OB Chapt 14 Nursing Management During Labor and Birth
A woman states that she does not want any medication for pain relief during labor. Her doctor has approved this for her. What is your best response to her concerning this choice? a) "I respect your preference whether it is to have medication or not." b) "Your doctor (a man) has never been in labor; he may be underestimating the pain you will have." c) "That's wonderful. Medication during labor is not good for the baby." d) "Let me get you something for relaxation if you don't want anything for pain."
"I respect your preference whether it is to have medication or not." Correct Explanation: Individualizing care to meet women's specific needs is a nursing responsibility.
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 of the following explanations should the nurse give? a) "It disrupts the nerve signal of pain via mechanical irritation of the nerves." b) "It blocks the transmission of nerve messages of pain at the receptors." c) "It causes the release of endorphins." d) "It distracts your brain from the sensations of pain."
"It distracts your brain from the sensations of pain." Correct Explanation: Concentrating intently on an object is another method of distraction, or another method of keeping sensory input from reaching the cortex of the brain. The other answers refer to other means of pain management.
Opioids are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request? a) "I will page the provider and ask for your pain medication." b) "You are so close to delivery; don't you want to have natural child birth?" c) "Rather than use fentanyl, we can ask the provider to order another analgesic at this point." d) "Pain medication given now might cause the baby to have slow respirations and is not recommended, let's try to focus and breathe."
"Pain medication given now might cause the baby to have slow respirations and is not recommended, let's try to focus and breathe." Correct Explanation: Once the woman has entered into the transition phase of labor, she is considered to be imminent for delivery. Any opioid medication might pass to the fetus and is not recommended due to the effects of respiratory compromise. The nurse will need to encourage nonpharmacologic methods at this point and should not consult the provider. The nurse should also remain supportive of the mother.
A woman refuses to have an epidural block because she does not want to have a spinal headache after delivery. Which of the following would be your best response? a) "Spinal headache is not a usual complication of epidural blocks." b) "The pain relief offered will compensate for the discomfort afterward." c) "Your doctor knows what is best for you." d) "The anesthesiologist will do her best to avoid this."
"Spinal headache is not a usual complication of epidural blocks." Correct Explanation: Because epidural anesthesia does not enter the cerebral spinal fluid space, it is unlikely to cause a "spinal headache."
A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which of the following would be the most appropriate response? a) "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem." b) "I have never read or heard of this happening." c) "The injection is given in the space outside the spinal cord." d) "An injury is unlikely because of expert professional care given."
"The injection is given in the space outside the spinal cord." Correct Explanation: An epidural block, as the name implies, does not enter the spinal cord but only the epidural space outside the cord.
A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated, she attended child birth classes and is aware of the stages and phases of labor. She had a vaginal exam 30 minutes prior to her asking again. How should the nurse respond to her question? a) "Checking your cervix will not speed up labor, let's wait." b) "The health care provider will have to check you, we can call them." c) "I can arrange for a cervix check, if you want." d) "You labor signs have not changed; we are looking for changes in your labor pattern before we check you again."
"You labor signs have not changed; we are looking for changes in your labor pattern before we check you again." Correct Explanation: The cervix must be assessed with a vaginal exam. The frequency of vaginal exams is based on the signs of changes in labor. The patient has not demonstrated any changes in her labor pattern; the nurse should provide education on the reason for not checking her.
Question: During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence. -4 station +2 station +4 station 0 station -2 station
-4 station -2 station 0 station +2 station +4 station Correct Explanation: Progressive fetal descent (-5 to +4) is the expected norm during labor, moving downward from the negative stations to zero station to the positive stations in a timely manner.
A nurse is serving as a doula to a client who is now in labor at an alternative birthing center. The client has opted for a water birth, and the nurse is now drawing the water into a large tub. What temperature should the nurse keep the water at? a) 35°C b) 41°C c) 39°C d) 37°C
37°C Correct Explanation: Standing under a warm shower or soaking in a tub of warm water, jet hydrotherapy tub, or whirlpool is another way to apply heat to help reduce the pain of labor. The temperature of water used should be 37°C to prevent hyperthermia of the woman and also the newborn at birth.
The nurse tests the pH of fluid found on the vaginal exam and determines that the woman's membranes have ruptured when the result is which of the following? a) 5.5 b) 6.5 c) 5.0 d) 6.0
6.5 Correct Explanation: Amniotic fluid is alkaline, so the membranes are probably ruptured if the pH ranges from 6.5 to 7.5.
