OB PrepU Chapter 13: Labor and Birth Process

A student observes during an initial prenatal visit. The student states, "I heard the primary care provider say that the client has a gynecoid pelvis. What does that mean?" The best response by the nurse is: "It is a typical male pelvis. With this type of pelvis, large neonates must be born by cesarean birth although some small neonates are able to be born vaginally." "It is flat and narrow, making it extremely difficult for the neonate to pass through." "It is rounded in shape and allows ample room for the neonate to fit through the passageway." "It is elongated, the width is roomy, but the length is narrow."

"It is rounded in shape and allows ample room for the neonate to fit through the passageway." The gynecoid pelvis is most favorable for a vaginal birth. The rounded shape of the gynecoid pelvis inlet allows the fetus room to pass through the dimensions of the bony passageway.

A primigravida client at 38 weeks' gestation calls the clinic and reports, "My baby is lower and it is more difficult to walk." Which response should the nurse prioritize? "The baby has dropped into the pelvis; your body and baby are getting ready for labor in the next few weeks." "This is not normal unless you are in active labor; come to the hospital and be checked." "That is something we expect with a second or third baby, but because it is your first, you need to be checked." "The baby moved down into the pelvis; this means you will be in labor within 24 hours, so wait for contractions then come to the hospital."

"The baby has dropped into the pelvis; your body and baby are getting ready for labor in the next few weeks." The baby can drop into the pelvis, an event termed lightening, and can happen for up to 2 weeks before the woman goes into labor. This is normal and does not require intervention.

The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out "0 station" refers to which sign? "This is just a way of determining your progress in labor." "This indicates that you start labor within the next 24 hours." "This means +1 and the baby is entering the true pelvis." "The presenting part is at the true pelvis and is engaged."

"The presenting part is at the true pelvis and is engaged." 0 station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus.

A client in her third trimester comes to the clinic for an evaluation. Assessment reveals that the cervix is thinning. The client says, "I know my cervix needs to dilate, but why does it get thinner?" Which response by the nurse would be appropriate? "Your cervix thins so that your contractions can increase." "You need the cervix to thin so it can stretch more easily." "It thins to let your baby change positions during labor." "Cervical thinning is a sign that you are in true labor."

"You need the cervix to thin so it can stretch more easily." The rigid cervix of pregnancy must become distensible to expel the fetus. Before labor begins, cervical softening and possible cervical dilation with descent of the presenting part into the pelvis occur. These changes can occur 1 month to 1 hour before actual labor begins. As labor approaches, the cervix changes from an elongated structure to a shortened, thinned segment. Cervical collagen fibers undergo enzymatic rearrangement into smaller, more flexible fibers that facilitate water absorption, leading to a softer, more stretchable cervix. These changes occur secondary to the effects of prostaglandins and pressure from Braxton Hicks contractions. Cervical thinning has no effect on contractions or fetal positioning. It is not a sign of true labor.

The nurse determines a client is 7 cm dilated. What is the best response when asked by the client's partner how long the client will be in labor? "Your partner is in active labor; they are progressing at this point and we will keep you posted." "Your partner is in the active phase of labor, and birth will be within 2 to 3 hours, though it might be sooner." "Your partner is still in early latent phase of labor; it is too early to estimate when they will give birth." "Your partner is doing well and is in the second stage of labor; birth could be anytime now."

"Your partner is in active labor; they are progressing at this point and we will keep you posted." At 7 cm dilated, the client is considered in the active phase of labor. There is no science that can predict the length of labor. The client is progressing in labor, and it is best that the nurse not give the family a specific time frame.

A fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station? +4 +2 0 -2

-2 When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2. A fetus at 0 (zero) station indicates that the fetal presenting part is at the level of the ischial spines. Positive stations indicate that the presenting part is below the level of the ischial spines.

A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanel (fontanelle). The client is anxious to know when the posterior fontanel (fontanelle) will close. Which time span is the normal duration for the closure of the posterior fontanel (fontanelle)? 4 to 6 weeks 8 to 12 weeks 12 to 14 weeks 14 to 18 weeks

8 to 12 weeks The posterior fontanel (fontanelle) is a triangular-shaped area at the back of the skull. The nurse should inform the client that the posterior fontanel (fontanelle) normally closes by 8 to 12 weeks after birth, and if there is delay the primary health care provider should be notified.

The first stage of labor is often a time of introspection. In light of this, which information would guide the nurse's plan of care? A woman should be left entirely alone during this period. A woman will rarely speak or laugh during this period. A woman may spend time thinking about what is happening to her. No nursing care is needed to be done during this time.

