OB Chapter 14:Nursing Management during Labor and Birth Part 2

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give? 1) "It disrupts the nerve signal of pain via mechanical irritation of the nerves." 2) "It distracts your brain from the sensations of pain." 3) "It causes the release of endorphins." 4) "It blocks the transmission of nerve messages of pain at the receptors."

"It distracts your brain from the sensations of pain." Explanation: Concentrating intently on an object is another method of distraction, or another method of keeping sensory input from reaching the cortex of the brain. The other answers refer to other means of pain management.

Which possible outcome would be a major disadvantage of any pain-relief method that also affects awareness of the mother? 1) The mother may have continued memory loss postpartum. 2) The mother may have difficulty working effectively with contractions. 3) The infant may show increased drowsiness. 4) The father's coaching role may be disrupted at times.

The mother may have difficulty working effectively with contractions. Explanation: Breathing and relaxation techniques can speed labor. An inability of the woman to do these as a result of pain relief measures can slow labor.

The labor client is prepared for natural birth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacologic pain management is this considered? 1) attention focusing 2) relaxation technique 3) hypnosis 4) continuous labor support

attention focusing Explanation: Attention focusing is the use of an object or picture or image for the woman to reflect and focus internally or externally during labor to distract her from the labor pain. A relaxation technique would be sitting in warm water or having a massage. Continuous labor support comes from the coach or partner. Hypnosis is a psychological state.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: 1) engagement of fetus. 2) dilatation of cervix. 3) rupture of amniotic membranes. 4) bloody show.

dilatation of cervix. Explanation: The best determination of effective contractions is dilation of the cervix. Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.

The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: 1) right lower quadrant. 2) right upper quadrant. 3) left lower quadrant. 4) left upper quadrant.

left lower quadrant. Explanation: The best position to auscultate fetal heart tones in on the fetus back. In this position, the best place for the FHR monitor is on the left lower quadrant.

A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next? 1) temperature 2) uterine contractions 3) respiratory rate 4) pulse

respiratory rate Explanation: The nurse must monitor for respiratory depression. Monitoring the client's respiratory rate will be the best indicator of respiratory depression.

A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client? 1) a failed block 2) postdural puncture headache 3) respiratory depression 4) accidental intrathecal block

respiratory depression Explanation: Respiratory depression is a complication of epidural anesthesia and should be closely monitored in laboring clients. A failed block, accidental intrathecal block, and a postdural headache are all side effects of a spinal epidural block.

The pain of labor is influenced by many factors. What is one of these factors? 1) The woman is prepared for labor and birth. 2) The woman has a high tolerance for pain. 3) The woman has a high threshold for pain. 4) The woman has lots of visitors during labor.

The woman is prepared for labor and birth. Explanation: The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared.

How should the nurse counsel a client who is about to receive meperidine 25 mg IV? 1) "After I give you the medication, you should feel complete pain relief." 2) "It's possible you may feel a bit sleepy or nauseous after I administer this medication." 3) "I'll be monitoring the fetal heart rate and your pulse and oxygen saturation continuously for the next four hours." 4) "I'll be assessing your blood pressure every 3 to 5 minutes for a half-hour."

"It's possible you may feel a bit sleepy or nauseous after I administer this medication." Explanation: During epidural administration, vital signs are measured every 3 to 5 minutes. For administration of analgesia, vital signs should be taken before the medication is administered and 15 minutes after administration. A baseline fetal heart tracing should be taken before administration and then again 15 minutes after administration.

What should the nurse's best response be to help the client remain calm and cooperative during birth? 1) "Do you want me to call in your family? 2) "The baby is coming. I'll explain what's happening and guide you." 3) "The baby is coming. Relax and everything will turn out fine." 4) "Even though the baby is coming, the health care provider will be here soon."

"The baby is coming. I'll explain what's happening and guide you." Explanation: The nurse is not to leave the side of the client; to keep her calm she needs to explain all procedures and discuss all events to the mother. An explanation will give the mother something else to think about, and it will assure her that everything is going well.

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse? 1) "An injury is unlikely because of expert professional care given." 2) "The injection is given in the space outside the spinal cord." 3) "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem." 4) "I have never read or heard of this happening."

"The injection is given in the space outside the spinal cord." Explanation: An epidural block, as the name implies, does not enter the spinal cord but only the epidural space outside the cord.