The expected fetal heart rate response in an active fetus is which of the following: a) Deceleration followed by acceleration of 15 bpm b) Decrease in variability for 15 seconds c) Acceleration of at least 15 bpm for 15 seconds d) Increase in variability by 15 bpm
Acceleration of at least 15 bpm for 15 seconds Explanation: A reassuring active fetal heart rate is a change in baseline by increase of 15 bpm for 15 seconds. This is a positive and reassuring periodic change in fetal heart rates as a response to fetal movement.
The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which of the following? a) Diastole b) Decrement c) Increment d) Acme
Acme Correct Explanation: The acme is the peak intensity of a contraction. The increment refers to the building up of the contraction. The decrement refers to the letting down of the contraction. Diastole refers to the relaxation phase of a contraction
The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this form of therapy as which of the following? a) Biofeedback b) Effleurage c) Acupuncture d) Acupressure
Acupressure Correct Explanation: Acupressure is the application of pressure or massage at designated susceptible body points. A common point used for a woman in labor is Co4, which is located between the first finger and thumb on the back of the hand. Women may report their contractions feel lighter when a support person holds and squeezes their hand because the support person is accidentally triggering this point. Acupuncture involves insertion of needles into the same body points. Effleurage, the technique of gentle abdominal massage often taught with Lamaze in preparation for childbirth classes is a classic example of therapeutic touch. Biofeedback is based on the belief people have control and can regulate internal events such as heart rate and pain responses.
Susan is in labor with her second child. She knows that she will want epidural anesthesia and she has already signed her consent form. What must the nurse do before Susan receives the epidural? a) Administer a fluid bolus through the IV line to reduce the risk of hypotension b) Prepare a sterile field with the supplies and medications that will be needed c) Review Susan's medical history and laboratory results, and interview Susan to confirm all information is accurate and up to date d) Place Susan in the fetal position on the table and keep her steady so that she won't move during the procedure
Administer a fluid bolus through the IV line to reduce the risk of hypotension Explanation: Epidurals can cause vasodilatation and result in hypotensive episodes, IV fluid bolus prior to epidural placement can help prevent the hypotensive episode. She has signed the consent form, so it is unnecessary to interview her again. Do not place her in the fetal position or prep the site until the anesthesiologist arrives; then, assist them.
A client has opted to receive epidural anesthesia during labor. Which of the following interventions should the nurse implement to reduce the risk of a significant complication associated with this type of pain management? a) Administration of aspirin b) Administration of 500 mL of IV Ringer's lactate c) Administration of 1000 mL of IV glucose solution d) Move the woman into a supine position
Administration of 500 mL of IV Ringer's lactate Correct Explanation: The chief concern with epidural anesthesia is its tendency to cause hypotension because of its blocking effect on the sympathetic nerve fibers in the epidural space. This risk can be reduced by being certain a woman is well hydrated with 500 to 1000 mL of IV fluid, such as Ringer's lactate, before the anesthetic is administered. Ringer's lactate is preferable to a glucose solution, because too much maternal glucose can cause hyperglycemia with rebound hypoglycemia in the newborn. Be certain a woman does not lie supine but remains on her side after an epidural block, to help prevent supine hypotension syndrome. Be sure to caution women not to take acetylsalicylic acid (aspirin) for pain in labor as aspirin interferes with blood coagulation, increasing the risk for bleeding in the newborn or herself.
A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. Which of the following should the nurse do? a) Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor b) Agree with the client and administer the drug immediately to keep the pain manageable c) Refuse to administer narcotics, because they can develop dependency in the client and the fetus d) Explain to the client that narcotics should only be administered an hour or less before birth
Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor Correct Explanation: The timing of administration of narcotics in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, narcotics are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.
Jennifer has just received IV sedation. What must the nurse tell Jennifer to do? a) Ambulate only with assistance from the nurse or caregiver b) Sit on the edge of the bed with her feet dangling before ambulating c) Remain in bed for at least 30 minutes d) Ambulate within 15 minutes to prevent spinal headache
Ambulate only with assistance from the nurse or caregiver Correct Explanation: The patient may have decrease sensory from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.
Jennifer has just received IV sedation. What must the nurse tell Jennifer to do? a) Ambulate within 15 minutes to prevent spinal headache b) Ambulate only with assistance from the nurse or caregiver c) Sit on the edge of the bed with her feet dangling before ambulating d) Remain in bed for at least 30 minutes
Ambulate only with assistance from the nurse or caregiver Correct Explanation: The patient may have decrease sensory from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.
