Test #2 Fetal Assess, Labor & Birth - from Mom

The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first? A. Change the client's position. B. Prepare for an emergency cesarean section. C. Check for placenta previa. D. Administer oxygen.

Correct Answer: A. Change the client's position. Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client's position from supine to side-lying may immediately correct the problem. Option B: An emergency cesarean section is necessary only if other measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful. Option C: Common causes of variable decelerations include vagal reflex triggered by head compression during pushing and cord compression such as that caused by short cord, nuchal cord, body entanglement, prolapsed cord, decreased amniotic fluid, and fetal descent. It does not include placenta previa. Option D: Administering oxygen may be helpful, but the priority is to change the woman's position and relieve cord compression. The fetus already has a surplus of oxygen due to high basal blood flow to its organs and vascular shunts.

After 4 hours of active labor, the nurse notes that the contractions of a primigravida client are not strong enough to dilate the cervix. Which of the following would the nurse anticipate doing? A. Obtaining an order to begin IV oxytocin infusion. B. Administering a light sedative to allow the patient to rest for several hours C. Preparing for a cesarean section for failure to progress D. Encourage the patient to begin pushing to help dilate the cervix further.

Correct Answer: A. Obtaining an order to begin IV oxytocin infusion. The client's labor is hypotonic. The nurse should call the physical and obtain an order for an infusion of oxytocin, which will assist the uterus to contract more forcefully in an attempt to dilate the cervix. Option B: Administering a light sedative would be done for hypertonic uterine contractions. Option C: Preparing for a cesarean section is unnecessary at this time. Option D: Oxytocin would increase the uterine contractions and hopefully progress labor before a cesarean would be necessary. It is too early to anticipate client pushing with contractions.

Which of the following are the functions of amniotic fluid? Select all that apply. A. Cushions the fetus from abdominal trauma B. Serves as the fluid for the fetus C. Maintains the internal temperature D. Facilitates fetal movement

Correct Answer: A, B, C, & D All the four functions enumerated are true of amniotic fluid. Amniotic fluid surrounds the embryo and fetus during development and has a myriad of functions. Option A: Physically, it protects the fetus in the event the maternal abdomen is the object of trauma. It protects the umbilical cord by providing a cushion between the fetus and the umbilical cord thus reducing risk of compression between the fetus and the uterine wall. Option B: It serves as a reservoir of fluid and nutrients for the fetus containing: proteins, electrolytes, immunoglobulins, and vitamins from the mother.Option C: The fluid insulates the fetus, keeping it warm and maintaining a regular temperature. Option D: It provides the necessary fluid, space, and growth factors to allow normal development and growth of fetal organs such as the musculoskeletal system, gastrointestinal system, and pulmonary system.

A primigravida patient is admitted to the labor delivery area. Assessment reveals that she is in the early part of the first stage of labor. Her pain is likely to be most intense: A. Around the pelvic girdle B. Around the pelvic girdle and in the upper arms C. Around the pelvic girdle and at the perineum D. At the perineum

Correct Answer: A. Around the pelvic girdle During most of the first stage of labor, pain centers around the pelvic girdle. During the late part of this stage and the early part of the second stage, pain spreads to the upper legs and perineum. The pain of early labor is referred to T10-T12 dermatomes such that the pain is felt in the lower abdomen, sacrum, and back. This pain is dull in character and is not always sensitive to opioid drugs. Option B: Upper arm pain is not common during any stage of labor. With each uterine contraction, pressure is transmitted to the cervix causing stretching and distension and activating excitatory nociceptive afferents. Option C: Pain arises due to afferents that innervate the vaginal surface of the cervix, perineum, and vagina and occurs as a result of stretching, distention, ischemia, and injury of the pelvic floor, perineum, and vagina. Option D: During the late part of the second stage and childbirth, intense pain occurs at the perineum. Somatic pain occurs closer to delivery, is sharp in character and easily localized to the vagina, perineum, and rectum. It radiates to the adjacent dermatomes T10 and L1 and compared to visceral pain, is more resistant to opioid drugs.

Immediately after delivery, the nurse-midwife assesses the neonate's head for signs of molding. Which factors determine the type of molding? A. Fetal body flexion or extension B. Maternal age, body frame, and weight C. Maternal and paternal ethnic backgrounds D. Maternal parity and gravidity

Correct Answer: A. Fetal body flexion or extension Fetal attitude—the overall degree of body flexion or extension—determines the type of molding in the head of a neonate. Option B: When a baby is born in a cephalic position, pressure on the head in the birth canal may mold the head into an oblong shape. The mother's age, body frame, and weight do not affect the pressure. Option C: There is research that indicates that infant head molding, the application of pressure or bindings to cranial bones to alter their shapes, is prevalent among various Caribbean, Latino, European, African American, Asian, and Native American groups. Option D: Infants born by primiparous women showed significantly higher degrees of molding of the head than those born by multiparous women.

Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why must the nurse monitor the patient's fluid intake and output closely during oxytocin administration? A. Oxytocin causes water intoxication. B. Oxytocin causes excessive thirst. C. Oxytocin is toxic to the kidneys. D. Oxytocin has a diuretic effect.

Correct Answer: A. Oxytocin causes water intoxication. The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death. In addition, oxytocin may cause water intoxication via an antidiuretic hormone-like activity when administered in excessive doses with electrolyte-free solution. Option B: Excessive thirst results from the work of labor and limited oral fluid intake—not oxytocin. Option C: Oxytocin, when given in rapid bolus, produces marked but short-lived hypotension and tachycardia. Sometimes, this abrupt and severe hemodynamic depression may need to be distinguished from placental abruption, myocardial infarction, or a pulmonary embolism in patients undergoing delivery. Option D: Oxytocin is known to possess antidiuretic properties. It can function physiologically as an antidiuretic hormone, mimicking the short-term action of vasopressin on water permeability, albeit with somewhat lower potency.

The nurse in charge is caring for a postpartum client who had a vaginal delivery with a midline episiotomy. Which nursing diagnosis takes priority for this client? A. Risk for deficient fluid volume related to hemorrhage. B. Risk for infection related to the type of delivery. C. Pain related to the type of incision. D. Urinary retention related to periurethral edema.

Correct Answer: A. Risk for deficient fluid volume related to hemorrhage Hemorrhage jeopardizes the client's oxygen supply — the first priority among human physiological needs. Therefore, the nursing diagnosis of Risk for deficient fluid volume related to hemorrhage takes priority over-diagnoses of Risk for Infection, Pain, and Urinary retention. Option B: Episiotomy infections are classically reported as being rare at a rate of 0.1% and increasing up to 2% if a third or fourth-degree tear occurs. Option C: Episiotomy pain may be relieved by an ice pack, warm or cold shallow baths or sitz baths, or medicated creams or local numbing sprays. Option D: Postpartum urinary retention (PPUR) is an upsetting condition that has no standard literature definition. It has been variably defined as the abrupt onset of aching or inability to completely micturate, requiring urinary catheterization, over 12 hours after giving birth or not to void spontaneously within 6 hours of vaginal delivery

After teaching a pregnant woman who is in labor about the purpose of the episiotomy, which of the following purposes stated by the client would indicate to the nurse that the teaching was effective? A. Shortens the second stage of labor. B. Enlarges the pelvic inlet. C. Prevents perineal edema. D. Ensures quick placenta delivery.

Correct Answer: A. Shortens the second stage of labor An episiotomy serves several purposes. It shortens the second stage of labor, substitutes a clean surgical incision for a tear, and decreases undue stretching of perineal muscles. An episiotomy helps prevent tearing of the rectum but it does not necessarily relieve pressure on the rectum. Tearing may still occur. Option B: The pelvic inlet or superior aperture of the pelvis is a planar surface that defines the boundary between the pelvic cavity and the abdominal cavity. It is not involved during an episiotomy. Option C: To prevent perineal edema, ice packs may be applied in the first 24 hours after birth to decrease swelling and pain. Option D: Placenta delivery may be sped up by either pulling the cord gently with one hand while pressing and kneading the uterus with the other, or exerting downward pressure on the top of the uterus, asking the woman to push at the appropriate time.

For a patient in active labor, the nurse-midwife plans to use an internal electronic fetal monitoring (EFM) device. What must occur before the internal EFM can be applied? A. The membranes must rupture. B. The fetus must be at 0 station. C. The cervix must be dilated fully. D. The patient must receive anesthesia.

Correct Answer: A. The membranes must rupture. Internal fetal heart rate monitoring uses an electronic transducer connected directly to the fetal skin. A wire electrode is attached to the fetal scalp or other body parts through the cervical opening and is connected to the monitor. Internal EFM can be applied only after the patient's membranes have ruptured when the fetus is at least at the -1 station, and when the cervix is dilated at least 2 cm. Option B: An electrode will be attached to the part of the infant's body that is closest to the cervical opening. Option C: Dilation of at least 2 cm is adequate enough to insert the electrode through the cervical opening. Option D: Although the patient may receive anesthesia, it is not required before application of an internal EFM device.

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? Select all that apply. A. Perform ultrasound to determine fetal positioning. B. Observe the patient for possible uterine contractions. C. Administer RhoGAM to the patient if she is Rh-negative. D. Perform a mini catheterization to obtain a urine specimen to assess for bleeding.

Correct Answer: B & C Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of the transabdominal needle. RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. RhoGAM is administered by intramuscular (IM) injection. RhoGAM is purified from human plasma containing anti-Rh (anti-D). Option A: The position of the baby in the uterus is called the presentation of the fetus. Ideally for labor, the baby is positioned head-down, facing the mother's back with the chin tucked to its chest and the back of the head ready to enter the pelvis. This position is called cephalic presentation. Option D: There is no need to assess the urine for bleeding as this is not considered to be a typical presentation or complication.

