OB EXAM 2 CH.14 PREP U

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? "It blocks the transmission of nerve messages of pain at the receptors." "It causes the release of endorphins." "It disrupts the nerve signal of pain via mechanical irritation of the nerves." "It distracts your brain from the sensations of pain."

"It distracts your brain from the sensations of pain."

The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth? "The baby is coming. Relax and everything will turn out fine." "The baby is coming. I'll explain what's happening and guide you." "Even though the baby is coming, the health care provider will be here soon." "Do you want me to call in your family?"

"The baby is coming. I'll explain what's happening and guide you."

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching? "If you end up having a cesarean, the epidural can be used for anesthesia during surgery." "You have no trouble walking around and using the bathroom after you receive the epidural." "You can continuously receive epidural anesthesia until you have the baby, and even afterward if you need it." "Epidural anesthesia is more effective than opioid analgesia in providing pain relief."

"You have no trouble walking around and using the bathroom after you receive the epidural."

The nurse is caring for a client in active labor who has had a fetal blood sampling to check for fetal hypoxia. The nurse determines that the fetus has acidosis when the pH is: 7.20. 7.25 or more. 7.15 or less. 7.21.

7.15 or less.

In the hypoxic fetus, the pH will fall below

7.2, which is indicative of fetal distress.

The licensed practical nurse is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the LPN do first? Assess and reposition the woman. Notify the registered nurse. Wait 2 minutes to review another tracing. Notify the health care provider.

Assess and reposition the woman.

A client has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8 out of 10 with each contraction. What should the nurse do first? Assist the client in ambulating to the bathroom. Assess for labor progression. Prepare the client for an epidural. Instruct the client to do slow-paced breathing.

Assess for labor progression.

The nurse is assessing a client in active labor and notes a small, rounded mass above the symphysis pubis that is distended but nontender. Which action should the nurse prioritize? Assume this is part of the uterus. Check the chart for the last void. Notify the health care provider about the mass. Ask the client if the mass has always been present.

Check the chart for the last void.

gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture? Greenish fluid Bloody fluid Clear to straw-colored fluid Cloudy white fluid

Clear to straw-colored fluid

The nurse cares for a pregnant client in labor and determines the fetus is in the right occiput anterior (ROA) position. Which action by the nurse is best? Prepare the client for cesarean birth of the fetus. Continue to monitor the progress of labor. Auscultate fetal heart rate (FHR) in the left upper quadrant. Educate the client this fetal position may result in a longer labor.

Continue to monitor the progress of labor.

A multigravida woman arrives in the emergency department panting and screaming, "The baby's coming!" Which action should the nurse prioritize? Assess maternal and fetal vital signs. Escort to Labor and Delivery. Ask medical and obstetrical history. Quickly evaluate the perineum.

Quickly evaluate the perineum.

the laboring client who is at 3 cm dilation (dilatation) and 25% effaced is asking for a narcotic for pain relief. The nurse explains this usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? This can lead to maternal hypertension. This would cause fetal depression in utero. The effects would wear off before birth. This may prolong labor and increase complications.

This may prolong labor and increase complications.

There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain? Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience. Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use. Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain. Women report higher levels of satisfaction when regional anesthetics are used to control pain.

Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience.

The nurse caring for a client in preterm labor observes abnormal fetal heart rate (FHR) patterns. Which nursing intervention should the nurse perform next? fetal scalp stimulation application of vibroacoustic stimulation administration of oxygen by mask tactile stimulation

administration of oxygen by mask

When educating a group of nursing students about the different types of pelves, the nurse describes one type as being flat, having a wider transverse diameter than anterior-posterior diameter, with ischial spines that are wide apart, and a short sacrum. The students are correct when they identify this description with which type? platypelloid android gynecoid anthropoid

platypelloid

Which procedure is contraindicated in an antepartum client with bright red, painless bleeding? Leopold maneuver Vaginal examination Urinalysis Nonstress test

Vaginal examination

In a hypoxic fetus, the last parameter to decline in the biophysical profile is

amniotic fluid volume fetal heart rate fetal breathing fetal movement fetal tone

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using? abdominal imagery massage pain pathway blockage effleurage

effleurage

Which intervention would be least effective in caring for a woman who is in the transition phase of labor? having the client breathe with contractions urging her to focus on one contraction at a time encouraging the woman to ambulate providing one-to-one support

encouraging the woman to ambulate

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? first, latent second third first, active

first, active SUBMIT ANSWER

A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? ampicillin epinephrine naloxone indomethacin

naloxone

During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used.

-4 -2 0 2 4

The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner? Remain in bed for at least 30 minutes. Ambulate only with assistance from the nurse or caregiver. Sit on the edge of the bed with her feet dangling before ambulating. Ambulate within 15 minutes to prevent spinal headache.

Ambulate only with assistance from the nurse or caregiver.

The nurse is monitoring a client in the first stage of labor. The nurse determines the client's uterine contractions are effective and progressing well based on which finding? Dilation (dilatation) of cervix Engagement of fetus Bloody show Rupture of amniotic membranes

Dilation (dilatation) of cervix

Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated? Assist the client to a Fowler position. Have the client lightly push to meet the need. Have the client divert the energy to squeezing a hand. Have the client pant and blow through the contraction.

Have the client pant and blow through the contraction.