A woman may spend time thinking about what is happening to her. Explanation: Women need a support person with them during all stages of labor.

During which time is the nurse correct to document the end of the third stage of labor? Following fetal birth When pushing begins At the time of placental delivery When the mother is moved to the postpartum unit

At the time of placental delivery The third stage of labor concludes with the delivery of the placenta. The nurse is correct to document that time in the medical record. The beginning of the third stage of labor is the documented time of birth. Neither the time when the woman begins to push nor when she is moved to the postpartum unit are notable.

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor? Braxton Hicks contractions get closer together with activity. Braxton Hicks contractions usually decrease in intensity with walking. Braxton Hicks contractions do not last long enough to be true labor. Braxton Hicks contractions cause "ripening" of the cervix.

Braxton Hicks contractions usually decrease in intensity with walking. Braxton Hicks contractions occur more frequently and are more noticeable as pregnancy approaches term. These irregular, practice contractions usually decrease in intensity with walking and position changes.

The nurse is documenting the length of time in the second stage of labor. Which data will the nurse use to complete the documentation? Admission time and time of fetal birth Complete cervical dilation (dilatation) and time of fetal birth Effacement time and time when contractions are regular Time of mucus plug expulsion and full cervical dilation

Complete cervical dilation (dilatation) and time of fetal birth The second stage of labor begins with complete cervical dilation (dilatation) of 10 cm and ends with delivery of the neonate.

A primigravida has an office appointment at 39 weeks' gestation. Which assessment data is most definitive of the onset of labor? The mother reports frequent urination. The fetal head is engaged in the pelvis. Cervical ripening is noted on examination. Expulsion of the mucus plug.

Cervical ripening is noted on examination. Clinical signs that labor is approaching include ripening or softening of the cervix with effacement and dilation (dilatation). Frequent urination is common during engagement where the fetal head is in the pelvis. This is common up to 2 weeks before true labor begins. Expulsion of the mucus plug also is common a week or two before labor begins.

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? Continue to monitor the progress of labor. Auscultate fetal heart rate (FHR) in the left upper quadrant. Prepare the client for cesarean birth of the fetus. Educate the client this fetal position may result in a longer labor.

Continue to monitor the progress of labor. ROA (right occiput anterior) means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part. This is a common and favorable position for vaginal birth. Based on the ROA location, the nurse will auscultate FHR at the right lower quadrant of the client's abdomen (FHR will be loudest where the fetus' back is located). Occiput posterior (not anterior) positions are associated with longer, more difficult births.

The nurse is caring for a client who is experiencing a noneventful labor process. Which assessment findings may occur as the client progresses through the stages of labor? Select all that apply. Dry mucous membranes Nausea Diuresis Increased white blood cell count Increased urine specific gravity Hyperventilation

Dry mucous membranes Nausea Increased white blood cell count Increased urine specific gravity Hyperventilation The nurse is correct to identify that normal changes occur during the labor process. Due to mouth breathing and drinking limited fluids, if any, dehydration with dry mucous membranes and an elevated urine specific gravity are common. Since labor prolongs gastric emptying, the client may experience nausea. An increase in the white blood cell stemming from the immune response is common. Concentrated urine and decreased urine production are common, not diuresis.

Which consideration is a priority when caring for a mother with strong contractions 1 minute apart? Fetal heart rate in relation to contractions The station in which the fetus is located Maternal heart rate and blood pressure Maternal request for pain medication

Fetal heart rate in relation to contractions The priority consideration is on the status of the fetus. Because each contraction temporarily interrupts blood flow to the placenta, there is a decrease in oxygen available. Therefore, a fetus cannot tolerate contractions lasting too long or too strong. All other options are important but not the priority.

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother? Fetal presentation Fetal attitude Fetal position Fetal lie

Fetal lie Fetal lie describes the position of the long axis of the fetus in relation to the long axis of the pregnant woman.

The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned? Fetal station Fetal attitude Fetal position Fetal size

Fetal position When documenting the ROA, this is the right occiput anterior or the relationship of the fetal position to the mother using the maternal pelvis as the point of reference. Fetal station refers to the relationship of the presenting part of the fetus to the ischial spines of the pelvis. Fetal attitude refers to the relationship of the fetal parts to one another. Fetal size refers the actual size of the developing fetus.