A client has just received IV sedation. What must the nurse tell the client to do? 1) Sit on the edge of the bed with her feet dangling before ambulating. 2) Ambulate within 15 minutes to prevent spinal headache. 3) Ambulate only with assistance from the nurse or caregiver. 4) Remain in bed for at least 30 minutes.

Ambulate only with assistance from the nurse or caregiver. Explanation: The client may have decreased sensory ability from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.

During an admission assessment of a client in labor, the nurse observes that there is no vaginal bleeding yet. What nursing intervention is appropriate in the absence of vaginal bleeding when the client is in the early stage of labor? 1) Assess amount of cervical dilation. 2) Monitor hydration status. 3) Monitor vital signs. 4) Obtain urine specimen for urinalysis.

Assess amount of cervical dilation. Explanation: If vaginal bleeding is absent during admission assessment, the nurse should perform vaginal examination to assess the amount of cervical dilation. Hydration status is monitored as part of the physical examination. A urine specimen is obtained for urinalysis to obtain a baseline. Vital signs are monitored frequently throughout the maternal assessment.

A 39-week-gestation client presents to the labor and birth unit reporting abdominal pain. What should the nurse do first? 1) Determine if the client is in true or false labor. 2) Ask if this is the client's first pregnancy. 3) Notify the healthcare provider. 4) Assess to see if the client has any drug allergies.

Determine if the client is in true or false labor. Explanation: When a nurse first comes in contact with a pregnant client, it is important to first ascertain whether the woman is in true or false labor. Information regarding the number of pregnancies or history of drug allergy is not important criteria for admitting the client. The healthcare provider should be notified once the nurse knows the client's current status.

A woman in labor at the hospital has just received an epidural block. Which intervention is a priority before and during epidural placement? 1) Provide adequate IV fluids to maintain her blood pressure. 2) Increase oral fluids every hour to prevent dehydration. 3) Monitor the maternal apical pulse for bradycardia. 4) Monitor temperature every four hours, and give acetaminophen if 100.4 degrees or higher.

Provide adequate IV fluids to maintain her blood pressure. Explanation: The client will need to have a bolus of IV fluids prior to and then maintained during the epidural to be prepared in the event of the hypotensive episodes that may accompany epidural placement. The hypotensive event is transitory, and increasing oral hydration is unnecessary and may lead to nausea later. Monitor the mother's body temperature, but wait for instructions from the primary care provider as to when to administer medication. Bradycardia is not a common side effect of epidural medication.

A woman arrives in the labor and birth department and is panting and screaming "the baby is coming". What is the priority intervention by the nurse? 1) Assess vital signs. 2) Admit her to the unit and escort to a room. 3) Ask medical and obstetrical history. 4) Quickly move the woman to a labor bed, and check the perineum.

Quickly move the woman to a labor bed, and check the perineum. Explanation: The woman is showing signs of advanced labor, possibly in transition or stage two. She needs to be managed as an imminent birth and taken directly to a room for vaginal assessment. Vital signs, medical/obstetrical history, and her room assignment can be taken care of later in the process.

What is the most important thing a nurse can do during labor and birth to prevent maternal and fetal infection? 1) Clean the woman's perineum with a Betadine scrub. 2) Strictly follow universal precautions. 3) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum. 4) Thoroughly wash the hands before and after client contact.

Thoroughly wash the hands before and after client contact. Explanation: The most important infection control technique in any health care setting is thoroughly washing hands on routine basis. Keeping the area clean is secondary, but is also important.

A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply. 1) Turn the client on her left side. 2) Assess client for underlying causes. 3) Reduce intravenous (IV) fluid rate. 4) Ignore questions from the client. 5) Administer oxygen by mask.

Turn the client on her left side. Administer oxygen by mask. Assess client for underlying causes. Explanation: The nurse should turn the client on her left side to increase placental perfusion, administer oxygen by mask to increase fetal oxygenation, and assess the client for any underlying contributing causes. The client's questions should not be ignored; instead, the client should be reassured that interventions are to effect FHR pattern change. A reduced IV rate would decrease intravascular volume, affecting the FHR further.

The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction? 1) diastole 2) acme 3) increment 4) decrement

acme Explanation: The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction.

The nurse is assisting a client through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist? 1) dry, cracked lips 2) inability to push 3) urinary retention 4) rapid progress of labor

inability to push Explanation: If she is not able to push, her epidural dose may be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so the nurse should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.