pregnancy labor childbirth
A nurse is evaluating the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located? 1 at the level of the umbilicus 2 one fingerbreadth above the umbilicus 3 above and to the right of the umbilicus 4 one or two fingerbreadths below the umbilicus
4 A nurse is evaluating the rate of involution of a client's uterus on the second postpartum day. Where does the nurse expect the fundus to be located?
A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. The nurse explains that an increase in which hormone is the precipitating cause of the nausea and vomiting? 1 estrogen 2 progesterone 3 luteinizing hormone 4 chorionic gonadotropin
4 A pregnant woman reports nausea and vomiting during the first trimester of pregnancy. The nurse explains that an increase in which hormone is the precipitating cause of the nausea and vomiting?
A pregnant woman who is past her due date is hospitalized for a labor induction. Which drug should be administered to the client? 1. clomiphrene 2. menotropins 3. dinoprostrone 4. choriogonadotropin alfa
Dinoprostrone Dinoprostone is a prostaglandin that stimulates uterine contractions to promote the progression of labor. Clomiphene, menotropins, and choriogonadotropin alfa are fertility drugs that are used to increase the likelihood of conception in an infertile woman.
During a childbirth class the nurse determines that the women understand how to use effleurage correctly when they are observed doing what? 1 rocking gently on their knees 2 practicing panting to avoid pushing during labor 3 taking deep breaths before imagined contracitons 4 massaging their abdomens gently with their fingertips
4 Effleurage is a gentle massage of the abdomen that is effective during the first stage of labor because it distracts the client from the discomfort of the contractions. Rocking gently on the knees, known as the pelvic rock, is used during pregnancy to relieve backache. Practicing panting to avoid pushing during labor is a technique of breathing. Taking deep breaths before imagined contractions is also a technique of breathing.
During a discussion regarding nutrition, the nurse explains to a pregnant client that she will need additional calcium during pregnancy and that the ideal source is milk. The client states, "I never drink milk or eat milk products. They turn my stomach." What is the nurse's best reply? 1 "Your practitioner can prescribe calcium supplements." 2 "Just make sure that the rest of your diet is nutritionally sound." 3 "Eliminating milk from your diet may cause your teeth to loosen." 4 "Drinking milk is so important for your baby to develop strong bones."
1 Calcium is essential to a pregnant woman's diet for the development of the fetal skeleton; it must be supplemented if the client dislikes or is allergic to milk and milk products. A nutritionally sound diet without dairy products does not meet the needs of the pregnant woman or her fetus. Dental care and oral hygiene will be more beneficial for maintaining healthy teeth than adding more calcium to the diet will. If milk makes the client ill, the statement "Drinking milk is so important for your baby to develop strong bones" is ineffective advice, and the dietary regimen probably will not be followed.
During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. What is the nurse's immediate reaction? 1 turning the client on her side 2 notifying the health care provider 3 checking the vaginal area for bleeding 4 checking the fetal heart rate every 3 minutes
1 Maternal hypotension is a common complication of epidural anesthesia during labor, and nausea is one of the first clues that it has occurred. Turning the client on her side will keep the uterus from putting pressure on the inferior vena cava, which causes a decrease in blood flow. If signs and symptoms do not abate after the client is turned on her side, the health care provider should be notified. Checking the vaginal area for bleeding is not an assessment specific to epidural anesthesia; it is part of the general nursing care during labor. Fetal heart rate monitoring is a continuous process, and the rate should be recorded every 15 minutes; if this monitoring is not being performed, the rate should be checked and recorded every 15 minutes.
A nurse in the prenatal clinic reviews second-trimester physiological changes in the hematological system before explaining them to a client. What is one of the changes the nurse should identify? 1 Increased hematocrit 2 Increased blood volume 3 Decreased white blood cells 4 Decreased sedimentation rate
2 Blood volume increases by approximately 50% during pregnancy; peak blood volume occurs between 30 and 34 weeks' gestation. Hematocrit decreases as a result of hemodilution. White blood cell count remains stable during the prenatal period. Sedimentation rate increases because of a decrease in plasma proteins.