A pregnant client is admitted to a maternity clinic for birth. The client wishes to adopt the kneeling position during labor. The nurse knows that which of the following is an advantage of adopting a kneeling position during labor? It helps the woman in labor to save energy. It facilitates vaginal examinations. It facilitates external belt adjustment. It helps to rotate the fetus in a posterior position.

It helps to rotate the fetus in a posterior position. The advantage of adopting a kneeling position during labor is that it helps to rotate the fetus in a posterior position. Facilitating vaginal examinations, facilitating external belt adjustment, and helping the woman in labor to save energy are advantages of the back-lying maternal position.

A nurse is caring for a 16-year-old primigravida client who is in active labor. The client did not attend prenatal classes and nervously asks the nurse to explain to what will happen. The nurse performs a focused assessment to determine the stage of labor and then explains the different phases of the first stage of labor. The nurse determines client understanding when they correctly identifies how each phase differs. For each finding, specify if the finding indicates a latent or active phase of the first stage of labor. Finding: contractions 2 to 3 minutes apart, strong to very strong rapid dilation and effacement contractions irregular, mild to moderate contraction duration 45 to 90 seconds contractions 5 to 30 minutes apart contraction duration 30 to 45 seconds start of fetal descent complete dilation and effacement cervical dilation 4 to 7 cm

Latent: contractions irregular, mild to moderate contractions 5 to 30 minutes apart contraction duration 30 to 45 seconds Active: contractions 2 to 3 minutes apart, strong to very strong rapid dilation and effacement contraction duration 45 to 90 seconds start of fetal descent complete dilation and effacement cervical dilation 4 to 7 cm Explanation: A pregnant client will progress through two phases during the first stage of labor: latent and active. The first phase of the first stage of labor is the latent phase, where the client is talkative. In this phase, contractions are irregular and mild to moderate, 5 to 30 minutes apart, and last 30 to 45 seconds. The second phase of the first stage labor is the active phase. In the beginning of this phase, contractions become more regular and moderate to strong, occur every 3 to 5 minutes, and last 40 to 70 seconds. There is also rapid cervical dilation 4 to 7 cm, and the fetus starts to descend. In the end of the active phase of the first stage of labor, the contractions become strong and occur 2 to 3 minutes apart, and last 45 to 90 seconds. At the end, complete cervical dilation at 10 cm with full effacement occurs.

A pregnant client is admitted to a maternity clinic for birth. Which assessment finding indicates that the client's fetus is in the transverse lie position? Long axis of fetus is at 60° to that of client. Long axis of fetus is parallel to that of client. Long axis of fetus is perpendicular to that of client. Long axis of fetus is at 45° to that of client.

Long axis of fetus is perpendicular to that of client. If the long axis of the fetus is perpendicular to that of the mother, then the client's fetus is in the transverse lie position. If the long axis of the fetus is parallel to that of the mother, the client's fetus is in the longitudinal lie position. The long axis of the fetus being at 45° or 60° to that of the client does not indicate any specific position of the fetus.

The skull is the most important factor in relation to the labor and birth processes. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible? Molding Caput succedaneum Cephalohematoma Vertex presentation

Molding The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull, thereby reducing the diameter of the head.

The nurse is instructing on maternal hormones which may impact the onset of labor. Which hormones are included in the discussion? Select all that apply. Testosterone Oxytocin Thyroxine Progesterone Prostaglandins Insulin

Oxytocin Progesterone Prostaglandins There are several hypotheses regarding what triggers labor to begin. Progesterone is the hormone of pregnancy and elimination may cause the uterus to contract. Oxytocin also causes the uterus to contract. Prostaglandins cause the cervix to soften and also cause the uterus to contract. Testosterone, thyroxine, and insulin are not one of the main factors in the onset of labor theories.

A nurse is coaching a woman during the second stage of labor. Which action should the nurse encourage the client to do at this time? Push with contractions and rest between them. Hold the breath while pushing during contractions. Begin pushing as soon as the cervix has dilated to 8 cm. Pant while pushing.

Push with contractions and rest between them. Make sure the woman pushes with contractions and rests between them. Holding the breath during a contraction could cause a Valsalva maneuver or temporarily impede blood return to her heart because of increased intrathoracic pressure, which could then also interfere with blood supply to the uterus. It is important for women to understand they should not bear down with their abdominal muscles to push until the cervix is fully dilated, which is 10 cm, not 8 cm. Panting limits the ability to push and is to be encouraged only when it is desirable to delay labor, such as when a nuchal cord is present.