The nurse understands that the fetal head is in which of the following positions with a face presentation? A. Completely flexed B. Completely extended C. Partially extended D. Partially flexed

Correct Answer: B. Completely extended In a face presentation, the fetal head and neck are hyperextended, causing the occiput to come in contact with the upper back of the fetus while lying on a longitudinal axis. Option A: With a vertex presentation, the head is completely or partially flexed. Option C: With a brow (forehead) presentation, the head would be partially extended. Option D: Partially flexed fetal head is categorized as a sinciput presentation.

When preparing to listen to the fetal heart rate at 12 weeks' gestation, the nurse would use which of the following? A. Stethoscope placed midline at the umbilicus. B. Doppler placed midline at the suprapubic region. C. Fetoscope placed midway between the umbilicus and the xiphoid process. D. External electronic fetal monitor placed at the umbilicus.

Correct Answer: B. Doppler placed midline at the suprapubic region At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. Option A: The fetal heart rate at this age is not audible with a stethoscope. Exciting circulatory developments continue at 12 weeks when baby-to-be's bone marrow begins busily producing blood cells. By 17 weeks, the fetal brain begins to regulate the heartbeat in preparation for supporting a baby in the outside world. (Up until this point, the heart has been beating spontaneously.) In three more weeks, by around week 20, the mother may hear her baby's heartbeat with a stethoscope. Option C: The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks the FHR would be difficult to auscultate with a fetoscope. A fetoscope, or a fetal stethoscope, works much like a regular stethoscope except that it has a bell-shaped end that magnifies sound waves from the fetal heartbeat in order to make them audible. One can usually hear a fetal heartbeat with the stethoscope starting around 20 weeks of pregnancy. Option D: Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.

A patient is in the second stage of labor. During this stage, how frequently should the nurse in charge assess her uterine contractions? A. Every 5 minutes. B. Every 15 minutes. C. Every 30 minutes. D. Every 60 minutes.

Correct Answer: B. Every 15 minutes During the second stage of labor, the nurse should assess the strength, frequency, and duration of contraction every 15 minutes. If maternal or fetal problems are detected, more frequent monitoring is necessary. Option A: Second stage of labor starts when cervical dilatation reaches 10 cm and ends when the baby is delivered. At this stage, the patient feels an uncontrollable urge to push. Monitoring every 5 minutes would be too frequent and inconvenient for the laboring mother. Option C: After cervical dilation is complete, the fetus descends into the vaginal canal with or without maternal pushing efforts. The fetus passes through the birth canal via 7 movements known as the cardinal movements. These include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. These movements may occur in a few minutes, so 30 minutes might be too long to assess for contractions. Option D: Monitoring hourly would be too long and the nurse might miss the important details of assessment.

Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client? A. Applying cold to limit edema during the first 12 to 24 hours. B. Instructing the client to use two or more peri pads to cushion the area. C. Instructing the client on the use of sitz baths if ordered. D. Instructing the client about the importance of perineal (Kegel) exercises.

Correct Answer: B. Instructing the client to use two or more peri pads to cushion the area Using two or more peripads would do little to reduce the pain or promote perineal healing. A fourth-degree perineal laceration is the injury to the perineum involving the anal sphincter complex and anorectal mucosa. Option A: Ice packs can help reduce pain and swelling in the perineum. Use ice cubes in a clean, disposable glove. Wrapped in a damp cloth or place the ice pack inside a pad. Never apply directly on skin. Apply for 10-20 minutes. Repeat every 2-3 hours until pain and swelling decrease. Option C: Hot sitz bath may help speed up the healing process. Use sitz baths a few times a day, 24 hours after giving birth. Sit in water that covers the vulvar area. Option D: The muscles lie deep in the pelvis and support the pelvic organs and control the bladder and bowel function. The pelvic floor muscles attach to the pubic bone at the front, tail bone at the back, and from one sitting bone to the other sitting bone. It is important to retrain the muscles after a tear, to prevent problems such as incontinence

A nurse in the labor room is monitoring a client with dysfunctional labor for signs of maternal or fetal compromise. Which of the following assessment findings would alert the nurse to a compromise? A. Coordinated uterine contractions B. Meconium in the amniotic fluid C. Progressive changes in the cervix D. Maternal fatigue

Correct Answer: B. Meconium in the amniotic fluid Signs of maternal or fetal compromise include passage of meconium, decreased movement felt by the mother, nonreassuring fetal heart rate, and fetal metabolic acidosis. Option A: Technically, effective uterine contractions include three factors: intensity, synchronization, and frequency of contractions. Most studies are based on single-lead recordings that can reflect the severity and frequency of uterine contractions. Therefore, uterine synchronization topography can be used to display labor progress in the labor room. Option C: A prolonged latent phase may result from oversedation or from entering labor early with a thickened or uneffaced cervix. It may be misdiagnosed in the face of frequent prodromal contractions. Option D: Maternal fatigue can occur with prolonged labor, but do not indicate maternal or fetal compromise. Fatigue is one of the most common complaints in pregnant women that often continues until delivery. Maternal fatigue prolongs the labor process and increases the rate of cesarean section. Studies on the pattern of uterine contractions have shown that the length of the fall time is longer in prolonged labors than in normal deliveries.

