OB Exam #4 prep
When assessing the following women, which would the nurse identify as being at the greatest risk for preterm labor? A. Woman who had twins in a previous pregnancy B. Client living in a large city close to subway C. Woman working full-time as a computer programmer D. Client with a history of previous preterm birth
D. Client with history of previous preterm birth Women with a history of preterm birth are at the highest risk for the same in subsequent pregnancies. Having had twins previously would have no bearing on this singleton pregnancy to influence preterm labor. Location of residence is not a risk for preterm labor. The woman's occupation as a computer programmer would not increase her risk of preterm labor. However, standing for long periods in a work environment might increase her risk.
After a vaginal exam, the nurse determines that the client's fetus is in an occiput posterior position. The nurse would anticipate that the client will have: A. Intense back pain B. Frequent leg cramps C. Nausea and vomiting D. Precipituous birth
A. Intense back pain Having a fetus in a posterior position would cause intense back pain secondary to the fetal head facing the maternal vertebra and causing pressure. Leg cramps are common during pregnancy and not caused by an occiput posterior position, but rather pressure from the heavy gravid uterus toward term. Fetal position would not contribute to nausea and vomiting. Going through transition in labor might cause nausea and vomiting, not the fetal position. A precipitous birth occurs rapidly and is not associated with intense back pain.
The nurse would anticipate a C-section for a client who has which active infection present at the onset of labor? A. Hepatitis B. Herpes simplex virus C. Toxoplasmosis D. Human pap.
B. Herpes simplex virus Herpes exposure during the birth process poses a high risk for mortality to the neonate. If the woman has active herpetic lesions in the genital tract, a surgical birth is planned to avoid this exposure. Hepatitis is a chronic liver disorder, and the fetus if exposed would at most become a carrier; a surgical birth would not be expected for this woman. Toxoplasmosis is passed through the placenta to the fetus prior to birth, so a cesarean birth would not prevent exposure. HPV would be manifested clinically by genital warts on the woman, and a surgical birth would not be anticipated to prevent exposure unless the warts caused an obstruction.
The nurse is caring for a woman experiencing hypertonic uterine dystocia. The woman's contractions are erratic in their frequency, duration, and high intensity. The priority nursing intervention would be to: A. Encourage ambulation every 30 min. B. Provide pain relief measures C. Monitor the Pitocin infusion rate closely D. Prepare the woman for an amniotomy
B. Provide pain relief measures Women with hypertonic uterine contractions experience a high level of pain related to the high intensity of contractions. Providing comfort measures along with pharmacologic agents to reduce would be a priority. Response A is incorrect since a woman experiencing a high level of pain secondary to contraction intensity would not feel like ambulating during this challenging time period. Response C is incorrect because with this type of dystocia, augmentation of labor contractions would not be needed. If Pitocin had been infusing prior to the identification of this dystocia pattern, it would be discontinued to reduce the intensity of the contractions. Response D is incorrect since an amniotomy would not be a therapeutic measure for hypertonic contractions. This would be an intervention for hypotonic contractions along with Pitocin augmentation.
A client who was in active labor and whose cervix had dilated to 4 cm experienced a weakening in the intensity and frequency of her contractions and exhibits no further progress in labor. The nurse interprets this as a sign of: A. Hypertonic labor B. Precipitate labor C. Hypotonic labor D. Dysfunctional labor
C. Hypotonic labor Hypotonic labor typically occurs in the active phase; it involves ineffective contractions to evoke cervical dilation and causes secondary inertia. Hypertonic labor is characterized by painful, high-intensity contractions that usually occur in the latent phase. A precipitous labor occurs within 3 hours and cervical dilation is very fast secondary to effective, high-intensity contractions. Dysfunctional labor describes any pattern that doesn't produce dilation and effacement in a timely manner.
The nurse is developing a plan of care for a woman experiencing dystocia. Which of the following nursing interventions would be the nurse's high priority? A. Changing woman's positions frequently B. Providing comfort measures to the woman C. Monitoring the fetal heart rate patterns D. Keeping the couple informed of the labor progress
C. Monitoring the fetal heart rate patterns The health status of the fetus is paramount throughout the labor process to identify any deviations in a timely manner for decisive interventions to be initiated. Responses A, B, and D are all important nursing interventions, but don't become the priority over the fetal health status during the labor.
