor

Is the first 2 hours after birth.

The third stage of labor lasts from

The infant's birth to the expulsion of the placenta.

The first stage of labor lasts from

The time dilation begins to the time when the cervix is fully dilated.

The second stage of labor lasts from

The time of full cervical dilation to the birth of the infant.

Oxytocin is a hormone It stimulates Synthetic oxytocin (Pitocin) may be used either to

normally produced by the posterior pituitary gland. uterine contractions and aids in milk let-down. induce labor or to augment a labor that is progressing slowly because of inadequate uterine contractions.

Labor and birth are affected by the five Ps:

passenger, passageway, powers, position of the woman, and psychologic response.

Inability to palpate the cervix during vaginal examination indicates

that complete effacement and full dilation have occurred and is the only certain, objective sign that the second stage has begun

The parent-infant relationship is strengthened through

the use of touch, eye contact, voice, odor, entrainment, biorhythmicity, reciprocity, and synchrony.

Causes of PPH are

uterine atony, retained placenta, lacerations of the genital tract, hematomas, inversion of the uterus, and subinvolution of the uterus.

Referred pain occurs

when pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, gluteal area, thighs, and lower back.

The second stage of labor is the stage in which the infant is born. This stage begins

with full cervical dilation (10 cm) and complete effacement (100%) and ends with the baby's birth.

The first stage of labor begins The first stage of labor consists of three phases:

with the onset of regular uterine contractions and ends with complete cervical effacement and dilation. the latent phase (through 3 cm of dilation), the active phase (4 to 7 cm of dilation), and the transition phase (8 to 10 cm of dilation).

On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? A) The fetal presenting part is 1 cm above the ischial spines. B) Effacement is 4 cm from completion. C) Dilation is 50% completed. D) The fetus has achieved passage through the ischial spines.

A) The fetal presenting part is 1 cm above the ischial spines. Station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Passage through the ischial spines with internal rotation would be indicated by a plus station such as +1.

The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A) progressive uterine contractions with cervical change. B) lightening. C) rupture of membranes. D) passage of the mucous plug (operculum).

A) progressive uterine contractions with cervical change. Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer

Baby-friendly hospitals mandate that infants be put to breast within what time frame after birth? A. 1 hour B. 30 minutes C. 2 hours D. 4 hours

A. 1 hour Baby-friendly hospitals mandate that the infant be put to breast within the first hour after birth (BFHI, 2010). The ideal time to initiate breastfeeding is within the first 1 to 2 hours after delivery. In many countries this is the norm; however, the Baby-Friendly Hospital Initiative (BFHI) mandates 1 hour. Ideally an infant should go no longer than 2 hours after delivery before being put to breast. This is much too long to wait to initiate breastfeeding, whether the hospital is baby-friendly or not.

Nurses can advise their patients that which of these signs precede labor? (Select all that apply.) A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions D. A decline in energy, as the body stores up for labor E. Uterus sinks downward and forward in first-time pregnancies.

A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions E. Uterus sinks downward and forward in first-time pregnancies. After lightening a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term.

Vaginal examinations should be performed by the nurse under which of these circumstances. (Select all that apply.) A. An admission to the hospital at the start of labor B. When accelerations of the fetal heart rate (FHR) are noted C. On maternal perception of perineal pressure or the urge to bear down D. When membranes rupture E. When bright, red bleeding is observed

A. An admission to the hospital at the start of labor C. On maternal perception of perineal pressure or the urge to bear down D. When membranes rupture Vaginal examinations should be performed when the woman is admitted to the hospital or birthing center at the start of labor. An accelerated FHR is a positive sign; variable decelerations, however, merit a vaginal examination. When the woman perceives perineal pressure or the urge to bear down is an appropriate time to perform a vaginal examination. After rupture of membranes (ROM) a vaginal examination should be performed. The nurse must be aware that there is an increased risk of prolapsed cord immediately after ROM. Examinations are never done by the nurse if vaginal bleeding is present since the bleeding could be a sign of placenta previa and a vaginal examination could result in further separation of the low-lying placenta.

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring? (Select all that apply.) A. Estriol is found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm. E. Fetal heart rate of 150 beats/minute

A. Estriol is found in maternal saliva. D. The cervix is effacing and dilated to 2 cm. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor, such as cervical changes. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Fetal heart rate is normal.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse would be to: A. assess the fetal heart rate (FHR) pattern. B. perform a vaginal examination. C. inspect the characteristics of the fluid. D. assess maternal temperature.

A. assess the fetal heart rate (FHR) pattern. The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). These are all important and should be done after the FHR and pattern are assessed. These are all important and should be done after the FHR and pattern are assessed. These are all important and should be done after the FHR and pattern are assessed.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: A. change in position. B. oxytocin administration. C. regional anesthesia. D. intravenous analgesic.