A negative home pregnancy test may result if the woman performs the test in what way? 1 By saturating the test strip 2 On the first void of the morning 3 10 days after intercourse took place 4 While taking a prescribed tranquilizer
3 The most common error made by women taking home pregnancy tests is to perform the test too early in the pregnancy. Although some tests may be accurate at 7 days, the test will be more accurate if it is performed at the time of the missed period. Saturation of the test strip and using the first void of the morning are necessary steps in the process. Taking a prescribed tranquilizer is more likely to cause a false-positive result.
The nurse is assessing a client in active labor for signs that the transition phase is beginning. What change does the nurse expect? 1 Bulging perineum 2 Pinkish vaginal discharge 3 Crowning of the fetal head 4 Rectal pressure during contractions
4 Rectal pressure occurs at the beginning of the transition phase of labor when the fetal head starts to press on the rectum during contractions. The perineum bulges when transition is complete and the cervix is fully dilated. Pink vaginal discharge occurs when labor begins, not at the beginning of the transition phase. The fetal head crowns at the end of the second stage, shortly before birth.
How does the nurse explain physiologic anemia to a pregnant client? 1 Erythropoiesis decreases. 2 Plasma volume increases. 3 Utilization of iron decreases. 4 Detoxification by the liver increases.
2 There is a 30% to 50% increase in maternal plasma volume at the end of the first trimester, leading to hemodilution and a decrease in the concentrations of hemoglobin and erythrocytes. Erythropoiesis increases after the first trimester. Iron utilization is unrelated to the development of physiologic anemia of pregnancy. Detoxification demands are unchanged during pregnancy.
A client required an extensive episiotomy because her newborn was large. What is a priority nursing intervention that minimizes edema and lessens discomfort at the episiotomy site? 1 applying ice packs to the perieum 2 Positioning the client off the incisional area 3 Administering an oral analgesic to the client 4 Spraying the perineum with a local anesthetic
1 Application of cold causes vasoconstriction and reduces edema by lessening the accumulation of blood and lymph at the episiotomy site. Cold also deadens nerve endings and lessens the pain. A side-lying position will not lessen pain or reduce edema. Analgesia may diminish the pain but will not lessen the edema. An anesthetic spray is not recommended after an episiotomy.
What is a priority intervention for the infant undergoing phototherapy? 1 Covering the infant's face with a soft mask 2 Administering glucose water between breast or bottle feedings 3 Keeping the infant in the supine position with the genitals covered 4 Exposing as much skin as possible by turning the infant every 2 hours
4 Turning the infant permits optimal skin exposure to the phototherapy lights. The infant's face should not be covered; only the eyes should be covered. Glucose water does not promote excretion of bilirubin in the stools. The supine position would expose only the front of the infant to the lights.
After being transported to the hospital by the ambulance, a pregnant woman is brought into the emergency department on a stretcher. The nurse notes that the fetus' head has emerged. How should the nurse assist the mother in the birth of the fetus' anterior shoulder? 1. Gently guiding the head downward 2. Gradually flexing the head toward the mother's thigh 3. Gently putting pressure on the head by pulling upward 4. Gradually extending the head above the mother's symphysis pubis
Gently guiding the head downward After the newborn's head has rotated externally, the nurse gently guides the head downward for the birth of the anterior shoulder. Gradually flexing the head toward the mother's thigh, gently putting pressure on the head by pulling upward, and gradually extending the head above the mother's symphysis pubis are all contraindicated.
One hour after a birth a nurse palpates a client's fundus to determine whether involution is taking place. The fundus is firm, in the midline, and two fingerbreadths below the umbilicus. What should the nurse do next? 1. encourage the client to void 2. notify the practitioner immediately 3. massage the uterus and attempt to express clots 4. continue periodic assessments and record the findings
continue periodic assessments and record the findings Immediately after birth the uterus is 2 cm below the umbilicus; during the first several postpartum hours the uterus will rise slowly to just above the level of the umbilicus. These findings are expected, and they should be recorded. Encouraging the client to void is unnecessary; if the bladder is full, the uterus will be higher and pushed to one side. Notifying the healthcare provider is unnecessary; involution is occurring as expected. Massage is used when the uterus is soft and "boggy."
