OB Chapt 13 Labor and Delivery

A woman is documented on the labor and delivery board to be 7cm dilated. Her family wants to know how long she will be in labor. The nurse should provide which information to the family? a) "She is in active labor, she is progressing at this point and we will keep you posted." b) "She is doing well, in the second stage and it could be anytime now." c) "She is in the transition phase of labor and it will be with in 2 to 3 hours, might be sooner." d) "She is still in early latent labor and has much too long to go to tell when she will deliver."

"She is in active labor, she is progressing at this point and we will keep you posted." Explanation: At 7cm dilated, she is considered in Active Phase of labor. There is no science that can predict the length of labor. She is progressing in labor and it is not best to give the family a specific time frame.

A fetus is assessed at 2 cm above the ischial spines. The nurse would document fetal station as: a) +2 b) -2 c) 0 d) +4

-2 Correct Explanation: When the presenting part is above the ischial spines, it is noted as a negative station. Since the measurement is 2 cm, the station would be -2. A 0 station indicates that the fetal presenting part is at the level of the ischial spines. Positive stations indicate that the presenting part is below the level of the ischial spines.

In a woman who measures 13 centimeters from the symphysis pubis to the sacral promontory, what would you estimate the obstetric conjugate to measure? a) 7.5 centimeters b) 11 centimeters c) 15 centimeters d) 8 centimeters

11 centimeters Correct Explanation: The obstetric conjugate measurement is the smallest diameter of the inlet through which the fetus must pass. This cannot be measured directly, measure the diagonal conjugate and subtract 1.5 to 2.0 centimeters from the measurement

A petite, 5-foot tall, 95-pound woman who is 28 years old is about to deliver her first child and would like to have a vaginal delivery. She has two sisters, both of whom have given birth vaginally. She has gained 25 pounds during a normal, uneventful pregnancy. What type of pelvis would a nurse expect this woman to have upon assessment of the patient? a) Platypelloid b) Gynecoid c) Android d) Cannot be determined

Cannot be determined Explanation: Pelvis shape cannot be determined by the information included in the statement. Early in the pregnancy, particularly if a woman has never delivered a baby vaginally, the practitioner may take pelvic measurements to estimate the size of the true pelvis. This helps to determine if the size is adequate for vaginal delivery. However, these measurements do not consistently predict which women will have difficulty delivering vaginally, so most practitioners allow the woman to labor and attempt a vaginal birth.

The RN in labor and delivery documents the fetus as ROA. To what does this documentation refer for a fetus? a) Fetal size b) Fetal station c) Fetal position d) Fetal attitude

Fetal position Correct Explanation: When documenting the ROA, this is the Right Occiput Anterior or the relationship of the fetal position to the mother using the maternal pelvis as the point of reference. Fetal refers to the relationship of the presenting part of the fetus to the ischial spines of the pelvis. Fetal attitude refers to the relationship of the fetal parts to one another. Fetal size refers the actual size of the developing fetus.

The nurse assesses a client in labor and finds that the fetal long axis is longitudinal to the maternal long axis. The nurse documents this finding as which of the following? a) Lie b) Attitude c) Presentation d) Position

Lie Correct Explanation: The nurse is assessing fetal lie, the relationship of the fetal long axis to the maternal long axis. When the fetal long axis is longitudinal to the maternal long axis, the lie is said to longitudinal. Presentation is the portion of the fetus that overlies the maternal pelvic inlet. Attitude is the relationship of the different fetal parts to one another. Position is the relationship of the fetal denominator to the different sides of the maternal pelvis

A nurse is coaching a woman during the second stage of labor. Which of the following should the nurse encourage the client to do at this time? a) Hold her breath while pushing during contractions b) Begin pushing as soon as the cervix has dilated to 8 cm c) Push with contractions and rest between them d) Pant while she pushes

Push with contractions and rest between them Correct Explanation: Make sure the woman pushes with contractions and rests between them. Holding the breath during a contraction could cause a Valsalva maneuver or temporarily impede blood return to her heart because of increased intrathoracic pressure, which could then also interfere with blood supply to the uterus. It is important for women to understand they should not bear down with their abdominal muscles to push until the cervix is fully dilated, which is 10 cm, not 8 cm. Panting limits the ability to push and is to be encouraged only when it is desirable to delay labor, such as when a nuchal cord is present.

