Week 2 Practice Questions

Which pregnant women would be advised to go to the hospital?

A pregnant woman with a decrease in the fetal kick count by half Decreased kick count suggests decreased fetal movement and may be a medical emergency. A multipara with regular contractions every 5 minutes for 2 hours The multipara should report to the hospital if experiencing regular contractions 10 minutes apart for at least 1 hour. A pregnant woman who experiences heavy, bright red bleeding Bleeding that is bright red and not mixed with mucus must be evaluated immediately.

A patient is experiencing painful contractions and is 7 cm dilated. The nurse recognizes these relevant cues and selects a hypothesis that the patient is in which phase of the first stage of labor?

Active labor Active labor typically begins at 6 cm, and most patients experience very frequent, painful contractions during this time.

Match the laboring positions to their advantages: Allows for rocking, bouncing, opening hips with contractions

Birthing ball

Which signs and symptoms exhibited by the woman in labor suggest that she may be getting closer to delivery?

Contractions are strong upon palpation. This is typical of contractions in active labor. Contractions are every 1 to 2.5 minutes. Active labor contractions demonstrate this frequency. There is a large amount of bloody mucus on the pad. This is usually observed in active labor.

Match the fetal surveillance method to its corresponding advantage: Accurate measurement of fetal heart rate

Fetal scalp electrode

Match the expected event with the stage of labor: Cervical effacement and dilation from onset of true labor to complete dilatation.

First stage

The nurse midwife writes in the progress note that the baby is in the occiput posterior presentation. The nurse knows that which maternal position will help facilitate rotation of the fetal head?

Hands and knees Hands-and-knees positions are thought to be especially useful when a baby presents in the occiput posterior position. This is thought to pull the fetal back forward, allowing for better rotation of the fetal head. Other benefits of this position are similar to those of the upright position.

Match the fetal surveillance method to its corresponding advantage: Accurate measurement of uterine contractions, including intensity

Intrauterine pressure catheter

While awaiting the delivery of the placenta in the third stage of labor, the nurse observes a large gush of blood and an increase in the length of the umbilical cord. Which event would the nurse recognize has probably occurred?

Placental separation from the uterine wall A large gush of blood and an increase in the length of the umbilical cord are signs of placental separation from the uterine wall.

Match the component of the birth process to the corresponding description: Uterine contractions and maternal pushing efforts

Powers

Which actions are additional responsibilities of the nurse in the second stage of labor?

Prepare a sterile environment. The nurse would ensure that the birthing area is sterile, including gowns, gloves, and drapes. Prepare for perineal cleansing. The nurse would prepare for perineal cleansing during the birth. Prepare for initial assessment of the newborn. The nurse would prepare for the initial assessment of newborn during the birth.

Match the laboring positions to their advantages: Prevents supine hypotension, promotes placental blood flow

Side-lying

Match the expected event with the stage of labor: Birth of the baby to expulsion of the placenta.

Third stage

The nurse recognizes that the patient understands the teaching when she makes which statement?

"Increasing clear vaginal secretions could mean labor will begin soon." This is a premonitory sign of labor and means labor could begin soon.

At ___________ cm, the cervix is considered to be fully dilated.

10 The cervix is fully dilated at 10 cm.

A woman who is at 38 weeks gestation reports suspected signs of labor to the triage nurse. Which statement by the nurse supports the beginning of true labor?

"Labor contractions will occur in a consistent pattern that increases in frequency, duration, and intensity." Contractions occurring in a consistent pattern of increasing frequency, duration, and intensity are a sign of true labor.

Which statement does the nurse use to describe to the patient's partner why opioid analgesics are being administered?

"Opioid analgesics help the laboring woman relax between contractions." The nurse explains that opioid analgesics affect the perception of pain, allowing the laboring woman to relax during contractions.

Which education would the nurse provide a patient who is worried that the intrauterine catheter will hurt the baby?

"The catheter is placed in the uterus next to the baby." By providing information about the safety and location of the catheter, the nurse can decrease the patient's anxiety and provide reassurance.

The nurse knows that patient education has been effective when the patient makes which statement about the difference between a tocodynamometer and an intrauterine pressure catheter (IUPC)?

"The tocodynamometer is positioned outside my body, while the IUPC is positioned inside my body." Whereas the tocodynamometer is an external monitoring device, the IUPC is an internal monitoring device.

Which response would the nurse provide to a patient who expresses concern about being switched from intermittent monitoring to continuous electronic monitoring?

"This doesn't necessarily mean there's a problem. The health care provider may just want to monitor you more closely." The nurse offers reassurance and normalizes the situation to reduce patient worry.

The nurse is assessing the fetal heart rate of a woman who is currently lying supine and identifies a nonreassuring pattern. Which recommendation would the nurse make to address this pattern?

"Turn on your side." The patient should not lie supine, because compression of the aorta could negatively affect the fetus. A change of position, such as lying on the side, is the first response to a nonreassuring fetal heart rate pattern in this situation.

A patient is concerned about the baseline variability in the heart rate of her fetus. Which responses by the nurse describe the significance of baseline variability to the patient?

"Variability demonstrates that there is adequate oxygenation of the fetus." Adequate oxygenation of the fetus, demonstrated by variability, is necessary, and therefore variability is significant. "Variability suggests that the fetus is able to adapt to the labor process." Variability is significant because its presence indicates that the autonomic nervous system is intact, allowing the fetus to adapt to the normal stress of labor.

Which response would the nurse provide the patient who asks why oxygen is being given after the nurse identifies a nonreassuring fetal heart rate?

"We need to increase your oxygen, which will increase the baby's oxygen." The nurse provides a simple and direct explanation for the intervention being provided.

At __________ station, the fetal head is considered "engaged" in the maternal pelvis.

0 The fetal head is considered engaged in the maternal pelvis when it reaches the ischial spines, or 0 station.

A patient in active labor requests regional anesthesia for pain management. The nurse knows that the minimum bolus of intravenous (IV) crystalloid fluid to prevent maternal hypotension before regional anesthesia is _____ mL.

500 A patient in active labor often presents to the hospital with a fluid volume deficit. A pre-load (bolus) of at least 500 to 1000 mL of an IV crystalloid fluid could help prevent maternal hypotension after regional anesthesia.

A woman is considered to be in active labor when the cervix is at least ____________ cm dilated.

6 Active labor generally begins at 6 cm dilation

A nurse is caring for a patient in labor who is receiving oxytocin via intravenous infusion to stimulate uterine contractions. Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?