A. change in position. Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Oxytocin administration may reduce maternal cardiac output. Regional anesthesia may reduce maternal cardiac output. Intravenous analgesic may reduce maternal cardiac output.

When working with parents who have some form of sensory impairment, nurses should consider which information when writing a plan of care? A. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals B. Visually impaired mothers cannot overcome the infant's need for eye-to-eye contact C. The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities D. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information E. Childbirth education and other materials are available in Braille.

A. One of the major difficulties visually impaired parents experience is the skepticism of health care professionals C. The best approach for the nurse is to assess the parents' capabilities rather than focusing on their disabilities D. Technologic advances, including the Internet, can provide deaf parents with a full range of parenting activities and information E. Childbirth education and other materials are available in Braille. The skepticism, open or hidden, of health care professionals throws up an additional and unneeded hurdle for the parents. Other sensory output can be provided by the parent, other people can participate, and other coping devices can be used. After the parents' capabilities have been assessed (including some the nurse may not have expected), the nurse can help find ways to assist the parents that play to their strengths. The Internet affords an extra teaching tool for the deaf, as do videos with subtitles or nurses signing. A number of electronic devices can turn sound into light flashes to help pick up a child's cry. Sign language is acquired readily by young children. Childbirth education and other materials are available in Braille.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? A. Place the woman in the knee-chest position. B. Cover the cord in a sterile towel saturated with warm normal saline. C. Prepare the woman for a cesarean birth. D. Start oxygen by face mask.

A. Place the woman in the knee-chest position. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. B-If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although this is an appropriate intervention, relieving pressure on the cord is the nursing priority. C-If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete. D-The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.

The maternity nurse should notify the health care provider about which assessment findings during labor? (Select all that apply.) A. Positive urine drug screen B. Blood glucose level of 78 mg/dL C. Increased systolic blood pressure during first stage D. Elevated white blood cell count E. Oral temperature of 99.8° F F. Respiratory rate of 10 breaths/min

A. Positive urine drug screen C. Increased systolic blood pressure during first stage F. Respiratory rate of 10 breaths/min The health care provider should be alerted to a positive urine drug screen, because certain drugs will have an effect on pain medications that can be safely administered. The respiratory rate usually increases during labor. A rate of 10 is low and needs to be reported. Decreased blood glucose levels (due to exertion and glucose consumption for energy), and increased systolic blood pressure, elevated white blood cell count (due to stress response), and a slightly elevated temperature (up to 100.4° F) are expected findings during labor.

For the labor nurse, care of the expectant mother begins with which situations? (Select all that apply.) A. The onset of progressive, regular contractions B. The bloody, or pink, show C. The spontaneous rupture of membranes D. Formulation of the woman's plan of care for labor E. Moderately painful contractions

A. The onset of progressive, regular contractions B. The bloody, or pink, show C. The spontaneous rupture of membranes Labor care begins with the onset of progressive, regular contractions. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when the blood-tinged mucoid vaginal discharge appears. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when amniotic fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment. Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment. Pain is subjective. The onset of progressive, regular contractions signals the beginning of labor; not the intensity of the pain.

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? (Select all that apply.) A. Unstable coronary artery disease B. Previous cesarean birth C. Placenta previa D. Initial blood pressure of 132/87 E. History of three spontaneous abortions

A. Unstable coronary artery disease B. Previous cesarean birth C. Placenta previa Indications for cesarean birth include: Maternal · Specific cardiac disease (e.g., Marfan syndrome, unstable coronary artery disease) · Specific respiratory disease (e.g., Guillain-Barré syndrome) · Conditions associated with increased intracranial pressure · Mechanical obstruction of the lower uterine segment (tumors, fibroids) · Mechanical vulvar obstruction (e.g., extensive condylomata) · History of previous cesarean birth Fetal · Abnormal fetal heart rate (FHR) or pattern · Malpresentation (e.g., breech or transverse lie) · Active maternal herpes lesions · Maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL · Congenital anomalies Maternal-Fetal · Dysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor) · Placental abruption · Placenta previa · Elective cesarean birth (cesarean on maternal request) The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth.

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: A. counterpressure against the sacrum. B. pant-blow (breaths and puffs) breathing techniques. C. effleurage. D. biofeedback.

A. counterpressure against the sacrum. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support.

On review of a fetal monitor tracing, the nurse notes that for several contractions, the fetal heart rate decelerates as a contraction begins and returns to baseline just before it ends. The nurse should: A. describe the finding in the nurse's notes. B. reposition the woman onto her side. C. call the physician for instructions. D. administer oxygen at 8 to 10 L/min with a tight face mask.