When educating a group of nursing students about the theories of onset of labor, the nurse identifies which of the following factors as the possible causes for onset of labor? Select all that apply. a) Prostaglandin production in the myometrium b) Release of oxytocin by the pituitary c) Fall in the estrogen at 34-35 weeks of pregnancy d) Increase in the production of progesterone e) Increase in the fetal cortisol levels

• Increase in the fetal cortisol levels • Release of oxytocin by the pituitary • Prostaglandin production in the myometrium Explanation: The possible causes for the onset of labor include increase in the fetal cortisol levels, release of oxytocin by the posterior pituitary and the production of prostaglandins. Progesterone withdrawal, and not an increase, initiates labor. There is a rise in the estrogen levels at 34-35 weeks of pregnancy. Estrogen stimulates prostaglandin production and also promotes the release of oxytocin.

A fetus is in the LST position. The nurse interprets this as indicating which of the following as the presenting part? a) Shoulder b) Chin c) Buttocks d) Fetal head

Buttocks Explanation: The letter "S" indicates the sacrum or buttocks as the presenting part. The fetal head would be noted by the letter "O," indicating occiput. The fetal chin would be noted by the letter "M," indicating mentum. The fetal shoulder would be noted by the letter "A," indicating the acromion process.

The four essential components of labor are known as the "four P's". Which of the four P's involves the pelvis? a) Passageway b) Powers c) Passenger d) Psyche

Passageway Correct Explanation: The passageway is one of the 4 P's and involves the pelvis, both bony pelvis and the soft tissues, cervix, and vagina. The "passenger" refers to the fetus. The primary powers are the involuntary contractions of the uterus, whereas the secondary powers come from the maternal abdominal muscles. The psyche refers to the mother's mental state.

Put the following events of labor in correct order: Crowning occurs The cervix dilates to 2 cm Placental separation Placental expulsion Fetus begins descent Cervix becomes fully effaced

The cervix dilates to 2 cm Cervix becomes fully effaced Fetus begins descent Crowning occurs Placental separation Placental expulsion Correct Explanation: The events of labor occur in this order: 1) the cervix dilates to 2 cm, 2) cervix becomes fully effaced, 3) fetus begins descent, 4) crowning occurs, 5) placental separation, 6) placental expulsion.

The woman has just delivered a healthy baby boy, but the placenta has not yet delivered. What stage of labor does this scenario represent? a) Third b) Fourth c) Second d) First

Third Correct Explanation: Stage 3 begins with the birth of the baby and ends with delivery of the placenta.

After teaching a pregnant client who is in her last weeks of pregnancy about the signs and symptoms of approaching labor, which of following if identified by the client would indicate effective teaching? Select all that apply. a) Weight gain b) Backache c) Constipation d) Bloody show e) Lightening

• Lightening • Bloody show • Backache Explanation: The signs of approaching labor include lightening, bloody show, and backache. Lightening is the falling forward of the pregnant uterus due to settlement of the fetal head into the maternal pelvis. Backache associated with pelvic cramping pain, which is regular and increases in the intensity, is suggestive of impending labor. Bloody show is the expulsion of the cervical mucus plug tinged with blood, and occurs due to cervical effacement and dilatation. Weight loss and diarrhea are other signs of impending labor. Weight gain and constipation are not signs of impending labor.

A patient, 38 weeks gestation, pregnant with her first child calls the clinic and states "my baby is lower and it is more difficult to walk" and ask if she should come to the hospital to be checked. How should the nurse respond? a) "That is something we expect with a second or third baby, because it is your fist, you need to be checked." b) "The baby has dropped into the pelvis, your body and baby are getting ready for labor in the next few weeks." c) "The baby moved down into the pelvis, this means you will be in labor within 24 hours, wait for contractions to come to the hospital." d) "This is not normal unless you are in active labor, come to the hospital and be checked."

"The baby has dropped into the pelvis, your body and baby are getting ready for labor in the next few weeks." Correct Explanation: The baby can drop into the pelvis, an event termed lightening, and can happen for up to 2 weeks before the woman goes into labor. This is normal and does not require intervention.

The patient is having a routine prenatal visit and asks the nurse what the childbirth education teacher meant when she used the term zero station. What is the best response by the nurse? a) "This means +1 and the baby is entering the true pelvis." b) "This is just a way of determining your progress in labor." c) This indicates that you start labor within the next 24 hours." d) "The presenting part is at the true pelvis and is engaged."

"The presenting part is at the true pelvis and is engaged." Correct Explanation: Zero station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the patient. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus.

The patient is having a routine prenatal visit and asks the nurse what the childbirth education teacher meant when she used the term zero station. What is the best response by the nurse? a) This indicates that you start labor within the next 24 hours." b) "This is just a way of determining your progress in labor." c) "This means +1 and the baby is entering the true pelvis." d) "The presenting part is at the true pelvis and is engaged."

"The presenting part is at the true pelvis and is engaged." Correct Explanation: Zero station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the patient. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus.