A fetal heart rate of 90 beats/min A normal fetal heart rate is 110 to 160 beats/min. Bradycardia and/or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin infusion.

What would the nurse expect when caring for a full-term primigravida who presents for a routine office visit and is not in labor?

A fetus that is engaged in the maternal pelvis Fetal engagement often occurs before the beginning of labor in primigravidas, where with multigravidas the fetus often does not engage until labor begins.

Which patient would most likely require general anesthesia during labor and delivery?

A patient refusing regional and local anesthetic methods who needs a cesarean delivery A patient who refuses regional and local anesthetic methods and needs a cesarean delivery does require general anesthesia.

Which premonitory labor sign becomes apparent when changing levels of estrogen and progesterone cause excretion of some of the extra interstitial fluid that accumulates in body tissue during pregnancy?

A small weight loss of 1 to 3 lb (2.2 to 6.6 kg) A small weight loss of 1 to 3 lb (2.2 to 6.6 kg) may occur because changing levels of estrogen and progesterone cause excretion of some of the extra interstitial fluid that accumulates during pregnancy.

The maternity nurse is monitoring a patient with dysfunctional labor for signs of potential fetal compromise. Which assessment findings would alert the nurse to a potential for fetal compromise?

Absent variability Variability is defined as fluctuations in the fetal heart rate of more than 2 cycles per minute. Normal fetal variability in labor should be in the moderate range of 6 to 25 beats/min. Absent variability in the absence of maternal drugs can indicate severe fetal anemia or severe fetal hypoxia. No cervical change in 4 hours Labor is defined by cervical change. Cervical change includes both dilation and effacement of the cervix. Contractions with the absence of cervical change can indicate an arrest in labor and may result in the need for a cesarean section. Uterine resting tone 30 mm Hg via intrauterine pressure catheter Uterine resting tone, via an intrauterine pressure catheter, should remain under 25 mm Hg. Uterine resting tone higher than 25 mm Hg is considered hypertonic, and it can result in uterine rupture, placental abruption, or uterine tachysystole. Recurrent late decelerations Late decelerations are the most ominous decelerations among the three types of fetal heart rate decelerations during labor. They are caused by decreased blood flow to the placenta, and they can signify an impending fetal acidemia.

Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information would the nurse consider when educating patients and support people about nonpharmacologic pain management techniques?

Acupressure to either side of the spine can facilitate the release of endorphins and decrease some back pain. Acupressure is an effective nonpharmacologic technique that can be used to relieve a variety of pain during labor.

Which interventions are involved with intrauterine resuscitation during labor?

Administer oxygen via face mask. The third priority of intrauterine resuscitation is to optimize oxygenation of the circulatory volume by providing oxygen via face mask. Increase the rate of the intravenous (IV) fluids. The second priority of intrauterine resuscitation is to increase blood volume by increasing the IV fluid. Notify the primary health care provider. If these interventions do not resolve the fetal heart rate issue quickly, the primary health care provider should be notified immediately. Change maternal position. The nurse should initiate intrauterine resuscitation in an ABC manner, similar to basic life support. The first priority is to open the maternal and fetal vascular systems by repositioning the mother for improved perfusion.

A postpartum patient who had a spinal block for a scheduled cesarean delivery complains of a headache. Which intervention would the nurse anticipate?

Administration of blood patch by the anesthesia provider Administration of a blood patch by an anesthesia professional is a procedure in which the patient's blood is injected into the spinal space, creating a seal over the site where the dural puncture occurred.

A G5/P4 is experiencing painful contractions that start in her back every 10 minutes for the last hour. How would the telephone triage nurse advise this woman?

Advise the patient to report to the hospital for labor and delivery. Multiparas should report to the hospital or birthing center with regular contractions for at least an hour that are 10 minutes apart.

When is fetal heart rate (FHR) and uterine activity (UA) assessment indicated for a low-risk patient in the first stage of labor?

After rupture of membranes FHR and UA should be assessed after rupture of membranes to assess fetal response to rupture and whether UA changes.

A woman is 10 cm dilated and feels occasional rectal pressure at the peak of a contraction, and the fetal station is 0. There is a reassuring fetal heart tracing. Which nursing action is appropriate at this time?

Allow the woman to labor down for passive descent. The latent phase may also be referred to as laboring down, delayed pushing, or passive descent. The woman should be encouraged to rest until she feels the strong urge to push with each contraction.

Which education would the nurse provide a low-risk patient regarding the advantages of intermittent auscultation?

Allows patient movement Intermittent auscultation of the fetal heart rate (FHR) allows more patient mobility than high-tech methods. Allows for a less medical atmosphere Intermittent auscultation is intermittent, so the patient is not focused on watching the monitor and listening to beeping noises. Appropriate for low-risk patients in labor Intermittent auscultation is appropriate for low-risk pregnancies. However, it is not the preferred method if the pregnancy is complicated or high-risk. Continuous external or internal electronic fetal monitoring is preferred with high-risk pregnancies. Offers patient more freedom in choosing pain management Intermittent auscultation allows the patient to use water-based methods of pain management (for example, a whirlpool) because no equipment is attached continuously.

Which phrases describe how cephalic presentation of the fetus facilitates labor?

Allows the fetal head to adapt to the maternal pelvis During labor the fetal head can gradually change shape to adapt to the size and shape of the maternal pelvis. Facilitates dilatation of the cervix The fetal head is smooth, round, and hard, making it an effective fetal part to dilate the cervix, which is also round.

A laboring woman's partner has become fatigued after massaging the woman's legs for the past 30 minutes. Which action would the nurse take first?

Ask the woman if it is OK for the nurse to take over massaging her legs. Massage is a nonpharmacologic pain relief method and is an appropriate method of pain relief for the nurse to perform. Before taking over massaging the woman's legs, the nurse would ask her permission.

Which qualities are considered normal when assessing fetal heart rate (FHR)?

Baseline FHRof 140 beats/min A baseline FHR of 110 to 160 beats/min is considered normal. FHR variability of 20 beats/min FHR variability of 6 to 25 beats/min is classified as moderate variability and is considered normal (reassuring).

A woman at 37 weeks gestation calls and reports, "My water broke and I have bloody show. I am changing my pad every 10 minutes." Which advice would the nurse provide in response?

Call her health care provider and go to the hospital or birthing center. Heavy bleeding and/or a gush of fluid from the vagina should be evaluated by a health care provider at the hospital or birthing center.

Which fetal heart rate classification is considered nonreassuring?

Category III Category III classification refers to abnormal findings that are nonreassuring.

Which labor assessment finding is indicative of true labor?