A. describe the finding in the nurse's notes An early deceleration pattern from head compression is described. No action other than documentation of the finding is required since this is an expected reaction to compression of the fetal head as it passes through the cervix. These actions would be implemented when non-reassuring or ominous changes are noted. These actions would be implemented when non-reassuring or ominous changes are noted. These actions would be implemented when non-reassuring or ominous changes are noted.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: A. encouraging the woman to try various upright positions, including squatting and standing. B. telling the woman to start pushing as soon as her cervix is fully dilated. C. continuing an epidural anesthetic so that pain is reduced and the woman can relax. D. coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction.

A. encouraging the woman to try various upright positions, including squatting and standing. Upright positions and squatting may enhance the progress of fetal descent. Many factors dictate when a woman will begin pushing. Complete cervical dilation is necessary, but it is only one factor. If the fetal head is still in a higher pelvic station, the physician or midwife may allow the woman to "labor down" (allowing more time for fetal descent, thereby reducing the amount of pushing needed) if she is able. The epidural may mask the sensations and muscle control needed for the woman to push effectively. Closed-glottic breathing may trigger the Valsalva maneuver, which increases intrathoracic and cardiovascular pressure, reducing cardiac output and inhibiting perfusion of the uterus and placenta. In addition, holding the breath for longer than 5 to 7 seconds diminishes the perfusion of oxygen across the placenta, resulting in fetal hypoxia.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: A. fentanyl (Sublimaze). B.promethazine (Phenergan). C. butorphanol tartrate (Stadol). D. nalbuphine (Nubain).

A. fentanyl (Sublimaze). Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

Parents can facilitate the adjustment of their other children to a new baby by: A. having the children choose or make a gift to give to the new baby on its arrival home. B. emphasizing activities that keep the new baby and other children together. C, having the mother carry the new baby into the home so she can show him or her to the other children. D, reducing stress on other children by limiting their involvement in the care of the new baby.

A. having the children choose or make a gift to give to the new baby on its arrival home. Having the sibling make or choose a gift for the new baby helps to make the child feel a part of the process. Special time should be set aside just for the other children without interruption from the newborn. Someone other than the mother should carry the baby into the home so she can give full attention to greeting her other children. Children should be actively involved in the care of the baby according to their ability without overwhelming them.

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include: A. little if any change B. leakage of milk at let-down C. swollen, warm, and tender on palpation D. a few blisters and a bruise on each areola E. small amount of clear, yellow fluid expressed

A. little if any change Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used. E. Colostrum, or early milk, a clear, yellow fluid, may be expressed from the breasts during the first 24 hours.

Nurses should be aware of the difference experience can make in labor pain, such as: A. sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C. women with a history of substance abuse experience more pain during labor. D. multiparous women have more fatigue from labor and therefore experience more pain.

A. sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A. the examiner's hand should be placed over the fundus before, during, and after contractions. B. the frequency and duration of contractions are measured in seconds for consistency. C. contraction intensity is given a judgment number of 1 to 7 by the nurse and client together. D. the resting tone between contractions is described as either placid or turbulent.

A. the examiner's hand should be placed over the fundus before, during, and after contractions. The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed. The duration of contractions is measured in seconds; the frequency is measured in minutes. The intensity of contractions usually is described as mild, moderate, or strong. The resting tone usually is characterized as soft or relaxed.

Fetal well-being during labor is assessed by: A. the response of the fetal heart rate (FHR) to uterine contractions (UCs). B. maternal pain control. C. accelerations in the FHR. D. an FHR greater than 110 beats/min.

A. the response of the fetal heart rate (FHR) to uterine contractions (UCs). Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement. Maternal pain control is not the measure used to determine fetal well-being in labor. Although FHR accelerations are a reassuring pattern, they are only one component of the criteria by which fetal well-being is assessed. Although an FHR greater than 110 beats/min may be reassuring, it is only one component of the criteria by which fetal well-being is assessed. More information is needed to determine fetal well-being.

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: A. wear a snug, supportive bra. B. allow warm water to soothe the breasts during a shower. C. express milk from breasts occasionally to relieve discomfort. D. place absorbent pads with plastic liners into her bra to absorb leakage.

A. wear a snug, supportive bra. A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.

The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are: (Select all that apply.) A) passenger. B) placenta. C) passageway. D) psychologic response. E) powers. F) position.

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A) Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B) Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours C) Lull: no contractions; dilation stable; duration of 20 to 60 minutes D) Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

B) Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

Concerning the third stage of labor, nurses should be aware that: A) the placenta eventually detaches itself from a flaccid uterus B) the duration of the third stage may be as short as 3 to 5 minutes C) it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface D) the major risk for women during the third stage is a rapid heart rate

B) the duration of the third stage may be as short as 3 to 5 minutes. The placenta cannot detach itself from a flaccid (relaxed) uterus. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth."

B. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." This statement is not accurate. Maternal and fetal risks are associated with every cesarean section. This statement is the most appropriate. This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: A. "Don't worry about it. You'll do fine." B. "It's normal to be anxious about labor. Let's discuss what makes you afraid." C. "Labor is scary to think about, but the actual experience isn't." D. "You may have an epidural. You won't feel anything."