When PROM occurs, which of the following provides evidence of the nurse's understanding of the client's immediate needs? A. The chorion and amnion rupture 4 hours before the onset of labor. B. PROM removes the fetus's most effective defense against infection. C. Nursing care is based on fetal viability and gestational age. D. PROM is associated with malpresentation and possibly incompetent cervix.

Correct Answer: B. PROM removes the fetus most effective defense against infection PROM can precipitate many potential and actual problems; one of the most serious is the fetus loss of an effective defense against infection. This is the client's most immediate need at this time. Option A: Typically, PROM occurs about 1 hour, not 4 hours, before labor begins. Option C: Fetal viability and gestational age are less immediate considerations that affect the plan of care. Option D: Malpresentation and an incompetent cervix may be causes of PROM.

A client who's admitted to labor and delivery has the following assessment findings: gravida 2 para 1, estimated 40 weeks gestation, contractions 2 minutes apart, lasting 45 seconds, vertex +4 station. Which of the following would be the priority at this time? A. Placing the client in bed to begin fetal monitoring. B. Preparing for immediate delivery. C. Checking for ruptured membranes. D. Providing comfort measures.

Correct Answer: B. Preparing for immediate delivery. This question requires an understanding of station as part of the intrapartum assessment process. Based on the client's assessment findings, this client is ready for delivery, which is the nurse's top priority. Option A: Fetal heart rate monitoring may help detect changes in the normal heart rate pattern during labor. If certain changes are detected, steps can be taken to help treat the underlying problem. Fetal heart rate monitoring also can help prevent treatments that are not needed. Option C: The membranes can break by themselves. This is called a spontaneous rupture of the membranes. It most often happens after active labor has started. Option D: Comfort measures may be given to the woman after ensuring all necessary measures to help her deliver successfully.

You performed Leopold's maneuver and found the following: breech presentation, fetal back at the right side of the mother. Based on these findings, you can hear the fetal heartbeat (PMI) BEST in which location? A. Left lower quadrant B. Right lower quadrant C. Left upper quadrant D. Right upper quadrant

Correct Answer: B. Right lower quadrant Right lower quadrant. The landmark to look for when looking for PMI is the location of the fetal back in relation to the right or left side of the mother and the presentation, whether cephalic or breech. The best site is the fetal back nearest the head. Option A: The fetal limbs may be palpated at the left lower quadrant. Option C: The fetal head may be facing the direction of the left upper quadrant. Option D: The right upper quadrant has the fetal back, but it is nearer to the lower extremities of the fetus.

During which of the following stages of labor would the nurse assess "crowning"? A. First stage B. Second stage C. Third stage D. Fourth stage

Correct Answer: B. Second stage Crowing, which occurs when the newborn's head or presenting part appears at the vaginal opening, occurs during the second stage of labor. Option A: During the first stage of labor, cervical dilation and effacement occur. Effacement means that the cervix stretches and gets thinner. Dilatation means that the cervix opens. As labor nears, the cervix may start to thin or stretch (efface) and open (dilate). This prepares the cervix for the baby to pass through the birth canal (vagina). Option C: During the third stage of labor, the newborn and placenta are delivered. This stage is often called delivery of the "afterbirth" and is the shortest stage of labor. It may last from a few minutes to 20 minutes. Option D: The fourth stage of labor lasts from 1 to 4 hours after birth, during which time the mother and newborn recover from the physical process of birth and the mother's organs undergo the initial readjustment to the nonpregnant state.

Which of the following may happen if the uterus becomes overstimulated by oxytocin during the induction of labor? A. Weak contraction prolonged to more than 70 seconds. B. Tetanic contractions prolonged to more than 90 seconds. C. Increased pain with bright red vaginal bleeding. D. Increased restlessness and anxiety.

Correct Answer: B. Tetanic contractions prolonged to more than 90 seconds Hyperstimulation of the uterus such as with oxytocin during the induction of labor may result in tetanic contractions prolonged to more than 90seconds, which could lead to such complications as fetal distress, abruptio placentae, amniotic fluid embolism, laceration of the cervix, and uterine rupture. Option A: With some methods, the uterus can be overstimulated, causing it to contract too frequently. Too many contractions may lead to changes in the fetal heart rate, umbilical cord problems, and other problems. Option C: Painless vaginal bleeding during the second or third trimester of pregnancy is the usual presentation in placenta previa. The bleeding may be provoked from intercourse, vaginal examinations, labor, and at times there may be no identifiable cause. On speculum examination, there may be minimal bleeding to active bleeding. Option D: Synthetic oxytocin, also known as Pitocin, is frequently administered during delivery for the purpose of inducing labor and preventing excessive post-delivery bleeding. One might hypothesize, based on the role that natural oxytocin plays, that women receiving oxytocin might receive some degree of benefit from the peri-partum use of Pitocin; however, a recent study calls this hypothesis into question. This study used population-based data available through the Massachusetts Integrated Clinical Academic Research Database (MiCARD) in order to retrospectively examine the relationship between peripartum synthetic oxytocin administration and the development of depressive and anxiety disorders within the first year postpartum. While the authors expected to observe that women exposed to synthetic oxytocin in this cohort would have a reduced risk of postpartum depressive and/or anxiety disorders than those without any exposure, they actually found the opposite.