A pregnant woman comes to the emergency department stating she thinks she is in labor. Which assessment finding concerning the pain will the nurse interpret as confirmation that this client is in true labor? Radiates from the back to the front Slows when the woman changes position Occurs in an irregular pattern Lasts about 20 to 25 seconds

Radiates from the back to the front Contractions that begin in the back and then radiate to the front are typical of true labor. Contractions that slow when a woman walks or changes position suggest false labor, as do irregular contractions. Contractions lasting 30 seconds or less commonly suggest Braxton Hicks contractions and are associated with false labor.

The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2030 related to women in labor? Reduce the rate of cesarean births among low-risk women. Encourage women with previous cesareans to always have a cesarean. Ensure care during labor includes immunizations. Ensure all couples receive preconception genetic counseling.

Reduce the rate of cesarean births among low-risk women. Healthy People 2030 includes one goal related to cesarean births in the United States, "Reduce cesarean births among low-risk women with no prior births." Immunizations and genetic counseling are not associated with women in labor.

A nurse is monitoring a client in labor. Which assessment finding is most concerning to the nurse? Client begins vomiting. Blood pressure is 128/82 mm Hg. Respiratory rate is 22 breaths/minute. Temperature is 101.6°F (38.7°C).

Temperature is 101.6°F (38.7°C). Although slight temperature elevations are normal during labor, a temperature of 101.6°F (38.7°C) indicates an infection and should be reported to the health care provider. As the client progresses through birth, numerous physiologic responses occur that assist the client to adapt to the laboring process. Some of these changes include heart rate increasing by 10 to 20 beats/min; blood pressure increases by up to 35 mm Hg; and respiratory rate increases as more oxygen is consumed. Nausea and vomiting are common during labor, especially during the active phase, due to decreased gastric motility.

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 cervix is softening The uterus is relaxing The cervix is dilating The perineum is relaxing

The cervix is softening The prostaglandin theory is another theory of labor initiation. Prostaglandins influence labor in several ways, which include softening the cervix and stimulating the uterus to contract. However, evidence supporting the theory that prostaglandins are the agents that trigger labor to begin is inconclusive.

A 24-year-old primigravida client at 39 weeks' gestation presents to the OB unit concerned she is in labor. Which assessment findings will lead the nurse to determine the client is in true labor? The contraction pains are 2 minutes apart and 1 minute in duration. The client reports back pain, and the cervix is effacing and dilating. The contraction pains have been present for 5 hours, and the patterns are regular. After walking for an hour, the contractions have not fully subsided.

The client reports back pain, and the cervix is effacing and dilating. True labor is indicated when the cervix is changing. Contractions occur for weeks before true labor, and may occur close together. Contractions may also occur for a long time before true labor begins.

The nurse is caring for a client at 39 weeks' gestation who is noted to be at 0 station. The nurse is correct to document which? The client is fully effaced. The fetus is floating high in the pelvis. The fetus is in the true pelvis and engaged. The fetus has descended down the birth canal.

The fetus is in the true pelvis and engaged. When the fetus is at a 0 (zero) station, it is at the level of the ischial spines and said to be engaged. Determining the station does not mean that the client's cervix is fully effaced. If the fetus is floating high in the pelvis, its station is noted as a negative number. Descending into the pelvis or birth canal is documented as a positive number.

The nurse is caring for four clients within the labor and delivery unit. Which client does the nurse anticipate will be sent home? The primigravida who is effaced, having intense contractions but at irregular intervals and dilation (dilatation) is 6 cm The multipara who just experienced lightening and is having contractions 7 minutes apart. The primigravida who has a thinning cervix and a dilation of 3 cm The multipara who is effaced with dilation of 4 cm.

The primigravida who has a thinning cervix and a dilation of 3 cm The primigravida who is not fully effaced with a low (3 cm out of 10) dilation (dilatation) will be sent home. At this point, it is unclear if the client is in true or false labor. Multiparous women typically have shorter labors, thus the nurse must consider this fact when anticipating health care provider decisions. The primigravida who is effaced and dilated 6 cm is definitely in labor even if the contractions are at irregular intervals.

Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting? shoulders occiput brow buttocks

occiput With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. The shoulders are the presenting part when the fetus is in a shoulder presentation. The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation.

A client experiencing contractions presents at a health care facility. Assessment conducted by the nurse reveals that the client has been experiencing Braxton Hicks contractions. The nurse has to educate the client on the usefulness of Braxton Hicks contractions. Which role do Braxton Hicks contractions play in aiding labor? These contractions help in softening and ripening the cervix. These contractions increase the release of prostaglandins. These contractions increase oxytocin sensitivity. These contractions make maternal breathing easier.