B. "It's normal to be anxious about labor. Let's discuss what makes you afraid." This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool. A-This statement negates the woman's fears and is not therapeutic. C-This statement negates the woman's fears and offers a false sense of security. D-This statement is not true. A number of criteria must be met for use of an epidural. Furthermore, many women still experience the feeling of pressure with an epidural.

Which description of postpartum restoration or healing times is accurate? A. The cervix shortens, becomes firm, and returns to form within a month postpartum. B. Rugae reappear within 3 to 4 weeks. C. Most episiotomies heal within a week. D. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B. Rugae reappear within 3 to 4 weeks. The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? A. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." B. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." C. "I will not have a menstrual cycle for 6 months after childbirth." D. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

B. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. This is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? (Select all that apply.) A. Keeping the head of bed elevated at all times B. Administration of oral analgesics C. Avoid caffeine D. Assisting with a blood patch procedure E. Frequent monitoring of vital signs

B. Administration of oral analgesics D. Assisting with a blood patch procedure E. Frequent monitoring of vital signs The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief. Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

Which characteristic is associated with false labor contractions? A. Painless B. Decrease in intensity with ambulation C. Regular pattern of frequency established D. Progressive in terms of intensity and duration

B. Decrease in intensity with ambulation True labor contractions are painful. Although false labor contractions decrease with activity, true labor contractions are enhanced or stimulated with activity such as ambulation. A regular pattern of frequency is a sign of true labor. A progression of intensity and duration indicates true labor.

Which test is performed to determine if membranes are ruptured? A. Urine analysis B. Fern test C. Leopold maneuvers D. Artificial Rupture of Membranes (AROM)

B. Fern test A urine analysis should be performed on admission to labor and delivery. This test is used to identify the presence of glucose and protein. In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid. The nurse performs Leopold maneuvers to identify fetal lie, presenting part, and attitude. AROM is the procedure of artificially rupturing membranes, usually with a device known as an amnihook.

When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions? (Select all that apply.) A. The father should take over care of the baby, because postpartum blues are exclusively a female problem. B. Get plenty of rest. C. Plan to get out of the house occasionally. D. Asking for help will not foster independence. E. Use La Leche League or community mental health centers.

B. Get plenty of rest. C. Plan to get out of the house occasionally. E. Use La Leche League or community mental health centers. Suggestions for coping with postpartum blues include: · Remember that the "blues" are normal and that both the mother and the father or partner may experience them. · Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") · Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). · Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. · Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. · Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). · If you are breastfeeding, give yourself and your baby time to learn. · Seek out and use community resources such as La Leche League or community mental health centers.

The maternity nurse promoting parental-infant attachment should incorporate which appropriate cultural beliefs into the plan of care? (Select all that apply.) A. Asian mothers are encouraged to return to work as soon as possible. B. Jordanian mothers have a 40-day lying-in after birth. C. Japanese mothers rest for the first 2 months after childbirth. D. Encourage Hispanics to eat plenty of fish and pork to increase vitamin intake. E. Encourage Vietnamese mothers to cuddle with the newborn.

B. Jordanian mothers have a 40-day lying-in after birth. C. Japanese mothers rest for the first 2 months after childbirth. Asian mothers must remain at home with the baby up to 30 days after birth and are not supposed to engage in household chores, including care of the baby. Jordanian mothers have a 40-day lying-in after birth, during which their mothers or sisters care for the baby. Japanese mothers rest for the first 2 months after childbirth. Hispanic practice involves many food restrictions after childbirth, such as avoiding fish, pork, and citrus foods. Vietnamese mothers may give minimal care to their babies and refuse to cuddle or further interact with the baby to ward off "evil" spirits.

After completing a postpartum assessment on woman who delivered 20 hours ago, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A. Temperature 100.0° F B. Pulse 110 beats/min C. Respiratory rate 12 breaths/min D. Blood pressure 125/78 E. Temperature 38° C

B. Pulse 110 beats/min E. Temperature 38° C During the first 24 hours postpartum, temperature may increase to 38° C (100.4° F) Pulse, remains elevated for the first hour or so after childbirth. It then begins to decrease to a nonpregnant rate. A rapid pulse may indicate hypovolemia. Respiratory rate is normal. Blood pressure is altered slightly if at all postpartum.

The nurse observes several interactions between a postpartum woman and her new son. What behavior, if exhibited by this woman, does the nurse identify as a possible maladaptive behavior regarding parent-infant attachment? A. Talks and coos to her son B. Seldom makes eye contact with her son C. Cuddles her son close to her D. Tells visitors how well her son is feeding

B. Seldom makes eye contact with her son Talking and cooing to her son is a normal infant-parent interaction. The woman should be encouraged to hold her infant in the en face position and make eye contact with him. Cuddling is a normal infant-parent interaction. Sharing her son's success at feeding is a normal infant-parent interaction.