Which of the following is true regarding analgesia versus anesthesia? a) Decreased FHR variability is a common side effect when regional anesthesia is used. b) Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. c) Hypotension is the most common side effect when systemic analgesia is used. d) Regional anesthesia should be given with caution close to the time of delivery because it crosses the placenta and can cause respiratory depression in the newborn.
Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. Correct Explanation: Systemic analgesia should be used with caution near the time of delivery because it can cause respiratory depression, in addition to decreased FHR variability. Hypotension is a common side effect of regional anesthesia.
A 30-year-old G2P0010 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 8/10 with each contraction. What should the nurse do first? a) Assist the patient in ambulating to the bathroom. b) Assess for labor progression. c) Instruct the patient to do slow-paced breathing. d) Prepare the patient for an epidural.
Assess for labor progression. Correct Explanation: Performing breathing exercises, ambulating, changing position, and emptying the bladder all can help the patient experience a reduction in pain. However, the best first step is to assess the patient for labor progress before assisting her otherwise. Bearing down can be a sign that the patient is 10 cm dilated.
Betsy is recovering from a standard delivery. The nurse has just removed Betsy's epidural catheter and applied a sterile pressure dressing. What is it important for the nurse to do now? a) Make sure that Betsy receives plenty of fluids b) Help Betsy to get up and walk around immediately c) Let Betsy rest and recover while keeping her legs slightly elevated d) Assess return of sensory and motor functions to the lower extremities
Assess return of sensory and motor functions to the lower extremities Correct Explanation: After removal of the epidural catheter and medication is terminated, the nurse needs to assess for return of motor function to ambulate the mother. The mother will not be able to walk for some time; at least until the medication wears off. Do not elevate the legs; you want to maintain normal circulation. Fluids are important, but they are not related to the epidural or to the metabolism of the medication.
A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? a) Skullcap b) Catnip c) Jasmine d) Black cohosh
Black cohosh Explanation: Several herbal preparations have traditionally been used to reduce pain with dysmenorrhea or labor, although there is little evidence-based support for their effectiveness. Examples include chamomile tea for its relaxing properties; raspberry leaf tea (women freeze it into ice cubes to suck on), which is thought to strengthen uterine contractions; skullcap and catnip, which are thought to help with pain. Jasmine and lavender may both be mixed into oils and rubbed on the perineum before and during labor to soften the muscle and help prevent perineal tears. Black cohosh (squaw root), an herb that induces uterine contractions, is not recommended because of the risk of acute toxic effects such as cerebrovascular accident to the mother or fetus.
The nurse is assessing a woman in active labor. She notes a small mass above the symphysis pubis, rounded and distended, non-tender. What intervention should the nurse take next? a) Assume this is part of the uterus b) Check the chart for the last void c) Ask the patient if the mass has always been present d) Notify a physician about the mass
Check the chart for the last void Correct Explanation: The most probable explanation of the mass is the bladder, which is full. The nurse should determine the last void by the patient and offer to assist the patient to void or prepare to catheterize the patient to empty the bladder. This can be taken care of by the nurse. The patient would not likely know if the mass was always present or not, given its location. If it were the uterus, it would be tender to the touch.
Which of the following would be the best way the nurse can facilitate an effective birth plan for the patient to achieve adequate pain relief? a) The nurse prescribes alternative methods of pain relief b) The health care provider decides the best pain relief for the mother and family c) The client has the baby without any analgesic or anesthetic d) Client priorities and preferences are incorporated into the plan
Client priorities and preferences are incorporated into the plan Correct Explanation: The nurse and the patient would work together; the nurse needs to seek information on the desires of the patient and work to achieve the desired level of pain control for the labor and delivery experience.
A woman is experiencing back labor and complains of intense pain in the lower back. Which is the most effective nursing intervention to relieve this type of pain? a) Effleurage of the abdomen during the contraction b) Counter pressure against the sacrum c) Conscious relaxation/guided imagery in low fowlers d) Pant-blow (breaths and puffs breathing techniques)
Counter pressure against the sacrum Correct Explanation: Counter pressure against the sacrum is a way to provide support and comfort for a women having intense back labor. Effleurage is ineffective for true back labor, as is conscious relaxation. Breathing will not diminish the pain of back labor.
When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: a) Bloody show b) Dilatation of cervix c) Engagement of fetus d) Rupture of amniotic membranes
Dilatation of cervix Correct Explanation: The best determination of effective contractions is dilation of the cervix. Engagement, membrane rupture, and bloody show may all occur before the cervix has dilated.