When caring for a client in the third stage of labor, the nurse anticipates expulsion of the placenta within which time frame after the birth of the newborn? a) 4-5 hours b) 3-4 hours c) 1-2 hours d) 5-30 minutes

5-30 minutes Correct Explanation: Following childbirth, the placenta is spontaneously expelled within 5-30 minutes. Delay in the expulsion of the placenta indicates some abnormality.

Dilation follows effacement in the primipara. Full dilation is a usual distance of a) 12 to 14 cm. b) 3 to 4 cm. c) 8 to 10 cm. d) 7 to 8 cm.

8 to 10 cm. Correct Explanation: Full dilation of the cervix is 8 to 10 cm.

A pregnant woman, multipara, has been in labor for several hours. She cries out that her contractions are getting harder and that she can't do this. The patient is really irritable, nauseated, annoyed, and fearful of being left alone. Considering the client's behavior, the nurse would expect the cervix to be dilated how many centimeters? a) 3-5 b) 8-10 c) 5-6 d) 0-2

8-10 Correct Explanation: The reaction of the patient is indicative of entering or being in the transition phase of labor, stage 1. The dilation would be 8-10 cm. Before that, when dilation is 0-7 cm, the patient has an easier time using positive coping skills.

The first stage of labor is often a time of introspection. In light of this, which of the following would guide your planning of nursing care? a) A woman will rarely speak or laugh during this period. b) A woman may spend time thinking about what is happening to her. c) No nursing care is needed to be done during this time. d) A woman should be left entirely alone during this period.

A woman may spend time thinking about what is happening to her. Correct Explanation: Women need a support person with them during all stages of labor.

Which of the following would be least effective in promoting a positive birth outcome for a woman in labor? a) Allowing the woman time to be alone b) Promoting the woman's feelings of control c) Providing clear information about procedures d) Encouraging the woman to use relaxation techniques

Allowing the woman time to be alone Correct Explanation: Positive support, not being alone, promotes a positive birth experience. Being alone can increase anxiety and fear, decreasing the woman's ability to cope. Feelings of control promote self-confidence and self-esteem, which in turn help the woman to cope with the challenges of labor. Information about procedures reduces anxiety about the unknown and fosters cooperation and self-confidence in her abilities to deal with labor. Catecholamines are secreted in response to anxiety and fear and can inhibit uterine blood flow and placental perfusion. Relaxation techniques can help to reduce anxiety and fear, in turn decreasing the secretion of catecholamines and ultimately improving the woman's ability to cope with labor.

When reviewing the history of a woman in labor, the nurse notes that the client has a funnel-shaped pelvis. The nurse would identify this pelvic shape as which of the following? a) Anthropoid b) Gyencoid c) Platypelloid d) Android

Android Explanation: The android pelvis is considered the male-shaped pelvis and is characterized by a funnel shape. The gynecoid pelvis is considered the true female pelvis and offers the optimal diameters in all three planes of the pelvic. An anthropoid pelvis has an oval pelvic inlet and long sacrum, producing a deep pelvis that is wider front to back than side to side. The platypelloid or flat pelvis has a shallow pelvic cavity that widens at the pelvic outlet.

The nurse should initially implement which intervention when a nulliparous woman telephones the hospital to report that she is in labor. a) Ask the woman to describe why she believes that she is in labor b) Tell the woman to stay home until her membranes rupture c) Arrange for the woman to come to the hospital for labor evaluation d) Emphasize that food and fluid should stop or be light

Ask the woman to describe why she believes that she is in labor Correct Explanation: The nurse needs further information to assist in determining if the woman is in true or false labor. She will need to ask the patient questions to seek further assessment and triage information. Having her wait until membranes rupture may be dangerous, as she may give birth before reaching the hospital. She should continue fluid intake until it is determined whether or not she is in labor. She may be in false labor, and more information should be obtained before she is brought to the hospital.

Braxton Hicks contractions are termed "practice contractions" and occur throughout pregnancy. When the woman's body is getting ready to go into labor, it begins to show anticipatory signs of impending labor. Among these signs are Braxton Hicks contractions that are more frequent and stronger in intensity. What differentiates Braxton Hicks contractions from true labor? a) Braxton Hicks contractions cause "ripening" of the cervix. b) Braxton Hicks contractions usually decrease in intensity with walking c) Braxton Hicks contractions get closer together with activity d) Braxton Hicks contractions do not last long enough to be true labor

Braxton Hicks contractions usually decrease in intensity with walking Correct Explanation: Braxton Hicks contractions occur more frequently and are more noticeable as pregnancy approaches term. These irregular, practice contractions usually decrease in intensity with walking and position changes.

