OB Exam 2

obesity

maternal ____ can cause shoulder dystocia, macrosomia, increase hemorrhage risk, delayed wound healing dvts and infection rates

third

____ maneuver: determines the presenting part

first

____ maneuver: determines what part of the fetus is location in the fundus of the uterus

active

____ phase of first stage: 6cm-complete and 40-80% effaced, contractions are more intense at 2-5 minutes

transition

____ phase of first stage: from 8-10cm dilated and 100% effaced, intense contractions every 1-2 minutes

descent

progress descent of fetus through maternal pelvis

effacement

progressive thinning of cervix (0-100%)

trendelenburg

put patient in ____ position for umbilical prolapse

15 20

the cup of the vacuum should not be on the fetal head for longer than ___-___ minutes

head

the fetal _____ is the largest portion to come through the birth canal

maximum minumum

the goal of analgesia use during labor is to provide _____ pain relief at _____ risk for mom and baby

nubain severe

____ should never be given to a laboring mother for pain if she has a history or opiate dependence as it can cause a ____ withdraw

third

____ stage of labor includes: birth of infant to delivery of placenta

second

____ stage of labor: complete dilation to delivery of baby

third

____ stage of labor: delivery of baby to delivery of placenta

fourth

____ stage of labor: immediate postpartum

early latent

____/____ phase of first stage: 0-4cm dilated and effacement from 0-40% with mild intensity contractions every 5-10 minutes

position

____: freedom of movement during labor, allowing the woman to labor in the position she finds the most comfortable

culture

____: must be culturally aware and sensitive to the needs and practices

position

____: the fetal presenting part in relation to the back, front, or sides of the maternal pelvis

expectations

____: unrealistic expectations can cause anxiety and negative experiences

apgar score's

_____ _____: obtained at 1 and 5 minutes after birth, for reporting the status of the newborn and the response to resuscitation immediately after birth

presentation

_____: determined by the fetal lie and body part entering the pelvis first, Cephalic-head down, breech or shoulder-shoulder first

cesarean

complications from ___ may include: hemorrhage, bladder/bowel trauma, maternal resp depression and hypotension

intensity

contraction strength at its acme (mild, moderate, strong)

hypertonic uterine dysfunction

contractions are frequent and painful but ineffective in promoting dilation and effacement

post-maturity syndrome

decreased subcutaneous fat and lack vernix and lanugo

powers

5 P's of Labor: _____: when contractions are responsible for dilation and effacement

powers, passage, passenger, psyche, position

5 P's of labor

position

5 P's of labor: _____: maternal postures, physical positons

passage

5 P's of labor: _____: pelvis and birth canal

psyche

5 P's of labor: _____: response of woman

passenger

5 P's of labor: _____: the fetus

Leopold's maneuvers

determines the fetal position, station, and size

calcium gluconate

Given for Magnesium Toxicity

dystocia

difficult labor; "failure to progress"

d

The first stage of labor includes which of the following? a: latent phase b: active phase c: transitional phase d: all the above

fourth

____ maneuver: determines the location of the cephalic prominence

oxytocin

Uterotonic that Helps Induce Labor or Control/Prevent Postpartum Bleeding through IV or IM

skin to skin

___ ___ ___ contact: facilitates parent-infant bonding and attachment

fetal hypoxia

___ ___ due to umbilical prolapse can lead to disability or death

golden hour

___ ___: baby is placed skin-to-skin with mom so bonding can occur, best time to institute breastfeeding

second

___ stage of labor includes: begins with complete dilation, ends with birth of baby, mom feels an urge to push (feels like she needs to have a BM), cardinal movements, engagement, descent, flexion, internal rotation, extension, external rotation, expulsion

fourth

___ stage of labor includes: preventing postpartum hemorrhage, using uterotonics, and an assessment of mom

first

___ stage of labor: onset of labor to complete cervical dilation

support system

____ ____: helps to decrease anxiety and women then feel more in control

nitrous oxide

____ ____: limited in the US, half (same term) and half oxygen, quick relief and dissipates quickly (50 seconds), allows complete control, easy to administer and no need for anesthesiologist, no effect on fetal HR or maternal BP, causes nausea and dizziness