Mrs. Timms is now in the transition phase of labor. One of your concerns is the possibility of an ineffective breathing pattern. If one of your goals was for the woman's breathing pattern to be effective, what outcome would you expect? a) Uses accelerated breathing patterns continuously b) Refrains from using the pant-blow technique so she doesn't push c) Does not hyperventilate d) Pants through each contraction as she pushes
Does not hyperventilate Correct Explanation: Goal: The woman's breathing pattern is effective. Expected Outcomes: The woman uses accelerated breathing techniques during contractions. does not hyperventilate. uses pant-blow techniques to refrain from pushing despite pressure from the fetal head.
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? a) Effleurage b) Abdominal imagery c) Massage d) Pain pathway blockage
Effleurage Correct Explanation: Effleurage, a form of touch that involves light circular fingertip movements on the abdomen, is a technique the woman can use in early labor. The theory is that light touch stimulates the nerve pathways to the brain and keeps them busy, thereby blocking the pain sensation.
A client in the first stage of labor is admitted to a health care center. The nurse caring for the client instructs her to rock on a birth ball. The nurse informs her that this causes the release of certain natural substances, which reduces the pain. To which of the following substances is the nurse referring? a) Prostaglandins b) Endorphins c) Progesterone d) Relaxin
Endorphins Correct Explanation: The nurse is referring to the release of endorphins, which are natural analgesic substances released by the movement of the client on the birth ball. The nurse should encourage the client to rock or sit on the birth ball. This causes the release of endorphins. The client's movement on the birth ball does not produce prostaglandins, progesterone, or relaxin. Prostaglandins are local hormones that bring about smooth muscle contractions in the uterus. Progesterone is a hormone involved in maintaining pregnancy. Relaxin is a hormone that causes backache during pregnancy by acting on the pelvic joints.
During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus how often? a) Every 5 minutes b) Every 15 minutes c) Every 10 minutes d) Every 20 minutes
Every 15 minutes Correct Explanation: During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus every 15 minutes, and then every 30 minutes for the next hour.
As a woman enters the second stage of labor, which of the following would you expect to assess? a) Feelings of being frightened by the change in contractions b) Complaints of feeling hungry and unsatisfied c) Falling asleep from exhaustion d) Expressions of satisfaction with her labor progress
Feelings of being frightened by the change in contractions Correct Explanation: The nature of contractions changes so drastically to an urge to push that this can be frightening.
How does a woman who feels in control of the situation during labor influence her pain? a) Feelings of control are inversely related to the patient's report of pain. b) There is no association between the two factors. c) Feeling in control shortens the overall length of labor. d) Decreased feeling of control helps during the third stage.
Feelings of control are inversely related to the patient's report of pain. Correct Explanation: Studies reveal that women who feel in control of their situation are apt to report less pain than those who feel they have no control.
A pregnant client in her 32nd week of gestation has been admitted to a health care center with complaints of decreased fetal movement. Which of the following should the nurse determine first before placing the fetoscope on the woman's abdomen, so as to auscultate the fetal heart sounds? a) Fetal back b) Fetal shoulders c) Fetal buttocks d) Fetal head
Fetal back Correct Explanation: The nurse assessing the client should first determine the fetal back before placing the fetoscope on the client's abdomen. The fetal back is determined first because it is through the back that the heart signals are best transmitted. During labor, the fetal heart rate should be assessed to check for any variations indicating distress. Fetal heart rate is auscultated by placing a fetoscope on the client's abdomen in the area of the fetal back. Determining the fetal head, shoulders, and the buttocks would be of no help in localizing the heart sounds.
If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which of the following patterns would you anticipate seeing on the monitor? a) Variable decelerations, too unpredictable to count b) Fetal baseline rate increasing at least 5 mm Hg with contractions c) Fetal heart rate declining late with contractions and remaining depressed d) A shallow deceleration occurring with the beginning of contractions
Fetal heart rate declining late with contractions and remaining depressed Correct Explanation: Lack of blood supply to the fetus because of poor placental filling prevents the fetal heart rate from recovering immediately following a contraction.
Beverly is being admitted to labor and delivery. When admitting an obstetric patient in early labor, the first intervention by the nurse is: a) Good rapport is established with the patient and significant other b) Perineal shave is done immediately to prepare for the examination c) Vital signs and FHR are assessed by internal electronic monitoring d) The personal belongings are properly checked and secured
Good rapport is established with the patient and significant other Correct Explanation: On admission the patient and her family need to establish a rapport with their caregiver. If the patient is stable and there is no immediate need, rapport should be established over actions that can be taken care of later.