When reviewing the medical record of a client, the nurse notes that the woman has a condition in which the fetus cannot physically pass through the maternal pelvis. The nurse interprets this as: A. Cervical insufficiency B. Contracted pelvis C. Maternal disproportion D. Fetopelvic disproportion
D. Fetopelvic disproportion Fetopelvic disproportion is defined as a condition in which the fetus is too large to pass through the maternal pelvis. Cervical insufficiency would lead to an abortion, typically in the second trimester, when the heavy gravid uterus would cause pressure on the weakened cervix. A contracted pelvis might cause passageway problems, but if the fetus was small, no problem might occur. Maternal disproportion doesn't indicate where the disproportion is located.
The rationale for using a prostaglandin gel for a client prior to induction of labor is to: A. Stimulate uterine contractions B. Numb cervical pain receptors C. Prevent cervical lacerations D. Soften and efface the cervix
D. Soften and efface cervix Prostaglandins soften and thin out the cervix in preparation for labor induction. Although they do irritate the uterus, they aren't as effective as oxytocin in stimulating contractions. Prostaglandin gel would stimulate cervical nerve receptors rather than numb them. Prostaglandins have no power to prevent cervical lacerations.
Which of the following practices would not be included in a physiologic birth? a. Early induction of labor <39 weeks' gestation b. Freedom of movement for the laboring woman c. Continuous presence and support throughout labor d. Encouraging spontaneous pushing when urge felt
Early induction of labor <39 weeks' gestation Inducing labor artificially, rather than waiting for spontaneous labor to start, does not provide for physiologic birth. Nature should be allowed to take its course without artificial means to initiate labor. Responses B, C, and D all contribute to physiologic birth practices.
A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply. a. "Maybe dimming the lights or some soft music will help you relax a bit." b. "Let me leave you alone for a little while so you can get some rest." c. "Things are moving along, but sometimes it can take a little longer." d. "I will keep you updated often on how you and your baby are doing." e. "I will have to stop giving you pain medicine because it is slowing your labor."
a. "Maybe dimming the lights or some soft music will help you relax a bit." c. "Things are moving along, but sometimes it can take a little longer." d. "I will keep you updated often on how you and your baby are doing." The client is experiencing problems with the psyche. The nurse should provide emotional support to the client and family. Comfort measures such as dimming the lights or putting on soft music can promote relaxation and help the client's body work more effectively with the forces of labor. Keeping the client updated about her status and that of her fetus can provide reassurance and encouragement. Explanations about labor and what to expect can help empower the client and help her cope. The nurse should provide a continuous presence to allay anxiety. Pain medication is needed to reduce anxiety and stress.
The client is anxious about her prolonged pregnancy. She informs the nurse that she has been researching on the Internet and has read about specific herbs that can help induce labor. Which response from the nurse would be appropriate? a. "Please talk to your primary care provider first to ensure it is safe." b. "Why would you do something as stupid as that?" c. "Personally, I would use them, but I cannot tell you to." d. "There is no scientific evidence they work. You will just complicate e. your situation more."
a. "Please talk to your primary care provider first to ensure it is safe." It is crucial that the primary care provider knows if and when the client is using herbal supplements to ensure there will be no danger to the woman or fetus. The risks and benefits of these agents are unknown. None have been evaluated scientifically, and thus none can be recommended regarding their efficacy or safety. The statement about personal use is inappropriate because the nurse should not reveal personal information. Telling the client that the herbs will complicate the situation is inappropriate because the statement is judgmental and there is no positive or negative information that the herbs can be harmful. The statement about doing something stupid is demeaning to the client.
The nurse is reviewing the medical record of a woman for whom induction of labor is being considered. The nurse notes the following: Cervical dilation 4 cm Effacement 60% 0 Station Soft cervix Anterior cervical position Based on this information, which Bishop score would the nurse assign? a. 10 b. 6 c. 8 d. 12
a. 10 For each parameter listed, a score of 2 would be given, leading to a total Bishop score of 10. A score of 2 is given for cervical dilation of 3 to 4 cm, 60% to 70% effacement, -1 or 0 station, soft cervical consistency, and anterior position of the cervix. A score of 0 would be given for a closed cervix, 0% to 30% effacement, -3 station, firm cervix, and posterior position. A score of 1 would be given for cervical dilation of 1 to 2 cm, 40% to 50% effacement, -2 station, medium cervical consistency, and midposition of the cervix. A score of 3 would be given for cervical dilation of 5 to 6 cm, 80% effacement, +1 or +2 station, a very soft cervix, and anterior cervical position.
