#1 OB EAQ Normal L&D

A pregnant client uses a computer while sitting almost continuously during her working hours. This has implications for her plan of care during pregnancy. What should the nurse recommend? 1. "Try to walk around every few hours during the workday." 2. "Ask for time in the morning and afternoon to elevate your legs." 3. "Tell your boss that you won't be able to work beyond the second trimester." 4. "Ask for time in the morning and afternoon so you can go get something to eat."

1. "Try to walk around every few hours during the workday." (Maintaining the sitting position for prolonged periods may constrict the vessels of the legs, particularly in the popliteal spaces, as well as diminish venous return. Walking causes the leg muscles to contract and applies gentle pressure to the veins, thereby promoting venous return. A better means of improving circulation is to walk around several times each morning and afternoon; the legs may be elevated while the client is sitting at her desk. If the client is feeling well, there are no contraindications to working throughout her pregnancy. Adequate nourishment can be obtained during mealtimes; the client does not require extra nutrition breaks.)

What is the priority nursing action during a client's second stage of labor? 1. Assessing the perineum for bulging 2.Administering the prescribed analgesia 3. Helping the client pant with each contraction 4. Catheterizing the client before the head reaches +3 station

1. Assessing the perineum for bulging (A bulging perineum is caused by the pressure of the fetal head against the perineal area and usually signifies imminent birth. Pain medication is not administered this close to the birth; it crosses the placental barrier and can cause respiratory distress in the newborn. During the second stage of labor the client is encouraged to push, not pant, with each contraction. Catheterization may be indicated earlier in labor so uterine contractions are not impeded; voiding will occur spontaneously as the client pushes.)

While a client is being interviewed on her first prenatal visit she states that she has a 4-year-old son who was born at 41 weeks' gestation and a 3-year-old daughter who was born at 35 weeks' gestation. The client lost one pregnancy at 9 weeks and another at 18 weeks. Using the GTPAL system, how would you record this information? 1. G5 T1 P1 A2 L2 2. G4 T1 P1 A2 L2 3. G4 T2 P0 A0 L2 4. G5 T2 P1 A1 L2

1. G5 T1 P1 A2 L2 (The client is gravida (G) 5: the current pregnancy, the 41-week pregnancy, the 35-week pregnancy, the 9-week pregnancy, and the 18-week pregnancy. She has had one term (T) pregnancy (one that lasts 40 weeks plus or minus 2 weeks): the 41-week pregnancy. The 35-week pregnancy is considered preterm (P). Pregnancies that end before 20 weeks are considered abortions, so the losses at 9 and 18 weeks would be scored as A2. The other options do not consider the present pregnancy or the correct definitions of term and preterm or do not include the abortions.)

Physical assessment of a client in active labor reveals that the cervix is dilated 3 to 4 cm and 50% effaced, the fetus is in the right sacrum anterior (RSA) position, and contractions are 5 minutes apart. Where should the nurse place the stethoscope to best locate the fetal heart tones? 1. a 2. b 3. c 4. d

1. a (When the fetus's back is on the right side of the mother and the fetal sacrum is in the lower portion of the fundus, the fetus is in the right sacrum anterior (RSA) position and the fetal heart can be heard in the right upper quadrant. Location b is appropriate when the fetus is in the right occipital posterior (ROP) position. Location c is appropriate when the fetus is in the left sacrum anterior (LSA) position. Location d is appropriate when the fetus is in the left occipital anterior (LOA) position.)

During her first prenatal visit the client reports that her last menstrual period began on April 15. According to Nägele rule, what is the expected date of delivery (EDD)? 1. January 8 2. January 22 3. February 8 4. February 22

2. January 22 (To determine EDD with the use of Nägele rule, subtract 3 months from the date of the last menstrual period and add 7 days. January 8 is 2 weeks too early according to this formula. February 8 is too late. February 22 would be 1 month past the true EDD.)

A client in the active phase of the first stage of labor begins to tremble, becomes very tense during contractions, and is quite irritable. She frequently states, "I can't take this a minute longer." What does this behavior indicate to the nurse caring for her? 1. There was no preparation for labor. 2. She should receive an analgesic for pain. 3. She is entering the transition phase of labor. 4. Hypertonic uterine contractions are developing.

3. She is entering the transition phase of labor. (The contractions become stronger, last longer, and occur erratically during the transition phase; the intervals between contractions become shorter than the contractions themselves; the client needs to apply a great deal of concentration and effort to pace her breathing with each contraction. Even clients who have been adequately prepared will experience these behaviors during the transition phase of the first stage of labor. Administration of an analgesic at this time may reduce the effectiveness of labor and depress the fetus. There is no indication that the contractions are hypertonic.)

The nurse is obtaining the health history of a woman who is visiting the prenatal clinic for the first time. She states that she is 5 months pregnant. Which positive sign of pregnancy should the nurse evaluate in this client? 1. Quickening 2. Enlarged abdomen 3. Cervical color change 4. Audible fetal heartbeat

4. Audible fetal heartbeat (The presence of the fetal heartbeat is a positive sign of pregnancy. The feeling of movement is a presumptive sign of pregnancy. An enlarged abdomen is a probable sign of pregnancy. The bluish color of the cervix (Chadwick sign) is caused by pelvic congestion and edema; it is a probable sign of pregnancy. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect.)

A woman in labor with her third child is dilated to 7 cm, and the fetal head is at station +1. The client's membranes rupture. What is the nurse's priority intervention? 1. Notify the practitioner. 2. Observe the vaginal opening for a prolapsed cord. 3. Reposition the client on a sterile towel on her left side. 4. Check the fetal heart rate while observing the color of the amniotic fluid.

4. Check the fetal heart rate while observing the color of the amniotic fluid. (Fetal well-being is the priority. The fetal heart rate will reflect the fetus's response to the rupture of the membranes, and the color of the amniotic fluid will reveal whether there is meconium staining. Notifying the practitioner is necessary if the nurse's assessments reveal fetal compromise. Although checking the vaginal opening for cord prolapse is important, it is not the priority; the fetal head is engaged at station +1. Although positioning the client on the left side promotes placental perfusion, it is not the priority, and a sterile pad is not needed. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.)

The partner of a woman in labor is having difficulty timing the frequency of contractions and asks the nurse to review the procedure. How should contractions be timed? 1. From the end of one contraction to the end of the next contraction 2. From the end of one contraction to the beginning of the next contraction 3. From the beginning of one contraction to the end of the next contraction 4. From the beginning of one contraction to the beginning of the next contraction

4. From the beginning of one contraction to the beginning of the next contraction (The frequency of contractions is timed from the beginning of one contraction to the beginning of the next; this is the definition of one contraction cycle. The beginning, not the end, of a contraction is the starting point for timing the frequency of contractions. The time between the end of one contraction and the beginning of the next contraction is the interval between contractions. Timing from the beginning of one contraction to the end of the next contraction is too long a timeframe and will produce inaccurate information.)

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the fetus is positioned how? 1. Breech 2. Transverse 3. Occiput anterior 4. Occiput posterior

4. Occiput posterior (Persistent occiput posterior positioning causes intense back pain, the result of fetal compression of the sacral nerves. The breech position is not associated with back pain. The transverse position is not associated with back pain. Occiput anterior, the most common fetal position, generally does not cause back pain.)