During contractions, the electronic fetal monitor (EFM) shows variable V-shaped decelerations in the FHR lasting about 30 seconds with accelerations of about 5 bpm before and after each deceleration. Overshoot is absent and the baseline FHR is within normal limits. What should you do first? a) Help the woman change positions b) Discontinue supplemental oxygen c) Start an oxytocic infusion and decrease the rate of IV fluids d) Position the woman on her side with a pillow under her left hip
Help the woman change positions Correct Explanation: Changing positions is a first intervention to determine if this will improve the oxygen to the fetus. Supplemental oxygen should be maintained until the mother is stable. Placing the patient on her side may increase the work of breathing. Pharmacological interventions are premature.
Your client is in active labor. When you check the EFM tracing, you note variables that are nonreassuring. What would be your first nursing intervention? a) Obtain assistance to check for a compressed umbilical cord b) Prepare the woman for an emergency C-Section. c) Help the woman change positions d) Document the finding
Help the woman change positions Correct Explanation: First, assist the woman to change positions. Try to find a position that is comfortable for the woman that relieves the compression. If the variables stop after the position change, you will know that the compression has been relieved. However, if the variables continue, try a variety of position changes, including the knee-chest position.
The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist? a) Rapid progress of labor b) Urinary retention c) Dry, cracked lips d) Inability to push
Inability to push Correct Explanation: If she is not able to push, her epidural dose may be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so you should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.
A multigravida is admitted to the hospital in active labor. The client's and the fetus' condition have been good since admission. The client calls out to the nurse, "the baby is coming!" What is the first action of the nurse? a) Contact the physician b) Auscultate the fetal heart tones c) Inspect the perineum d) Time the contractions
Inspect the perineum Correct Explanation: The nurse needs to determine if delivery is imminent and be prepared for delivery. Once the nurse assesses the coming labor, the heart sounds, contraction rate, and contacting the physician can all be done, if there is time.
At which time during a woman's labor might the nurse assist with a pudendal block? a) Before dilation only b) Just before delivery c) Just after delivery d) Early stage labor
Just before delivery Correct Explanation: Pudendal block is a local block in the perineal area and is used to numb for delivery. Application before labor begins or while it is in the early stages would be counterproductive, as the patient would not have proper feeling and would have a harder time pushing. After delivery it is pointless; the most painful part is over.
Early in labor, a pregnant client asks why contractions hurt so much. Which of the following should the nurse mention? a) Distraction of the brain cortex by other stimuli b) Release of endorphins in response to contractions c) Lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels d) Blocking of nerve transmission via mechanical irritation of nerve fibers
Lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels Correct Explanation: During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. This anoxia can cause pain in the same way blockage of the cardiac arteries causes the pain of a heart attack. Endorphins are naturally occurring opiate-like substances that reduce pain, not cause it. Distraction and mechanical irritation of nerve fibers are also methods of reducing pain, not causes of pain.
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: a) Right upper quadrant b) Left lower quadrant c) Left upper quadrant d) Right lower quadrant
Left lower quadrant Correct Explanation: 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.
You place an external fetal monitor on a woman in labor. Which of the following instructions would be best to give her? a) Avoid flexing her knees so her abdomen is not tense. b) Lie supine so the tracing does not show a shadow. c) Avoid using her call bell to reduce interference. d) Lie on her side so she is comfortable.
Lie on her side so she is comfortable. Correct Explanation: The best position for all women during labor is on their side.
The following are nursing measures commonly offered to women in labor. Which nursing intervention would probably be most effective in applying the gate control theory for relief of labor pain? a) Give the prescribed medication b) Encourage the woman to rest between contractions c) Change the woman's position d) Massage for the woman's back
Massage for the woman's back Correct Explanation: Gate-control is based on the idea of distraction or redirection of the conduction of impulses up the neural pathways. Massage redirects the paths of sensation away from the pain to the other area. Encouragement is a form of psychological support. Position change will only distract the patient. Medication should be withheld until all non-pharmacological treatments have been exhausted.
A nurse is caring for a client who has just received an epidural. Which of the following is the MOST common side effect of epidural anesthesia? a) Maternal hypotension, which can lead to fetal tachycardia b) Maternal hypertension, which can lead to fetal bradycardia c) Maternal hypertension, which can lead to fetal tachycardia d) Maternal hypotension, which can lead to fetal bradycardia
Maternal hypotension, which can lead to fetal bradycardia Correct Explanation: Epidural anesthesia conveys the risk of hypotension, especially if the client has not received an adequate amount of fluid before the procedure is performed. A sudden drop in maternal blood pressure can cause uterine hypoperfusion, which may result in fetal bradycardia.