There are four essential components of labor. The first is the passageway. It is composed of the bony pelvis and soft tissues. What is one component of the passageway? a) Perineum b) False pelvis c) Cervix d) Uterus

Cervix Correct Explanation: The cervix and vagina are soft tissues that form the part of the passageway known as the birth canal.

At 37 weeks gestation a patient calls the labor and delivery floor and thinks she is in labor. What statement should the nurse recognize as an assessment finding for true labor? a) Bloody mucus in the toilet once earlier in the day b) Contraction, regular and lasting longer and stronger c) Contractions, irregular, lasting 15 to 20 seconds d) Scant amount of thick white vaginal discharge, no odor

Contraction, regular and lasting longer and stronger Correct Explanation: True labor contraction will progressively get worse and last longer. The pain will come to a point where the woman will not be able to walk or talk through the contractions. Irregular contractions, bloody show, and white vaginal discharge are normal for pregnancy but do not indicate true labor.

The nurse notes that the fetal head is at the vaginal opening and does not regress between contractions. The nurse interprets this finding as which of the following? a) Descent b) Engagement c) Restitution d) Crowning

Crowning Correct Explanation: Crowning occurs when the top of the fetal head appears at the vaginal orifice and no longer regresses between contractions. Engagement occurs when the greatest transverse diameter of the head passes through the pelvic inlet. Descent is the downward movement of the fetal head until it is within the pelvic inlet. Restitution or external rotation occurs after the head is born and free of resistance. It untwists, causing the occiput to move about 45 degrees back to its original left or right position.

A nurse is performing a physical assessment of a woman in labor. As part of her assessment, she examines the outer and inner surfaces of her lips. What is the best rationale for this assessment? a) Detection of rales b) Detection of herpes virus infection c) Detection of a respiratory infection d) Detection of anemia

Detection of herpes virus infection Correct Explanation: Examine the outer and inner surfaces of her lips carefully to detect herpes lesions (pinpoint vesicles on an erythematous base). Report to her primary care provider if herpetic lesions are present anywhere because although oral lesions are invariably a type I herpes virus (common cold sores), type II (genital) herpes virus needs to be identified as this can be lethal to newborns; a woman primary health care provider may suggest the woman with oral herpes lesions take isolation precautions such as not kissing her newborn until the lesions crust. Be certain to palpate for enlargement of neck lymph nodes to detect the possibility of a respiratory infection. Inspect the mucous membrane of her mouth and the conjunctiva of her eyes for color to see if paleness suggests anemia. Auscultate the woman's lungs to be certain they are clear of rales.

When teaching a group of nursing students about the stages of labor, the nurse explains that softening, thinning, and shortening of the cervical canal occur during the first stage of labor. Which of the following terms is the nurse referring to in the explanation? a) Crowning b) Molding c) Dilatation d) Effacement

Effacement Correct Explanation: The nurse is explaining about effacement, which involves softening, thinning, and shortening of the cervical canal. Dilatation refers to widening of the cervical os from a few millimeters in size to approximately 10 cm wide. Crowning refers to a point in the maternal vagina from where the fetal head cannot recede back after the contractions have passed. Molding is a process in which there is overriding and movement of the bones of the cranial vault, so as to adapt to the maternal pelvis.

The initial descent of the fetus into the pelvis to zero station is which one of the cardinal movements of labor? a) Expulsion b) Extension c) Engagement d) Felxion

Engagement Correct Explanation: The movement of the fetus into the pelvis from the upper uterus is engagement. This is the first cardinal movement of the fetus in preparation for the spontaneous vaginal delivery. Flexion occurs as the fetus encounters resistance from the soft tissues and muscles of the pelvic floor. Extension is the state in which the fetal head is well flexed with the chin on the chest as the fetus travels through the birth canal. Expulsion occurs after delivery of the anterior and posterior shoulders.

An infant born by cesarean birth is usually able to establish respirations more easily than one born vaginally. a) True b) False

False Correct Explanation: The process of labor appears to aid in the maturation of surfactant production by alveoli in the fetal lung. Both the pressure applied to the chest from contractions and passage through the birth canal help to clear the respiratory tract of lung fluid. For this reason, an infant born vaginally is usually able to establish respirations more easily than a fetus born by cesarean birth.

What term is used to describe the position of the fetal long axis in relation to the long axis of the mother? a) Fetal lie b) Fetal position c) Fetal attitude d) Fetal presentation

Fetal lie Correct Explanation: Fetal lie describes the position of the long axis of the fetus in relation to the long axis of the pregnant woman.