Cervical effacement and dilatation The best distinction between the two is that the contractions of true labor cause progressive changes in the cervix. Effacement and dilatation occur with true labor contractions.

Which clinical conditions must be met before placing a fetal scalp monitor?

Cervix should be at least 2 cm dilated The fetal scalp monitor may be placed once the patient's cervix has dilated to at least 2 cm. The cervix must be dilated enough to allow contact with the fetal scalp. The patient's membranes must be ruptured The fetal scalp monitor can be used once the patient's membranes have ruptured to allow contact with the fetal scalp.

Which observations would the nurse make that are suggestive of placental separation?

Change in uterine shape When the infant is born, the uterine cavity becomes much smaller and takes a spherical shape. Change in uterine location The uterus rises upward in the abdomen as the placenta descends into the vagina and pushes the fundus upward. Gush of blood flow from the vagina A gush of blood appears as blood trapped behind the placenta is released.

Which intervention is most appropriate to increase a laboring woman's maternal cardiac output?

Change maternal position. Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and to avoid the supine position.

While evaluating an external monitor tracing of a woman who just received regional analgesia for pain management, the nurse notes recurrent late decelerations. Which action should the nurse take next?

Change the woman's position. Late decelerations may be caused by maternal supine hypotension syndrome. They may be corrected when the woman turns on her side to displace the weight of the gravid uterus from the vena cava.

Match the appropriate type of anesthesia to the patient description: Patient wants pain relief while being able to move and feel contractions

Combined spinal-epidural anesthesia

A nurse is beginning to care for a patient in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin. The nurse makes sure that which implementations occur before initiation of the infusion?

Continuous electronic fetal monitoring Continuous electronic fetal monitoring, either external or internal, is a standard of practice with the administration of IV oxytocin. Making sure that a vial of terbutaline is immediately available Terbutaline, administered either intravenously or subcutaneously, is a tocolytic that can be used to decrease or stop uterine contractions when uterine tachysystole occurs. Preparing an IV infusion pump IV oxytocin should only be administered via an IV pump. IV oxytocin during labor should never be administered without the use of a pump for titration.

Which clinical measure is transmitted by a tocodynamometer?

Contraction frequency Contraction frequency and duration are transmitted by the tocodynamometer (toco) which detects changes of the abdomen to detect contractions

Which assessment findings in the laboring patient would suggest to the nurse that delivery is imminent?

Contractions are 1.5 to 2 minutes apart. This is common in active labor. Mucous vaginal discharge is bloody. Bloody show is a sign of labor progress and often appears in active labor. The woman is experiencing vomiting, nausea, and sweating. These are signs that a patient is in active labor. The patient complains of rectal pressure. This is a sign of fetal descent and often happens in active labor.

Which fetal condition can cause a fetal heart rate (FHR) of <60 beats/min for more than 60 seconds that does not quickly return to baseline?

Cord compression Variable decelerations that last a long time and do not quickly return to baseline can occur with cord compression, which could compromise the fetus.

A woman is experiencing back labor and complains of intense pain in her lower back. The nurse instructs the support person to use which nonpharmacologic technique?

Counterpressure against the sacrum Counterpressure can be provided to the lower back and either hip and is effective when the pain is concentrated in those areas. Typically, the partner might take on the role of using massage during childbirth; however, if the partner is becoming fatigued and the patient is finding this method effective, the nurse may want to offer to step in to assume the role.

Which factors could improve a woman's experience with pain during labor?

Cultural factors Cultural influences may impose certain behavioral expectations regarding acceptable and unacceptable behavior when experiencing pain. Women with strong religious beliefs, for example, often accept pain as a necessary and inevitable part of bringing a new life into the world, whereas others tend to vocalize their pain by moaning, breathing rhythmically, or shouting. Environmental factors The quality of a laboring woman's environment can play an integral part in how she experiences pain in labor. Environmental factors in labor may include a support person or people present, a supportive physical environment (availability of birthing ball, comfortable chairs, etc.), place of birth (home, birth center, hospital, etc.), and the laboring woman's comfort with her health care providers. Psychological factors Psychological factors including the laboring woman's partner or support person play a key role in maintaining a calm and supportive environment. Previous experience with childbirth, whether her own or experiencing someone else's birth, can affect the psyche of the laboring woman. Physiologic factors Physiologic factors, such as understanding the different types of pain, can improve a woman's experience in labor.

When teaching a childbirth class for first-time parents, the nurse includes which benefits of breathing techniques used during labor?

Decreases sensation of pain The sensation of pain is decreased with breathing techniques. Provides a different focus during contractions Breathing techniques provide laboring women with a different focus during contractions, reducing the perception of pain. This is a benefit of using breathing techniques in labor. Can also substitute for pharmacologic therapies Breathing techniques often decrease the need for pharmacologic therapies during labor, as they can work to decrease the sensation of pain. Can be used with other nonpharmacologic techniques Breathing techniques can be used to supplement other relaxation techniques during labor, such as mental stimulation and cutaneous stimulation.

Which event results in a somatic pain response during labor?

Delivery of the fetal head Delivery of the fetal head causes the perineum to stretch. Delivery of the fetal head results in a somatic pain response caused by the burning experienced at the perineum during the delivery of the fetal head.

Which terms describe progressive changes that occur in the cervix during labor?

Dilatation Dilatation (opening) of the cervix occurs when the cervix is pulled downward and the fetus is pushed upward. Effacement Effacement (thinning and shortening) of the cervix occurs when the cervix becomes shorter and thinner as it is drawn over the fetus and amniotic sac.

Which nursing actions are appropriate when the fetal monitor shows a pattern of late decelerations?

Discontinue oxytocin. Discontinuing oxytocin will decrease the effect of uterine stimulants on the contractions. Administer oxygen by face mask. Oxygen increases the oxygenation to the patient, which increases perfusion of oxygen to the placenta. Reposition the patient onto her side. Repositioning the patient on her side, rather than allowing a supine position, is preferred. A supine position increases pressure on the vena cava, which reduces the blood supply, causing decreased perfusion of the placenta.

Match the type of nonreassuring deceleration with the associated cause.

Disrupted oxygen transfer Late Interrupted oxygen supply Prolonged Umbilical cord compression Variable

Which deceleration is considered a normal finding?

Early Early decelerations are a result of fetal head compression and are considered a normal finding that is not associated with poor fetal status or outcomes.

A G2/P1 woman presents for evaluation. She is excited, can talk through regular contractions every 7 to 10 minutes, and states that her pain is "manageable." She does not desire epidural anesthesia in labor. The nurse suspects this patient is in which phase of labor?