When caring for a client during the active phase of labor without continuous electronic fetal monitoring, the nurse would intermittently assess FHR every: a. 15 to 30 minutes b. 5 to 10 minutes c. 45 to 60 minutes d. 60 to 75 minutes
a. 15 to 30 minutes Several professional women's health organizations have published guidelines concerning the timing of intermittent FHR assessments during the active stage of labor. The current recommendation is that intermittent FHR is assessed every 15 minutes during the active phase of labor.
The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: a. 4,000 g to 4500 g b. 3,500 g to 4000 g c. 3,000 g to 3500 g d. 2500 to 3000 g
a. 4,000 g to 4500 g Macrosomia, in which a newborn weighs 4,000 to 4,500 g (8.13 to 9.15 lb) or more at birth, complicates approximately 10% of all pregnancies The excessive fetal size and abnormalities contribute to labor and birth dysfunctions.
A nurse provides care to a couple who has experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time? a. Avoid any discussion of the situation with the couple. b. Assist the family in making arrangements for their stillborn infant. c. Give the parents a lock of the infant's hair. d. Allow the couple to spend as much time as they want with their stillborn infant.
a. Avoid any discussion of the situation with the couple. The nurse should encourage discussion of the loss and allow the couple to vent their feelings of grief and guilt. The nurse should allow the parents to spend unlimited time with their stillborn infant so that they can validate the death. Providing the parents and family with mementos of the infant helps validate the reality of the death. Assisting the family with arrangements is helpful in reducing the stress of coping with the situation and making decisions at this difficult time.
A client presents to the birthing center in labor. The client's membranes have just ruptured. Which assessment is the nurse's priority? a. FHR b. signs of infection c. maternal comfort level d. fetal position
a. FHR When membranes rupture, the priority focus should be on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. Prolonged rupture can lead to an infection. Assessing the fetal position and maternal comfort are important but should not be the primary focus.
A pregnant client is experiencing dystocia resulting from persistent occiput posterior position. In the first stage of labor, the client reports significant back pain. The nurse encourages the client to change positions frequently for comfort and to help promote rotation of the fetal head. Which position(s) would be appropriate for the nurse to suggest? Select all that apply. a. Hands and knees b. Side-lying c. Modified Sims d. Squatting e. Trendelenburg
a. Hands and knees b. Side-lying d. Squatting Appropriate maternal position changes to promote fetal head rotation include hands and knees, rocking pelvis back and forth, side-lying position, side lunges during contractions, sitting, kneeling, or standing while leaning forward, and the squatting position (to give birth and enlarge the pelvic outlet). Modified Sims and Trendelenburg are appropriate for umbilical cord prolapse.
Interventions that are underutilized in promoting a normal birth. Select all that apply. a. Oral nutrition and fluids in labor b. Open glottis pushing in the second stage of labor c. Skin-to-skin contact after birth for infant bonding d. Routine artificial rupture of membranes (amniotomy) e. Labor induction with Pitocin IV f. Routine episiotomy to shorten labor length
a. Oral nutrition and fluids in labor b. Open glottis pushing in the second stage of labor c. Skin-to-skin contact after birth for infant bonding These are evidence-based interventions that are physiologically sound without placing the mother or the neonate in danger. Food and clear fluids provide hydration and nutrition and give comfort to laboring women. Fasting during labor will increase gastric acid production. Open glottis while pushing allows the woman's body to naturally sense the urge to push. Skin-to-skin contact promotes mother-infant bonding and warmth. Incorrect responses would include D, E, and F since these are artificial means to speed up the labor process which places the mother and newborn in jeopardy. Amniotomy may be associated with umbilical cord prolapse and fetal heart rate decelerations. Episiotomy is associated with increasing third- and fourth-degree perineal lacerations, discomfort, and healing delays. Induction with Pitocin may cause tetanic contractions causing hypoxia in the fetus.
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 should include what goal of Healthy People 2030 is related to women in labor? a. Reduce the rate of cesarean births among low-risk women b. Ensure care during labor includes immunizations. c. Encourage women with previous cesareans to always have a cesarean. d. Ensure all couples receive preconception genetic counseling.
a. Reduce the rate of cesarean births among low-risk women Healthy People 2030 includes one goal related to cesarean births in the United States, "MICH-2030-06 Reduce cesarean births among low-risk women with no prior births." Healthy People 2030 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. Immunizations and genetic counseling are not associated with women in labor.