A nurse performs an initial assessment of a laboring woman and reports the following findings to the primary care provider: fetal heart rate is 152 bpm, cervix is 100% effaced and 5 cm dilated, membranes are intact, and presenting part is well applied to the cervix and at -1 station. The nurse recognizes that the client is in which stage of labor? a) Third b) First, latent c) First, active d) Second

First, active Correct Explanation: Because the cervix is dilating (5 cm) and has fully effaced (100%), the woman appears to be in active labor, which is characterized by cervical dilation of 4 to 7 cm. Regular uterine contractions are effective in facilitating fetal descent through the pelvis, because the presenting part is well applied on the cervix and at -1 station. Second stage of labor begins when the cervix is 10 cm dilated. The first latent phase is characterized by the onset of regular contractions and cervical dilation of 0 to 4 cm. Third stage of labor is from birth of the infant to completed delivery of the placenta.

During a spontaneous vaginal birth several things need to occur to the fetus in sequence. As the fetus encounters resistance, what is its usual reaction? a) Flexion b) Extension c) Internal rotation d) Engagement

Flexion Explanation: As the head descends during labor, the fetus encounters resistance from the soft tissues and muscles of the pelvic floor. This resistance normally coaxes the fetus to assume an attitude of flexion. Flexion is the attitude that presents the smallest diameters of the fetal head to the dimensions of the pelvis.

A nurse is teaching a group of nursing students about the mechanism of labor when the fetus is in a cephalic presentation. Given below, in random order, are a series of events that take place in a cascade to finally deliver the baby. Arrange the series of events in the most likely sequence they occur. Flexion Extension Internal rotation Restitution External rotation

Flexion Internal rotation Extension Restitution External rotation Correct Explanation: The sequence of normal mechanism of labor involves flexion, internal rotation, extension, restitution, and external rotation. Following descent, the baby's head encounters resistance and flexes so that the chin touches the chest. During internal rotation, the occiput is rotated 45° anteriorly so as to lie beneath the symphysis pubis. The baby's neck is twisted in internal rotation. Following internal rotation, the delivery of the head is by extension. Once the head is born by extension, there is external rotation, in which it turns 45° more so that the shoulders lie anterior posteriorly.

Which type of pelvis has a roomy, round inlet and is most favorable for vaginal birth? a) Platypelloid b) Android c) Gynecoid d) Anthropoid

Gynecoid Correct Explanation: 50% of women have a gynecoid pelvis. It is considered the true female pelvis.

To deliver her infant, a woman is asked to push with contractions. Which of the following is the most effective and safest pushing technique to teach her? a) Head elevated, grasping knees, breathing out b) Squatting while holding her breath c) Lying supine with legs in lithotomy stirrups d) Lying on side, arms grasped on abdomen

Head elevated, grasping knees, breathing out Correct Explanation: An important point is to be certain the woman does not hold her breath, as this puts pressure on the vena cava, reducing blood return.

If a fetus is in an ROA position during labor, you would interpret this to mean the fetus is a) In a common breech delivery position b) In a longitudinal lie facing the left posterior c) Facing the right anterior abdominal quadrant d) Presenting with the face as the presenting part

In a longitudinal lie facing the left posterior Correct Explanation: ROA (right occiput anterior) means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part.

The nurse is teaching a prenatal class the signs and symptoms of true labor. Identify the appropriate response by the class that shows an understanding of true labor contractions. a) Cause discomfort over the top of my uterus. b) Increase even if I relax and take a shower. c) Remain irregular with the same intensity. d) Subside when I walk around and use the lateral position.

Increase even if I relax and take a shower. Correct Explanation: True labor contractions do not stop; they continue and strengthen, as well as increase in frequency. If the contractions subside while taking a shower or relaxing, then they are not labor contractions. The discomfort over the top of the uterus is normal for full term pregnancy.

The nurse is reviewing the laboratory tests results of a client in labor. Which of the following would the nurse consider a normal finding? a) Increased white blood cell count b) Increased blood coagulation time c) Increased blood glucose levels d) Decreased plasma fibrinogen levels

Increased white blood cell count Correct Explanation: The nurse should identify increased white blood cell count as the hematological change occurring in a client during labor. The increase in the white blood cell count can be attributed to physical and emotional stress during labor. During labor there could be a decrease, and not increase, in the blood coagulation time. There is an increased, and not a decreased, plasma fibrinogen level during labor. Blood glucose levels are decreased during labor.

Place the following stages of labor in order from what occurs first to last. Transition stage Latent stage Third stage Active stage Second stage

Latent stage Active stage Transition stage Second stage Third stage Explanation: The latent stage is the beginning of labor from approximately 0 cm dilated to 3 to 4 cm dilated. The active stage is from when the cervix is 4 cm dilated to 8 cm dilated. Active labor begins to become more uncomfortable for the patient and the contractions are usually stronger, longer, and closer together. Transition is approximately 8 to 10 cm. The second stage of labor is from when the patient is 10 cm dilated to delivery of the baby. The third stage of labor is from the delivery of the baby to the delivery of the placenta.

