OB Exam 2
A nurse is caring for a client who asks, "How will I know if I'm having true or false labor contractions?" Which of the following responses should the nurse make?
"True contractions will begin irregularly and then become regular in timing"
A nurse is teaching a client about using the Lamaze method to manage pain during labor. Which of the following pieces of information should the nurse include?
"You will learn how to prevent pain during labor by focusing your mind to control your breathing"
What is the appearance of the umbilical cord?
2 arteries, 1 vein
A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. What statement should the nurse make?
A distended bladder reduces pelvic space needed for birth.
A nurse discussing epidural anesthesia with a client who is receiving oxytocin to induce labor. Which of the following statements should the nurse make?
An epidural given too early can prolong labor
A nurse is caring for a client in active labor. When last examined 2 hr ago, the client's cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states, "my water broke." The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal exam, noticing clear fluid and a pulsing loop of umbilical cord in the client's vagina. What action should the nurse perform first?
Apply pressure to the presenting part with the fingers
A nurse is assisting with an amniotomy for a client who is in active labor. Which of the following actions should the nurse take?
Assess the fetal heart rate before and after the procedure
A nurse is caring for a client who is 40 weeks of gestation and reports having large gush of fluid from the vagina while walking from the bathroom. What action should the nurse take first?
Check the FHR
A nurse is providing care to a client who is in labor. A fetal heart tracing shows early decelerations. Which of the following actions should the nurse take?
Continue to monitor fetal heart tracings
A nurse is planning care for a newly admitted client who reports, "I am in labor and I have been having vaginal bleeding for 2 weeks." What should the nurse include in the plan of care?
Defer vaginal exams
What is caput succedaneum?
Edema under the scalp that crosses suture lines and is usually present at birth (after vacuum-assisted deliver); disappears within 3-5 days
A nurse is caring for a client who has been in labor for 12 hr with intact membranes. The nurse performs a vaginal examination to ensure what prior to the performance of the amniotomy?
Fetal engagement
A nurse is caring for a client who is pregnant and has a rupture of membranes. The nurse notes the presence of meconium-stained fluid. Which of the following actions should the nurse take?
Gather equipment for neonatal resuscitation
What are the phases of the first stage of labor?
Latent, Active and Transition
A nurse is caring for a client who is in active labor, irritable, and reports the urge to have a bowel movement. The client vomits and states, "I've had enough. I can't do this anymore." What stage of labor is the client experiencing?
Transition phase
How are the contractions for the transition phase of stage 1?
strong; every 2-3 min; 45-90 sec long dilated: 8-10 cm
What is the fourth stage of labor?
begins with delivery of the placenta and includes at least the first 2 hr after birth
What is the third stage of labor?
lasts from birth of the fetus until the placenta is delivered
A nurse is caring for a client who is in labor. The client questions the application of an internal fetal scalp monitor. Which of the following responses should the nurse provide?
"We need to observe your baby more closely"
A nurse in a clinic is providing teaching to a client who is at 37 weeks of gestation and is scheduled for an external cephalic version. Which of the following statements should the nurse take?
"You will receive a medication to relax your uterus prior to the procedure."
A nurse is creating a plan of care for a client who is in the active stage of labor and expresses a desire to use nonpharmacological methods of pain relief. Which of the following interventions should the nurse include?
Assist the client into a warm shower
A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. What is the first action the nurse should take?
Assist the client into the left-lateral position
A nurse is caring for a client and partner during the second stage of labor. The client's partner asks the nurse to explain how to know when crowning occurs. What response should the nurse make?
The vaginal area will bulge as the baby's head appears.
A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses. What statement by a nurse indicates understanding of the teaching?
They are tablets administered vaginally
A client calls a provider's office and reports having contractions for 2 hr that increased with activity and did not decrease with rest and hydration. The client denies leaking of vaginal fluid but did notice blood when wiping after voiding. What manifestation is the client experiencing?
True contractions
What is a Bishop score?
Used to determine maternal readiness for labor by evaluating whether the cervix is favorable by rating the following: dilation, effacement, cervical consistency, cervical position and station of presenting part (each assigned number from 0-3; 8= successful vaginal birth; 6= induce)
What is McRobert's Maneuver?
Used to manage shoulder dystocia during delivery of the infant. Maternal legs are removed from stirrups and sharply flexed upon the abdomen.
What is VEAL CHOP?