These contractions help in softening and ripening the cervix. Braxton Hicks contractions assist in labor by ripening and softening the cervix and moving the cervix from a posterior position to an anterior position. Prostaglandin levels increase late in pregnancy secondary to elevated estrogen levels; this is not due to the occurrence of Braxton Hicks contractions. Braxton Hicks contractions do not help in bringing about oxytocin sensitivity. Occurrence of lightening, not Braxton Hicks contractions, makes maternal breathing easier.

A client has just given birth to a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent? First Second Third Fourth

Third Stage three begins with the birth of the baby and ends with delivery of the placenta.

A woman is in the second stage of labor and is crowning. Which diameter of the fetal skull—the smallest diameter—should align with the anteroposterior diameter of the mother's pelvis (which is the narrowest diameter at the pelvic inlet)? Transverse (biparietal) Occipitomental Occipitofrontal Suboccipitobregmatic

Transverse (biparietal) The anteroposterior diameter of the pelvis, a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet, so the best presentation for birth is when the fetus presents a transverse (biparietal) diameter (the narrowest fetal head diameter, at 9.25 cm) to this. The other diameters of the fetal skull that are listed are all larger.

A multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of the frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor? perineal phase latent phase active phase pelvic phase

active phase The client is likely in the active phase of labor, which is in the first stage, as evidenced by the increasing anxiety and distress, intense frequent contractions, and cervical dilation of 9 cm. The amount of bloody show indicates remarkable cervical changes. Cervical dilation (dilatation) in the active phase is 6 to 10 cm. The latent phase is in the first stage of labor and characterized by positive coping, mild contractions, and cervical dilation (dilatation) of 1 to 6 cm. The pelvic and perineal phases are in the second stage of labor. Contractions are every 2 to 3 minutes and the client is fully dilated (10 cm).

A nurse is conducting an in-service program for staff nurses working in the labor and birth unit. The nurse is discussing ways to promote a positive birth outcome for the woman in labor. The nurse determines that additional teaching is necessary when the group identifies which measure? promoting the woman's feelings of control providing clear information about procedures allowing the woman time to be alone encouraging the woman to use relaxation techniques

allowing the woman time to be alone Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor.

A pregnant client is being discharged from the labor and birth suite because of false labor. The client asks the nurse how to tell whether the contractions are true contractions or Braxton Hicks contractions. Which description(s) will the nurse mention as characteristic of true contractions? Select all that apply. begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity begin and remain irregular felt first abdominally and remain confined to the abdomen and groin often disappear with ambulation or sleep

begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity True contractions begin irregularly but become regular and predictable; are felt first in the lower back and sweep around to the abdomen in a wave; continue no matter what the pregnant client's level of activity; increase in duration, frequency, and intensity; and achieve cervical dilatation. False (Braxton Hicks) contractions begin and remain irregular; are felt first abdominally and remain confined to the abdomen and groin; often disappear with ambulation or sleep; do not increase in duration, frequency, or intensity; and do not achieve cervical dilatation.

A nurse is providing care to a woman in labor. When reviewing the woman's medical record, the nurse notes that fetal position is documented as LSA. The nurse interprets this to mean that which part of the fetus is presenting? occiput buttocks chin acromion process

buttocks The second letter of LSA denotes the presenting part. In this case, it is "S" which is for sacrum or buttocks. "O" refers to the occiput; "M" would be used to refer to the chin. "A" would be used to refer to the acromion process.

A new parent is alarmed at the shape of the newborn's head. Assessment reveals swelling at the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which condition? molding caput succedaneum cephalohematoma closed anterior fontanel (fontanelle)

caput succedaneum Caput succedaneum can be described as edema of the scalp at the presenting part. This swelling crosses suture lines and disappears within 3 to 4 days. The changed (elongated) shape of the fetal skull at birth as a result of overlapping of the cranial bones is known as molding. Along with molding, fluid can also collect in the scalp (caput succedaneum), or blood can collect beneath the scalp (cephalohematoma), further distorting the shape and appearance of the fetal head. Cephalohematoma is a collection of blood between the periosteum and the bone that occurs several hours after birth. It does not cross suture lines and is generally reabsorbed over the next 6 to 8 weeks. The findings do not suggest a closed anterior fontanel (fontanelle).

