Labor Quiz 2

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

uterine stimulants; For hypotonic labor, a uterine stimulant such as oxytocin may be prescribed once fetopelvic disproportion is ruled out. Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. Tocolytics would be ordered to control preterm labor. Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor.

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?

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.

If a fetus is in an ROA position during labor, the nurse would interpret this to mean the fetus is: A. in a longitudinal lie facing the left posterior B. facing the right anterior abdominal quadrant

A; 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.

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called? A. External version B. Internal rotation

A; External version is the process of manipulating the position of the fetus in order to try to turn the fetus to a cephalic presentation.

The fetus of a woman in labor is determined to be in persistent occiput posterior position. Which intervention would the nurse identify as the priority? A. Pain relief measures B. Position changes

A; Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Counterpressure and backrubs may be helpful. Position changes that can promote fetal head rotation are important after the nurse institutes pain relief measures. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.

A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if which condition occurs? A. Fetal distress B. Water intoxication

B; Oxytocin can lead to water intoxication and can cause hypotension. Uterine hypertonicity is a possible adverse effect of oxytocin administration. Oxytocin does not cross the placental barrier, and no fetal problems have been observed.

When educating the post-term pregnant client, what should the nurse be sure to include to prevent fetal complications?

Be sure to monitor fetal movements daily

True or False: An infant born by cesarean birth is usually able to establish respirations more easily than one born vaginally.

False; The process of labor appears to aid in the maturation of surfactant production by alveoli in the fetal lung. Both the pressure applied to the chest from contractions and passage through the birth canal help to clear the respiratory tract of lung fluid. For this reason, an infant born vaginally is usually able to establish respirations more easily than a fetus born by cesarean birth.

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

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

The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?

Prepare the client for a cesarean birth; The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous good pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth.

The nurse is admitting a client in labor. The care provider determines that the fetus is in a transverse lie and not responsive to Leopold maneuvers. What intervention should the nurse provide for the client?

Prepare the client for a cesarean birth; If a transverse lie persists, the fetus cannot be born vaginally. The most common method the practitioner uses to diagnose fetal malpresentation is Leopold's maneuvers followed by ultrasound. Sometimes the practitioner notes transverse lie by looking at the contour of the abdomen, which tends to be in the shape of a football, wider side to side than top to bottom.

A fetus is in the LST position. The nurse interprets this as indicating which area of the body as the presenting part?

butt

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical?

amniotomy; Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.

The fetus of a nulliparous woman is in a shoulder presentation. The nurse would prepare the client for which type of birth?

cesarean; The fetus is in a transverse lie with the shoulder as the presenting part, necessitating a cesarean birth. Vaginal birth, forceps-assisted, and vacuum extraction births are not appropriate.

Before calling the primary care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the care provider?

check for a full bladder; A full bladder can interfere with the progress of labor, so the nurse must be sure that the client has emptied her bladder.

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?

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.

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? A. less than 3 hours B. Less than 5 hours

A; Precipitous labor is completed in less than 3 hours.

The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?

Caput succedaneum; Caput succedaneum is a complication that may occur in the newborn of a woman who had a forceps- assisted birth. Maternal complications include tissue trauma, such as lacerations of the cervix, vagina, and perineum, hematoma, extension of episiotomy into the anus, hemorrhage, and infection.

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

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 fetus is assessed at 2 cm above the ischial spines. How would the nurse document the fetal station?

-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.

The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply. A. It significantly increases the risk of cesarean birth. B. It significantly increases the admissions to the neonatal ICU. C. It significantly increases instrumented birth. D. It significantly increases the use of epidural analgesia.

A,B,C,D; Evidence is compelling that elective induction of labor significantly increases the risk of cesarean birth, instrumented birth, use of epidural analgesia, and neonatal ICU admissions. Increased birth weight is not a factor.

The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which risks should she include? Select all that apply. A. shoulder dystocia B. macrosomia C. cephalopelvic disproportion D. brachial plexus injuries

A,B,C,D; Fetal risks associated with a postterm pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, and cephalopelvic disproportion. Failure to thrive is more frequently associated with newborns who are of a low birth weight.

A client is 2 weeks past her due date, and her health provider is considering whether to induce labor. Which conditions must be present before induction can take place? Select all that apply. A. A presenting part is engaged. B. There is absence of eclampsia. C. Maternal blood pressure is normal. D. The fetus is in a longitudinal lie. E. The cervix is ripe

A,D,E; Before induction of labor is begun in term and postterm pregnancies, the following conditions should be present: the fetus is in a longitudinal lie; the cervix is ripe, or ready for birth; a presenting part is engaged; there is no cephalopelvic disproportion; and the fetus is estimated to be mature by date (over 39 weeks) or demonstrated by a lecithin/sphingomyelin ratio or ultrasound biparietal diameter to rule out preterm birth. Normal maternal blood pressure and absence of eclampsia are not conditions required for induction; in fact, severe hypertension and eclampsia are conditions that may necessitate induction.