V: variable deceleration; C: cord compression E: early deceleration; H: head compression A: accelerated; O: okay L: late deceleration; P: placental insufficiency
What indicates the use of dinoprostone?
any condition in which augmentation or induction of labor is indicated; failure of cervix to dilate and efface, failure of labor to progress
How are the contractions for the latent phase of stage 1?
irregular, mild; every 5-30 min; 30-45 sec long dilated: 0-3 cm
What is the second stage of labor?
lasts from the time the cervix is fully dilated to the birth of the fetus
What should the nurse monitor for after a cesarean birth?
monitor for infection and excessive bleeding at incision site; assess uterine fundus for firmness/tenderness; assess lochia for amount and characteristics
How are the contractions for the active phase of stage 1?
more regular, moderate; every 3-5 min; 40-70 sec long dilated: 4-7 cm
What are adverse effects for use of dinosprostone?
nausea, vomiting, diarrhea, fever, uterine tachysystole
What is used to assess amniotic fluid after rupture?
nitrazine paper- turns blue if amniotic fluid is present
What is the first stage of labor?
onset of regular uterine contractions to full effacement and dilation of cervix
What should be monitored during amnioinfusion?
prevent uterine overdistention and increased uterine tone; monitor fluid output; continually monitor FHR
What is dinoprostone?
prostaglandin E2 used to soften and thin the cervix
A nurse is caring for a client who is in active labor. The client reports lower-back pain. The nurse suspects that this pain is related to a persistent occiput posterior fetal position. What nonpharmalogical nursing intervention should the nurse recommend to the client?
sacral counterpressure
What is the gate-control theory of pain?
sensory nerve pathways will only allow a limited number of sensations to travel at any given time; sending alternate signals can block the brain's perception of pain
A nurse is assessing a client who is in the fourth stage of labor. Which of the following findings should the nurse expect?
urinary retention
What are the nursing actions for the use of dinoprostone?
urinary retention, rupture of membranes, uterine tenderness/pain, contractions, vaginal bleeding, fetal distress
What should the nurse do in the case of a prolapsed cord?
use a STERILE gloved hand and insert 2 fingers into the vagina to relieve pressure off the cord; reposition client knee-chest, Trendelenburg, or side-lying position with rolled towel under right/left hip
A nurse is caring for a client at 39 weeks gestation who is in the active phase of labor. The nurse observes late decelerations in the fetal heart rate. Which of the following findings should the nurse identify as the cause of late decelerations?
uteroplacental insufficiency
A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter placed to monitor uterine contractions. What nursing contraction pattern should the nurse discontinue the infusion of the oxytocin?
Duration of 90 or greater
A nurse is caring for a client who is at 40 weeks of gestation and experiencing contractions every 3 to 5 min and becoming stronger. A vaginal exam reveals that the client's cervix is 3 cm dilated, 80% effaced, and -1 station. The client asks for pain medication. What actions should the nurse take?
Encourage use of patterned breathing techniques; Administer opioid analgesic medication; Suggest application of cold
A nurse is providing care to a client who is in labor and experienced a spontaneous rupture of membranes. Which of the following findings requires intervention by the nures?
Fetal heart rate decreased by 15/min
A nurse is caring for a client having contractions every 8 min that are 30 to 40 seconds in duration. The client's cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station with a FHR around 140/min. What stage and phase is the client experiencing?
First stage, latent phase
A nurse is a labor and delivery is teaching a newly licensed nurse about performing the McRoberts maneuver to relieve shoulder dystocia. Which of the following pieces of information should the nurse include?
Flex the client's legs apart and raise her knees to her abdomen
A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. What maternal position should the nurse suggest to the client to facilitate normal labor progress?
Hands and knees
A nurse is caring for a client in labor who has an epidural for pain relief. Which of the following is a complication of the epidural block?
Hypotension
A charge nurse is providing teaching for a newly hired nurse about the potential side effects of an epidural anesthetic for a laboring client. Which of the following effects should the charge nurse include in the teaching?
Impaired placental perfusion
A nurse is caring for a client who is in labor and has received epidural analgesia. The client's blood pressure is 88/50 mmHg, and the fetal heart tracing shows late decelerations. Which of the following actions should the nurse take?
Increase the rate of the primary IV infusion
A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagina for 2 days. What condition is the client at risk for developing?
Infection
A nurse is teaching a client about the benefits of internal fetal heart monitoring. What statements should the nurse include?
It can detect abnormal fetal heart tones early; It allows for accurate readings with maternal movement; It can measure uterine contraction intensity
A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. What statement should the nurse make?