A nurse is teaching a group of pregnant women about the signs that labor is approaching. When describing these signs, which sign would the nurse explain as being essential for effacement and dilation (dilatation) to occur? cervical ripening and softening Braxton Hicks contractions bloody show lightening

cervical ripening and softening The ripening and softening of the cervix that result from the effects of prostaglandins and pressure from Braxton Hicks contractions are essential for effacement and dilation (dilatation) of the cervix. Lightening occurs when the fetal presenting part begins to descend into the true pelvis. Bloody show occurs as the mucus plug is expelled as a result of cervical softening and increased pressure of the presenting part.

When explaining to a class of pregnant women why labor begins, the nurse will include the fact that there are several theories that have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories? change in estrogen-to-progesterone ratio decrease in number of oxytocin receptors decrease in the level of estrogen decrease in prostaglandins, leading to myometrium contractions

change in estrogen-to-progesterone ratio One of the theories suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. The number of oxytocin receptors have been noted to increase. Estrogen levels also increase, which in turn increases myometrial sensitivity to oxytocin. Prostaglandin levels also increase, which in turn leads to myometrial contractions.

The nurse is assisting a pregnant client in labor and delivery and notes the placenta is now delivered. What will the nurse document? completion of the fourth stage of labor attachment phase completion of the third stage of labor postpartum phase

completion of the third stage of labor The third stage of labor ends with the expulsion of the placenta. The fourth stage begins with completion of the expulsion of the placenta and membranes and ends with the initial physiologic adjustment and stabilization of the pregnant client (1 to 4 hours after birth). The fourth stage initiates the postpartum phase. Within this fourth stage, the attachment process begins with the client inspecting the newborn and desiring to cuddle and breastfeed the newborn.

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which process? engagement descent restitution crowning

crowning Crowning occurs when the top of the fetal head appears at the vaginal orifice and no longer regresses between contractions. Engagement occurs when the greatest transverse diameter of the head passes through the pelvic inlet. Descent is the downward movement of the fetal head until it is within the pelvic inlet. Restitution or external rotation occurs after the head is born and free of resistance. It untwists, causing the occiput to move about 45 degrees back to its original left or right position.

The student nurse is learning about normal labor. The teacher reviews the cardinal movements of labor and determines the instruction has been effective when the student correctly states the order of the cardinal movements as follows: internal rotation, descent, extension, flexion, external rotation, expulsion descent, flexion, external rotation, extension, internal rotation, expulsion descent, flexion, internal rotation, extension, external rotation, expulsion internal rotation, flexion, descent, extension, external rotation, expulsion

descent, flexion, internal rotation, extension, external rotation, expulsion The six cardinal movements of the fetus, in order, are descent, flexion, internal rotation, extension, external rotation, and expulsion.

A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor in the client? diffuse abdominal cramping rupturing of fetal membranes start of regular contractions dilation (dilatation) of cervix diameter to 10 cm

dilation (dilatation) of cervix diameter to 10 cm The first stage of labor terminates with the dilation (dilatation) of the cervix diameter to 10 cm. Diffused abdominal cramping and rupturing of the fetal membrane occur during the first stage of labor. Regular contractions occur at the beginning of the latent phase of the first stage; they do not mark the end of the first stage of labor.

The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding? duration intensity frequency peak

duration Duration refers to how long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine catheter. Frequency refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction. The peak or acme of a contraction is the highest intensity of a contraction.

When teaching a group of nursing students about the stages of labor, the nurse explains that softening, thinning, and shortening of the cervical canal occur during the first stage of labor. Which term is the nurse referring to in the explanation? crowning effacement dilation (dilatation) molding

effacement The nurse is explaining about effacement, which involves softening, thinning, and shortening of the cervical canal. Dilation (dilatation) refers to widening of the cervical os from a few millimeters in size to approximately 10 cm wide. Crowning refers to a point in the maternal vagina from where the fetal head cannot recede back after the contractions have passed. Molding is a process in which there is overriding and movement of the bones of the cranial vault, so as to adapt to the maternal pelvis.

A pregnant client in labor has to undergo a sonogram to confirm the fetal position of a shoulder presentation. For which condition associated with shoulder presentation during a vaginal birth should the nurse assess? uterine abnormalities fetal anomalies congenital anomalies birth after due date

fetal anomalies The nurse, along with the primary care provider, has to assess for fetal anomalies, which are usually associated with a shoulder presentation during a vaginal birth. The other conditions include placenta previa and multiple gestations. Uterine abnormalities, congenital anomalies, and prematurity are conditions associated with a breech presentation of the fetus during a vaginal birth.