presenting part

____ ____: the specific fetal structure lying nearest to the cervix

sutures

____ are used to identify positioning of the fetus

analgesia

____ include: morphine sulfate, butorphanol tartrate (stadol), nalbuphine hydrochloride (Nubain), sublimaze (fentanyl)

McRobert's

____ maneuver used to help a mom deliver a baby with shoulder dystocia, includes putting moms thighs as close to her shoulders as possible

second

____ maneuver: determines location of the fetal back

attitude

_____: the relationship of fetal parts to one another; fetal (same term), the head if flexed forward with the chin almost resting on the chest, the arms and legs are flexed

lie

_____: the relationship of fetal spine to maternal spine, longitudinal, transverse

uterine rupture

a ___ ___ is rare but most common during a VBAC

scheduled

a ___ cesarean occurs before the onset of labor

nonurgent

a ____ cesarean is needed due to failure to progress or failure to descend

vacuum-assisted delivery

a birth involving the use of a vacuum cup on the fetal head to assist with delivery of the head

3 5

a client arrives at a birthing center in active labor. after examination, it is determined that the client's membranes are still intact and the client is at a -2 station. the primary health care provider prepares to perform an amniotomy. what will the nurse relay to the client the most likely outcome of the amniotomy? select all that apply 1: less pressure on cervix 2: decreased number of contractions 3: increase the efficiency of contractions 4: the need for increased maternal blood pressure monitoring 5: the need for frequent fetal heart rate monitoring to detect the presence of a prolapsed cord

1

a client in labor is transported to the delivery room and prepared for cesarean delivery. after the client is transferred to the delivery room table, the nurse would place the client in which position? 1: supine position with a wedge under right hip 2: Trendelenburg's position with the legs in stirrups 3: prone position with legs separated and elevated 4: semi-fowler's position with a pillow under the knees

shoulder dystocia

a difficulty encountered during delivery if the shoulders after the birth of the head, which can be caused by macrosomia, maternal diabetes, a hx of this issue, and excessive weight gain.

2

a nurse has developed a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. the nurse prioritizes the plan of care and selects which intervention as the highest priority. 1: providing comfort measures 2: monitoring fetal heart rate 3: changing the client's position frequently 4: keeping the significant other informed on the progress of the labor

4

a nurse in the labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. which of the following assessment findings would alert the nurse to a compromise 1: maternal fatigue 2: coordinated uterine contractions 3: progressive changes in the cervix 4: persistent non-reassuring fetal heart rate

c

a nurse is caring for a client in labor. the nurse determines that the client is beginning the second stage of labor when which of the following assessments is noted? a: contractions are regular b: membranes have ruptured c: cervix is dilated completelyy d: client begins to expel clear vaginal fluid

2 1 5 3 4 6

a nurse is monitoring a client in labor who is receiving oxytocin (pitocin) and notes that the client is experiencing hypertonic uterine contractions. list in order of priority the actions that the nurse takes 1: reposition client 2: stop oxytocin infusion 3: perform vaginal exam 4: check clients BP 5: administer oxygen by face mask at 8-10L/min 6: administer medication as prescribed to reduce uterine activity

c

a nurse is reviewing the record of a client in the labor room and notes that the nurse-midwife has documental that the fetus is at a -1 station. the nurse determines that the fetal presenting part is a: 1 inch below the coccyx b: 1 inch below the iliac crest c: 1 cm above the ischial spine d: 1 fingerbreadth below the symphysis pubis

d

a nurse is reviewing true and false labor signs with a multiparous client. the nurse determines that the client understands the signs of true labor if she makes which statement? a: i won't be in labor until my baby drops b: my contractions will be felt in my abdominal area c: my contractions will not be as painful if i walk d: my contractions will increase in duration and intensity

epidural

a regional anesthesia

disseminated intravascular coagulation DIC

a syndrome that occurs when the body is breaking down blood clots faster than it can for a clot (include abbreviation)

VBAC

a trial of labor and vaginal birth is attempted in a woman who has had a prior c-section