A client is having a routine prenatal visit and asks the nurse what the birth education teacher meant when she used the term zero station. What is the best response by the nurse? A. This is just a way of determining your progress in labor B. the presenting part is at the true pelvis and is engaged

A; Zero 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 nurse is educating a group of nursing students about the molding of the fetal skull during the birth process. What would the nurse include as the usual cause of molding? A. poorly ossified bones of the cranial vault B. tight membranous attachments

A; Molding is an adaptive process in which there is overriding and movement of the bones of the cranial vault to adapt to the maternal pelvis. The poorly ossified bones of the cranial vault, along with loosely attached membranous attachments, allow for the process of molding in the fetal skull. The bones of the face and the base of the skull are completely ossified and united. Hence they cannot allow for movement or overriding. The membranous attachments are loosely bound to the cranial vault and not tightly, which allows for molding of the fetal skull.

A client with a pendulous abdomen and uterine fibroid tumors had just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman? A. Transverse lie B. Occipitoposterior position

A; A transverse lie, in which the fetus is more horizontal than vertical, occurs in women with pendulous abdomens, with uterine fibroid tumors that obstruct the lower uterine segment, with contraction of the pelvic brim, with congenital abnormalities of the uterus, or with hydramnios. Anterior fetal position and cephalic presentation are normal conditions. Occipitoposterior position tends to occur in women with android, anthropoid, or contracted pelves.

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe?

Administer oxytocin diluted as a "piggyback" infusion; Oxytocin is always infused in a secondary or "piggyback" infusion system so it can be halted quickly if overstimulation of the uterus occurs.

The nurse identifies a nursing diagnosis of risk for injury related to possible effects of oxytocin therapy. Which action would the nurse perform to ensure a positive outcome for the client?

Assess contractions by using external monitor; In a client with the risk for injury, continuous assessment of contractions using external monitor and palpation to ensure the presence of a low resting tone will assist in collecting information about labor and the need for further intervention. Turning down oxytocin administration by half is required if hyperstimulation occurs not to prevent it. Tocolytic therapy is generally employed when preterm labor has been definitively diagnosed. Administering hydration and sedation frequently and bedrest are employed to halt preterm labor since these stop uterine activity by increasing intravascular volume and uterine blood flow.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client?

Assess fetal heart sounds; To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes whether this occurs spontaneously or by amniotomy, as the fetal heart rate will be unusually slow or a variable deceleration pattern will become apparent when cord prolapse has occurred. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed.

When teaching a group of nursing students about the different types of pelvis, the nurse describes which features of a gynecoid pelvis? Select all that apply. A. convergent side walls B. dull ischial spines C. wide pubic arch D. round-shaped inlet

B, C, D; The features of a gynecoid pelvis are oval-shaped inlet, dull ischial spines, and wide pubic arch. The birth of a baby is easiest in a gynecoid pelvis. Straight sacrum and convergent side walls are seen in an android pelvis.

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

B; The term presentation is the part of the fetal body that is entering the maternal pelvis first. 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. Relation of the fetal presenting part to maternal ischial spine is termed the station.

A petite, 5-foot tall, 95-pound woman who is 28 years old is about to give birth to her first child and would like to have a vaginal birth. She has two sisters, both of whom have given birth vaginally. She has gained 25 pounds during a normal, uneventful pregnancy. What type of pelvis would a nurse expect this woman to have upon assessment of the client? A. Gynecoid B. cannot be determined

B; Pelvis shape cannot be determined by the information included in the statement. Early in the pregnancy, particularly if a woman has never given birth to a baby vaginally, the practitioner may take pelvic measurements to estimate the size of the true pelvis. This helps to determine if the size is adequate for vaginal birth. However, these measurements do not consistently predict which women will have difficulty giving birth vaginally, so most practitioners allow the woman to labor and attempt a vaginal birth.

When a woman in labor has reached 8 cm dilation, the nurse notices that the fetal heat rate suddenly slows. On perineal inspection, the nurse observes the fetal cord has prolapsed. The nurse's first action would be to: A. turn her to her left side B. place her in a knee to chest position

B; Keeping the pressure of the fetus off the cord improves fetal circulation. Placing the woman in a knee-chest position accomplishes this. Replacing the cord could knot it; allowing it to dry would constrict cord blood vessels. Turning the woman to the left side is not the intervention of choice.

The nurse assesses that the fetus of a woman is in an occiput posterior position. Which description identifies the way the nurse would expect the client's labor to differ from others? A. need to have the baby manually rotated B. Experience of additional back pain

B; Most women whose fetus is in a posterior position experience back pain while in labor. Pressure against the back by a support person often reduces this type of pain. An occiput posterior position does not make for a shorter dilatational stage of labor, it does not indicate the need to have the baby manually rotated, and it does not indicate a necessity for a vacuum extraction birth.

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate? A. Slow the oxytocin infusion to the initial rate B. Stop the infusion immediately

B; The woman is exhibiting signs of uterine hyperstimulation, which necessitate stopping the oxytocin infusion immediately to prevent further complications. Once the infusion is stopped, the nurse should notify the birth attendant and continue to monitor the woman's contractions and fetal heart rate.

A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? A. The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. B. The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.

B; There are two types of uterine dysfunction: hypotonic and hypertonic. The most common is hypotonic dysfunction. This labor pattern manifests by uterine contractions that may or may not be regular, but the quantity or strength is insufficient to dilate the cervix.

When assessing several women for possible VBAC, which woman would the nurse identify as being the best candidate?

One who had a previous Cesarean birth via a low transverse incision; VBAC is an appropriate choice for women who have had a previous cesarean birth with a lower abdominal transverse incision. It is contraindicated in women who have a prior classic uterine incision (vertical), prior transfundal surgery, such as myomectomy, or a contracted pelvis.