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? second first, latent first, active third

first, active Because the cervix is dilating (5 cm) and has fully effaced (100%), the woman appears to be in active labor, which is characterized by cervical dilation (dilatation) of 4 to 7 cm. Regular uterine contractions are effective in facilitating fetal descent through the pelvis because the presenting part is well applied on the cervix and at -1 station. The second stage of labor begins when the cervix is 10 cm dilated. The first latent phase is characterized by the onset of regular contractions and cervical dilation (dilatation) of 0 to 4 cm. The third stage of labor is from birth of the infant to completed delivery of the placenta.

The nurse is determining how often contractions occur measuring from the beginning of the one contraction to the beginning of the next contraction. The nurse documents this finding as: duration. intensity. frequency. peak.

frequency. Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. The peak or acme of a contraction is the highest intensity of a contraction.

To give birth to her infant, a woman is asked to push with contractions. Which pushing technique is the most effective and safest? lying supine with legs in lithotomy stirrups squatting while holding her breath head elevated, grasping knees, breathing out lying on side, arms grasped on abdomen

head elevated, grasping knees, breathing out For the most effective pushing during the second stage of labor, a woman should wait to feel the urge to push even though a pelvic exam has revealed she is fully dilated. Pushing is usually best done from a semi-Fowler's position with legs raised against the abdomen, squatting, or on all fours rather than lying flat to allow gravity to aid the effort .Make sure the woman pushes with contractions and rests between them. She can use short pushes or long, sustained ones, whichever feels more comfortable. Holding the breath during a contraction could cause a Valsalva maneuver or temporarily impede blood return to her heart because of increased intrathoracic pressure, which could then also interfere with blood supply to the uterus. To prevent her from holding her breath during pushing, urge her to grunt or breathe out during a pushing effort (as tennis players do).

The nurse is teaching a prenatal class on the difference between true and false labor contractions. The nurse determines the session is successful when the class correctly chooses which factor as an indication of true labor contraction? increase even if relaxing and taking a shower remain irregular with the same intensity subside when walking around and use the lateral position cause discomfort over the top of uterus

increase even if relaxing and taking a shower True labor contractions do not stop; they continue and strengthen, as well as increase in frequency. If the contractions subside while taking a shower or relaxing, then they are not labor contractions. The discomfort over the top of the uterus is normal for full term pregnancy.

A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. increase in heart rate increase in blood pressure increase in respiratory rate slight decrease in body temperature increase in gastric emptying and pH

increase in heart rate increase in blood pressure increase in respiratory rate When caring for a client in labor, the nurse should monitor for an increase in the heart rate by 10 to 20 bpm, an increase in systolic blood pressure by as much as 35 mm Hg, and an increase in respiratory rate. During labor, the nurse should monitor for a slight elevation in body temperature as a result of an increase in muscle activity. The nurse should also monitor for decreased gastric emptying and gastric pH, which increases the risk of vomiting with aspiration.

A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? increased risk of infection potential rapid birth of fetus potential placenta previa increased risk of breech presentation

increased risk of infection After the amniotic sac has ruptured, the barrier to infection is gone, and an ascending infection is possible. In addition, there is a danger of cord prolapse. The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.

The nurse is reviewing the laboratory test results of a client in labor. Which finding would the nurse consider normal? decreased plasma fibrinogen levels increased blood coagulation time increased blood glucose levels increased white blood cell count

increased white blood cell count The nurse should identify increased white blood cell count as the hematological change occurring in a client during labor. The increase in the white blood cell count can be attributed to physical and emotional stress during labor. During labor there could be a decrease, and not increase, in the blood coagulation time. There is an increased, not decreased, plasma fibrinogen level during labor. Blood glucose levels are decreased during labor.

A nursing instructor is conducting a class on the various types of pelvic shapes to a group of nursing students. The instructor determines the class is successful when the students correctly choose which factor is specific for an anthropoid pelvis? is narrow transversely is ideal for birth has weaker bones than normal is "male" shaped

is narrow transversely A gynecoid pelvis is the best shape for birth. An anthropoid pelvis is usually narrow. A "male" pelvis is termed an "android pelvis." The condition of the bones is not a determining factor for the shape of the pelvis.