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

Inhale slowly through nose and exhale through pursed lips.

The nurse is caring for a client who received a dose of IV sedation, given by the charge nurse, 30 minutes prior. What action is appropriate? Assure the fetal heart tones are assessed every 2 to 3 hours via monitoring. Restrict the client's fluid to further prevent constipation from the medication. Remind the client to call for assistance before getting out of bed. Remind the client that medication will assist in relieving pain from contractions.

Remind the client to call for assistance before getting out of bed.

Which neonatal assessment is the highest priority if the mother received meperidine during labor? Time of first meconium Respiratory rate Temperature regulation Lung sounds

Respiratory rate

The nurse is caring for a client who is late in her pregnancy. What assessment finding should the nurse attribute to the role of prostaglandins? The perineum is relaxing The cervix is dilating The cervix is softening The uterus is relaxing

The cervix is softening

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? "The injection is given in the space outside the spinal cord." "I have never read or heard of this happening." "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem." "An injury is unlikely because of expert professional care given."

"The injection is given in the space outside the spinal cord."

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: effleurage. therapeutic touch. patterned breathing. acupressure.

effleurage.

The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next? Fetal status Maternal obstetrical history Risk factors Maternal status

Fetal status

client is in active labor. As one of the nursing diagnoses is "Risk for trauma to the woman or fetus related to intrapartum complications or a full bladder," what would be appropriate for the nurse to do in order to achieve the goal of "no complications due to a full bladder"? Palpate the area above the symphysis pubis every 2 hours. Insist the client use a bedpan every 2 hours Do a sterile "in and out" catheterization every 3 hours Limit fluid intake to 300 mL every hour

Palpate the area above the symphysis pubis every 2 hours.

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

The woman is prepared for labor and birth.

The nurse explains Leopold maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply. determining the position of the fetus determining the weight of the fetus determining the presentation of the fetus determining the size of the fetus determining the lie of the fetus

determining the presentation of the fetus determining the position of the fetus determining the lie of the fetus

A nurse notes a pregnant woman has just entered the second stage of labor. Which interaction should the nurse prioritize at this time to assist the client? encouraging the woman to push when she has a strong desire to do so alleviating perineal discomfort with the application of ice packs completing the identification process of the newborn with the mother palpating the woman's fundus for position and firmness

encouraging the woman to push when she has a strong desire to do so

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states: "Breathing patterns are distraction techniques taught to decrease pain in labor." "Breathing patterns help a woman concentrate on pain." "Breathing patterns must be used with a coach." "Breathing patterns cannot be taught while in labor."

"Breathing patterns are distraction techniques taught to decrease pain in labor."

As a woman enters the second stage of labor, which would the nurse expect to assess? falling asleep from exhaustion feelings of being frightened by the change in contractions expressions of satisfaction with her labor progress reports of feeling hungry and unsatisfied

feelings of being frightened by the change in contractions

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which pattern would the nurse anticipate seeing on the monitor? fetal heart rate declining late with contractions and remaining depressed fetal baseline rate increasing at least 5 mm Hg with contractions variable decelerations, too unpredictable to count a shallow deceleration occurring with the beginning of contractions

fetal heart rate declining late with contractions and remaining depressed

A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? Practicing effleurage on the abdomen Immersing the client in warm water in a pool or hot tub Administering a sedative such as secobarbital or pentobarbital Administering an opioid such as meperidine or fentan

Practicing effleurage on the abdomen

A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response? Gently remind the client of her goal of a natural birth and encourage and help her. Support the client's decision and call the provider. Suggest a less extreme alternative such as a sedative. Ask the husband to gently remind her of their goal of natural birth and to encourage and help her.

Support the client's decision and call the provider.

A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly? above the level of the maternal umbilicus just below the maternal umbilicus at the level of the maternal umbilicus lower quadrant of the maternal abdomen

lower quadrant of the maternal abdomen

To assess the frequency of a woman's labor contractions, the nurse would time: the beginning of one contraction to the beginning of the next. how many contractions occur in 5 minutes. the end of one contraction to the beginning of the next. the interval between the acme of two consecutive contractions.

the beginning of one contraction to the beginning of the next.

A client asks her nurse what effleurage means. After instruction is given, the nurse determines learning has taken place when the client states: "Effleurage is massaging the perineum as the fetus enlarges the vaginal opening." "Effleurage is the pattern for cleaning the perineum before birth." "Effleurage is the effect of a full bladder on fetal descent." "Effleurage is light abdominal massage used to displace pain."

"Effleurage is light abdominal massage used to displace pain."

A low-risk client is in the active phase of labor. The nurse evaluates the fetal monitor strip at 10:00 a.m. and notes the following: moderate variability, FHR in the 130s, occasional accelerations, and no decelerations. At what time should the nurse reevaluate the FHR? 11:30 a.m. 10:05 a.m. 11:15 a.m. 10:30 a.m.

10:30 a.m. every 30 min

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering? Assess for dry mouth. Assess fetal heart rate. Assess maternal blood pressure. Assess for CONSTIPATION

Assess fetal heart rate.

The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client? Prenatal classes Pharmacologic pain management Massage therapy Continuous labor support

Continuous labor support

LOA position

Left Occiput Anterior This means fetus is head down, over on mom's left side w/fetal face looking backward & occiput facing front

perineum

in females, the area between the anus and the vagina