When determining the frequency of contractions, the nurse would measure which of the following? a. Start of one contraction to the start of the next contraction b. Beginning of one contraction to the end of the same contraction c. Peak of one contraction to the peak of the next contraction d. End of one contraction to the beginning of the next contraction
a. Start of one contraction to the start of the next contraction Frequency is measured from the start of one contraction to the start of the next contraction. The duration of a contraction is measured from the beginning of one contraction to the end of that same contraction. The intensity of two contractions is measured by comparing the peak of one contraction with the peak of the next contraction. The resting interval is measured from the end of one contraction to the beginning of the next contraction.
After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? a. amniotomy b. breast stimulation c. prostaglandin d. laminaria
a. amniotomy Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.
The nurse assesses a client who has given birth within the past hour. The nurse would expect to find the woman's fundus at which location? a. at the level of the umbilicus b. 2 cm above the umbilicus c. between the umbilicus and symphysis pubis d. one fingerbreadth below the umbilicus
a. at the level of the umbilicus After birth, the fundus is located midline between the umbilicus and symphysis pubis but then slowly rises to the level of the umbilicus during the first hour after birth. Then the uterus contracts, approximately 1 cm (or fingerbreadth) each day after birth.
The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus? a. caput succedaneum b. infection of episiotomy c. cervical lacerations d. perineal hematoma
a. caput succedaneum Caput succedaneum is a complication that may occur in the newborn of a woman who had a forceps-assisted birth. Maternal complications include tissue trauma such as lacerations of the cervix, vagina, and perineum; hematoma; extension of episiotomy into the anus; hemorrhage; and infection.
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 process? a. crowning b. engagement c. descent d.restitution
a. crowning 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 reviews the FHR and notes it to be in the range of 100 to 106 bpm over the past 10 minutes. Which conditions might the nurse suspect as the cause? Select all that apply. a. effect of maternal analgesia b. maternal fever c. fetal hypoxia d. prolonged umbilical cord compression e. prematurity
a. effect of maternal analgesia c. fetal hypoxia d. prolonged umbilical cord compression Fetal bradycardia occurs when the FHR is below 110 bpm and lasts 10 minutes or longer. It can be the initial response of a healthy fetus to asphyxia. Causes of fetal bradycardia might include fetal hypoxia, prolonged maternal hypoglycemia, fetal acidosis, administration of analgesic drugs to the mother, hypothermia, anesthetic agents (epidural), maternal hypotension, fetal hypothermia, prolonged umbilical cord compression, and fetal congenital heart block. Maternal fever and prematurity are associated causes of fetal tachycardia.
The nurse determines how often contractions occur measuring from the beginning of one contraction to the beginning of the next contraction. The nurse documents this finding as: a. frequency. b. peak. c. duration. d. intensity.
a. frequency. Frequency refers to how often the contractions occur and is measured from the beginning of one contraction to the beginning of the next contraction. Duration refers to how long a contraction lasts and is measured from the beginning of one contraction to the end of that same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine pressure catheter. The peak or acme of a contraction is the highest intensity of a contraction.
The nurse encourages a woman in labor to ambulate based on the understanding that ambulating does what? Select all that apply. a. helps the fetus line up with the angle of the pelvis. b. Increases the urge to push during the second stage. c. Encourages rotation of the fetus d. Widens one side of the pelvis e. Enhances the effectiveness of contractions f. Enlists the aid of gravity to move the fetus
a. helps the fetus line up with the angle of the pelvis. b. Increases the urge to push during the second stage. c. Encourages rotation of the fetus e. Enhances the effectiveness of contractions f. Enlists the aid of gravity to move the fetus Walking, like standing, takes advantage of gravity, makes contractions more productive, helps to increase the urge to push in the second stage, helps the fetus line up with the angle of the maternal pelvis, and encourages rotation of the fetus. Lunging widens one side of the pelvis.
A nurse sees a pregnant client at the clinic. The client is close to her due date. During the visit the nurse would emphasize that the client get evaluated quickly should her membranes rupture spontaneously based on the understanding of which possibility? a. increased risk of infection b. increased risk of breech presentation c. potential rapid birth of fetus d. potential placenta previa
a. increased risk of infection After the amniotic sac ruptures, the barrier to infection is gone, and an ascending infection is possible. In addition, there is a danger of cord prolapse. The spontaneous rupture does not hasten labor, although it might signal the beginning of labor. The client may have placenta previa with the membranes intact.