The cervix of a client in labor is fully dilated and 100% effaced. The fetal head is at +3 station; the fetal heart rate ranges from 140 to 150 beats/min; and the contractions, lasting 60 seconds, are 2 minutes apart. What does the nurse expect to see when inspecting the perineum? 1. small tears 2. greenish-yellow amniotic fluid 3. enlarging area of caput with each contraction 4. increasing amount of amniotic fluid with each contraction
enlarging area of caput with each contraction At this point, the client should be pushing with each contraction; with the head at +3 station, each push will bring more of the caput into view at the vaginal opening. It is too early for the perineum to be stretched to the point of tearing; if this should occur later, an episiotomy may be performed. Greenish-yellow amniotic fluid indicates meconium is present; it is an unexpected finding that may indicate that the fetus is at risk. There is a decreased, not an increased, amount of amniotic fluid at the end of labor.
A client is admitted in active labor. The nurse, performing Leopold maneuvers, determines that the fetus is in the left occiput anterior (LOA) position. Where should the nurse place the transducer of the electronic fetal monitor? 1. right lower midline 2. left lower quadrant 3. left upper quadrant 4. right upper quadrant
left lower quadrant The LOA position indicates that the fetus is on the left side of the mother and in a head presentation with the occiput anterior; therefore fetal heart sounds are best found in the left lower quadrant of the woman's abdomen. If the fetal heartbeat is found toward the right lower midline of the mother's abdomen, the fetus is probably in a shoulder presentation, in the right scapular anterior position. If the fetal heartbeat is found in the left upper quadrant of the mother's abdomen, the fetus is in the breech presentation on the left side of the mother (left sacrum anterior). If the fetal heartbeat is found in the right upper quadrant of the mother's abdomen, the fetus is in the breech presentation on the right side of the mother (right sacrum anterior).
A client at 30 weeks' gestation visits the clinic for a routine examination. At her last visit she told the nurse that she wanted to diet to avoid losing her figure after the baby's birth, and as a result the nurse provided nutrition counseling. At this visit the client weighs 10 lb (4.5 kg) less than on her previous visit. The nurse suspects that the client is not compliant with the recommended nutritional guidelines for pregnancy. Which complication should the client be monitored for? 1 ketonemia 2 hyperglycemia 3 anorexia nervosa 4 hyperemesis gravidarum
1 When protein and carbohydrate intake is inadequate, the body catabolizes fat stores for energy, leading to the production of excess fatty acids. Excess fatty acids produce excess ketones in the blood (ketonemia). Hypoglycemia is more likely to occur because carbohydrate intake probably is low. Anorexia nervosa is a pre-pregnancy disorder. The data do not indicate a history of this problem. The data do not indicate that the client has a history of hyperemesis gravidarum, which begins during the first trimester.
A nurse concludes that a laboring couple has benefited from the Lamaze method of childbirth preparation when during the transition phase of labor they use which breathing pattern? 1 pant blow 2 slow chest 3 shallow chest 4 accelerated decelerated
1 Panting and blowing keep the glottis open so the mother cannot hold her breath and bear down. Slow-chest breathing is not effective during transition. Shallow-chest breathing interferes with adequate oxygenation of the fetus because it limits the mother's oxygen intake. Accelerated-decelerated breathing is not effective during transition.
Which cervical changes are observed during pregnancy? Select all that apply. 1. the cervical tip becomes soft 2. the fragility of cervical tissues decreases 3. the volume of cervical muscles increases 4. the external cervical os appears as a jagged slit 5. the elasticity of cervicla collagen- rich connect tissue increases
1, 3, 5 By the beginning of the sixth week of pregnancy, the cervical tip softens. During pregnancy, the cervical muscles and its collagen-rich connective tissues increase in volume and become loose and highly elastic. Cervical tissue fragility also increases. The external cervical os appears as a jagged slit postpartum; however, not during pregnancy.