The skull is the most important factor in relation to the labor and birth process. The fetal skull must be small enough to travel through the bony pelvis. What feature of the fetal skull helps to make this passage possible? a) Caput succedaneum b) Cephalohematoma c) Vertex presentation d) Molding

Molding Correct Explanation: The cartilage between the bones allows the bones to overlap during labor, a process called molding that elongates the fetal skull thereby reducing the diameter of the head.

A 37-year-old woman in the final weeks of her first pregnancy visits the doctor's office for a scheduled check-up. What might a nurse note as a sign of labor in speaking with the woman prior to the examination? a) Dilation b) Nesting c) Effacement d) Ripening of the cervix

Nesting Correct Explanation: Nesting is the activity or burst of energy women often experience prior to the onset of labor. The patient could express this in her words or by what her activities had been at home. Dilation, effacement and cervical ripening are all observable by the provider on exam.

Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that the presenting part is which of the following? a) Shoulders b) Buttocks c) Occiput d) Brow

Occiput Correct Explanation: With a vertex presentation, a type of cephalic presentation, the fetal presenting part is the occiput. The shoulders are the presenting part when the fetus is in a shoulder presentation. The brow or sinciput is the presenting part when a fetus is in a brow presentation. The buttocks are the presenting part when a fetus is in a breech presentation.

A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? a) Pain from the dilation or stretching of the cervix b) Pressure on the lower back, buttocks, and thighs c) Hypoxia of the contracting uterine muscles d) Distention of the vagina and perineum

Pain from the dilation or stretching of the cervix Correct Explanation: In the first stage of labor, the primary source of pain is the dilation of the cervix. Hypoxia of the contracting uterine muscles, distension of the vagina and perineum, and pressure on the lower back, buttocks, and thighs may occur in the first stage but are more significantly associated with the second stage of labor.

A client in labor has been admitted to the labor and birth suite. The nurse assessing her notes that the fetus is in a cephalic presentation. Which of the following should the nurse identify by the term presentation? a) Relation of the different fetal body parts to one another b) Relationship of the presenting part to the maternal pelvis c) Part of the fetal body entering the maternal pelvis first d) Relation of the fetal presenting part to the maternal ischial spine

Part of the fetal body entering the maternal pelvis first Correct Explanation: The term presentation is the part of the fetal body that is entering the maternal pelvis first. Relationship of the presenting part to the sides of the maternal pelvis is called the position. Attitude is the term that describes the relation of the different fetal body parts to one another. Relation of the fetal presenting part to maternal ischial spine is termed the station

The five "P's" of labor are a) Passenger, Posture, Position, Presentation, Psych b) Passageway, Passenger, Position, Powers, Psych c) Passenger, Position, Powers, Presentation, Psych d) Passenger, Position, Presentation, Pushing, Psych

Passageway, Passenger, Position, Powers, Psych Correct Explanation: The five "P's" are Passageway (birth canal), Passenger (fetus and placenta), Position (maternal), Powers (contractions), and Psych (maternal psychological response).

When going through the transition phase of labor women often feel out of control. What do women in the transition phase of labor need? a) Just to be left alone b) Positive reinforcement c) Intense nursing care d) Their significant other beside them

Positive reinforcement Correct Explanation: Any women, even ones who have had natural childbirth classes, have a difficult time maintaining positive coping strategies during this phase of labor. Many women describe feeling out of control during this phase of labor. A woman in transition needs support, encouragement, and positive reinforcement.

A client you care for in labor asks you what causes labor to begin. Which of the following statements is a possible explanation? a) Progesterone levels rise at term to initiate contractions b) The ovary releases additional estrogen at term c) Prostaglandins may be the causative factor of labor d) Calcium is drawn from bones to block relaxation fibers

Prostaglandins may be the causative factor of labor Correct Explanation: The cause of labor is unknown, but prostaglandin release is theoretically one of the possible causes for onset of labor. It is unknown whether progesterone, estrogen, or calcium has any effect on labor.

A 32-year-old woman presents to the labor-and-delivery suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus? a) ROA b) LOP c) ROP d) LOA

ROA Correct Explanation: Document the fetal position in the clinical record using abbreviations (Box 8-1). The first letter describes the side of the maternal pelvis toward which the presenting part is facing ("R" for right and "L" for left). The second letter or abbreviation indicates the reference point ("O" for occiput, "Fr" for frontum, etc.). The last part of the designation specifies whether the presenting part is facing the anterior (A) or the posterior (P) portion of the pelvis, or whether it is in a transverse (T) position.