A new dad is alarmed at the shape of his newborn's head. Assessment reveals swelling in the area of the presenting part. The swelling crosses the suture lines. The nurse suspects which condition? a. molding b. closed anterior fontanelle c. cephalohematoma d. caput succedaneum
a. molding The changed (elongated) shape of the fetal skull at birth due to the overlapping of the cranial bones is known as molding. Along with molding, fluid can also collect in the scalp (caput succedaneum), or blood can collect beneath the scalp (cephalohematoma), further distorting the shape and appearance of the fetal head. Caput succedaneum can be described as edema of the scalp at the presenting part. This swelling crosses suture lines and disappears within 3 to 4 days. Cephalohematoma is a blood collection between the periosteum and the bone that occurs several hours after birth. It does not cross suture lines and is generally reabsorbed over the next 6 to 8 weeks. The findings do not suggest a closed anterior fontanelle.
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: a. 6 b. 5 c. 7 d. 9
b. 5 A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.
A laboring woman is admitted to the labor and birth suite at 6-cm dilation. She would be in which phase of the first stage of labor? a. Latent b. Active c. Transition d. Early
b. Active Cervical dilation of 4 cm indicates that the woman is in the latent phase of the first stage of labor, which lasts from 0 to 6 cm of dilation. The active and late phases are marked by different measurements. There is no early phase.
Which fetal lie is most conducive to a spontaneous vaginal birth? a. Transverse b. Longitudinal c. Perpendicular d. Oblique
b. Longitudinal A longitudinal lie places the fetus in a vertical position, which would be most conducive to a spontaneous vaginal birth. A transverse lie does not allow for a vaginal birth because the fetus is lying perpendicular to the maternal spine. A perpendicular lie describes the transverse lie, which would not be conducive to a spontaneous birth. An oblique lie would not allow for a spontaneous vaginal birth because the fetus would not fit through the maternal pelvis in this side-lying position.
As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is: a. Discomfort level is greater with false labor. b. Progressive cervical changes occur in true labor. c. There is a feeling of nausea with false labor. d. There is more fetal movement with true labor.
b. Progressive cervical changes occur in true labor. Progressive cervical changes occur in true labor. This is not the case with false labor.
During the fourth stage of labor, the nurse assesses the woman at frequent intervals after giving childbirth. What assessment data would cause the nurse the most concern? a. Moderate amount of dark red lochia drainage on peripad b. Uterine fundus palpated to the right of the umbilicus c. An oral temperature reading of 100.6°F d. Perineal area bruised and edematous beneath her ice pack
b. Uterine fundus palpated to the right of the umbilicus A full bladder causes displacement of the uterus above it, and increased bleeding results secondary to the uncontracted status of the uterus. Massaging the uterus will help to make it firm but will not help to bring it back into the midline, since the full bladder is occupying the space the uterus would normally assume. Notifying the primary health care provider is not necessary unless the woman continues to have difficulty voiding and the uterus remains displaced. The normal location of the uterus in the fourth stage of labor is in the midline. Displacement suggests a full bladder, which is not considered a normal finding.
When teaching a group of soon-to-be parents about the structures of the fetal skull, the nurse describes the anterior fontanel (fontanelle). Which description would the nurse include? a. closes 8 to 12 weeks after birth b. approximately 2 to 3 cm in size c. triangular shaped. d. located at the back of the fetal head.
b. approximately 2 to 3 cm in size The anterior fontanel (fontanelle) measures about 2 to 3 cm in size, is diamond-shaped and closes 12 to 18 months after birth. The posterior fontanelle is triangular and located at the back of the fetal head. The posterior fontanelle closes about 8 to 12 weeks after birth.
The nurse determines that the fetal heart rate averages approximately 140 beats per minute over a 10-minute period. The nurse identifies this as: a. baseline variability. b. baseline FHR. c. fetal bradycardia. d. short-term variability.
b. baseline FHR. The baseline FHR averages 110 to 160 beats per minute over a 10-minute period. Fetal bradycardia occurs when the FHR is less than 110 beats per minute for 10 minutes or longer. Short-term variability is the beat-to-beat change in FHR. Baseline variability refers to the normal physiologic variations in the time intervals that elapse between each fetal heartbeat observed along the baseline in the absence of contractions, decelerations, and accelerations.
