OB Chapter 13 Labor and Delivery
A client gave birth to a child 3 hours ago and noticed a triangular-shaped gap in the bones at the back of the head of her newborn. The attending nurse informs the client that it is the posterior fontanelle. The client is anxious to know when the posterior fontanelle will close. Which time span is the normal duration for the closure of the posterior fontanelle? 14 to 8 weeks 4 to 6 weeks 8 to 12 weeks 12 to 14 weeks
8 to 12 weeks
When caring for a client in the third stage of labor, the nurse notices that the expulsion of the placenta has not occurred within 5 minutes after birth of the infant. What should the nurse do? 1) Increase the IV tocolytic to help in expulsion of the placenta. 2) Do a vaginal exam to see if the placenta is stuck in the birth canal. 3) Nothing. Normal time for stage three is 5 to 30 minutes. 4) Notify the primary care provider of the problem.
Nothing. Normal time for stage three is 5 to 30 minutes. Explanation: Following birth, the placenta is spontaneously expelled within 5 to 30 minutes, so there is no problem with this client. No further interventions are needed.
Place the cardinal movements of labor in the order in which they occur from first to last. All options must be used. 1) extension 2) expulsion 3) internal rotation 4) flexion 5) engagement, then descent 6) external rotation
engagement, then descent flexion internal rotation extension external rotation expulsion
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?
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.
When teaching a group of nursing students about uterine contractions, the instructor would include which typical feature? 1) thinning out of the upper segment 2) contracting stronger in the lower segment 3) retracting of the lower segment 4) pulling down of the cervical portion
retracting of the lower segment 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 caring for a woman in labor and understands that as the fetus travels through the birth canal, the fetus makes positional changes. List the cardinal movements of labor in the correct order that the nurse would expect the fetus to move. All options must be used. 1) explusion 2) extension 3) internal rotation 4) flexion 5) engagement
engagement flexion internal rotation extension explusion Explanation: The cardinal movements of labor describe the positional changes the fetus goes through as it travels through the passageway. They are deliberate, specific, and very precise that allow the smallest diameter of the fetal head to pass through a corresponding diameter of the mother's pelvic structure. They are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
The third stage of labor is considered to be expulsion of the placenta. This stage can last anywhere from five to 20 minutes. What is a sign that the placenta is separating from the wall of the uterus? 1) expulsion of blood clots 2) globular shape to the fundus 3) shortening of the umbilical cord 4) firm fundus
globular shape to the fundus Explanation: Signs that indicate the placenta is separating from the uterine wall include a gush of blood, lengthening of the umbilical cord, and a globular shape to the fundus.
A new OB/GYN care provider has just finished evaluating her one hundredth client. In reviewing the documentation from all clients thus far, which types of pelvis would the nurse assume the care provider has seen the most and the least? 1) anthropoid and gynecoid, respectively 2) gynecoid and platypelloid, respectively 3) gynecoid and android, respectively 4) android and platypelloid, respectively
gynecoid and platypelloid, respectively Explanation: The gynecoid is the typical female pelvis shape; platypelloid pelvis is the least common type of pelvis in women. Women with anthropoid pelvic shapes are able to give birth normally one third of the time and are somewhat rare. An android pelvis is similar to a male pelvis and is seen in 16% of nonwhite women.
A client is in the transitional phase of labor. Which findings would the nurse expect? Select all that apply. 1) irritability with restlessness 2) cervical dilation of 6 cm contractions occurring every 3 minutes 3) strong desire to push 4)cervical effacement of 70% 5) apprehension mixed with excitement
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.
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 statement by the nurse would best encourage the client regarding her progress? 1) "There has been no further dilatation; effacement is progressing." 2) Don't mention anything to the client yet; wait for further dilatation to occur. 3) "You haven't dilated any further, but hang in there; it will happen eventually." 4) "You are still 2 cm dilated, but the cervix is thinning out nicely."
"You are still 2 cm dilated, but the cervix is thinning out nicely." 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 nurse should initially implement which intervention when a nulliparous woman telephones the hospital to report that she is in labor? 1)Tell the woman to stay home until her membranes rupture. 2) Ask the woman to describe why she believes that she is in labor. 3) Emphasize that food and fluid should stop or be light. 4) Arrange for the woman to come to the hospital for labor evaluation.
Ask the woman to describe why she believes that she is in labor. 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 client 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.
Labor can be indicated by which occurrence? 1) The client reports back pain, and the cervix is effacing and dilating. 2) After walking for an hour, the contractions have not fully subsided. 3) The contraction pains have been present for 5 hours, and the patterns are regular. 4)The contraction pains are 2 minutes apart and 1 minute in duration.
The client reports back pain, and the cervix is effacing and dilating. Explanation: True labor is indicated when the cervix is changing. Contractions occur for weeks before true labor, and may occur close together. Contractions may also occur for a long time before true labor begins.
A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply. 1) contractions every 90 seconds 2) cervical dilation of 6 cm 3) contractions every 2 to 3 minutes 4) cervical effacement of 90% strong desire to push
cervical dilation of 6 cm contractions every 2 to 3 minutes Explanation: During the active phase, the cervix usually dilates from 4 to 7 cm, with 40% to 80% effacement taking place. Contractions become more frequent (every 2 to 5 minutes) and increase in duration (45 to 60 seconds). Contractions occurring every 90 seconds, a cervical effacement of 90%, and a strong desire to push signify the transition phase.