A nurse is checking the external fetal monitor of a client in active labor. Which fetal heart pattern indicates cord compression? 1 Smooth, flat baseline tracings of 135 beats/min 2 Abrupt decreases in fetal heart rate that are unrelated to the contractions 3 Accelerations in the fetal heart rate of 10 beats/min above baseline 4 Decelerations when a contraction begins that return to baseline when the contraction ends
2 Abrupt decreases in fetal heart rate that are unrelated to the contractions are variable decelerations that indicate cord compression. These are most common during the second stage of labor and are considered benign unless the heart rate does not recover adequately. A flat baseline reading indicates decreased variability and may have many causes, but it is not related to cord compression. Fetal heart rate accelerations are not related to cord compression. Decelerations when a contraction begins that return to baseline when the contraction ends indicate head compression during contractions; they are an expected, benign finding.
A lactating woman is diagnosed with migraine headaches. What drug should be prescribed to the client if she wishes to continue breastfeeding? 1 morphine 2 sumatriptan 3 bromocriptine 4 acetaminophen
2 Because sumatriptan is not excreted in breast milk, this drug is safe for a lactating woman with migraines. Morphine is the drug of choice for a lactating woman who reports severe pain. Bromocriptine is contraindicated for lactating women. Acetaminophen is a drug of choice for lactating women with pain.
A primipara gives birth to an infant weighing 9 lb 15 oz (4508 g). During labor a midline episiotomy is performed, and the client sustains a third-degree laceration. The client tells the nurse that her perineal area is very painful. What should the nurse consider before explaining the reason for the pain? 1 Perineal muscles have been cut. 2 The anal sphincter muscle has been injured. 3 The anterior wall of the rectum has been traumatized. 4 Structures superficial to muscles have been damaged.
2 A third-degree laceration extends through the perineal muscles and continues through the anal sphincter muscle. Cutting of the perineal muscles constitutes a second-degree laceration. Trauma to the rectum constitutes a fourth-degree laceration. Damage to superficial muscles is a first-degree laceration.
When a client at 39 weeks' gestation arrives at the birthing suite she says, "I've been having contractions for 3 hours, and I think my water broke." What will the nurse's action be to confirm that the membranes have ruptured? 1 Take the client's oral temperature. 2 Test the leaking fluid with Nitrazine paper. 3 Obtain a clean-catch urine specimen. 4 Inspect the perineum for leaking fluid.
2 Nitrazine paper will turn dark blue if amniotic fluid is present; it remains the same color in the presence of urine. Temperature assessment is not specific to ruptured membranes at this time; vital signs are part of the initial assessment. Although this may be done as part of the initial assessment, a urine test is unrelated to leakage of amniotic fluid. Inspecting the vagina for leaking fluid will not confirm rupture of the membranes.
A contraction stress test (CST) is performed on a client at 40 weeks' gestation. The findings are interpreted as negative. What does the nurse conclude from this interpretation? 1 Testing will be repeated in 24 hours because the results indicate hyperstimulation. 2 There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves. 3 Emergency birth will be considered because the fetal heart rate has early decelerations with uterine contractions. 4 Induction of labor will be performed because fetal heart rate accelerations with movement is indicative of a false result.
2 A negative test result implies that placental support is adequate; it is associated with a low fetal death rate within 1 week. A negative test result does not indicate hyperstimulation. This is a negative test result; if there were persistent late decelerations with contractions, the test would be positive and intervention would be required. Fetal heart rate accelerations with movement are reassuring; an expeditious birth is not indicated.
Why should the nurse limit food and oral fluids as a laboring client approaches the second stage of labor? 1 The mechanical and chemical digestive processes require energy that is needed for labor. 2 Undigested food and fluid may cause nausea and vomiting and limit the choice of anesthesia. 3 The gastric phase of digestion stimulates the release of hydrochloric acid and may cause dyspepsia. 4 Food and fluid will further aggravate gastric peristalsis, which is already increased because of the stress of labor.