In Leopold's maneuver step #3 you palpated a hard round movable mass at the suprapubic area. The correct interpretation is that the mass palpated is: A. The buttocks because the presentation is breech. B. The mass palpated is the head. C. The mass is the fetal back. D. The mass palpated is the small fetal part.

Correct Answer: B. The mass palpated is the head. When the mass palpated is hard round and movable, it is the fetal head. The head feels hard and round with a smooth surface of uniform consistency, is very mobile and ballotable. The third maneuver aids in confirmation of fetal presentation. The first Pawlík grip, sometimes called the first pelvic grip, helps to define which presenting part of the fetus is situated in hypogastrium. Option A: The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass. Option C: The uterine fundus is pressed with force using one hand, which accentuates the curvature of the fetal back, allowing for easier palpation with the other hand. The fetal heart can be auscultated at this time, which can also provide information on fetal orientation. The heart is well perceived when the stethoscope or the doppler transducer is placed on the back of the fetus. Option D: The second maneuver, sometimes called the umbilical grip, involves palpation of the lateral uterine surfaces. Still facing the maternal xiphoid cartilage, both hands slide down from the uterine fundus towards the lateral uterine walls. The clinician's hands are placed flat and parallel to each other along the abdominal wall at the level of the umbilicus. It allows establishing if the fetus is in a longitudinal, transverse, or oblique situation, and to determine the position of the back and small parts.

The most common normal position of the fetus in utero is: A. Transverse position B. Vertical position C. Oblique position D. None of the above

Correct Answer: B. Vertical position Vertical position means the fetal spine is parallel to the maternal spine thus making it easy for the fetus to go out of the birth canal. Most babies are lying vertically by the seventh month, with the baby's head towards the cervix of the uterus. This is the safest position for normal delivery. Option A: The transverse lie position is where the fetus's head is on one side of the mother's body and the feet on the other, rather than having the head close to the cervix or close to the heart. The fetus can also be slightly at an angle, but still more sideways, than up or down. Option C: If a fetus is lying diagonally across the uterus, the position is called oblique. It's very unusual for a fetus to stay in this position right up until labor. Only one percent of babies will be transverse or oblique.

After completing a second vaginal examination of a client in labor, the nurse-midwife determines that the fetus is in the right occiput anterior position and at (-1) station. Based on these findings, the nurse-midwife knows that the fetal presenting part is: A. 1 cm below the ischial spines. B. Directly in line with the ischial spines. C. 1 cm above the ischial spines. D. In no relationship to the ischial spines.

Correct Answer: C. 1 cm above the ischial spines. Fetal station — the relationship of the fetal presenting part to the maternal ischial spines — is described in the number of centimeters above or below the spines. A presenting part above the ischial spines is designated as -1, -2, or -3. Option A: A presenting part below the ischial spines, as +1, +2, or +3. Option B: 0 station is when the baby's head is even with the ischial spines. The baby is said to be "engaged" when the largest part of the head has entered the pelvis. Option D: If the head is high and not yet engaged in the birth canal, it may float away from the physician's fingers during the vaginal exam.

Which of the following is the priority focus of nursing practice with the current early postpartum discharge? A. Promoting comfort and restoration of health. B. Exploring the emotional status of the family. C. Facilitating safe and effective self and newborn care. D. Teaching about the importance of family planning.

Correct Answer: C. Facilitating safe and effective self and newborn care Because of early postpartum discharge and limited time for teaching, the nurse's priority is to facilitate the safe and effective care of the client and newborn. Option A: After a vaginal birth, recovery can take anywhere from three weeks if the woman didn't tear to six weeks or more if she had a perineal tear or an episiotomy. If the woman is delivered by C-section, expect to spend the first three to four days postpartum in the hospital recovering; it will take four to six weeks before the woman will feel back to normal. Option B: Having a baby is a life-changing experience. Almost every mom faces a bout of the baby blues due to a roller coaster of hormones, lack of sleep, and the struggle to adjust to that tiny new human at home. That said, if the woman has symptoms of postpartum depression — including feeling persistently hopeless, sad, isolated, irritable, worthless, or anxious — for more than two weeks postpartum, she should talk to a doctor. Option D: Teaching about family planning is important in postpartum/newborn nursing care, but they are not the priority focus in the limited time presented by early postpartum discharge.