1 3

a weight loss of ___ to ___ pounds with low back ache and bloody show may be a sign of labor

vertical

a women cannot have a vbac if she has a ____ uterine incision

fetal maturity

accurate maternal menstrual dating, early ultrasounds determine

sweeping or stripping of the membranes

digital separation of the chorionic membranes from the wall of the cervix and lower uterine segment during a vaginal exam

transverse

advantages of a ___ incision: lies on the thinnest part of the uterus and involves less blood loss, only a moderate dissection of the bladder from myometrium, easier to repair, less likely to rupture with subsequent pregnancies, and a decreased risk of adherence of bowel or omentum to incision line

three

after ___ unsuccessful attempts at a vacuum birth, a cesarean is required

balloon catheters

along with cervidil and cytotec, ___ ___ are also used to help cervix dilate

anaphylactic syndrome

amniotic fluid embolism: amniotic fluid leaks and is driven into maternal circulation/lungs with sudden respiratory distress, acute hemorrhage, and circulatory prolapse. hemorrhagic shock, coma/maternal death, fetal death is birth is not immediate

urgent

an ___ cesarean is when a rapid delivery is needed due to malpresentation or placenta previa with mild bleeding

induction

an ____ can only happen if the mother is over 39 weeks if elective, an assessment of the cervix, pelvis, and fetal size/presentation must be done prior, gestational age, and maternal/fetal conditions are viewed

emergent

an ____ cesarean is an immediate need to deliver the fetus due to prolapse of umbilical cord or rupture of uterus

d

analgesics used during labor include: a: morphine sulfate b: butorphanol c: sublimaze d: all the above

amniotomy

artificial rupture of membranes to induce or augment labor with an amnihook during a SVE

rate of infusion

based on the physician/CNM protocol and careful assessment of the contraction pattern during induction

increment

building up; this is the longest phase of a contraction

nesting

burst of energy

fetal dystocia

caused by excessive fetal size, malpresentation, multifetal pregnancy, or fetal anomalies

Cervidil

cervical ripening agent

cytotec

cervical ripening agent, also used as uterotonic (contracts uterus) in postpartum hemorrhage, PO/Rectally

cervical changes

cervix becomes soft and partially effaced

neonatal resuscitation

common to perform if an infant is stuck in a shoulder dystocia situation for 5 minutes, requires assistance and notification to the neonatal team

vertical lower

disadvantages of a ___ ___ uterine incision: may extend down into cervix, requires more extensive dissection of bladder, hemostasis and closure more difficult, requires repeat cesarean due to higher risk of uterine rupture

classic

disadvantages of a ___ uterine incision: heavy blood loss, difficult to repair, increased risk of uterine rupture with subsequent pregnancy

transverse

disadvantages of a _____ incision: slower to cut, not used in emergency, limited in size because of uterine vessels on either side, greater tendency to extend laterally into uterine vessels, may stretch and become a thin window

powers passenger passage

dystocia can be related to ____, ____, or _____

oxytocin induction

effectively initiates uterine contractions to induce or augment labor

lightening

engagement; fetus descends into pelvic inlet, breathing is easier

LOA

example of position: occiput in left anterior quad of pelvis would be known as

ROA

example of position: occiput in right anterior quad of pelvis

LSP

example of position: sacrum in left posterior pelvis

tachysystole

excessive frequent contractions during labor

occiput O, sacrum S, mentum M, shoulder A

fetal landmark's that may present are ____, ____, ____, ____ (Include the letter they are known by)

anterior A, posterior P, transverse T

fetus may be laying ____, ____, or ____ in the maternal pelvis (include the letter they are known by)

hemabate

give for postpartum hemorrhage, contraindicated with a history of asthma IM

methergine

given for postpartum hemorrhage, contraindicated with hypertension PO, IM, emergencies IV

2 3 40 60

goal of induction is to achieve stable contractions every ___-___ minutes that lasts ___-___ seconds

prostaglandin

hormone that prepares the uterus and cervix for labor; con contract uterus/create contractions

suprapubic

if a baby is stuck due to shoulder dystocia, mcroberts maneuver is performed along with pressure to the ____ region

negative number

if the presenting part of the baby is above the ischial spine, the station is a _____ _____

forceps delivery

in which an instrument is used to assist with delivery of the fetal head

sudden unexpected newborn collapse SUNC

infant suddenly experiences respiratory and cardiac arrest (include abbreviation)

meconium

infants first stool

chorioamnionitis

intra-amniotic infection, also known as ____ is marked by: inflammation and infection, maternal fever, maternal or fetal tachycardia, elevated WBC, purulent fluid, needs antibiotics and antipyretics during post partum