2 Gastric peristalsis often ceases during periods of stress. Abdominal contractions put pressure on the stomach and can cause nausea and vomiting, increasing the risk for aspiration. Although it is true that the increased acid secretion during the gastric phase may cause dyspepsia, it is not the reason for withholding food and oral fluids during labor; the primary reason for withholding it is the prevention of aspiration. Gastric peristalsis is decreased, not increased, during the stress of labor and birth.
A woman's pregnancy has been uneventful, and she has gained 25 lb. At term her hemoglobin level is 10.6 g/dL, and her hematocrit is 31%. What does the nurse identify as the reason for these hemoglobin and hematocrit levels? 1 infection 2 hemodilution 3 nutritional deficits 4 concealed bleeding
2 The increase in circulating blood volume during pregnancy is reflected in lower hemoglobin and hematocrit readings (physiological anemia of pregnancy). Infection does not lead to a lower hematocrit. The history reveals no prenatal problems, and weight gain is adequate. In the absence of other significant signs and symptoms, concealed bleeding is unlikely.
What findings occur with supine hypotensive syndrome? Select all that apply. 1 Reflex tachycardia 2 Feeling of faintness 3 Increased cardiac output 4 Increased venous pressure 5 Increased diastolic pressure 6 Decreased systolic pressure
2, 4, 6, Compression of the vena cava hinders venous return, which in turn results in a decrease in the systolic pressure, an increase of venous pressure in the legs, and decreased blood flow to the brain, causing the woman to feel faint. Blood pressure decreases when venous return is compromised. Supine hypotensive syndrome results in a reflex bradycardia. Cardiac output is decreased by half.
While caring for a client who gave birth 1 day ago, the nurse determines that the client's uterine fundus is firm at one fingerbreadth below the umbilicus, blood pressure is 110/70 mm Hg, pulse is 72 beats per minute, and respirations are 16 breaths per minute. The client's perineal pad is saturated with lochia rubra. What is the priority nursing action? 1. Recording these expected findings 2. Obtaining an order for an oxytocic medication 3.Asking the client when she last changed the perineal pad 4. Notifying the primary healthcare provider that the client may be hemorrhaging
3 The amount of lochia would be excessive if the pad were saturated in 15 minutes; saturating the pad in 2 hours is considered heavy bleeding. If the pad has not been changed for a longer period, this could account for the large quantity of lochia. These findings cannot be supported or recorded without additional information. Oxytocics are administered for uterine atony; the need for this is not supported by the assessment of a firm fundus. The vital signs do not indicate hemorrhage; further assessment is needed before the nurse comes to this conclusion.
The nurse evaluates a new mother who is breastfeeding. The client asks how to care for her nipples. What should the nurse recommend? 1 Putting lanolin cream on the nipples after breastfeeding 2 Applying vitamin E gel to the nipples before breastfeeding 3 Using soap and water to clean the breasts and nipples at least once a day 4 Spreading breast milk on the nipples after the feeding and allowing them to air dry
4 Breast milk is a natural lubricant for the nipples and obviously is not toxic for the infant. Products containing lanolin or vitamin E are not recommended because these may be ingested by the infant. Soap should not be used on the nipples because it has a drying effect, which may precipitate cracking of the nipples.
A 16-year-old adolescent at 24 weeks' gestation visits the prenatal clinic for the first time. After the physical examination she tells the nurse, "I can't believe how big I am. Will I get much bigger?" What information about adolescent growth and development does the nurse need to know before responding? 1 Adolescents generally regain their figures 2 weeks after the birth, so size is of moderate concern. 2 Adolescents are in a high-risk category, so weight gain should be limited to prevent complications. 3 Body image is very important to adolescents, so pregnant teenagers are concerned about body size. 4 Physiological growth in adolescents is more rapid than in adults, so the gravid size is larger than that of an adult woman.