A client has a mid pelvic contracture from a previous pelvic injury due to a motor vehicle accident as a teenager. The nurse is aware that this could prevent a fetus from passing through or around which structure during childbirth? A. Symphysis pubis B. Sacral promontory C. Ischial spines D. Pubic arch

Correct Answer: C. Ischial spines The ischial spines are located in the mid-pelvic region and could be narrowed due to the previous pelvic injury. Option A: The pubic symphysis is a secondary cartilaginous joint (a joint made of hyaline cartilage and fibrocartilage) located between the left and right pubic bones near the midline of the body. More specifically, it is located above any external genitalia and in front of the bladder. Option B: Superiorly, there is an anterior projection of bone, known as the sacral promontory. It forms the posterior margin of the pelvic inlet and as a result, it is serially continuous with the margin of the ala of the sacrum, arcuate line of the ilium, and the pectin pubis and pubic crest of the pubic bone. Option D: The pubic arch, also referred to as the ischiopubic arch, is part of the pelvis. It is formed by the convergence of the inferior rami of the ischium and pubis on either side, below the pubic symphysis. The angle at which they converge is known as the subpubic angle.

The amniotic fluid of a client has a greenish tint. The nurse interprets this to be the result of which of the following? A. Lanugo B. Hydramnios C. Meconium D. Vernix

Correct Answer: C. Meconium The greenish tint is due to the presence of meconium. Meconium is a thick, green, tar-like substance that lines the baby's intestines during pregnancy. Typically this substance is not released in the baby's bowel movements until after birth. However, sometimes a baby will have a bowel movement prior to birth, excreting the meconium into the amniotic fluid. Option A: Lanugo is the soft, downy hair on the shoulders and back of the fetus. This downy, unpigmented hair is the first type of hair that grows from hair follicles. It can be found everywhere on a baby's body, except on the palms, lips, and soles of the feet. Most fetuses develop lanugo around the fourth or fifth month of pregnancy. Option B: Hydramnios represents excessive amniotic fluid. Option D: Vernix is the white, cheesy substance covering the fetus. It is produced by dedicated cells and is thought to have some protective roles during fetal development and for a few hours after birth.

The cervical dilatation taken at 8:00 AM in a G1P0 patient was 6 centimeters. A repeat I.E. done at 10 A. M. showed that cervical dilation was 7 cm. The correct interpretation of this result is: A. Labor is progressing as expected. B. The latent phase of Stage 1 is prolonged. C. The active phase of Stage 1 is protracted. D. The duration of labor is normal.

Correct Answer: C. The active phase of Stage 1 is protracted The active phase of Stage I starts from 4cm cervical dilatation and is expected that the uterus will dilate by 1cm every hour. Since the time elapsed is already 2 hours, the dilatation is expected to be already 8 cm. Hence, the active phase is protracted. Option A: In the active phase, the cervix changes more rapidly and predictably until it reaches 10 centimeters and cervical dilation and effacement are complete. Active labor with more rapid cervical dilation generally starts around 6 centimeters of dilation. During the active phase, the cervix typically dilated at a rate of 1.2 to 1.5 centimeters per hour. Option B: During the latent phase, the cervix dilates slowly to approximately 6 centimeters. The latent phase is generally considerably longer and less predictable with regard to the rate of cervical change than is observed in the active phase. A normal latent phase can last up to 20 hours and 14 hours in nulliparous and multiparous women respectively, without being considered prolonged. Option D: Sedation can increase the duration of the latent phase of labor. Multiparas, or women with a history of prior vaginal delivery, tend to demonstrate more rapid cervical dilation. The absence of cervical change for greater than 4 hours in the presence of adequate contractions or six hours with inadequate contractions is considered the arrest of labor and may warrant clinical intervention.

Which of the following is true regarding the fontanels of the newborn? A. The anterior is triangular shaped; the posterior is diamond-shaped. B. The posterior closes at 18 months; the anterior closes at 8 to 12 weeks. C. The anterior is large in size when compared to the posterior fontanel. D. The anterior is bulging; the posterior appears sunken.

Correct Answer: C. The anterior is large in size when compared to the posterior fontanel. The anterior fontanel is larger in size than the posterior fontanel. Additionally, the anterior fontanel, which is diamond-shaped, closes at 18 months, whereas the posterior fontanel, which is triangular shaped, closes at 8 to 12 weeks. Neither fontanel should appear bulging, which may indicate increased intracranial pressure, or sunken, which may indicate dehydration. Option A: The anterior fontanelle is the largest of the six fontanelles, and it resembles a diamond-shape ranging in size from 0.6 cm to 3.6 cm with a mean of 2.1 cm. Unlike the anterior fontanelle, the posterior fontanelle is triangular and completely closes within about six to eight weeks after birth. Option B: The average closure time of the anterior fontanelle ranges from 13 to 24 months. The posterior fontanel completely closes within about six to eight weeks after birth. Option D: In addition to being the largest, the anterior fontanelle is also the most important clinically. This structure offers insight into the newborn's state of health, especially hydration and intracranial pressure status. A sunken fontanelle is primarily due to dehydration. Other clinical indicators that support the diagnosis of dehydration are dry mucous membranes, sunken eyes, poor tear production, decreased peripheral perfusion, and lack of wet diapers. Furthermore, a bulging fontanelle may indicate a rise in intracranial pressure, suggesting multiple pathologies: hydrocephalus, hypoxemia, meningitis, trauma, or hemorrhage.