stillbirth

intrauterine fetal demise is also known as ____: fetal death after 20 weeks' gestation

braxton-hicks contractions

irregular, intermittent, may not increase in frequency and discomfort, do not result in cerivcal changes

positive number

is the presenting part of the baby is below the ischial spine, the station is a _____ _____

zero

ischial spines are ___ station

color odor amount time

it is important to assess the ___, ___, and ___ of amniotic fluid and document ___ of rupture

precipitous labor

labor lasting fewer than 3 hours from onset of labor to birth

decrement

letting up phase of a contraction

terbutaline

management of preterm labor (risk of maternal and fetal tachycardia)

epidural

monitor VS, assess FHR, assess effectiveness, monitor for N/V, assess bladder distension, protect LE from injuries when mother has an ____

one hour

neonatal depression may occur is medication is given ___ ___ before delivery

umbilical cord prolapse

occurs when the cord lies below the presenting part of the fetus

hypotonic uterine dysfunction

occurs when the pressure of the contraction is insufficient to promote cervical dilation and effacement

dilation

opening of cervical os to permit fetus through (0-10cm)

uterotonics

oxytocin (pitocin) methylergonovine (methergine) carboprost (hemabate), misoprostol (cytotec) are types of ____

ruptured uterus

partial or complete tear in the uterine muscle

acme

peak; the strongest phase of a contractions

android

pelvic type: inlet heart-shaped with short posterior sagittal diameter, midpelvis diameter reduced, outlet capacity reduced

anthropoid

pelvic type: inlet oval in shape with long anteroposterior diameter, midpelvis diameters adequate, outlet adequate

platypelloid

pelvic type: inlet oval in shape with long transverse diameters, midpelvis diameters reduced, outlet capacity inadequate

gynecoid

pelvic type: inlet rounded with all inlet diameters adequate, midpelvis diameters adequate with parallel side walls, outlet adequate

1 20 30 minutes spontaneously

placenta delivery usually takes ___ to ___ minutes and should not exceed (30 minutes/one hour) and occurs (with help from doctor/spontaneously)

right left R L

position: fetus may lay on the ____ or ____ of the maternal pelvis, noted by letters __ and __

infection bleeding unplanned ROM

possible issues of a membrane sweep include ___, ___, or ____

vertical lower

preferred use of a ___ ___ uterine incision when mom has: multiple gestations, abnormal presentation, placenta previa, non-reassuring fetal status, preterm, microsomic fetus

post-term pregnancy

pregnancy that has reached or extended beyond 42 weeks' gestation

resting tone

pressure in the uterus between contractions

external cephalic version

procedure in which the fetus is rotated from the breech to cephalic presentation by manipulation through the mothers abdomen

AWHONN

results of quality nursing management during labor is through

dystocia

risk factors of ____: malpresentation of the fetus, cephalopelvic disproportion, maternal fatigue and dehydration, extreme maternal fear or exhaustion

vbac

risk/benefits of ____: rupture of uterus, fetal death, shorter hospital stay/recovery, fewer complications, fewer neonatal breathing problems

anaphylactic syndrome

s&s of ___: chest pain, dyspnea, cyanosis, frothy sputum, tachycardia, hypotension, massive hemorrhage

amniotomy

severe variable decelerations, bleeding from undiagnosed previa, and umbilical cord prolapse can be caused by an

perineal lacerations clavical

shoulder dystocia can cause severe ____ ____ for mom, a broken ____ on the infant, neonatal encephalopathy, asphyxia, or death

a b c

signs of delivery of the placenta include: a: an upward rising of the uterus into a ball shape b: lengthening of the umbilical cord c: sudden gush of blood from the vagina d: increase in HR and BP e: all the above

pelvic dystocia

small pelvis, abnormal pelvic shape

magnesium sulfate

smooth muscle relaxant that can help stop preterm labor or reduce complications with pre-eclampsia

15 45

stillbirth is more known in moms under ___ and older than ___

dexamethosone

stimulates production of surfactant, assisting in maturing fetal lungs

augmentation

stimulation of contractions when labor fails to progress

mold molding

the bones and the membranous space help the baby's skull to ____, and _____ is the ability of the fetal head to change shape

false true

the bony pelvis is divided into: ____ and ____ pelvis

2

the nurse has been working with a laboring client and notes that the client has been pushing effectively for 1 hour. what is the client's primary physiological need at this time 1: ambulation 2: rest between contractions 3: change positions frequently 4: consume oral food and fluids