Early labor In early labor a woman may present for evaluation as excited and able to talk and walk through most contractions, though they are still uncomfortable. She may be focused on herself and her baby. She may follow directions well and pain may be easily managed.

A patient in labor experiences minimal relief after nonpharmacologic interventions, and she is not coping well in labor. Which action would the nurse take next?

Educate on the risks and benefits of pharmacologic interventions. By providing the patient with education and options, the nurse empowers her to make decisions about her body and labor and delivery experience.

A patient reports a feeling of lightness in her abdomen, increasing whitish, thin, and odorless vaginal discharge, and occasional contractions that go away after an hour or so. Which action would the nurse take next?

Educate the patient on the premonitory signs of labor. The nurse would educate the patient on premonitory signs of labor and counsel the patient that what she is experiencing is normal. The nurse would also educate on true versus false labor signs.

Which action taken by the patient will reduce discomfort during Leopold maneuvers and make fetal presenting parts easier to feel?

Emptying the bladder Emptying the bladder reduces discomfort during palpation and makes fetal parts easier to feel.

Which nonpharmacologic actions can the nurse take that would be most beneficial to a patient in labor who expresses fear about movement in labor?

Encourage support people to assist the patient with positioning. Support people can help with maternal anxiety in labor. The nurse can help by teaching support people how to assist the laboring woman into varying positions. Utilize positive and supportive language. Positive and supportive language is an essential way to empower a woman in labor, regardless of whether nonpharmacologic interventions are effective. Provide options for new positioning. Providing the woman with options allows her to choose which position she would like to try and encourages her to feel more in control of a very stressful situation. Offer music, therapeutic breathing, or other distractions to help the patient cope. Distraction can be an effective way to help a patient cope during or in between contractions.

Which solution can the nurse consider to encourage a positive birth experience for the patient and her support person following delivery?

Encourage the family to talk about the labor and delivery experience. Encouraging the patient and the support person to talk freely about the birth experience is a very important way to help them make sense of the experience and to reflect on the positive and negative aspects of the labor and delivery.

A woman with an epidural is 10 cm dilated and the baby is at 0 station. There is a reassuring fetal heart pattern, although the woman does not feel the urge to push. Which are appropriate actions by the nurse?

Encourage the patient to wait to push until she feels the urge. Even with an epidural, a patient usually feels the urge to push as the fetal head descends. This is known as the Ferguson reflex. She should be encouraged to "labor down." Encourage frequent position changes while remaining in the bed. Frequent position changes help the fetus to descend in the pelvis. This will help trigger the Ferguson reflex. It also promotes uteroplacental perfusion.

When caring for a patient in the active stage of labor, which solutions would the nurse generate to promote, protect, and support natural labor and birth?

Encourage upright positions without restricting movement. Encouraging and permitting a woman to move freely in labor allow for a natural labor experience and encourage fetal descent. Provide support and allow visitors for labor support beginning in early labor. Allowing support persons in the labor and delivery room helps decrease maternal anxiety and promotes better coping. Allow intermittent fetal monitoring, when appropriate, according to policy. Implementing intermittent fetal monitoring in low-risk appropriate patients, according to facility policy, is an evidence-based practice to encourage freedom of movement. It limits routine unnecessary interventions in the delivery room.

Match the appropriate type of anesthesia to the patient description: Patient in labor wants pain relief while being awake for the birth

Epidural block

A woman is experiencing strong contractions every 1.5 to 2 minutes, feels rectal pressure, and has a large amount of bloody show. At which frequency would the nurse anticipate assessing the fetal heart rate and pattern?

Every 15 to 30 minutes Based on the patient's signs and symptoms, she is in active labor, so it is recommended that the nurse assess the fetal heart rate and pattern every 15 to 30 minutes.

Match the fetal surveillance method to its corresponding advantage: Noninvasive and suitable for most patients in labor

External electronic fetal monitoring

Which fetal monitoring method is preferred in high-risk pregnancies?

External electronic fetal monitoring (EFM) External EFM is the preferred monitoring method in high-risk pregnancies. External EFM is less invasive than internal monitoring but more accurate than intermittent monitoring.

Which assessment would the nurse complete when a woman is in active labor?

Fetal heart rate and pattern every 15 to 30 minutes This is appropriate in active labor.

Which description of moderate variability of the fetal heart rate is accurate?

Fetal heart rate fluctuates between 10 and 20 beats/min. A fluctuating fetal heart rate of 6 to 25 beats/min is considered moderate variability and is normal and reassuring.

Which fetal heart rate finding may result from maternal fever?

Fetal heart rate of 180 beats/min for 12 minutes A maternal fever can directly increase the fetal temperature or infect the fetus in cases of infection. The fetus responds with an increased heart rate, which can lead to fetal tachycardia.

A woman is visibly anxious, refuses position changes in labor, and verbalizes, "I'm afraid I'm going to die." The nurse knows it is important to help the woman relax through effective coaching because of which responses to stress experienced in labor?

Fetal intolerance to labor Stress results in the release of catecholamines, which decrease blood flow to the placenta and fetus and can lead to fetal intolerance to labor. Release of catecholamines in the mother's body Stress in labor results in the release of catecholamines. Inhibited uterine contractions because of decreased blood flow to the placenta Decreased blood flow to the uterus can lead to inhibited uterine contractions.

The nurse caring for the patient in labor understands that absent (or minimal) variability is usually considered nonreassuring. However, which condition related to decreased variability is considered benign?

Fetal sleep Fetal sleep states are benign causes of absent baseline variability. The episodes are usually 40 minutes or less and happen occasionally.

Which noninvasive tools may be used to evaluate fetal heart rate?

Fetoscope A noninvasive monitoring device that uses conduction to amplify fetal heart sounds to the listener Doppler ultrasound A noninvasive tool that transmits the fetal heart rate audibly and displays the heart rate in beats/min

Match the expected event with the stage of labor: Expulsion of the placenta to physical recovery of mother and infant.

Fourth stage

Match the appropriate type of anesthesia to the patient description: Patient with active skin infection requires an emergency cesarean delivery

General anesthesia

Which pelvic type is most favorable for vaginal birth?

Gynecoid This is the classic female pelvis and is most favorable for vaginal birth.

Match each pushing position to its benefit: Helps rotation of occiput posterior presentation

Hands and knees

Match the laboring positions to their advantages: Support person can reach back massage, relieves back labor pain

Hands and knees

A patient is experiencing intense back pain and discomfort during active labor. Which position would the nurse encourage the patient to assume?