It is needed to counteract hypotension
A nurse is caring for a client in the third stage of labor. What findings indicate placental separation?
Lengthening of the umbilical cord, appearance of dark blood from the vagina, fundus firm upon palpation
A nurse is caring for a client who just had a spontaneous rupture of membranes. The nurse observes fetal bradycardia on the FHR tracing and a prolapsed umbilical cord. Which of the following actions should the nurse take first?
Manually apply upward pressure intravaginally on the presenting part
A nurse is caring for a client who is at 42 weeks of gestation and in active labor. What finding is the fetus at risk for developing?
Meconium aspiration
A nurse is caring for a client who is in active labor. The cervix is dilated to 5 cm, and the membranes are intact. Based on the use of external electronic fetal monitoring, the nurse notes a FHR of 115 to 125/min with occasional increases up to 150 to 155/min that last for 25 seconds and have moderate variability. There is no slowing of the FHR from the baseline. The client is exhibiting manifestations of what?
Moderate variability, FHR accelerations, normal baseline FHR
When is an amnioinfusion indicated?
Oligohydraminios (scant/absent amniotic fluid); Fetal cord compression
A nurse is caring for a client who is 42 weeks of gestation and is having an ultrasound. What conditions should the nurse plan for an amnioinfusion?
Oligohydramnios, Fetal cord compression
A nurse is performing Leopold maneuvers on a client who is in labor. What techniques should the nurse use to identify the fetal lie?
Palpate the fundus of the uterus
A nurse is caring for a client who is using patterned breathing during labor. The client reports numbness and tingling of the fingers. What action should the nurse take?
Place an oxygen mask over the client's nose and mouth
A nurse is caring for a client in active labor who is experiencing hypotension following epidural placement. Which of the following actions should the nurse take?
Place the client in a lateral position
A nurse is caring for a client who is at 38 weeks of gestation and is receiving an oxytocin IV for labor augmentation. The nurse notes variable decelerations on the FHR tracing. Which of the following actions should the nurse take first?
Place the client in a side-lying position
A nurse is providing care for a client who is in the second stage of labor. The fetal heart tracing indicates multiple variable decelerations. Which of the following actions should the nurse take?
Prepare an amnioinfusion
A nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions. What action should the nurse make?
Prepare for an impending delivery
A nurse is caring for a pregnant client who is at 37 weeks of gestation and who had a biophysical profile with a total score of 4. Which of the following actions should the nurse anticipate taking?
Prepare for delivery of the infant
A nurse is caring for a client who is attempting a trial of labor after several cesarean births. The client reports sudden onset of constant abdominal pain, and the nurse observes a prolonged deceleration on the fetal heart rate tracing. Which of the following actions should the nurse take?
Prepare the client for an emergency cesarean delivery
A nurse is caring for a client who experienced a spontaneous rupture of membranes and has prolonged decelerations on the fetal monitor. Which of the following conditions should the nurse expect?
Prolapsed umbilical cord
A nurse is caring for a client who is in labor. With the use of Leopold maneuvers, it is noted that the fetus is in a breech position. Which possible complication should the nurse observe?
Prolapsed umbilical cord
A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and a vaginal delivery is expected in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that what types of regional anesthetic block is to be adminsitered?
Pudendal
A nurse is caring for a client who is receiving IV oxytocin for the induction of labor and notes repetitive early decelerations on the electronic fetal heart rate tracing. Which of the following actions should the nurse take?
Re-evaluate the FHR tracing in 15 minutes
A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse should identify that this contraction pattern increases the risk for what?
Reduced fetal oxygen supply
A nurse is reviewing the electronic monitor tracing of a client who is in active labor. A fetus receives more oxygen when what appears on a tracing?
Relaxation between uterine contractions
A nurse is caring for a client who is in labor and has fetal heart tracings of variable decelerations. Which of the following actions should the nurse take?
Reposition the client from side to side
A nurse is caring for a client who had no prenatal care, is Rh-negative, and will undergo an external version at 38 weeks of gestation. What medication should the nurse plan to administer prior to the version?
Rh(D) immune globulin
What is lithotomy position?
Supine with knees and hips flexed.
A nurse is caring for a client who is at 39 weeks gestation and in active labor. Which of the following actions should the nurse include in the plan of care?
Check the cervix prior to analgesic administration
What are different gate-control pain interventions?
-Cognitive strategies (Lamaze, Doulas) -Sensory stimulation (aromatherapy, music, imagery) -Cutaneous stimulation (walking, rocking, effleurage)