The nurse is monitoring a client who is in labor and notes the client is happy, cheerful, and "ready to see the baby." The nurse interprets this to mean the client is in which stage or phase of labor? active stage two latent stage three

latent The client in labor undergoes numerous psychologic adaptations during labor. During the latent phase, the client is often talkative and happy, and yet anxious. During active phase, the client may show fear and anger. Both the latent and active phases occur during stage 1. During stages 2 and, the client may remain positive, but the work of labor is very intense.

The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. How should the nurse document this finding? presentation attitude lie position

lie The nurse is assessing fetal lie, the relationship of the fetal long axis to the maternal long axis. When the fetal long axis is longitudinal to the maternal long axis, the lie is said to be longitudinal. Presentation is the portion of the fetus that overlies the maternal pelvic inlet. Attitude is the relationship of the different fetal parts to one another. Position is the relationship of the fetal denominator to the different sides of the maternal pelvis.

A nurse is meeting with a group of pregnant clients who are in their last trimester to teach them the signs that may indicate they are going into labor. The nurse determines the session is successful after the clients correctly choose which signs as an indication of starting labor? Select all that apply. lightening weight gain constipation bloody show backache

lightening bloody show backache The signs of approaching labor include lightening, bloody show, and backache. Lightening is the falling forward of the pregnant uterus due to settlement of the fetal head into the maternal pelvis. Backache associated with pelvic cramping pain, which is regular and increases in intensity, is suggestive of impending labor. Bloody show is the expulsion of the cervical mucus plug tinged with blood, and occurs due to cervical effacement and dilation (dilatation). Weight loss and diarrhea are other signs of impending labor. Weight gain and constipation are not signs of impending labor.

A pregnant woman at 37 weeks' gestation calls the clinic to say she thinks that she is in labor. The nurse instructs the woman to go to the health care facility based on the client's report of contractions that are: occurring in the abdomen and groin. lasting about 30 seconds. occurring about every 5 minutes. relieved by walking.

occurring about every 5 minutes. The nurse needs to determine if the client is experiencing true labor contractions. True labor contractions are commonly felt in the lower back, in contrast to Braxton Hicks contractions that typically last about 30 seconds and occur primarily in the abdomen and groin and are relieved by walking, voiding, eating, increasing fluid intake, or changing positions. However, if contractions last longer than 30 seconds and occur more often than 4 to 6 times per hour, the nurse should have the woman evaluated, especially if she is less than 38 weeks' pregnant.

A client in labor has been admitted to the labor and birth suite. The nurse assessing the woman notes that the fetus is in a cephalic presentation. Which description should the nurse identify by the term presentation? relationship of the presenting part to the maternal pelvis part of the fetal body entering the maternal pelvis first relation of the fetal presenting part to the maternal ischial spine relation of the different fetal body parts to one another

part of the fetal body entering the maternal pelvis first The term presentation is the part of the fetal body that is entering the maternal pelvis first. The relationship of the presenting part to the sides of the maternal pelvis is called the position. Attitude is the term that describes the relation of the different fetal body parts to one another. The relation of the fetal presenting part to the maternal ischial spine is termed the station.

The five "Ps" of labor are: passageway, passenger, position, powers, psych. passenger, posture, position, presentation, psych. passenger, position, presentation, pushing, psych. passenger, position, powers, presentation, psych.

passageway, passenger, position, powers, psych. The five "Ps" are passageway (birth canal), passenger (fetus and placenta), position (maternal), powers (contractions), and psych (maternal psychological response).

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic? relaxin progesterone oxytocin prolactin

relaxin As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth. Progesterone, oxytocin, and prolactin are not involved.

The nurse is working triage in the emergency department. The nurse realizes the client is in true labor when she states that the she is experiencing: contractions. expelling mucus plug. ruptured membranes. fetal engagement.

ruptured membranes. The nurse realizes that the client is in true labor when her membranes spontaneously rupture. At this point, the woman is transferred to the labor and delivery unit. Fetal engagement and expelling the mucus plug may occur a week before true labor begins. Contractions may or may not indicate true labor.

Assessment of a woman in labor reveals that the scapula of the fetus is the presenting part. The nurse interprets this finding as indicating which fetal presentation? cephalic vertex breech shoulder

shoulder The three main fetal presentations are cephalic or vertex, with the head as the presenting part, breech, with the pelvis as the presenting part, and shoulder, with the scapula as the presenting part.

During the second stage of labor, a woman is generally: very aware of activities immediately around her. anxious to have people around her. no longer in need of a support person. turning inward to concentrate on body sensations.

turning inward to concentrate on body sensations. Second-stage contractions are so unusual that most women are unable to think of things other than what is happening inside their body.