Hands and knees A hands-and-knees position reduces back pain because the fetus falls forward, away from the sacral promontory. It promotes normal mechanisms of birth. The woman can use pelvic rocking to decrease back pain. Caregivers can rub the woman's back or apply sacral pressure easily.

A laboring woman wishes to labor in the shower to alleviate pain. Which nonpharmacologic pain relief method is she applying?

Hydrotherapy Taking a shower is an example of hydrotherapy, a form of cutaneous stimulation, and it is a relaxation technique that can be very helpful for laboring women.

Which uterine contraction strength classification is used when labor is measured at >500 Montevideo units (MVUs)?

Hypertonic Above 400 MVUs, the uterine contraction strength is considered hypertonic, which is abnormal.

Several hours into an unmedicated labor, a woman complains of lightheadedness and anxiety. The nurse assists the woman with patterned breathing techniques to address which condition?

Hyperventilation Hyperventilation is sometimes a problem if a woman is breathing too rapidly, especially in an unmedicated birth that has been prolonged. Dizziness, lightheadedness, anxiety, numbness of the extremities, and tingling of the extremities are signs of hyperventilation.

A woman is experiencing intense pain with each contraction during labor. Her partner asks her to describe in detail her favorite beach. Which relaxation technique is her partner using?

Imagery Describing in vivid detail the location of a pleasant destination is an example of the use of imagery and mental stimulation. Imagery can help a laboring woman dissociate herself from the painful aspects of labor.

The nurse notes fetal tachycardia and suspects that the patient may be dehydrated. Which nursing action is appropriate to address this nonreassuring finding?

Increase the rate of intravenous (IV) saline administration. Tachycardia can be the result of maternal hypovolemia caused by dehydration. Increasing the rate of nonadditive intravenous fluids can improve placental perfusion by increasing maternal blood volume.

A patient arrives at a birthing center in active labor. Her membranes are still intact, and the health care provider prepares to perform an artificial rupture of membranes (AROM). What will the nurse relay to the patient as the most likely outcome of the procedure?

Increased pressure on the cervix The rupture of the amniotic membranes releases the cushion provided by the amniotic sac and causes an increase in the pressure of the fetal head on the cervix. This increased pressure will often result in an increase in contractions and a decrease in the time for dilation and effacement of the cervix.

Which physiologic effect results from labor pain?

Increased production of catecholamines The production of "fight-or-flight" hormones increases as a result of labor pain and anxiety. These include the catecholamines epinephrine and norepinephrine.

The nurse would question a prescription for spinal anesthesia for a woman with which condition?

Infection at the site of insertion Contraindications and precautions include the woman's refusal, coagulation defects, uncorrected hypovolemia, infection in the area of insertion, systemic infection, allergy, and possibly prior spinal surgery.

Which prescription would the nurse expect to administer to a patient at high risk for maternal hypotension before epidural anesthesia?

Intravenous fluids The nurse would anticipate intravenous fluids, which should be administered before epidural anesthesia.

Which examples demonstrate how labor pain differs from other types of pain?

Labor pain is intermittent. A woman may experience little discomfort with contractions, and she may be relatively comfortable during the short rest periods between contractions. This makes labor pain different from other types of pain. Labor pain has a foreseeable end. A woman can expect her labor to end within hours, rather than days, weeks, or months, whereas other types of pain may not have a foreseeable end. Childbirth pain is part of a normal process. Childbirth pain is part of a normal process, whereas other types of pain usually indicate an injury or illness. Women can acquire skills to help manage labor pain. Different from other types of pain, pain associated with the birth process can be addressed, in part, by realistic preparation and knowledge about the birth process.

Which method of anesthesia in labor is considered safest for the fetus?

Local infiltration Local anesthesia rarely has any adverse effects on either the laboring woman or fetus.

A laboring patient reports moderate back pain. Her partner rubs her lower back and reminds her to look at the teddy bear they bought for the newborn. Which relaxation techniques are being used?

Massage Massage is a form of cutaneous stimulation that involves rubbing areas of pain to reduce discomfort. This relaxation technique can help with lower back pain during labor. Focal point The use of a teddy bear to look at during labor is an example of a focal point. By using a focal point, the woman focuses on an external focal point (usually an object with positive associations) as opposed to the internal sensation of pain.

A laboring woman is attempting an unmedicated birth and asks the nurse to hold her hand during contractions. Which relaxation technique is the nurse performing?

Massage Nonclinical touch by the nurse is a powerful tool if the laboring woman does not object to it. Holding the woman's hand, stroking her hair, or similar actions convey caring, comfort, affirmation, and reassurance.

During the fourth stage of labor, the nurse notes an increased amount of bleeding. The uterine fundus consistency is boggy. Which is the most appropriate initial nursing action?

Massage the uterine fundus and observe for change in consistency. This is the most appropriate initial nursing action. Often uterine massage will cause a change in uterine tone from boggy to firm and will decrease vaginal lochia flow.

Which assessment is most important to monitor after the administration of epidural anesthesia?

Maternal blood pressure (BP) Maternal hypotension may occur after administration of epidural anesthesia; therefore, the nurse must have an accurate maternal BP reading for several minutes after the epidural is placed.

Which characteristics describe Braxton Hicks contractions?

Menstrual-like cramping True labor contraction discomfort begins in the lower back and gradually sweeps around to the lower abdomen like a girdle. Braxton Hicks contractions feel like menstrual cramps. Occur every 5 to 25 minutes Braxton Hicks contractions are typically irregular and infrequent.

The nurse is caring for a woman in the second stage of labor whose contractions have become more intense. What actions could the nurse take to assist this woman?

Model modified-paced breathing. Modified-paced breathing is most effective in the second stage of labor and involves the pant-blow method of breathing. Monitor for hyperventilation. Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding the breath for a couple of seconds. All of these techniques decrease partial pressure of carbon dioxide (PCO2). Ask the patient if it is OK to hold her hand. Holding a woman's hand is a nonpharmacologic method of pain relief and may help calm the woman during intense contractions. The nurse would always ask the woman's permission before grasping her hand.

Which uterine contraction intensity classification is defined as a firm but not a rigid fundus that is difficult to indent with fingertips?

Moderate A moderate-strength contraction means a firm fundus that is difficult to indent with fingertips (feels like touching a finger to a chin).

A patient has received fentanyl, and her respiratory status is rapidly declining. Which medication would the nurse anticipate administering to counteract the effects of this drug?

Naloxone Naloxone counteracts opioid-induced respiratory depression.