A pregnant woman comes to the emergency department because she thinks she is in labor. The nurse determines that the client is in true labor when assessment of contractions reveals which of the following? a) Lasting about 20 to 30 seconds b) Occurring in an irregular pattern c) Radiating to the front of the abdomen from the back d) Slowing when the woman changes position

Radiating to the front of the abdomen from the back Correct Explanation: Contractions that begin in the back and then radiate to the front are typical of true labor. Contractions that slow when a woman walks or changes position suggest false labor, as do irregular contractions. Contractions lasting 30 seconds or less commonly suggest Braxton-Hicks contractions and are associated with false labor.

When teaching a group of nursing students about uterine contractions, which of the following would the instructor include as a typical feature? a) Retracting of the lower segment b) Contracting stronger in the lower segment c) Thinning out of the upper segment d) Pulling down of the cervical portion

Retracting of the lower segment Correct Explanation: The nurse should identify retraction of the lower segment of the uterus as a feature of typical uterine contractions. As labor progresses the uterine contractions become stronger. The upper segment of the uterus contracts more actively than the lower segment. The lower segment retracts, pulling up the cervix. The upper segment thickens with time and the lower segment thins.

A nurse is performing a vaginal examination of a woman in the early stages of labor. The woman has been at 2 cm dilated for the past 2 hours, but effacement has progressed steadily. Which of the following should the nurse do to best encourage the client regarding her progress? a) Say, "there has been no further dilatation; effacement is progressing." b) Say, "you haven't dilated any further, but hang in there; it will happen eventually." c) Don't mention anything to the client yet; wait for further dilatation to occur. d) Say, "you are still 2 cm dilated, but the cervix is thinning out nicely."

Say, "you are still 2 cm dilated, but the cervix is thinning out nicely." Correct Explanation: Women are anxious to have frequent reports during labor, to reassure them everything is progressing well. If giving a progress report, remember most women are aware of the word dilatation but not effacement. Just saying, "no further dilatation", therefore, is a depressing report. "You're not dilated a lot more, but a lot of thinning is happening and that's just as important" is the same report given in a positive manner.

The laboring patient is having contractions every 2-3 minutes, lasting 45-60 seconds and of strong intensity. The fetal head crowns when the client pushes. The cervix is completely dilated (10 centimeters) and 100 percent effaced. The nurse assesses the patient to be in what stage or phase of labor? a) Active b) Transition c) Third d) Second

Second Explanation: The second stage of labor is between full dilatation and delivery of the infant. This woman has completed transition and is in the second stage of labor. The third stage begins with the birth of the baby and ends with delivery of the placenta. The active phase begins at 4 cm cervical dilation and ends when the cervix is dilated 8 cm.

In preparing for the actual birth, which fetal presentation would a nurse be least likely to find? a) Shoulder b) Breech c) Oblique lie d) Transverse lie

Shoulder Explanation: Shoulder presentations are the least likely to occur in less than 0.3 percent of all births. Approximately 97 percent of fetuses are in a cephalic presentation at the end of pregnancy. A longitudinal lie, in which the long axis of the fetus is parallel to the long axis of the mother, is the most common. When the fetus is in a transverse lie, the long axis of the fetus is perpendicular to the long axis of the woman. An oblique lie is in between the two.

A pregnant woman calls her provider's office to report she thinks she is in labor. The patient reports contractions have been at these times: 12:05, 12:10, 12:15, and 12:20. What information is gathered based on this data? a) The contractions are increasing in duration and frequency b) The frequency of the contractions is every 5 minutes c) Nothing useful about the client's contractions d) The duration of the contractions is every 5 minutes

The frequency of the contractions is every 5 minutes Correct Explanation: Based on the information, the nurse knows the contractions are regular and every 5 minutes apart. This is the only data gathered based on the information given, but it is very useful to the provider.

A post delivery CBC has noted an elevated WBC count of 22,000/mm3. Which rationale is accurate regarding the elevated WBC count? a) Abnormal finding and she needs antibiotics b) Might be a false result, recommend re-testing c) Occurs in patients who have cesarean birth, from the trauma of surgery d) This is a normal variation due to stress of labor

This is a normal variation due to stress of labor Correct Explanation: An elevation of WBC up to 30,000mm/3 can be normal variation for any woman after delivery. This is related to the stress on her body from labor and delivery. Antibiotics are not indicated as this is a normal response to intense stress. The increase in WBC is not related to cesarean birth. Retesting would be wasteful as it is known that this is a normal response to any stress.

