OB - Chapter 14

When assessing fetal heart rate patterns, which of the following would alert the nurse to a possible problem? a) Prolonged decelerations b) Variable decelerations c) Accelerations d) Early decelerations

Prolonged decelerations

A nurse is serving as a doula to a client who is now in labor at an alternative birthing center. The client has opted for a water birth, and the nurse is now drawing the water into a large tub. What temperature should the nurse keep the water at? a) 41°C b) 39°C c) 37°C d) 35°C

37°C

What is the primary role of the nurse in pain management for a nurse working with labor patients? a) Work with the labor patient to plan pain management options b) Provide any medication the patient request c) Dictate the pain management during labor for the best outcome d) Monitor the patient for active labor and suggest she have an epidural to have increased satisfaction with her delivery experience

Work with the labor patient to plan pain management options

A woman states that she does not want any medication for pain relief during labor. Her doctor has approved this for her. What is your best response to her concerning this choice? a) "That's wonderful. Medication during labor is not good for the baby." b) "I respect your preference whether it is to have medication or not." c) "Let me get you something for relaxation if you don't want anything for pain." d) "Your doctor (a man) has never been in labor; he may be underestimating the pain you will have."

"I respect your preference whether it is to have medication or not."

A woman who has just been admitted in labor indicates that her husband is parking the car and her doula is on her way. The nurse's best response would be a) "I'm sorry, but we allow only one other person in the labor room with you at a time." b) "OK, let me ask you some personal questions before she arrives." c) "That's great. Do you want her in the room when you deliver?" d) "OK, great. Once she gets here, I'll be able to spend more time with my other patients."

"OK, let me ask you some personal questions before she arrives."

Opioids are often used in labor for pharmacologic pain management. A patient in the transition phase of labor is requesting fentanyl (Sublimaze) for pain. How should the nurse respond to her request? a) "I will page the provider and ask for your pain medication." b) "Pain medication given now might cause the baby to have slow respirations and is not recommended, let's try to focus and breathe." c) "Rather than use fentanyl, we can ask the provider to order another analgesic at this point." d) "You are so close to delivery; don't you want to have natural child birth?"

"Pain medication given now might cause the baby to have slow respirations and is not recommended, let's try to focus and breathe."

A woman refuses to have an epidural block because she does not want to have a spinal headache after delivery. Which of the following would be your best response? a) "Spinal headache is not a usual complication of epidural blocks." b) "The anesthesiologist will do her best to avoid this." c) "The pain relief offered will compensate for the discomfort afterward." d) "Your doctor knows what is best for you."

"Spinal headache is not a usual complication of epidural blocks."

A client in labor has requested the administration of narcotics to reduce pain. At 2 cm cervical dilatation, she says that she is managing the pain well at this point but does not want it to get ahead of her. Which of the following should the nurse do? a) Refuse to administer narcotics, because they can develop dependency in the client and the fetus b) Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor c) Explain to the client that narcotics should only be administered an hour or less before birth d) Agree with the client and administer the drug immediately to keep the pain manageable

Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor

A 30-year-old G2P0010 has been in labor for 10 hours and is 6 cm dilated. She has already expressed a desire to use nonpharmacologic pain management techniques. For the past hour, she has been lying in bed with her doula rubbing her back. Now, she has begun to moan loudly, grit her teeth, and bear down with each contraction. She rates her pain as 8/10 with each contraction. What should the nurse do first? a) Prepare the patient for an epidural. b) Assess for labor progression. c) Assist the patient in ambulating to the bathroom. d) Instruct the patient to do slow-paced breathing.

Assess for labor progression

The labor patient is prepared for natural childbirth and has brought with her a picture to use as her object for imagery during labor. What type of nonpharmacological pain management is this considered? a) Relaxation technique b) Continuous labor support c) Hypnosis d) Attention focusing

Attention focusing

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: a) Dilatation of cervix b) Bloody show c) Rupture of amniotic membranes d) Engagement of fetus

Dilatation of cervix

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: a) Therapeutic touch b) Patterned breathing c) Acupressure d) Effleurage

Effleurage

A client in the first stage of labor is admitted to a health care center. The nurse caring for the client instructs her to rock on a birth ball. The nurse informs her that this causes the release of certain natural substances, which reduces the pain. To which of the following substances is the nurse referring? a) Endorphins b) Prostaglandins c) Relaxin d) Progesterone

Endorphins

During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus how often? a) Every 10 minutes b) Every 5 minutes c) Every 15 minutes d) Every 20 minutes