A woman received 25 mg of meperidine intravenously 1 hour before delivery. Which drug would the nurse have readily available?

Naloxone Naloxone is the antagonist for opioid medications and should be available for administration to the neonate who exhibits signs of respiratory depression after birth.

A nurse is caring for a patient in the first stage of labor who received a combined spinal-epidural (CSE) block with opioid analgesics for pain relief from uterine contractions. The nurse observes for which common side effects of these drugs?

Nausea Nausea is a common side effect of intrathecal opioid analgesics. Nalbuphine is one drug that can counteract nausea from intrathecal opioid administration. Pruritus Pruritus is a common side effect of intrathecal opioid analgesics as a result of the release of histamine. Antihistamines, such as nalbuphine, can counteract pruritus from intrathecal administration. Vomiting Vomiting is a common side effect of intrathecal opioid analgesics. Nalbuphine is one drug that can counteract nausea from intrathecal opioid administration and will also decrease the incidence of vomiting.

A nurse is managing the administration of nitrous oxide for a patient in labor. The nurse observes for which common side effects of nitrous oxide?

Nausea Nausea is a common side effect of nitrous oxide. Vomiting may also be present with the administration of nitrous oxide. Nitrous oxide is administered by the labor and delivery nurse, and side effects should be reported to the health care provider or midwife who prescribed the medication. Dizziness Dizziness is a common side of nitrous oxide. Nitrous oxide is a gas that is inhaled and does not take away contraction pain but rather helps reduce anxiety and increases a feeling of well-being so that the labor pain is easier to deal with. Dysphoria Dysphoria is a common side effect of nitrous oxide. Because nitrous oxide is an inhalant, it creates a feeling of dysphoria and reduces anxiety so that labor pain is easier to deal with.

A woman is administered fentanyl during labor and is still experiencing significant pain. Which prescription from the health care provider would the nurse anticipate for administration?

Nitrous oxide The nurse anticipates a prescription for nitrous oxide, which can be administered to a woman who is still experiencing pain after the administration of fentanyl.

What approach would a nurse take to best assess the progress of a woman in labor?

Observe for classic signs of labor progress while keeping in mind that labor is variable from birth to birth. It is appropriate to monitor for classic signs while recognizing that not every labor demonstrates these signs.

In the fourth stage of labor, the nurse monitors the hemodynamic stability of the postpartum patient through which assessment?

Obtaining maternal vital signs every 15 minutes in the first postpartum hour The maternal pulse, blood pressure, and respiratory rate should be assessed and documented every 15 minutes in the fourth stage of labor.

The nurse would perform which assessment to ensure proper uterine involution after birth?

Palpate the fundus. Because bleeding can be caused by an uncontracted uterus, the fundus must be palpated at regular intervals to assess for consistency, which indicates contraction of the uterine muscle.

Which methods are used to assess uterine activity externally?

Palpation Palpation is an external method of assessing uterine activity. If using external electronic fetal monitoring, palpation is needed to assess contraction intensity and uterine resting tone. Tocodynamometer The tocodynamometer (toco) is an external method to monitor uterine activity. The toco measures uterine contraction frequency and duration; palpation is needed to assess intensity and uterine resting tone.

Match the component of the birth process to the corresponding description: Maternal pelvic and soft tissues

Passage

Match the component of the birth process to the corresponding description: Fetus, membranes, and placenta

Passenger

Occiput posterior refers to which component of the birth process?

Passenger Occiput posterior refers to the fetal presentation within the female pelvis. The occiput anterior position is the most favorable for vaginal birth.

List relevant patient cues in the order the nurse recognizes them in a primipara during labor as the patient progresses from the first stage of labor to the second stage of labor.

Patient wakes up and feels mild contractions at home. Cervix is thick and 50% effaced on assessment at the hospital. Contractions become closer and coordinated. Cervix is 6 cm dilated. Patient has bloody show and reports rectal pressure. The relevant patient cues the nurse recognizes as the patient progresses from the first stage of labor to the second stage of labor in order would be feeling mild contractions at home, then the cervix is thick and 50% effaced on assessment at the hospital. Next the contractions become closer and coordinated and then the cervix is 6 cm dilated. And the then the patient has bloody show and reports rectal pressure.

Which action would the nurse take to improve placental blood flow immediately after administration of an epidural?

Place a wedge under the woman's right hip Placing a wedge under the right hip improves placental blood flow after a procedure that causes vasodilation.

The labor nurse is evaluating the patient's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which explanations most likely explains this occurrence?

Placental abruption Late decelerations are almost always caused by uteroplacental insufficiency, the result of uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, intrauterine growth restriction (IUGR), intraamniotic infection, or placental abruption. Vena cava syndrome Late decelerations are almost always caused by uteroplacental insufficiency, the result of uterine tachysystole, maternal hypotension, epidural or spinal anesthesia, intrauterine growth restriction (IUGR), intraamniotic infection, or placental abruption.

Which device would the nurse prepare for internal uterine monitoring if the midwife has requested an amnioinfusion?

A transducer-tip pressure catheter the nurse would prepare a transducer-tip intrauterine pressure catheter, which specifically has an extra lumen for amnioinfusion

Which nonreassuring fetal heart rate (FHR) pattern includes a reduction in FHR of ≥15 beats/min for more than 2 minutes?

Prolonged decelerations Prolonged decelerations cause a decrease in FHR of ≥15 beats/min below baseline and last longer than 2 minutes but less than 10 minutes. The return to baseline FHR usually occurs after the contraction is over.

A patient experiences nausea and vomiting during labor. Which medication might the nurse anticipate administering?

Promethazine The nurse would anticipate promethazine because it relieves the nausea and vomiting that may occur when opioid drugs are given.

The nurse understands that which hormonal changes are thought to encourage the onset of labor?

Rising estrogen counteracts the relaxing effect of progesterone on the uterus. Rising estrogen levels counteract the action of progesterone. When estrogen levels rise above progesterone levels, the relaxant effects of progesterone on the uterine muscle are reduced. This enables uterine contractions to begin. Prostaglandins are secreted by the fetal membranes preparing the uterus. Prostaglandins are secreted from the lower area of the fetal membranes (forebag) during labor, which prepares the uterus for oxytocin stimulation. The fetus secretes cortisol, which may act as an additional uterine stimulant. The fetal membranes release prostaglandin in high concentrations during labor. In addition to fetal oxytocin secretion, large quantities of cortisol are secreted by the fetal adrenal gland, possibly acting as a uterine stimulant. Oxytocin is secreted by the mother, which causes uterine contractions. The natural increase in secretion of oxytocin from the mother and the increase in oxytocin availability resulting from the compression of the fetal head on the cervix furthers and maintains labor once it has begun. Oxytocin receptors in the uterus increase markedly during labor and peak at delivery, allowing oxytocin to have its effect on the uterus.