FHR can be auscultated with a fetoscope as early as which of the following? A. 5 weeks gestation B. 10 weeks gestation C. 15 weeks gestation D. 20 weeks gestation

Correct Answer: D. 20 weeks gestation The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is auscultated at the midline suprapubic region with a Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation. Option A: A fetal heartbeat may first be detected by a vaginal ultrasound as early as 5 1/2 to 6 weeks after gestation. That's when a fetal pole, the first visible sign of a developing embryo, can sometimes be seen. Option B: With all the rapid growth, the woman will probably be able to hear her baby's heartbeat for the first time around week 9 or week 10 of pregnancy, though it can vary a bit. It will be about 170 beats per minute by this time, a rate that will slow from here on out. Her doctor or midwife will place a handheld ultrasound device called a Doppler on your belly to amplify the sound. Option C: The baby's heartbeat may be heard as early as the twelfth week of pregnancy using a highly sensitive Doppler that allows hearing the baby's heartbeat. The normal range for the baby's heart rate is 115 to 160 beats per minute.

With a fetus in the left anterior breech presentation, the nurse would expect the fetal heart rate would be most audible in which of the following areas? A. Above the maternal umbilicus and to the right of midline. B. In the lower-left maternal abdominal quadrant. C. In the lower-right maternal abdominal quadrant. D. Above the maternal umbilicus and to the left of the midline.

Correct Answer: D. Above the maternal umbilicus and to the left of midline With this presentation, the fetal upper torso and back face the left upper maternal abdominal wall. The fetal heart rate would be most audible above the maternal umbilicus and to the left of the middle. The other positions would be incorrect. Option A: The fetal heart rate would be most audible above the maternal umbilicus but to the left of the midline. Option B: It should not be at the lower-left of the maternal abdominal quadrant. Fetal heart rate heard in this area may be inaccurate or maybe the maternal heart rate. Option C: This would be an inaccurate area to check for the fetal heart rate. Since the baby is in breech position, the fetal back may be located at the upper maternal abdominal wall.

A multigravida at 38 weeks' gestation is admitted with painless, bright red bleeding and mild contractions every 7 to 10 minutes. Which of the following assessments should be avoided? A. Maternal vital sign B. Fetal heart rate C. Contraction monitoring D. Cervical dilation

Correct Answer: D. Cervical dilation The signs indicate placenta previa and vaginal exam to determine cervical dilation would not be done because it could cause hemorrhage. Option A: Assessing maternal vital signs can help determine maternal physiologic status. Option B: Fetal heart rate is important to assess fetal well-being and should be done. Option C: Monitoring the contractions will help evaluate the progress of labor.

Immediately before expulsion, which of the following cardinal movements occur? A. Descent B. Flexion C. Extension D. External rotation

Correct Answer: D. External rotation Immediately before expulsion or birth of the rest of the body, the cardinal movement of external rotation occurs. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman's inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch. Option A: The baby's head moves deep into the pelvic cavity and is commonly called lightening. The baby's head becomes markedly molded when these distances are closely the same. When the occiput is at the level of the ischial spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet. Option B: Flexion occurs during descent and is brought about by the resistance felt by the baby's head against the soft tissues of the pelvis. The resistance brings about a flexion in the baby's head so that the chin meets the chest. The smallest diameter of the baby's head (or suboccipitobregmatic plane) presents into the pelvis. Option C: After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face, and chin are born.

A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective? A. Back B. Abdomen C. Fundus D. Perineum

Correct Answer: D. Perineum A bilateral pudendal block is used for vaginal deliveries to relieve pain primarily in the perineum and vagina. Pudendal block anesthesia is adequate for episiotomy and its repair. Option A: A spinal anesthetic is given into the middle of the lower back and local anesthetic is injected through the needle into the fluid that surrounds the spinal cord. It numbs the nerves that supply the abdomen, hips, bottom, and legs. Option B: General or regional anesthesia can be appropriate for patients undergoing abdominal surgery. Balanced anesthesia with inhalational anesthetics, opioids, and neuromuscular blockers are used in general anesthesia for abdominal surgical procedures. Option C: Spinal anesthesia is one of the most preferred anesthetic methods during Cesarean section since it provides easy and rapid induction, effective sensory and motor block, and has little effect on the fetus.

In the late 1950s, consumers and health care professionals began challenging the routine use of analgesics and anesthetics during childbirth. Which of the following was an outgrowth of this concept? A. Labor, delivery, recovery, postpartum (LDRP) B. Nurse-midwifery C. Clinical nurse specialist D. Prepared childbirth

Correct Answer: D. Prepared childbirth Prepared childbirth was the direct result of the 1950s challenging the routine use of analgesic and anesthetics during childbirth. Option A: The LDRP was a much later concept and was not a direct result of the challenging of routine use of analgesics and anesthetics during childbirth. Option B: A nurse-midwife is a licensed healthcare professional who specializes in women's reproductive health and childbirth. In addition to attending births, they perform annual exams, give counseling, and write prescriptions. According to the ACNM, the vast majority of midwives in the U.S. are CNMs. Option C: Clinical nurse specialists (CNS) are advanced practice registered nurses (APRNs) that serve as experts in evidence-based nursing practice within one of a number of different specialty areas. They integrate their advanced knowledge of disease processes in assessing, diagnosing, and treating patient illnesses, but their role extends beyond providing patient care.