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior? A. The parents have difficulty naming the infant. B. The parents hover around the infant, directing attention to and pointing at the infant. C. The parents make no effort to interpret the actions or needs of the infant. D. The parents do not move from fingertip touch to palmar contact and holding.

B. The parents hover around the infant, directing attention to and pointing at the infant. Reluctance to name the baby is an inhibiting behavior. Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior. Failure to interpret the actions and needs of the infant is an inhibiting behavior. Lack of fingertip, palmar touch, and holding represents an inhibiting behavior.

A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: A. uterine contractions occurring every 8 to 10 minutes B. a fetal heart rate (FHR) of 180 with absence of variability C. the client needing to void D. rupture of the client's amniotic membranes

B. a fetal heart rate (FHR) of 180 with absence of variability The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. This FHR is non-reassuring. The oxytocin should be immediately discontinued and the physician should be notified. This is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.

With regard to systemic analgesics administered during labor, nurses should be aware that: A. systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. effects on the fetus and newborn can include decreased alertness and delayed sucking. C. IM administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. effects on the fetus and newborn can include decreased alertness and delayed sucking. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: A. urinary tract infection. B. excessive uterine bleeding. C. a ruptured bladder. D. bladder wall atony.

B. excessive uterine bleeding. A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. encourage the woman to breathe more slowly. B. help the woman breathe into a paper bag. C. turn the woman on her side. D. administer a sedative.

B. help the woman breathe into a paper bag. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression since this woman, being in the transition phase, is near the birth process. The side-lying position would be appropriate for supine hypotension.

When assessing a fetal heart rate (FHR) tracing, the nurse notes a decrease in the baseline rate from 155 to 110. The rate of 110 persists for more than 10 minutes. The nurse could attribute this decrease in baseline to: A. maternal hyperthyroidism. B. initiation of epidural anesthesia that resulted in maternal hypotension. C. maternal infection accompanied by fever. D. alteration in maternal position from semirecumbent to lateral.

B. initiation of epidural anesthesia that resulted in maternal hypotension. Hyperthyroidism would result in baseline tachycardia. Fetal bradycardia is the pattern described and results from the hypoxia that would occur when uteroplacental perfusion is reduced by maternal hypotension. The woman receiving epidural anesthesia needs to be well hydrated before and during induction of the anesthesia to maintain an adequate cardiac output and blood pressure. A maternal fever could cause fetal tachycardia. Assumption of a lateral position enhances placental perfusion and should result in a reassuring FHR pattern.

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: A. place her on a bedpan to empty her bladder. B. massage her fundus. C. call the physician. D. administer Methergine, 0.2 mg IM, which has been ordered prn.

B. massage her fundus. There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: A. foster an active role in the baby's care. B. provide time for the mother to reflect on the events of and her behavior during childbirth. C. recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. D. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

B. provide time for the mother to reflect on the events of and her behavior during childbirth. Once the mother's needs are met, she would be more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. visceral. B. referred. C. somatic. D. afterpain.

B. referred. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1½ to 2 minutes. The nurse's IMMEDIATE action would be to: A. change the woman's position. B. stop the Pitocin. C. elevate the woman's legs. D. administer oxygen via a tight mask at 8 to 10 L/min.

B. stop the Pitocin. The woman is already in an appropriate position for uteroplacental perfusion. Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic that stimulates the uterus to contract. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

A woman is evaluated to be using an effective bearing-down effort if she: A. begins pushing as soon as she is told that her cervix is fully dilated and effaced. B. takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. C. uses the Valsalva maneuver by holding her breath and pushing vigorously for a count of 12. D. continues to push for short periods between uterine contractions throughout the second stage of labor.

B. takes two deep, cleansing breaths at the onset of a uterine contraction and at the end of the contraction. Bearing-down efforts should begin during the active-descent phase of the second stage of labor when the urge to bear down (Fresno reflex) is perceived. Cleansing breaths at the onset of a contraction allow it to build to a peak before pushing begins. They also enhance gas exchange in the alveoli and help the woman relax after the uterine contraction subsides. Women should avoid closed-glottis pushing (Valsalva maneuver) since uteroplacental perfusion is usually reduced. Open-glottis pushing is recommended. The woman should push with contractions to combine the force of both powers of labor: uterine and abdominal. Pushing gently between contractions is only advised when the fetal head is being delivered.

With regard to dysfunctional labor, nurses should be aware that: A. women who are underweight are more at risk. B. women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. C. hypertonic uterine dysfunction is more common than hypotonic dysfunction. D. abnormal labor patterns are most common in older women.

B. women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. Short women more than 30 lbs overweight are more at risk for dysfunctional labor. Precipitous labor lasts less than 3 hours. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women younger than 20 years of age.