Match the expected event with the stage of labor: Complete cervical dilatation and effacement to birth of the baby.

Second stage

Match each pushing position to its benefit: Allows for easy access in an emergency

Semi-recumbent

Match the laboring positions to their advantages: Gravity promotes fetal descent, woman can walk

Standing

Match each pushing position to its benefit: Fetal descent is enhanced by gravity

Standing/squatting

The nurse is caring for a woman who is receiving oxytocin. The data displayed on the electronic fetal monitor shows that the contractions are approximately 10 seconds apart. Which intervention would the nurse perform next?

Stop the oxytocin. One of the side effects of oxytocin or other uterine stimulants is excessive uterine activity, which can be harmful to the patient and fetus. Therefore the first action would be to stop the medication.

A patient arrives at the labor and delivery unit with steady contractions and is 5 cm dilated. On assessment, the fetal heart rate is 200 beats/min, and it is determined that a cesarean delivery should be performed. Which anesthesia method does the nurse anticipate?

Subarachnoid (spinal) block (SAB) The nurse would anticipate an SAB because it is recommended when a quick cesarean birth is necessary and an epidural catheter is not in place.

Which are the advantages of external electronic fetal monitoring (EFM)?

Suitable for most patients in labor External EFM is a noninvasive method for continuously monitoring fetal heart rate and uterine contractions. It is safe to use in high-risk pregnancies. Visualization of heart rate pattern External EFM provides visualization of the fetal heart rate pattern in response to uterine contractions. Allows mobility if connected to mobile unit Mobile external EFM units allow patients to remain mobile, as the unit may be wheeled during ambulation.

The nurse is monitoring a patient in the active stage of labor with internal fetal monitoring. The patient has been experiencing contractions that last 70 to 90 seconds and occur every 1 to 2 minutes, and she has a uterine resting tone of 25 mm Hg. The nurse recognizes that the patient is experiencing which type of difficult labor?

Tachysystole Tachysystole, or hypertonic uterine dysfunction, is a potential complication of labor induction. It is defined by an increase in the uterine resting tone or more than 5 uterine contractions in a 10-minute time frame.

Which statements describe how the Ferguson reflex supports maternal pushing efforts?

The fetal head pushing on the vaginal tissue triggers the Ferguson reflex. When the head is engaged, the tissues are stretched, and an endogenous surge of oxytocin is released. When tissues are stretched, an endogenous surge of oxytocin is released. The endogenous surge of oxytocin causes the woman to feel an overwhelming urge to bear down. The Ferguson reflex is a biological response causing an overwhelming urge to bear down. The urge to bear down is known as the Ferguson reflex and facilitates birth.

Place the feedback loop events responsible for labor contractions at term in the order of their expected occurrence.

The fetal head stretches the cervix. The fundus of the uterus contracts. The fetal head pushes against the cervix. Oxytocin is increasingly secreted. A feedback loop is probably responsible for labor contractions at term: the fetal head stretches the cervix, causing the fundus of the uterus to contract, further pushing the fetal head against the cervix, and causing more fundal contractions. Cervical stretching also causes secretion of oxytocin, thereby causing more contractions.

Which physiological event is associated with lightening?

The fetus assumes a position lower in the pelvis. Lightening ("dropping") occurs as the fetus descends toward the pelvic inlet.

Which maternal or fetal condition might require an amnioinfusion?

The fetus has experienced umbilical cord compression. One common indication for amnioinfusion is umbilical cord compression. Instillation of sterile fluid often relieves the compression.

The nurse notes accelerations on the fetal heart rate pattern. Which information is the nurse able to determine given this assessment?

The fetus has normal acid-base balance. Accelerations are usually a reassuring sign that the fetus has a responsive central nervous system and is not in acidosis.

Which observations suggest that a woman is the latent phase of the second stage of labor?

The fetus is at 0 station. The Ferguson reflex is not usually present until the fetus begins to descend deeper into the pelvis. Latent labor allows for passive descent with the primary force being contractions. There is an irregular and inconsistent urge to bear down with contractions. The Ferguson reflex is not usually present until the fetus begins to descend deeper into the pelvis. Latent labor allows for passive descent with the primary force being contractions. The woman sleeps between contractions. In the latent phase of the second stage of labor, maternal behaviors may be relaxed. She may be very quiet as she rests in this phase. The woman may sleep or rest in between contractions.

A pregnant woman arrives at the emergency department, and after completing a vaginal examination the nurse midwife states that the patient is 5 cm dilated and 75% effaced and the fetus is at −3 station. Which statement is accurate regarding this assessment?

The fetus is not engaged within the maternal pelvis. Fetal engagement begins at 0 station.

Which phase of the second stage of labor includes relaxed maternal behaviors and passive descent of the fetus?

The latent phase Passive descent of the fetus and relaxed maternal behaviors are characteristic of the latent phase of the second stage of labor.

Which statement regarding pain experienced during labor is accurate?

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen. This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia. This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia.

Which signs are considered warning signs in labor that should be reported to the health care provider?

The presence of thin green fluid leaking from the vagina This could be meconium-stained amniotic fluid and should be reported. Maternal temperature of 100.8°F This could be an early sign of infection and should be reported to the health care provider. Bright red vaginal bleeding with blood clots This is a warning sign that could indicate maternal or fetal trauma, placenta previa, or placental abruption. Minimal variability on the fetal heart tracing for the past 60 minutes This is longer than a normal sleep cycle and should be reported to the health care provider. This finding could indicate decreased fetal oxygen reserve.

Which situation demonstrates how an environmental factor could negatively affect a woman's experience of pain during labor?

The woman has no support at her bedside. Environmental factors that affect a woman's perception of pain include a support person or people present, a supportive physical environment, and comfort with her health care providers.

A laboring patient places a cool, damp compress over her forehead. This is an example of which nonpharmacologic method of pain relief?

Thermal stimulation Placing a cool, damp compress over the head is an example of thermal stimulation. The laboring woman may place it on her head, throat, or abdomen, particularly if she feels overheated. Another example of thermal stimulation is a warm, relaxing shower or bath.

The nurse receives reports on two women in early labor, a nulliparous woman and a multiparous woman. Both are 3 cm dilated. Which statement is true regarding who will enter active labor first?