The amniotic fluid is green when the membranes rupture. What finding would the nurse document? a) Umbilical cord prolapse b) Meconium in the amniotic sac c) Amniotic fluid embolism d) Infection
Meconium in the amniotic sac Correct Explanation: Green tinted fluid with ROM is indicative of meconium in the amniotic sac, or the infant having a bowel movement in utero. Infection would be shown by puss or cloudy fluid. Umbilical cord prolapse occurs when pressure on the cord stops the flow of oxygen to the fetus. Amniotic embolism results when amniotic fluid enters circulation.
Which medication is administered to reverse the depressant effects of opioids? a) Nalbuphine (Nubain) b) Butorphanol (Stadol) c) Naloxone (Narcan) d) Meperidine (Demerol)
Naloxone (Narcan) Correct Explanation: Naloxone (Narcan) is an opioid antagonist. Butorphanol (Stadol), nalbuphine (Nubain), and meperidine (Demerol) are opioids.
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? a) Fetal hypersensitivity to anesthetic b) Neonatal depression c) Woman is more sensitive to pre-anesthetic medications d) Woman is less sensitive to inhalation anesthetics
Neonatal depression Correct Explanation: General anesthesia is not used frequently in obstetrics because of the risks involved. The pregnant woman is at higher risk for aspiration. It requires more skill to intubate a pregnant woman because of physiologic changes in the trachea and thorax. In addition, general anesthetic agents cross the placenta and can result in the birth of a severely depressed neonate who requires full resuscitation.
You are the nurse preparing an educational event for pregnant women on the topic of labor pain and delivery. You know that you will need to include the origin of labor pain for each stage of labor. What information will you present for the first stage of labor? a) Diffuse abdominal pain signals a complication with progression of labor b) It is reported as the worst pain you will ever feel c) Pain is focal in nature d) Pain originates from the cervix and lower uterine segment
Pain originates from the cervix and lower uterine segment Correct Explanation: Pain sensations associated with labor originate from different places depending on the stage of labor. During the first stage of labor, the stretching required to efface and dilate the cervix stimulates pain receptors in the cervix and lower uterine segment.
Joanne has been in labor for 5 hours. Earlier there was a gradual increase in FHR baseline with variables, but Joanne has changed position several times and now the fetus shows no signs of hypoxia. Joanne's cervix is almost completely effaced and is dilated to 8 cm. However, the labor graph indicates that the fetus has stopped descending. What should you do first? a) Alert the team that internal fetal monitoring may be needed b) Institute effleurage and apply pressure to Joanne's lower back during contractions c) Encourage Joanne to push d) Palpate the area just above the symphysis pubis
Palpate the area just above the symphysis pubis Correct Explanation: Palpate to determine if the infant is engaged and what the presenting part of the infant is by the symphysis pubis, it is possible for infants to rotate and change position during labor. Assess the situation and act further if necessary, but until you have more information on fetal position, assume all is going well.
Nancy has presented in the early phase of labor. She's experiencing abdominal pain and shows signs of growing anxiety about the pain. What is the best pain management technique the nurse can suggest at this stage? a) Administering an opioid such as meperidine (Demerol) or fentanyl (Sublimaze) b) Immersing Nancy in warm water in a pool or hot tub c) Practicing effleurage on the abdomen d) Administering a sedative such as secobarbital (Seconal) or pentobarbital (Nembutal)
Practicing effleurage on the abdomen Correct Explanation: In early labor, the less medication use the better, allow use of nonpharmacologic management and control the pain with gate theory. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor.