The nurse knows that the second stage of labor, the descent phase, has begun when: A) the amniotic membranes rupture. B) the cervix cannot be felt during a vaginal examination. C) the woman experiences a strong urge to bear down. D) the presenting part is below the ischial spines.

C) the woman experiences a strong urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation.

Which description of the phases of the second stage of labor is accurate? A. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes B. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies D. Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies. The latent phase is the lull, or "laboring down," period at the beginning of the second stage. It lasts 10 to 30 minutes on average. The second stage of labor has no active phase. The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The transition phase is the final phase in the second stage of labor; contractions are strong and painful.

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? A. The healthy newborn should be taken to the nursery for a complete assessment. B. After drying, the infant should be given to the mother wrapped in a receiving blanket. C. Encourage skin-to-skin contact of mother and baby. D. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

C. Encourage skin-to-skin contact of mother and baby. Although this is the practice in many facilities, it is neither evidence-based nor supportive of family-centered care. This is a common practice and more family friendly than separating mother and baby; however, ideally the baby should be placed skin to skin. The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding. The father or support person is likely anxious to hold and admire the newborn. This can happen after the infant has been placed skin to skin and breastfeeding has been initiated.

A postpartum woman preparing for discharge asks the nurse about resuming sexual activity. Which information is appropriate to include in the patient teaching? (Select all that apply.) A. Do not perform Kegel exercises to decrease pelvic floor muscle healing time. B. If breastfeeding, sexual interest may be delayed. C. Fatigue may affect interest in sexual activity. D. Sexual activity can usually be safely resumed by 5 to 6 weeks after birth. E. Water-soluble lubrication may increase comfort. F. The female-on-top position may be more comfortable than other positions.

C. Fatigue may affect interest in sexual activity. D. Sexual activity can usually be safely resumed by 5 to 6 weeks after birth. E. Water-soluble lubrication may increase comfort. F. The female-on-top position may be more comfortable than other positions. Kegel exercises are usually recommended and can strengthen the pubococcygeal muscle. Breastfeeding mothers often are interested in returning to sexual activity before nonbreastfeeding mothers. The amount of psychologic energy expended by the mother in child care activities may lead to fatigue and decreased interest in sexual activity. Most women can safely resume sexual activity by 5 to 6 weeks after birth. A water-soluble gel or jelly is recommended for lubrication. A position in which the mother has control of the depth of insertion of the penis, such as the female-on-top position may be more comfortable than other positions.

Which measure would be least effective in preventing postpartum hemorrhage? A. Administer Methergine, 0.2 mg every 6 hours for four doses, as ordered B. Encourage the woman to void every 2 hours C. Massage the fundus every hour for the first 24 hours following birth D. Teach the woman the importance of rest and nutrition to enhance healing

C. Massage the fundus every hour for the first 24 hours following birth Administration of Methergine can help prevent postpartum hemorrhage. Voiding frequently can help the uterus contract, thus preventing postpartum hemorrhage. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Rest and nutrition are helpful for enhancing healing and preventing hemorrhage.

Which statement regarding postpartum depression (PPD) is essential for the nurse to be aware of when attempting to formulate a plan of care? A. PPD symptoms are consistently severe. B. This syndrome affects only new mothers. C. PPD can easily go undetected. D. Only mental health professionals should teach new parents about this condition.

C. PPD can easily go undetected. PPD symptoms range from mild to severe, with women having good days and bad days. Screening should be done for mothers and fathers. PPD may also occur in new fathers. PPD can go undetected because parents do not voluntarily admit to this type of emotional distress out of embarrassment, fear, or guilt. The nurse should include information on PPD and how to differentiate this from the baby blues for all clients on discharge. Nurses also can urge new parents to report symptoms and seek follow-up care promptly if they occur.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A. Encourage her to empty her bladder. B. Decrease her intravenous (IV) rate to a keep vein-open rate. C. Turn the woman to the left lateral position or place a pillow under her hip. D. No action is necessary since a decrease in the woman's blood pressure is expected.

C. Turn the woman to the left lateral position or place a pillow under her hip. Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

When palpating the fundus of a woman 18 hours after birth, the nurse notes that it is firm, 2 fingerbreadths above the umbilicus, and deviated to the left of midline. The nurse should: A. massage the fundus. B. administer Methergine, 0.2 mg PO, that has been ordered prn. C. assist the woman to empty her bladder. D. recognize this as an expected finding during the first 24 hours following birth.

C. assist the woman to empty her bladder. A firm fundus should not be massaged since massage could overstimulate the fundus and cause it to relax. Methergine is not indicated in this case since it is an oxytocic and the fundus is already firm. The findings indicate a full bladder, which pushes the uterus up and to the right or left of midline. The recommended action would be to empty the bladder. If the bladder remains distended, uterine atony could occur, resulting in a profuse flow. This is not a normal finding, and an action is required.