1

the nurse in the labor room is caring for a client in the active stage of the first phase of labor. the nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. what is the most appropriate nursing action? 1: administer oxygen via face mask 2: place the client in a supine position 3: increase the rate of oxytocin intravenous infusion 4: document the findings and continue to monitor the fetal patterns

2

the nurse is admitting a pregnant client to the labor room and attaches an external fetal monitor to the client's abdomen after attachment of the electronic fetal monitor, what is the next nursing action. 1: identify the types of accelerations 2: assess the baseline FHR 3: determine the intensity of the contractions 4: determine the frequency of the contractions

1

the nurse is assisting a client undergoing induction of labor at 41 weeks of gestation. the client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. an internal FHR monitor is in place. the baseline FHR has been 120-122 bpm for the past hour. what is the priority nursing action? 1: discontinue the infusion of oxytocin 2: notify the primary health care provider 3: place oxygen on at 8-10 l/min via face mask 4: contact the client's primary support persons in not currently present

4

the nurse is caring for a client in labor and is monitoring the fetal heart rate patterns. the nurse notes the presence of episodic accelerations on the electronic fetal monitoring tracing. Which action if most appropriate? 1: notify the primary health care provider of the findings 2: reposition the client and check the monitor for changes in the fetal tracing 3: take the clients VS and tell the client that bed rest is required to conserve oxygen 4: document the findings and tell the client that the pattern on the monitor indicates fetal well-being

1

the nurse is monitoring a client in active labor and notes that the client is having contractions every 3 minutes that last 45 seconds. the nurse notes that the FHR between contractions is 100 BMP. which nursing action is most appropriate. 1: notify the primary health care provider 2: continue to monitor the FHR 3: encourage the client to continue pushing with each contraction 4: instruct the client's coach to continue encouraging breathing techniques

4

the nurse is monitoring a client in labor. the nurse suspects umbilical cord compression if which is noted on the external monitor tracing during contractoin 1: variability 2: accelerations 3: early decelerations 4: variable decelerations

2

the nurse is performing an assessment of a client who is scheduled for a cesarean delivery at 39 weeks of gestation. which assessment finding indicates the need to contact the primary health care provider? 1: hemoglobin of 11g/dl (110mmol/l) 2: fetal heart rate of 180 bmp 3: maternal pulse rate of 85 bpm 4: WBC count of 12000mm3

cervical ripening

the process of physical softening, thinning, and dilating of the cervix in preparation for labor and birth

station

the relationship of the ischial spines to the presenting part of the fetus

three

there are ___ phases of first stage of labor

android platypelloid

these two types of pelvis are least favorable for vaginal birth: _____ and _____

gynecoid anthropoid

these two types of pelvis are most favorable for vaginal birth: _____ and _____

frequency

time from the beginning of one contraction to the beginning of the next

duration

time from the beginning to end of a single contraction

true

umbilical cord prolapse must be delivered by cesarean asap true false

bishop's 8

using ____ prelabor scoring to determine if an induction is an option, a score of ___ or higher is needed

d

what are ways to lower the risk of cesarean birth? a: allow labor to progress naturally b: use vacuum-assisted birth c: use forceps d: all the above

placenta

what deteriorates as it ages to trigger contractions?

estrogen

what hormone stimulates contractions?

oxytocin

what hormone stimulates uterine contractions?

e

what nursing interventions should be done for hypertonic uterine dysfunction a: evaluate cause of labor dysfunction b: hydrate to improve uterine perfusion and coordination c: provide pain management and allow women to sleep and prevent exhaustion d: provide emotional support e: all the above

e

what nursing interventions should be done for hypotonic uterine dysfunction a: augment labor with oxytocin b: perform amniotomy c: provide emotional support d: ambulate and hydrate e: all the above

meconium aspiration syndrome

when meconium is present in the amniotic fluid, the infant may have

3

which assessment finding after an amniotomy needs to be conducted first? 1: cervical dilation 2: bladder distention 3: fetal heart rate pattern 4: maternal blood pressure

d

which of the following is a method of induction? a: oxytocin b: sweeping the membranes c: cervical ripening d: all the above