They will both progress at similar rates. Nulliparous and multiparous women have been found to progress at similar rates in this phase.

How is effacement measured?

Through digital palpation by a trained professional Digital palpation and transvaginal ultrasound can estimate cervical effacement. Using transvaginal ultrasound Digital palpation and transvaginal ultrasound can estimate cervical effacement.

For which reason would a nurse administer a narcotic to a woman at the beginning of a contraction?

To allow for less medication to be transferred to the fetus To obtain the most beneficial effects of the opioid analgesia during labor and limit transfer to the fetus, the nurse would start the injection of the medication at the beginning of the contraction, when the blood flow to the placenta is normally reduced. When placental blood flow resumes, much of the drug is in maternal tissues (El-Wahab & Fernando, 2014).

Which passenger position would interfere with a safe vaginal birth?

Transverse fetal lie The fetal lie is the relationship of the long axis of the baby to the long axis of the mother. With a transverse fetal lie, there is a significant risk for fetal distress, trauma, and maternal trauma if vaginal delivery occurs.

Which conditions are the most common causes of postpartum hemorrhage?

Trauma to the woman's body Trauma to the perineum, vaginal canal, or cervix can cause postpartum hemorrhage. Blood-clotting disorders Increased clotting time can cause postpartum hemorrhage. Retained placental fragments Retained placental fragments prevent optimal uterine involution and therefore can cause an increase in bleeding. Uterine atony Uterine atony is the most common cause of postpartum hemorrhage and occurs when the fundus is boggy. There are a number of causes of uterine atony.

During an emergency delivery, which maternal adverse effects would a nurse monitor in a patient undergoing general anesthesia?

Uterine relaxation The nurse would monitor for uterine relaxation, which is an adverse effect of general anesthesia. Respiratory depression The nurse would monitor for respiratory depression, which is an adverse effect of general anesthesia. Maternal aspiration of gastric contents The nurse would monitor for maternal aspiration of gastric contents, which is an adverse effect of general anesthesia.

The nurse caring for the woman in labor recognizes that maternal hypotension puts the laboring woman at risk for which result?

Uteroplacental insufficiency Low maternal blood pressure reduces placental blood flow during uterine contractions and results in fetal hypoxemia. This hypoxemia can lead to late decelerations in the fetal heart rate.

Match each pushing position to its benefit: Greater maternal satisfaction, less need for analgesia/anesthesia

Water birth

The nurse is instructing a childbirth class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths/min. What should the patient's rate be while performing slow-paced breathing techniques?

11 breaths/min The ideal rate for slow-paced breathing is half the normal breathing rate. Because her baseline respiratory rate is 22 breaths/min, the ideal breathing rate for slow-paced breathing is 11 breaths/min.

Which uterine resting tones are considered reassuring?

18 mm Hg with an intrauterine pressure catheter (IUPC) The average uterine resting tone is expected to be less than 20 mm Hg if measured with the IUPC. This would be a reassuring finding. 350 Montevideo units with electronic fetal monitoring (EFM) The average uterine resting tone is expected to be less than 400 Montevideo units by internal EFM with an intrauterine pressure catheter (IUPC). This would be a reassuring finding.

The nurse understands that __________ Montevideo units (MVUs) or more are considered adequate for normal labor progression.

200 200 Montevideo units (MVUs) or more are considered adequate for normal labor progression.

Place the steps in the order in which they would be applied to perform Leopold maneuvers.

1. Palpate the uterine fundus. 2. Palpate for the fetal back. 3. Palpate the suprapubic area to confirm presentation. 4. Determine if head is flexed (vertex) or extended (face). Leopold maneuvers are performed to identify fetal presentation and position and to help the nurse locate the fetal back, which is the area of maximal intensity for the fetal heart rate. The nurse first palpates the uterine fundus, then palpates for the fetal back. Then the nurse palpates the suprapubic area to confirm presentation. The nurse would finally determine if the head is flexed or extended.

Match the component of the birth process to the corresponding description: Adaptive or maladaptive responses that alter the birth process

Psyche

A nurse is caring for a patient undergoing an episiotomy repair after birth. Which types of anesthesia does the nurse anticipate?

Pudendal anesthesia The nurse would anticipate pudendal anesthesia for episiotomy repair. Pudendal blocks anesthetize the lower vagina and part of the perineum. Local infiltration anesthesia The nurse would anticipate local infiltration, which is routinely used for episiotomy repair. Local infiltration anesthesia numbs the immediate area of the episiotomy or laceration.

Match the appropriate type of anesthesia to the patient description: Patient requires a vaginal laceration repair after delivery

Pudendal block

Which characteristics describe early decelerations?

Referred to as mirror images of contraction Early decelerations are sometimes called a mirror image of a contraction because they correspond to the beginning, peak, and end of a contraction. Primarily periodic and often benign Early decelerations are usually periodic and are considered a benign finding, as they are not associated with fetal hypoxia, academia, or low Apgar scores. Onset, nadir, and recovery correspond with beginning, peak, and end of contraction The onset, nadir, and recovery of an early deceleration correspond with the beginning, peak, and end of a contraction.

Which statements explain how the maternal psyche facilitates childbirth?

Relaxation supports the natural process of labor. Relaxation techniques, such as slow breathing patterns, augment the natural process of labor. Calmness increases a woman's ability to cope with pain during labor. In contrast, marked anxiety, fear, or fatigue decreases a woman's ability to cope with pain in labor.

After assessment of an actively laboring woman, the nurse finds a fetal heart rate (FHR) of 180 beats/min with contractions occurring less than 2 minutes apart and lasting more than 90 seconds. Which action would the nurse take next?

Reposition the patient to her side and alert the health care provider. The patient is experiencing tachysystole, fetal tachycardia, and incomplete uterine relaxation, which can lead to fetal compromise. Lateral positioning allows for optimal placental perfusion. The health care provider will need to evaluate this patient at the bedside.

A woman in labor is given an opioid analgesic for pain. Which vital sign is a priority for the nurse to monitor in the newborn infant?

Respiratory rate Opioid analgesics can cause respiratory depression, which is more likely to occur in the newborn than in the mother; therefore respiratory rate should be monitored.

Which uterine activity indicators does the intrauterine pressure catheter (IUPC) measure in mm HG?

Resting tone Resting tone is measured by the IUPC in mm Hg and is usually between 5 and 15 mm Hg. Intensity Contraction intensity is measured by the IUPC in mm Hg and is 50 to 75 mm Hg during labor and up to 110 mm Hg with pushing during the second stage.