OB exam 2
A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure?
The fetal head is currently engaged in the maternal pelvis (at the ischial spines). To prevent cord prolapse, the fetal head should be engaged.
The nurse is looking at an EFM (external monitoring) strip and sees that the patient in active labor is having contractions that are every 10 minutes with mild intensity for the past 2 hours and the fetus is in fetal distress. What would this indicate for next steps?
The patients' contractions are inadequate; the provider could consider an amnioinfusion through the IUPC, and once the fetus has improved, contractions need to be augmented to be more effective. Baby is in need of intrauterine resuscitation then needs to get out quick.
The nurse is reading the patient's chart, which indicates the patient has a "gynecoid pelvis." What finding is expected in this patient?
Wider outlet
The nurse is monitoring the fetal heart rate (FHR) tracing and sees that her patient has a tracing with a baseline of 120bpm, moderate variability, with absence of decelerations and accelerations. According to the National Institute of Child Health and Human Development five tier system, what category tracing does the patient's fall into?
A Category I tracing
The obstetric nurse is managing her laboring patients while covering for another nurse who is on a break. Which patient is the LOWEST priority?
A patient with Category I FHR tracings
The nurse is providing care for a primip (never been pregnant before this one) patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next?
Augmentation of labor with oxytocin per health care provider's order Contractions are not adequate thus must be augmented.
A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (VBAC) screening. The nurse is aware that which patient information will likely disqualify the patient for VBAC?
Cesarean due to pelvic abnormalities
The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor?
Dystocia is associated with extreme fear.
The nurse educator is in a childbirth education class discussing nonpharmacological ways nurses can assist to enhance labor and spontaneous vaginal delivery. Which of the following facts regarding nonpharmacologic approaches will the nurse use to help illustrate its benefits?
Effleurage is performed in rhythm with breathing during a contraction. Effleurage is massage involving a circular stroking movement on the abdomen to promote relaxation during a contraction.
The nursing is caring for a 31-year-old female patient who is pregnant at 37 weeks and 5 days gestation. The patient is having contractions every 3 minutes and was found to have a platypelloid pelvis upon examination. The fetus has an estimated fetal weight of 7 lbs and is in the LOA position. This patient is laboring on the birth ball, and her mother-in-law is helping her labor. The nurse is concerned about the five Ps and their effect on the patient's labor. Which P is the nurse most likely concerned about based on the patient's history?
Passage
While providing care for a patient (the patient is moving around), the nurse notices an erratic FHR recording. What action should the nurse take next?
Place the transducer (ultrasound) in a different position. Moving around is what displaced the monitor.
The nurse is using the five-tier system fetal heart system. A co-worker is concerned about a patient whose fetus has an acceptably low risk of acidemia but evidence of impending fetal asphyxia (orange color). What is the next best step for the nurse?
Prepare for possible urgent delivery. This is for the orange category.
Stage two labor is defined as?
Complete cervical dilation and ends with delivery of baby.
True labor is when......
the cervix dilates
The nurse is explaining telemetry to the patient, who has just begun active labor. The patient would like to have a labor in which she is mobile, able to change positions, and use hydrotherapy. Which response by the nurse is most appropriate?
"We can start using telemetry now, and if there are no problems with the signal, we can continue it throughout your labor until delivery." With no risk factors or interruption of the signal, telemetry can be used throughout the laboring process.
The nursing is caring for a patient in active labor with significant back pain. The patient has requested nonpharmacologic methods of pain relief. The nurse thinks that sterile water injections may help with her pain management. Which of the following explanations should the nurse explain to the patient?
"We will inject 0.5 mL of sterile water subcutaneously, and it will last for an hour to 90 minutes."
The nurse is caring for a 24-year-old woman who is G1P0 at 40 weeks, 1 day gestation and in active labor. She has just received an epidural and now complains of "an itchy feeling all over." Her vitals are as follows: HR 120, RR 12, BP 130/74, T 98.8, and O2 sat 98% on room air. Which action should the nurse take first?
Call the health care provider regarding the patient's pruritus to order an antipruritic medication.
A nurse-preceptor is explaining to a new nurse about the fetal heart monitoring. The new nurse is looking at the EFM paper and sees that, of the two tracked heart rates, the one on the bottom is in the 80s. The nurse is concerned that the fetal heart rate is bradycardic. Which of the following should the nurse do first?
Check to make sure that the maternal radial pulse is being recorded correctly. It could be picking up the mother's heartbeat.
An internal fetal monitor (Scalp Electrode) has been ordered for Chrissy, a 24-year-old G2P0010 at 38 weeks and 1 day gestation. Her medical history is significant for a history of pregnancy-induced hypertension. Her laboratory values are as follows: H/H 11/30, O negative, RPR negative, GBS positive. Based on Chrissy's history and presentation, what action should the nurse take next?
Discuss with the health care provider that Chrissy is GBS positive and therefore should not receive an internal monitor. Internal monitoring in contraindicated for a GBS positive patient.
The nurse is reviewing the chart of a 35-year-old G4P2012 woman. The patient is at 38 weeks, 4 days and is in active labor with SROM (spontaneous rupture of membranes) 2 hours ago, with clear fluid. What action should the nurse take?
Help the patient change her position from side to side every 30 minutes.
The nurse is providing care for a patient in the second stage of labor (pushing stage). After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the GREATEST risk to the fetus related to the nurse's suspected complication?
Neonatal asphyxia related to prolonged labor
The EFM tracing shows the following: FHR baseline 166 bpm, moderate variability, and recurrent late decelerations to 100 bpm. Using the five-tier FHR interpretation system, how should the nurse interpret this tracing?
Orange: acceptable low risk of acidemia, prepare for possible urgent delivery
The nursing preceptor asks the nursing student how to best determine the intensity of contractions before placing the patient on an electronic fetal monitoring system. How would the nurse assess this?
Palpate the maternal abdomen during a contraction.
The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met?
The "three-pull rule" has been achieved. The prevent fetal compromise the nurse must count the number of times the vacuum procedure is attempted.
The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator (Laminaria). Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening?
The method may be used for a fetal demise. Usually used for mechanical abortion.