Which type of pelvis has a roomy, round inlet and is most favorable for vaginal birth? 1) android 2) platypelloid 3) anthropoid 4) gynecoid
gynecoid Explanation: The gynecoid pelvis considered the true female pelvis. Its room, round inlet makes it favorable for vaginal birth.
A nurse is conducting a presentation for a group of pregnant women about labor and the importance of being well prepared and having good labor support. The nurse determines that additional discussion is needed when the group identifies which possible outcome as the result of being prepared? 1) less likely to need anesthesia 2) unlikely to require cesarean birth 3) less likely to need analgesia 4) need for someone to control the situation
need for someone to control the situation Explanation: Prenatal education teaches the woman about the birth experience and increases her sense of control. An increasing body of evidence indicates that the well-prepared woman, with good labor support, is less likely to need analgesia or anesthesia and is unlikely to require cesarean birth.
In preparing for the actual birth, which fetal presentation would a nurse be least likely to find? 1) transverse lie 2) shoulder 3) breech 4) oblique lie
shoulder Explanation: Shoulder presentations are the least likely to occur. The 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 multigravid client has been in labor for several hours and is becoming anxious and distressed with the intensity of her frequent contractions. The nurse observes moderate bloody show and performs a vaginal examination to assess the progress of labor. The cervix is 9 cm dilated. The nurse knows that the client is in which phase of labor? 1) active phase 2) transition phase 3) early phase 4) latent phase
transition phase Explanation: The woman is likely in transitional labor (first stage, transition phase) as evidenced by her increasing anxiety and distress, intense frequent contractions, and cervical dilation of 9 cm. The amount of bloody show indicates remarkable cervical changes. Cervical dilation in the transition phase is 8 to 10 cm. The latent and early phase is the same phase of labor in the first stage and characterized by positive coping, mild contractions, and cervical dilation of 1 to 4 cm. The active phase is characterized by increased anxiety but cervical dilation of 4 to 7 cm.
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 Explanation: The nurse should document the fetal position in the clinical record using abbreviations. 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.
The nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2020 related to women in labor? 1) Encourage women with previous cesareans to always have a cesarean. 2) Reduce the rate of cesarean births among low-risk births. 3) Ensure care during labor includes immunizations. 4) Ensure all couples receive preconceptional genetic counseling.
Reduce the rate of cesarean births among low-risk births. Explanation: Healthy People 2020 has two goals related to cesarean births in the United States. They are to reduce the rate of cesarean births among low-risk women and reduce the rate of cesarean births among women who have had a prior cesarean birth. Immunizations and genetic counseling are not associated with women in labor.
A pregnant woman calls her provider's office to report she thinks she is in labor. The client reports contractions have been fairly strong and at these times: 12:05, 12:10, 12:15, and 12:20. What information is gathered based on this data? 1) The frequency of the contractions is every 5 minutes. 2) The contractions are increasing in duration and frequency. 3) The duration of the contractions is every 5 minutes. 4) There is no useful information about the client's contractions.
The frequency of the contractions is every 5 minutes. 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.
During a prenatal visit a pregnant client asks the nurse how to tell whether the contractions she is having are true contractions or Braxton Hicks contractions. Which description should the nurse mention as characteristic of true contractions? 1) often disappear with ambulation or sleep 2) begin and remain irregular 3) increase in duration, frequency, and intensity 4) felt first in lower back and sweep around to the abdomen in a wave 5) begin irregularly but become regular and predictable 6) felt first abdominally and remain confined to the abdomen and groin
begin irregularly but become regular and predictable felt first in lower back and sweep around to the abdomen in a wave increase in duration, frequency, and intensity Explanation: True contractions begin irregularly but become regular and predictable; are felt first in the lower back and sweep around to the abdomen in a wave; continue no matter what the woman's level of activity; increase in duration, frequency, and intensity; and achieve cervical dilatation. False (Braxton Hicks) contractions begin and remain irregular; are felt first abdominally and remain confined to the abdomen and groin; often disappear with ambulation or sleep; do not increase in duration, frequency, or intensity; and do not achieve cervical dilatation.
After teaching a pregnant client who is in her last weeks of pregnancy about the signs and symptoms of approaching labor, which signs or symptoms if identified by the client would indicate effective teaching? Select all that apply. 1) weight gain 2) bloody show 3) lightening 4) backache 5) constipation
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 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 finding? 1) radiating to the front of the abdomen from the back 2) occurring in an irregular pattern 3) lasting about 20 to 30 seconds 4) slowing when the woman changes position
radiating to the front of the abdomen from the back 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
Which phase of the involuntary uterine contraction pattern should the nurse be observing that is beneficial to the pH of the fetal scalp? 1) acme 2) decrement 3) relaxation 4) increment
relaxation Explanation: The relaxation phase of uterine contractions is the time in which the fetus has a break. This time needs to be observed, and it is beneficial for the fetus to have a break. The three phases of a uterine contraction are the increment (building up in intensity), acme (peak intensity), and decrement (decreasing intensity).