Excessive blood loss after childbirth can have several causes; however, the most common is: A. vaginal or vulvar hematomas. B. unrepaired lacerations of the vagina or cervix. C. failure of the uterine muscle to contract firmly. D. retained placental fragments.

C. failure of the uterine muscle to contract firmly. Although vaginal or vulvar hematomas are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Although unrepaired lacerations are a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause. Uterine atony can best be thwarted by maintaining good uterine tone and preventing bladder distention. Although retained placental fragments is a possible cause of excessive blood loss, uterine muscle failure (uterine atony) is the most common cause.

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: A. kidney function returns to normal a few days after birth. B. diastasis recti abdominis is a common condition that alters the voiding reflex. C. fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. D. with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

C. fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. either hot or cold applications may provide relief, but they should never be used together in the same treatment. B. acupuncture can be performed by a skilled nurse with just a little training. C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

A nurse providing care to a woman in labor should be aware that cesarean birth: A. is declining in frequency in the United States. B. is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do. C. is performed primarily for the benefit of the fetus. D. can be either elected or refused by women as their absolute legal right.

C. is performed primarily for the benefit of the fetus. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: A. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. B. there are no important maternal (as opposed to fetal) contraindications. C. its most important function is to afford the opportunity to administer antenatal glucocorticoids. D. if the client develops pulmonary edema while on tocolytics, IV fluids should be given.

C. its most important function is to afford the opportunity to administer antenatal glucocorticoids. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Tocolytic-induced edema can be caused by IV fluids.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: A. narcotics. B. barbiturates. C. methamphetamines. D. tranquilizers.

C. methamphetamines. Maternal ingestion of narcotics may be the cause of decreased variability. The use of barbiturates may also result in a significant decrease in variability as these are known to cross the placental barrier. The use of illicit drugs, such as cocaine or methamphetamines, might cause increased variability. Tranquilizer use is a possible cause of decreased variability in the fetal heart rate.

With regard to afterbirth pains, nurses should be aware that these pains are: A. caused by mild, continual contractions for the duration of the postpartum period. B. more common in first-time mothers. C. more noticeable in births in which the uterus was overdistended. D. alleviated somewhat when the mother breastfeeds.

C. more noticeable in births in which the uterus was overdistended. The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus. Breastfeeding intensifies afterbirth pain because it stimulates contractions.

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: A. return to prepregnant weight is usually achieved by the end of the postpartum period. B. fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3-lb weight loss. C. the expected weight loss immediately after birth averages about 11 to 13 lbs. D. lactation will inhibit weight loss since caloric intake must increase to support milk production.

C. the expected weight loss immediately after birth averages about 11 to 13 lbs. Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 lbs. The expected weight loss immediately following delivery is 11 to 13 lbs, followed by a gradual decrease and a return to prepregnancy weight in 2 to 3 months. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process.

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: A. express a strong need to review events and her behavior during the process of labor and birth. B. exhibit a reduced attention span, limiting readiness to learn. C. vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. D. have reestablished her role as a spouse/partner.

C. vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. This is characteristic of the taking-in stage, which lasts for the first few days after birth. This is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. This reflects the letting-go stage, which indicates that psychosocial recovery is complete.

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: A) weight gain of 1 to 3 lbs. B) quickening. C) fatigue and lethargy. D) bloody show.

D) Bloody show Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.

Two hours after giving birth, a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm, at the umbilicus, and midline. Her lochia is moderate rubra with no clots. The nurse would suspect: A. bladder distention. B. uterine atony. C. constipation. D. hematoma formation.

D. hematoma formation. Bladder distention would result in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony would result in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: A) The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. B) Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. C) Having the woman point her toes reduces leg cramps. D) The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation.

D) The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan would be considered unrealistic and require further discussion with the nurse? A. "My husband and I have agreed that my sister will be my coach since he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is OK." B. "We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." C. "We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage."

D. "We do not want the fetal monitor used during labor since it will interfere with movement and doing effleurage." Since monitoring is essential to assess fetal well-being, it is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long as labor is progressing normally.

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A. Maternal blood pressure of 108/79 B. Maternal heart rate of 98 C. Respiratory rate of 14 breaths/min D. Fetal heart rate of 100 beats/min Correct E. Minimal variability on a fetal heart monitor Correct

D. Fetal heart rate of 100 beats/min E. Minimal variability on a fetal heart monitor After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

Which statement is most likely to be associated with a breech presentation? A. Least common malpresentation B. Descent is rapid C. Diagnosis by ultrasound only D. High rate of neuromuscular disorders

D. High rate of neuromuscular disorders Breech is the most common malpresentation affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound. Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? A. Notify nursery nurse of imminent delivery. B. Insert a Foley catheter. C. Start oxytocin (Pitocin). D. Notify the primary health care provider immediately (HCP).