A patient is in labor and has just been told she has a breech presentation. The nurse should be particularly alert for which of the following? A. Quickening B. Ophthalmia neonatorum C. Pica D. Prolapsed umbilical cord

Correct Answer: D. Prolapsed umbilical cord In a breech position, because of the space between the presenting part and the cervix, prolapse of the umbilical cord is common. Option A: Quickening is the woman's first perception of fetal movement. Option B: Ophthalmia neonatorum usually results from maternal gonorrhea and is conjunctivitis. Option C: Pica refers to the oral intake of nonfood substances.

Which of the following nursing interventions would the nurse perform during the third stage of labor? A. Obtain a urine specimen and other laboratory tests. B. Assess uterine contractions every 30 minutes. C. Coach for effective client pushing. D. Promote parent-newborn interaction.

Correct Answer: D. Promote parent-newborn interaction. During the third stage of labor, which begins with the delivery of the newborn, the nurse would promote parent-newborn interaction by placing the newborn on the mother's abdomen and encouraging the parents to touch the newborn. Option A: Collecting a urine specimen and other laboratory tests is done on admission during the first stage of labor. Option B: Assessing uterine contractions every 30 minutes is performed during the latent phase of the first stage of labor. Option D: Coaching the client to push effectively is appropriate during the second stage of labor.

In Leopold's maneuver step #1, you palpated a soft, broad mass that moves with the rest of the mass. The correct interpretation of this finding is: A. The mass palpated at the fundal part is the head part. B. The presentation is breech. C. The mass palpated is the back. D. The mass palpated is the buttocks.

Correct Answer: D. The mass palpated is the buttocks. The palpated mass is the fetal buttocks since it is broad and soft and moves with the rest of the mass. The first maneuver also called the fundal grip, assesses the uterine fundus to determine its height and which fetal pole—that is, cephalic or podalic—occupies the fundus. Option A: The head feels hard and round with a smooth surface of uniform consistency, is very mobile and ballotable. Option B: The breech gives the sensation of a large, nodular mass, and its surface is uneven, non-ballotable, and not very mobile. The first maneuver aims to determine the gestational age and the fetal lie. Option C: The uterine fundus is pressed with force using one hand, which accentuates the curvature of the fetal back, allowing for easier palpation with the other hand. The fetal heart can be auscultated at this time, which can also provide information on fetal orientation. The heart is well perceived when the stethoscope or the doppler transducer is placed on the back of the fetus.

The nurse in charge is caring for a patient who is in the first stage of labor. What is the shortest but most difficult part of this stage? A. Active phase B. Complete phase C. Latent phase D. Transitional phase

Correct Answer: D. Transitional phase The transitional phase, which lasts 1 to 3 hours, is the shortest but most difficult part of the first stage of labor. This phase is characterized by intense uterine contractions that occur every 1 ½ to 2 minutes and last 45 to 90 seconds. Option A: The active phase lasts 4 ½ to 6 hours; it is characterized by contractions that start out moderately intense, grow stronger, and last about 60 seconds. Option B: The complete phase occurs during the second, not first, stage of labor. Option C: The latent phase lasts 5 to 8 hours and is marked by mild, short, irregular contractions.

When giving narcotic analgesics to a mother in labor, the special consideration to follow is: A. The progress of labor is well established reaching the transitional stage. B. Uterine contraction is progressing well, and delivery of the baby is imminent. C. Cervical dilatation has already reached at least 8 cm. and the station is at least (+)2. D. Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours.

Correct Answer: D. Uterine contractions are strong and the baby will not be delivered yet within the next 3 hours. Narcotic analgesics must be given when uterine contractions are already well established so that it will not cause stoppage of the contraction thus protracting labor. Also, it should be given when delivery of a fetus is imminent or too close because the fetus may suffer respiratory depression as an effect of the drug that can pass through the placental barrier. Option A: Opioid analgesia offers a systemic alternative to regional analgesia procedures. Since the early 1940s, the most commonly used systemic analgesic has been meperidine (pethidine). As with all opioids, meperidine crosses the placenta and presents a dose-dependent risk of neonatal respiratory depression and reduction of fetal heart frequency. The mother may suffer from nausea, vomiting, respiratory depression, dysphoria, and delayed gastric emptying. Option B: The effects of systemic opioids in labor are predominantly sedative rather than analgesic; other opioids, when used in labor, are usually administered as patient-controlled analgesia. Option C: Visceral labor pain occurs during the early first stage and the second stage of childbirth. With each uterine contraction, pressure is transmitted to the cervix causing stretching and distension and activating excitatory nociceptive afferents. These afferents innervate the endocervix and lower segment from T10 - L1.