OB ch7.8

An opioid antagonist used to counteract respiratory depression in the newborn is:

Naloxone (Narcan)

If the patient asks the nurse where the medication is placed during an epidural block, the most appropriate response is that the anesthetic is introduced:

Near the dural sac in the lumbar region of the spine

The patient is experiencing uterine contractions lasting approximately 100 seconds each. What action by the nurse is most appropriate?

Notify the charge nurse.

After receiving a pudendal block, which reaction is the patient likely to experience?

Numbness of the birth canal and perineum to allow pushing during delivery

Focusing strategies, cutaneous stimulation, and back massage are thought to reduce pain by:

Preventing pain sensations from being transmitted by the spinal column

During the fourth stage of labor, the primary reason that the nurse encourages the mother to hold and examine her baby is to:

Promote mother-infant bonding.

Which nursing action will be most effective in helping a woman who is apprehensive cope with her labor?

Promote relaxation through reassurance and comfort measures.

The patient who delivered without anesthesia requires an episiotomy repair. The nurse will most likely prepare for which type of anesthesia?

Pudendal block

The labor patient's electronic fetal monitor detects increasing late decelerations. Which action is warranted in this situation?

Reposition the woman and notify the health care provider.

Maternal responses to the transition phase of labor include:

Restlessness, trembling of the legs, nausea, and vomiting

Before administration of epidural anesthesia, a woman should be adequately hydrated with which intravenous solution?

Ringer's lactate solution

When anesthesia is introduced into the cerebrospinal fluid, it is referred to as _____ anesthesia.

Spinal

Which position would be inappropriate during labor?

Supine

When assessing a woman who has just given birth, the nurse notes that the woman's fundus is firm and has risen in her abdomen. A gush of dark red blood comes from her vagina. The nurse concludes that:

The placenta has separated.

The nurse performs a vaginal examination to determine labor progress. She notes that the FHR, as indicated on EFM, rises approximately 30 beats/minute above baseline for about 60 seconds. The nurse recognizes that:

This is a normal response of the fetus to the vaginal examination and requires documentation only.

What is an abnormal finding in a newborn infant?

Two veins and one artery in the umbilical cord

Guidelines for intermittent auscultation of fetal heart rate (FHR) during labor include:

Use of an ultrasound device or a fetoscope may be used

The patient states, "My epidural isn't working! I can still feel my contractions." Which of the following statements by the nurse is most appropriate?

"An epidural will allow you to sense your contractions, but you won't feel the pain."

A new admission to the labor and delivery unit asks whether she can have something to eat or drink. The nurse's best response is:

"Let's check your orders. You may be able to have ice chips and liquids."

A pregnant woman who thinks she is in labor asks the nurse how they will determine whether her membranes have ruptured. Which statement by the nurse is correct?

"Nitrazine paper will turn blue in the presence of amniotic fluid."

Two patients are at the same stage of labor. One is lying still with her eyes closed and her breathing controlled, and the other is grasping the side rails and crying out with each contraction. The nursing assistant wants to know why the second patient is not quiet like the first. The nurse's best response is:

"Some people believe that pain should be quietly endured; others express it freely."

Sensitivity to a woman's culture is reflected in which statement by the nurse?

"You are very quiet. Please tell me if you have pain."

The nurse is assessing a laboring patient. Which specific behavior(s) or sign(s) indicate(s) that birth is imminent? (Select all that apply.)

-Involuntarily bearing down with contractions -Bulging of the perineum -Grunting sounds

The nurse understands that childbirth pain differs from pain experienced in other conditions in what way(s)? (Select all that apply.)

-Labor pain is part of a normal process. -There is time for preparation to manage labor pain. -The pain of labor is self-limiting. -The purpose of labor pain helps in the birthing process.

The nurse is caring for a patient who delivered under general anesthesia. The nurse understands the risks of general anesthesia and will assess for which complication(s)? (Select all that apply.)

-Postpartum hemorrhage in the mother -Decreased respiratory status of infant -Aspiration of gastric contents in the mother

Pain during labor occurs as a result of which stressor(s)? (Select all that apply.)

-Pressure and pulling of the pelvic structures -Distention and stretching of the vagina and perineum -Size and position of the fetus -Fear and anxiety

The nurse understands that amnioinfusions are performed for what purpose(s)? (Select all that apply.)

-To decrease the compression of the umbilical cord -To dilute meconium in the uterine cavity -To decrease effects of oligohydramnios

During the first hour of the fourth stage of labor, the nurse should assess vital signs, fundal consistency, and amount of vaginal bleeding every _____ minutes.