A woman in labor at the hospital has just received an epidural block. Which intervention is priority before and during epidural placement? a) Increase oral fluids every hour to prevent dehydration b) Monitor temperature every four hours and give Tylenol if 100.4 c) Monitor the maternal apical pulse for Bradycardia d) Provide adequate IV fluids to maintain her blood pressure
Provide adequate IV fluids to maintain her blood pressure Correct Explanation: The patient will need to have a bolus of IV fluids prior to and then maintained during the epidural to be prepared in the event of the hypotensive episodes that may accompany epidural placement. The hypotensive event is transitory, and increasing oral hydration is unnecessary and may lead to nausea later. Monitor the mother's body temperature, but wait for instructions from the doctor as to when to administer medication. Bradycardia is not a common side effect of epidural medication
A woman dilated to 10 centimeters and feeling the urge to "have a bowel movement" is refusing to push, she is screaming "it hurts down there too much to push." What is the option the nurse should suggest at this point for pain management to facilitate pushing? a) Paracervical block b) Pudendal block c) Parenteral medication d) Epidural anesthesia
Pudendal block Correct Explanation: The patient is too far dilated to have any parenteral medication or an epidural block. The best option is a local block or a pudendal block that will numb the vaginal wall to block the pain sensation to the pudendal nerve. The paracervical block is only used in the first stage of labor and this patient is in the second stage.
A woman arrives in labor and delivery, is panting and screaming "the baby is coming". What is the priority intervention by the nurse? a) Quickly move the woman to a labor bed, check the perineum b) Admit her to the unit and escort to a room c) Assess vital signs d) Ask medical and obstetrical history
Quickly move the woman to a labor bed, check the perineum Correct Explanation: The woman is showing signs of advanced labor, possibly in transition or stage two. She needs to be managed as an imminent birth and taken directly to a room for vaginal assessment. Vital signs, medical/obstetrical history, and her room assignment can be taken care of later in the process.
Sarah has just arrived at the hospital, in early labor, showing signs of extreme anxiety over the birth to come. Why is it so important that the nurse help Sarah relax? a) This is the time at which the nurse must establish that she is in control; she will be taking care of Sarah and Sarah needs to trust the nurse b) Sarah's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus c) Sarah needs to sleep now so that she can save her energy for the later stages of labor d) Sarah's anxiety will increase her blood pressure, increasing her risk with an epidural
Sarah's anxiety can actually slow down the labor process and decrease the amount of oxygen reaching the uterus and the fetus Correct Explanation: Anxiety out of control can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and have a negative impact on the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural. It is premature to be stern with the patient. While it is preferable that she save her energy, it is not damaging to her or to the fetus if she does not sleep.
Which of the following is NOT an opioid that is commonly used during labor and delivery? a) Nalbuphine (Nubain) b) Secobarbital (Seconal) c) Meperidine (Demerol) d) Butorphanol (Stadol)
Secobarbital (Seconal) Correct Explanation: Meperidine, butorphanol, and nalbuphine are opioids that are commonly used during labor and delivery. Secobarbital is a barbiturate.
Opioids are the most frequently used medications to provide analgesia during labor. Which of the following drugs is an opioid that is used in obstetrics for relief of labor pain? a) Sublimaze b) Ultram c) Carbamazepine d) Toradol
Sublimaze Explanation: Opioids, medications with opium-like properties (also known as narcotic analgesics), are the most frequently administered medications to provide analgesia during labor. Opioids, such as meperidine (Demerol) and fentanyl (Sublimaze), frequently assist the woman to better tolerate labor contractions by causing relaxation and sleep between contractions (Grant, 2006b). Opioids are most frequently given by the intravenous (IV) route because this route provides fast onset and more consistent drug levels than do the subcutaneous or intramuscular routes.
While waiting for the placenta to deliver during the third stage of labor you must assess the new mother's vital signs every 15 minutes. What signs would indicate impending shock? a) Bradypnea and hypertension b) Tachypnea and a widening pulse pressure c) Bradycardia and auscultation of fluid in the base of the lungs d) Tachycardia and a falling blood pressure
Tachycardia and a falling blood pressure Correct Explanation: Monitor the woman's vital signs at least every 15 minutes during the third stage of labor. Tachycardia and a falling blood pressure are signs of impending shock; immediately report these signs.
As the nurse in an obstetric clinic, you are conducting patient education with a group of expectant mothers. One young woman asks you to tell the group what labor pain is like. What would be your best response? a) It comes in waves. b) The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in. c) It is best evaluated by talking with visitors in the labor room because they know you best. d) It has been described as the worst pain you will ever feel.
The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in. Correct Explanation: Pain sensations associated with labor originate from different places, depending on the stage of labor.
Which of the following signs signify that the second stage of labor has begun? a) Emotions are calm and happy b) Frequency of contractions are 5-6 minutes c) The urge to push occurs d) Fetus is a -1 station
The urge to push occurs Correct Explanation: Second stage of labor is the pushing stage; this is typically identified by the woman's urge to push or a feeling of needing to have a bowel movement. The emotional state may be altered due to pain and pressure. Contraction frequency is variable and not clearly indicative of a particular stage. The fetus can be at stage -1 for any length of time.