A woman is in the second stage of labor and is crowning. Which diameter of the fetal skull, which is the smallest, should align with the anteroposterior diameter of the mother's pelvis, which is the narrowest diameter at the pelvic inlet? a) Occipitomental b) Occipitofrontal c) Transverse (biparietal) d) Suboccipitobregmatic

Transverse (biparietal) Explanation: The anteroposterior diameter of the pelvis, a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet so the best presentation for birth is when the fetus presents a transverse (biparietal) diameter (the narrowest fetal head diameter, at 9.25 cm) to this. The other diameters of the fetal skull that are listed are all larger.

A nurse is assisting a client who is in the first stage of labor. Which of the following principles should the nurse keep in mind to help make this client's labor and birth as natural as possible? a) Women should be able to move about freely throughout labor b) Routine intravenous fluid should be implemented c) The support person's access to the client should be limited to prevent the client from becoming overwhelmed d) A woman should be allowed to assume a supine position

Women should be able to move about freely throughout labor Correct Explanation: Six major concepts that make labor and birth as natural as possible are as follows: 1) labor should begin on its own, not be artificially induced; 2) women should be able to move about freely throughout labor, not be confined to bed; 3) women should receive continuous support from a caring other during labor; 4) no interventions such as intravenous fluid should be used routinely; 5) women should be allowed to assume a nonsupine position such as upright and side-lying for birth; and 6) mother and baby should be housed together after the birth, with unlimited opportunity for breast-feeding.

During the second stage of labor, a woman is generally a) turning inward to concentrate on body sensations. b) anxious to have people around her. c) no longer in need of a support person. d) very aware of activities immediately around her.

turning inward to concentrate on body sensations. Correct Explanation: Second-stage contractions are so unusual that most women are unable to think of things other than what is happening inside their body.

A nurse is caring for a client in her fourth stage of labor. Which of the following assessments would indicate normal physiologic changes occurring during the fourth stage of labor? Select all that apply. a) Well-contracted uterus in the midline b) Decrease in the pulse rate c) Mild uterine cramping and shivering d) Decreased intra-abdominal pressure e) Increase in the blood pressure

• Decreased intra-abdominal pressure • Well-contracted uterus in the midline • Mild uterine cramping and shivering Explanation: The normal physiologic changes for which a nurse should assess during the fourth stage of labor are a well-contracted uterus in the midline of the abdomen, mild cramping pain and generalized shivering, and decreased intra-abdominal pressure. Hemodynamic changes are due to normal blood loss during delivery, causing moderate tachycardia and a slight fall in the blood pressure during the fourth stage of labor. A fall in the pulse rate and increased blood pressure are not normal findings occurring during the fourth stage of labor.

When teaching a group of nursing students about the different types of pelvis, the nurse describes which of the following as the features of a gynecoid pelvis? Select all that apply. a) Dull ischial spines b) Straight sacrum c) Convergent side walls d) Round-shaped inlet e) Wide pubic arch

• Dull ischial spines • Round-shaped inlet • Wide pubic arch Correct Explanation: The features of a gynecoid pelvis are oval-shaped inlet, dull ischial spines, and wide pubic arch. The birth of a baby is easiest in a gynecoid pelvis. Straight sacrum and convergent side walls are seen in an android pelvis.

A nurse is caring for a client in her third stage of labor. Which of the following would the nurse assess as indicating placental separation? Select all that apply. a) Renewed bearing down efforts by client b) Fresh gushing of blood from the vagina c) Falling downward of uterus in the abdomen d) A relaxed and distended uterus e) Umbilical cord descending lower down

• Renewed bearing down efforts by client • Fresh gushing of blood from the vagina • Umbilical cord descending lower down Correct Explanation: The signs of placental separation include a fresh gush of blood from the vagina, lengthening of the umbilical cord, and renewed bearing-down efforts by the client. When the client is in her third stage of labor, these indicate placental separation. A rising upwards of the uterus and a well-contracted globular uterus are the other signs of placental separation. Falling downward of the uterus in the abdomen and a relaxed uterus are the signs of uterine atony.

A client is in the transitional phase of labor. Which of the following would the nurse most likely find? Select all that apply. a) Cervical effacement of 70% b) Strong desire to push c) Irritability with restlessness d) Contractions occurring every 3 minutes e) Apprehension mixed with excitement f) Cervical dilation of 6 cm

• Strong desire to push • Irritability with restlessness Explanation: A strong desire to push occurs most often in the transitional phase of the first stage of labor. During this phase the woman commonly experiences increased apprehension and irritability with restless movements and feelings of loss of control and being overwhelmed. Cervical dilation from 4 to 7 cm characterizes the active phase of the first stage of labor. Contractions occurring every 2 to 5 minutes are associated with the active phase of the first stage of labor. The woman in the early or latent phase of the first stage of labor often is filled with apprehension but is excited about the start of labor. During the active phase of the first stage of labor, cervical effacement of 40% to 80% occurs.