3 Because of the changes in body size, the pregnant adolescent may feel insecure as she struggles to establish her identity. There are no data to support the statement that adolescents generally regain their figures 2 weeks after the birth. The optimal weight gain for an adolescent is at the upper range for her body mass index; this will help prevent complications. Although physiological growth is rapid, the adolescent's gravid size falls within the expected parameters for pregnant women.
A nurse performs Leopold's maneuvers on a pregnant client and documents the following data: soft, firm mass in the fundus; several small parts on the right side; hard, round, movable object in pubic area; and cephalic prominence on right side. Applying these findings, which fetal position does the nurse identify? 1 Left sacroposterior (LSP) 2 Right sacroposterior (RSP) 3 Left occipitoanterior (LOA) 4 Right occipitoanterior (ROA)
3 In the LOA position, the small parts are on the right, the smooth back is on the left, and the head is in the pelvis. The LSP position is a breech position, and therefore the fetal head will not be in the pelvic area; the data reveal a hard, round, movable object in the pubic area, which indicates that the fetus is in the vertex position. The RSP position is a breech position, and therefore the fetal head will not be in the pelvic area. In the ROA position, the small parts will be on the left and the smooth back on the right.
A 22-year-old primigravida is admitted to the hospital in labor. After performing a vaginal examination, the nurse determines that the client's cervix is dilated 2 cm and 80% effaced and that the presenting part is at 0 station. What is the location of the presenting part? 1. entering the vagina 2. floating within the bony pelis 3. at the level of the ischial spines 4. above the level of the ischial spines
3 The ischial spines are used as landmarks in relation to the fetus's head, because they reflect the progression of labor; 0 station indicates that the presenting part is at the ischial spines. When the head enters the vagina it is below the ischial spines and its position is designated with positive numbers (+1 to +5). When the presenting part is floating, the fetus is at -5 station postion above the ischial spines is designated by a minus number (-1 to -5).
A nurse is teaching a primigravida about how she can identify the onset of labor. What clinical indicator of labor would necessitate the client to call her health care provider? 1. Bloody show and back pressure occurring with no contractions 2. Irregular contractions coming 10 minutes apart 3. Rupture of membranes or contractions 5 minutes apart 4. Contractions 12 minutes apart and lasting about 30 seconds
3 When the membranes rupture the potential for infection is increased, and when the contractions are 5 to 8 minutes apart they are usually of sufficient force to warrant professional supervision. Bloody show and back pressure may be early signs of labor or signs of posterior fetal position, but it is too early to notify the health care provider. The other options indicate that it is too soon in the labor process to call the health care provider; the client should remain with her family and keep moving around at home.
A vaginal examination reveals that a client in labor is dilated 7 cm. Soon afterward she becomes nauseated and has the hiccups, and bloody show increases. What phase of labor does the nurse determine the client is entering? 1 latent 2 active 3 transition 4 early active
3 The transition phase is the most difficult phase of labor . Characterized by restlessness, irritability, nausea, and increased bloody show, it continues from 8 to 10 cm of dilation. The latent phase is early labor (1 to 4 cm of dilation). It is relatively easy to tolerate and the client generally is in control and not too uncomfortable. The active phase lasts from about 6 to 8 cm of dilation. It is difficult but is not accompanied by nausea, irritability, or an increase in bloody show. The early active phase lasts from about 4 to 6 of cm dilation. It is difficult but is not accompanied by nausea, irritability, or an increase in bloody show.
A nurse assesses the frequency of a client's contractions by timing them from the beginning of a contraction until when? 1 The uterus starts to relax 2 The end of a second contraction 3 The uterus has relaxed completely 4 The beginning of the next contraction
4 Timing until the beginning of the next contraction is the accepted way of determining the frequency of contractions. The time between beginning of a contraction and when the uterus starts to relax is not an indication of the duration of a contraction. The time from the beginning of a contraction to the end of a second one does not reflect the frequency of contractions. Complete relaxation of the uterus indicates the end of a contraction, but measuring the time from the beginning of the contraction until relaxation occurs is not the accepted way of timing the frequency of contractions.