D. Notify the primary health care provider immediately (HCP). The patient needs to be evaluated by the HCP immediately to determine whether delivery is warranted at this time. If the FHR were to continue in an abnormal or non-reassuring pattern, a cesarean section may be warranted. This would require the insertion of a Foley catheter; however, the physician must make that determination. Oxytocin may put additional stress on the fetus. To relieve an FHR deceleration, the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/min B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D. One fetal movement noted in 1 hour of assessment by the mother. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. A score of 8 on the BPP is a normal finding in a 42-week gestation pregnancy. Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation.

Which findings would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? (Select all that apply.) A. Postural hypotension B. Temperature of 100.4° F C. Bradycardia—pulse rate of 55 beats/min D. Pain in left calf with dorsiflexion of left foot E. Lochia rubra with foul odor

D. Pain in left calf with dorsiflexion of left foot E. Lochia rubra with foul odor Postural hypotension is an expected finding related to circulatory changes after birth A temperature of 100.4° F in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake. A heart rate of 55 beats/min is an expected finding in the initial postpartum period. These findings indicate a positive Homans' sign and are suggestive of thrombophlebitis and should be investigated. Lochia with odor may indicate infection.

Which finding meets the criteria of a reassuring fetal heart rate (FHR) pattern? A. FHR does not change as a result of fetal activity. B. Average baseline rate ranges between 100 and 140 beats/min. C. Mild late deceleration patterns occur with some contractions. D. Variability averages between 6 to 10 beats/min.

D. Variability averages between 6 to 10 beats/min. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats/min. Late deceleration patterns are never reassuring, although early and mild variable decelerations are expected, reassuring findings. Variability indicates a well-oxygenated fetus with a functioning autonomic nervous system.

Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm at the umbilicus and midline. Her lochia is moderate rubra with no clots. The nurse suspects: A. bladder distention B. uterine atony C. constipation D. hematoma formation

D. hematoma formation Bladder distention results in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony results in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia is: A. severe postpartum headache. B. limited perception of bladder fullness. C. increase in respiratory rate. D. hypotension.

D. hypotension. Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic because it would be with a low spinal (saddle block) anesthetic. Limited perception of bladder fullness is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure.

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: A. begin an IV infusion of Ringer's lactate solution. B. assess the woman's vital signs. C. call the woman's primary health care provider. D. massage the woman's fundus.

D. massage the woman's fundus. The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from an impending hemorrhage; assessing vital signs should not be the nurse's first action. The physician should be notified after the nurse completes assessment of the woman. The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss.

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to: A. acidify the urine by drinking three glasses of orange juice each day. B. maintain a fluid intake of 1 to 2 L/day. C. empty her bladder every 4 hours throughout the day. D. perform perineal care on a regular basis.

D. perform perineal care on a regular basis. Urine is acidified with cranberry juice. The woman should drink at least 3 L of fluid each day. The woman should empty her bladder every 2 hours to prevent stasis of urine. Keeping the perineum clean will help prevent a urinary tract infection.

Postbirth uterine/vaginal discharge, called lochia: A. is similar to a light menstrual period for the first 6 to 12 hours. B. is usually greater after cesarean births. C. will usually decrease with ambulation and breastfeeding. D. should smell like normal menstrual flow unless an infection is present.

D. should smell like normal menstrual flow unless an infection is present. Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A. tell the woman she can rest after she feeds her baby. B. recognize this as a behavior of the taking-hold stage. C. record the behavior as ineffective maternal-newborn attachment. D. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

D. take the baby back to the nursery, reassuring the woman that her rest is a priority at this time. The woman should not be told what to do and needs to care for her own well-being. The taking-hold stage occurs about 1 week after birth. Because the woman needs to rest does not indicate ineffective maternal-newborn attachment. The behavior described is typical of this stage and not a reflection of ineffective attachment unless it persists. Mothers need to reestablish their own well-being to effectively care for their baby.

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 the symphysis pubis back to the episiotomy. C, changes her perineal pad every 2 to 3 hours. D. uses the peribottle to rinse upward into her vagina.

D. uses the peribottle to rinse upward into her vagina. The peribottle 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.

During the fourth stage of labor the woman's fundal tone, lochial flow, and vital signs should be

assessed frequently to ensure that she is physically recovering well after giving birth.

The five essential components of the FHR tracing are

baseline rate, baseline variability, accelerations, decelerations, and changes or trends over time.

Preterm labor consists of uterine contractions with cervical change (e.g., effacement and dilation) that occur

between 20 and 37 completed weeks of pregnancy; preterm birth is any birth that occurs before the completion of 37 weeks of pregnancy

The cardinal movements of the mechanism of labor are

engagement, descent, flexion, internal rotation, extension, restitution and external rotation, and expulsion of the infant.