Every 15 minutes

If a fetus were not receiving enough oxygen during labor because of uteroplacental insufficiency, which of the following patterns would you anticipate seeing on the monitor? a) Fetal heart rate declining late with contractions and remaining depressed b) Fetal baseline rate increasing at least 5 mm Hg with contractions c) Variable decelerations, too unpredictable to count d) A shallow deceleration occurring with the beginning of contractions

Fetal heart rate declining late with contractions and remaining depressed

A client in active labor is given spinal anesthesia. Which of the following would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? a) Excessive contractions of the uterus b) Passage of the drug to the fetus c) Headache following anesthesia d) Increased frequency of micturition

Headache following anesthesia

If the monitor pattern of uteroplacental insufficiency were present, which of the following would you do first? a) Ask her to pant with the next contraction. b) Help the woman to sit up in a semi-Fowler's position. c) Administer oxygen at 3 to 4 L by nasal cannula. d) Turn her or ask her to turn to her side.

Help the woman change positions

The nurse is assisting Monica through labor, monitoring her closely, now that she has received an epidural. The nurse would report which finding to the anesthesiologist? a) Inability to push b) Dry, cracked lips c) Urinary retention d) Rapid progress of labor

Inability to push

The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: a) Right upper quadrant b) Right lower quadrant c) Left upper quadrant d) Left lower quadrant

Left lower quadrant

A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly? a) Above the level of the maternal umbilicus b) At the level of the maternal umbilicus c) Just below the maternal umbilicus d) Lower quadrant of the maternal abdomen

Lower quadrant of the maternal abdomen

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? a) Neonatal depression b) Woman is more sensitive to pre-anesthetic medications c) Fetal hypersensitivity to anesthetic d) Woman is less sensitive to inhalation anesthetics

Neonatal depression

You are the nurse preparing an educational event for pregnant women on the topic of labor pain and delivery. You know that you will need to include the origin of labor pain for each stage of labor. What information will you present for the first stage of labor? a) Diffuse abdominal pain signals a complication with progression of labor b) It is reported as the worst pain you will ever feel c) Pain is focal in nature d) Pain originates from the cervix and lower uterine segment

Pain originates from the cervix and lower uterine segment

You are the nurse preparing an educational event for pregnant women on the topic of labor pain and delivery. You know that you will need to include the origin of labor pain for each stage of labor. What information will you present for the first stage of labor? a) It is reported as the worst pain you will ever feel b) Diffuse abdominal pain signals a complication with progression of labor c) Pain is focal in nature d) Pain originates from the cervix and lower uterine segment

Pain originates from the cervix and lower uterine segment

A pregnant client is admitted with vaginal bleeding. The nurse performs a nitrazine test to confirm that the membranes have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5 and 6. What does this indicate? a) Membranes have ruptured b) Presence of vaginal fluid c) Presence of excess blood d) Presence of amniotic fluid

Presence of vaginal fluid

A client administered combined spinal-epidural analgesia is showing signs of hypotension and associated fetal heart rate (FHR) changes. What interventions should the nurse perform to manage the changes? a) Turn client to her left side. b) Assist client to a supine position. c) Provide supplemental oxygen. d) Discontinue intravenous (IV) fluid.

Provide supplemental oxygen.

Which of the following signs signify that the second stage of labor has begun? a) Emotions are calm and happy b) The urge to push occurs c) Fetus is a -1 station d) Frequency of contractions are 5-6 minutes

The urge to push occurs

The laboring patient who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. Identify the appropriate rationale for this practice. a) This would cause fetal depression in utero. b) The effects would wear off before delivery. c) This may prolong labor and increase complications. d) This can lead to maternal hypertension.

This may prolong labor and increase complications.

What is the most important thing that you can do during labor and delivery to prevent maternal and fetal infection? a) Clean the woman's perineum with a Betadine scrub b) Thoroughly wash your hands before and after patient contact c) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum d) Strictly follow universal precautions

Thoroughly wash your hands before and after patient contact

What is the most important thing that you can do during labor and delivery to prevent maternal and fetal infection? a) Strictly follow universal precautions b) Remove soiled drapes and linen; place an absorbent pad under the buttocks and two sterile perineal pads against the perineum c) Thoroughly wash your hands before and after patient contact d) Clean the woman's perineum with a Betadine scrub

Thoroughly wash your hands before and after patient contact

To assess the frequency of a woman's labor contractions, you would time a) the beginning of one contraction to the beginning of the next. b) the end of one contraction to the beginning of the next. c) how many contractions occur in 5 minutes. d) the interval between the acme of two consecutive contractions.

the beginning of one contraction to the beginning of the next.