The nurse instructs the patient about skin massage and the gate-control theory of pain. Which of the following statements would be appropriate for the nurse to include for patient understanding of the nonpharmacological pain-relief methods? a) The gate control mechanism opens so all the stimuli pass through to the brain. b) This is a technique to prevent the painful stimuli from entering the brain. c) The gate control mechanism is located at the pain site. d) Pain perception is decreased if anxiety is present.
This is a technique to prevent the painful stimuli from entering the brain. Correct Explanation: Gate control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location.
The laboring patient who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice. a) The effects would wear off before delivery. b) This may prolong labor and increase complications. c) This can lead to maternal hypertension. d) This would cause fetal depression in utero.
This may prolong labor and increase complications. Correct Explanation: Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The patient should be offered nonpharmacologic options at this point until she is in active labor.
What is the most important thing that you can do during labor and delivery to prevent maternal and fetal infection? a) Clean the woman's perineum with a Betadine scrub b) Thoroughly wash your hands before and after patient contact c) Strictly follow universal precautions d) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum
Thoroughly wash your hands before and after patient contact Correct Explanation: The most important infection control technique in any health care setting is thoroughly washing hands on routine basis. Keeping the area clean is secondary, but is also important.
If the monitor pattern of uteroplacental insufficiency were present, which of the following would you do first? a) Turn her or ask her to turn to her side. b) Ask her to pant with the next contraction. c) Administer oxygen at 3 to 4 L by nasal cannula. d) Help the woman to sit up in a semi-Fowler's position.
Turn her or ask her to turn to her side. Correct Explanation: The most common cause of uteroplacental insufficiency is compression of the vena cava; turning the woman to her side removes the compression.
Which instructions should be given by the nurse to the patient in the second stage of labor to facilitate natural childbirth? a) Use a squatting position and use the squat bar for support b) Stay low on her back to ease the back pain c) Use the Valsalva maneuver for effective pushing d) Ask for privacy and have just the partner present
Use a squatting position and use the squat bar for support Correct Explanation: The position is very important during labor. The woman needs to be in a position of comfort. Allowing the woman to assume the most comfortable position will facilitate natural childbirth. The Valsalva maneuver may result in dangerous increases in blood pressure, so be sure to instruct the mother to breathe as she pushes. The nurse should not intervene with who comes in or what family members are present unless she is asked, or unless the visitation is upsetting the mother.
While caring for woman in labor the fetal heart monitor demonstrates late decelerations. The most common cause for their occurrence is: a) Cord compression b) Uteroplacental insufficiency c) Maternal fatigue d) Maternal hypotension
Uteroplacental insufficiency Explanation: Late decelerations are associated with uteroplacental insufficiency. They typically indicate decreased blood flow to the uterus during the contractions. Maternal hypotension and fatigue would not be observed on the fetal heart monitor. Cord compression would be marked by fetal tachycardia
The pain of labor is influenced by many factors. What is one of these factors? a) Woman has a high threshold for pain b) Woman has a high tolerance for pain c) Woman has lots of visitors during labor d) Woman's preparation for labor and delivery
Woman's preparation for labor and delivery Correct Explanation: The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared.
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? a) Women report higher levels of satisfaction when regional anesthetics are used to control pain b) Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience c) Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain d) Women report higher levels of satisfaction when the physician makes the decision on what type of pain control to use
Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience Correct Explanation: Research has shown that women report higher levels of satisfaction with their labor experience when they feel a high degree of control over the experience of pain (Stuebe & Barbieri, 2005).
What is the primary role of the nurse in pain management for a nurse working with labor patients? a) Provide any medication the patient request b) Monitor the patient for active labor and suggest she have an epidural to have increased satisfaction with her delivery experience c) Dictate the pain management during labor for the best outcome d) Work with the labor patient to plan pain management options
Work with the labor patient to plan pain management options Correct Explanation: The role of the nurse is to work with the patient and plan with the nurse the pain management technique desired by the patient to meet the level of expectation for the patient. Pain is subjective and each woman has a right to her own labor plan.
To assess the frequency of a woman's labor contractions, you would time a) how many contractions occur in 5 minutes. b) the interval between the acme of two consecutive contractions. c) the end of one contraction to the beginning of the next. d) the beginning of one contraction to the beginning of the next.
the beginning of one contraction to the beginning of the next. Correct Explanation: Measuring from the beginning of one contraction to the next marks the time between contractions.