15

An analgesic drug is usually not given until the cervix is dilated to at least _____ cm.

4

During labor, a woman's bladder should be assessed at least every 2 hours because:

A full bladder may interfere with labor progress

What information should be obtained immediately on admission of a woman to the labor unit?

Activity level of the fetus

A woman who is a gravida 2, para 1 comes to the labor and delivery suite with a spontaneous rupture of membranes, uterine contractions every 2 minutes, and strong cervical dilation 10 cm with 100% effacement, +2 station. She states she feels a lot of pressure and is asking for something for pain. The nurse recognizes that:

Analgesics given at this time could cause respiratory depression in the newborn.

Which class of medication would the nurse expect to administer to a patient undergoing general anesthesia?

Antacid

In a precipitate delivery in which no physician or midwife is present, the nurse should:

Apply gentle pressure to the perineum and deliver the head between contractions.

After administration of epidural anesthesia, the nurse should immediately:

Assess blood pressure and fetal heart tones.

The nurse recognizes the most common treatment for a postspinal headache to be which of the following?

Blood patch

A labor patient is dilated 8 cm, and her contractions are every 3 minutes with a duration of 80 seconds. She begins to thrash about, cries out, and pushes her covers off of the bed. The nurse's most appropriate action is to:

Calmly talk her through the breathing pattern with each contraction.

When using a bulb syringe to clear a newborn's airway immediately after birth, the nurse should first suction the mouth and then the nose because:

Clearing the mouth first decreases the risk of aspiration.

A newborn's 1-minute Apgar score was 9. Which of the following criteria is most likely responsible for the loss of 1 point from a possible score of 10?

Color

Variable decelerations are most likely to occur because of:

Cord compression

A woman is complaining of intense lower back pain during contractions. An effective pain relief measure would be to use:

Counterpressure against the sacrum

Effleurage is an example of:

Cutaneous stimulation

Nursing care during the active phase of labor should include:

Monitoring vital signs and fetal heart rate

A plan to achieve adequate pain relief without maternal or fetal risk is most effective if:

Mother and family priorities and preferences are incorporated into the plan.

When evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate begins to decelerate at the onset of several contractions and returns to baseline before each contraction ends. The nurse should:

Document the findings on the patient's record

A person hired by the mother or couple to provide labor support, guidance, and encouragement to the mother or couple during labor is known as what?

Doula

Use of an ultrasound device or a fetoscope may be used

EFM monitors characteristics of uterine activity and fetal cardiac activity.

The natural opiate-like chemicals produced by a woman during labor and delivery are known as:

Endorphins

Maternal hypotension is a major adverse reaction to which method of pain relief?

Epidural block

Meconium-stained amniotic fluid when the fetus is in a cephalic position is associated with:

Fetal compromise

Immediately after rupture of the amniotic membranes, the nurse should assess:

Fetal heart tones

The Apgar score of a newborn is likely to be lowest when the mother has which type of anesthesia for childbirth?

General anesthesia

After a woman's amniotic membranes rupture, the nurse notes the characteristics of the amniotic fluid. The nurse would be concerned if what was observed?

Greenish color

When the nurse is caring for a labor patient who is on continuous electronic fetal monitoring, the baseline fetal heart rate is 150 beats/minute. Which pattern would alert the nurse to possible fetal distress?

Heart rate of 100 beats/minute beginning at the peak of a uterine contraction

A woman in active first stage of labor is using a shallow pattern of breathing that is about twice the normal adult breathing rate. She begins to complain of feeling lightheaded and dizzy and states her fingers are tingling. The nurse should:

Help her breathe into a paper bag or her cupped hands.

Thirty minutes after delivery, the nurse's assessment of the woman reveals vaginal bleeding, a soft uterus, blood pressure 90/54 mm Hg, and pulse 110 beats/minute. Which complication should be suspected?

Hemorrhage

If a narcotic antagonist is administered to a laboring woman, she should be told:

Her pain will return.

During the active phase of labor, a patient reports severe back pain that becomes increasingly intense during contractions. The nurse should place the woman in which position?

Knee-chest

The main disadvantage of home birth is:

Lack of emergency equipment

When caring for a newborn infant immediately after birth, the first priority is to:

Maintain a clear airway.

Forty-five minutes after delivery, a woman tells the nurse that she thinks she is bleeding. The nurse observes a steady trickle of vaginal bleeding. The first nursing action should be to:

Massage the uterus

A complication of epidural block is:

Maternal hypotension

What is an advantage of using external electronic fetal monitoring?

Monitoring can be done before amniotic fluid membranes rupture.