Choice Multiple question - Select all answer choices that apply. The nurse encourages a woman in labor to ambulate based on the understanding that it helps with which of the following? Select all that apply. a) Encourages rotation of the fetus b) Enlists the aid of gravity to move the fetus c) Helps the fetus line up with the angle of the pelvis d) Widens one side of the pelvis e) Increases the urge to push during the second stage f) Enhances the effectiveness of contractions

• Enlists the aid of gravity to move the fetus • Enhances the effectiveness of contractions • Increases the urge to push during the second stage • Encourages rotation of the fetus • Helps the fetus line up with the angle of the pelvis

After administration of epidural anesthesia during labor, the patient develops a temperature of 100.1F. The patient's husband is asking if she is "getting sick". How should the nurse respond to the patient and her husband? a) "Can you tell me if you have been exposed to any illnesses you might be developing?" b) "This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour." c) "We will have to take her temperature every 30 minutes and might start antibiotics." d) "Due to the length of your labor, you might be dehydrated and that may cause your temperature to rise, let's get you something to drink."

"This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour."

A woman at 39 weeks gestation has been in labor for 8 hours and is asking how far she is dilated, she attended child birth classes and is aware of the stages and phases of labor. She had a vaginal exam 30 minutes prior to her asking again. How should the nurse respond to her question? a) "The health care provider will have to check you, we can call them." b) "I can arrange for a cervix check, if you want." c) "Checking your cervix will not speed up labor, let's wait." d) "Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again."

"Your labor signs have not changed; we are looking for changes in your labor pattern before we check you again."

The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this form of therapy as which of the following? a) Acupressure b) Biofeedback c) Effleurage d) Acupuncture

Acupressure

The nurse caring for a client in preterm labor observes nonreassuring fetal heart rate (FHR) patterns. Which of the following nursing interventions should the nurse perform? a) Tactile stimulation b) Fetal scalp stimulation c) Application of vibroacoustic stimulation d) Administration of oxygen by mask

Administration of oxygen by mask

Marie, a 21-year-old first-time mother in the second stage of labor, has been moaning and screaming and generally vocal throughout her labor. Her husband is distraught seeing his wife this way and comes to the nurse asking that his wife receive more pain medication. How should the nurse respond? a) Reassure the first-time father that Marie will be fine and offer to stay with her while he takes a walk b) Page the obstetrician to evaluate Marie's pain and administer an appropriate increase in her pain medication c) Assist Marie with breathing and imagery techniques in an attempt to calm her down d) Ask Marie to describe the intensity of her pain on a scale of 0 to 10

Ask Marie to describe the intensity of her pain on a scale of 0 to 10

The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as which of the following? a) Fetal bradycardia b) Baseline FHR c) Baseline variability d) Short-term variability

Baseline FHR

A nurse is monitoring the FHR of a client in labor using an electronic fetal monitor. The reading shows a late deceleration. Which of the following interventions should the nurse implement? a) Administer exogenous oxytocin b) Change maternal position to an upright or side lying position c) Place the client in the lithotomy position d) Encourage the Valsalva maneuver

Change maternal position to an upright or side lying position

The nurse is assessing a woman in active labor. She notes a small mass above the symphysis pubis, rounded and distended, non-tender. What intervention should the nurse take next? a) Check the chart for the last void b) Assume this is part of the uterus c) Ask the patient if the mass has always been present d) Notify a physician about the mass

Check the chart for the last void

Which of the following would be the best way the nurse can facilitate an effective birth plan for the patient to achieve adequate pain relief? a) The client has the baby without any analgesic or anesthetic b) The health care provider decides the best pain relief for the mother and family c) Client priorities and preferences are incorporated into the plan d) The nurse prescribes alternative methods of pain relief

Client priorities and preferences are incorporated into the plan Correct

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: a) Dilatation of cervix b) Rupture of amniotic membranes c) Engagement of fetus d) Bloody show

Dilatation of cervix

As a woman enters the second stage of labor, which of the following would you expect to assess? a) Expressions of satisfaction with her labor progress b) Complaints of feeling hungry and unsatisfied c) Feelings of being frightened by the change in contractions d) Falling asleep from exhaustion

Feelings of being frightened by the change in contractions

A nurse is teaching a couple about patterned breathing during their childbirth education. Which of the following techniques should the nurse suggest for slow-paced breathing? a) Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. b) Punctuated breathing by a forceful exhalation through pursed lips every few breaths. c) Hold breath for 5 seconds after every 3 breaths. d) Inhale slowly through nose and exhale through pursed lips.

Inhale slowly through nose and exhale through pursed lips.

The pain of labor is influenced by many factors. What is one of these factors? a) Woman has a high tolerance for pain b) Woman has lots of visitors during labor c) Woman's preparation for labor and delivery d) Woman has a high threshold for pain

Woman's preparation for labor and delivery