When explaining to a class of pregnant women why labor begins, the nurse will include the fact that several theories have been proposed to explain why labor begins, although none have been proven scientifically. Which idea is one of those theories? a. decrease in prostaglandins, leading to myometrium contractions b. change in the estrogen-to-progesterone ratio c. decreases in the number of oxytocin receptors d. decrease in the level of estrogen
b. change in the estrogen-to-progesterone ratio One of the theories suggests that labor is initiated by a change in the estrogen-to-progesterone ratio. The number of oxytocin receptors have been noted to increase. Estrogen levels also increase, which in turn increases myometrial sensitivity to oxytocin. Prostaglandin levels also increase, which in turn leads to myometrial contractions.
A woman received morphine during labor to help with pain control. Which finding would the nurse need to monitor the newborn for after birth? a. increased crying b. decreased alertness c. increased agitation d. low Apgar
b. decreased alertness Morphine is a commonly used opioid for the management of pain during labor. It is associated with newborn respiratory depression, decreased alertness, inhibited sucking, and a delay in effective feeding.
The nurse is measuring a contraction from the beginning of the increment to the end of the decrement for the same contraction. The nurse would document this as which finding? a. peak b. duration c. intensity d. frequency
b. duration Duration refers to how long a contraction lasts and is measured from the beginning of the increment to the end of the decrement for the same contraction. Intensity refers to the strength of the contraction determined by manual palpation or measured by an internal intrauterine catheter. Frequency refers to how often contractions occur and is measured from the increment of one contraction to the increment of the next contraction. The peak or acme of a contraction is the highest intensity of a contraction.
A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as: a. therapeutic touch. b. effleurage. c. acupressure. d. patterned breathing.
b. effleurage. Effleurage is a light, stroking, superficial touch of the abdomen in rhythm with breathing during contractions. Acupressure involves the application of a finger or massage at a trigger point to reduce the pain sensation. Patterned breathing involves controlled breathing techniques to reduce pain through a stimulus-response conditioning. Therapeutic touch involves light or firm touch to the energy field of the body using the hands to redirect the energy fields that lead to pain.
A client has arrived at the birthing center in labor, requesting a VBAC. After reading the client's previous history, the nurse anticipates that the client would be a good candidate based on which finding? a. had prior transfundal uterine surgery b. has a previous lower abdominal incision c. had a prior classic uterine incision d. has contracted pelvis
b. has a previous lower abdominal incision The choice of a vaginal or repeat cesarean birth can be offered to women who have had a lower abdominal incision. Contraindications to VBAC include a prior classic uterine incision, prior transfundal uterine surgery, uterine scar other than a low-transverse cesarean scar, contracted pelvis, and inadequate staff at a facility if an emergency cesarean birth is required.
During the assessment of a woman in labor, the nurse explains that certain landmarks are used to determine the progress of the birth. The nurse identifies which area as one of these landmarks? a. cervical os b. ischial spine c. pubic symphysis d. ischial tuberosity
b. ischial spine Station is assessed in relation to the maternal ischial spines and the presenting fetal part. These spines are not sharp protrusions but rather blunted prominences at the midpelvis. The ischial spines serve as landmarks and have been designated as zero station.
A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines this drug's effectiveness when the woman demonstrates which finding? a. decreased sedation b. less anxiety c. increased feelings of control d. increased cervical dilation
b. less anxiety Promethazine is used in combination with an opioid to decrease nausea and vomiting and lessen anxiety. It may also be used to increase sedation. It does not affect the progress of labor. Benzodiazepines are used to calm a woman who is out of control, allowing her to relax enough to participate effectively during labor.
A client at 33 weeks' gestation is calling the office with various reports and is very concerned. The nurse recognizes which report(s) as indicating the client is potentially going into preterm labor? Select all that apply. a. irregular contractions b. low, dull backache c. GI upset (nausea, vomiting, diarrhea) d. general sense of discomfort e. achiness in the thighs
b. low, dull backache c. GI upset (nausea, vomiting, diarrhea) d. general sense of discomfort e. achiness in the thighs There are various subtle symptoms of preterm labor that a woman may experience. They include change or increase in vaginal discharge; pelvic pressure; low, dull backache; menstrual-like cramps; feeling of pelvic pressure or fullness; GI upset; general sense of discomfort or unease; heaviness or aching in the thighs; uterine contractions, with or without pain; more than six contractions per hour; intestinal cramping, with or without diarrhea; and persistent contractions.
A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? a. dystocia b. preterm labor c. normal labor d. precipitate labor
b. preterm labor Preterm labor is the occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation. If not halted, it leads to preterm birth. Normal labor can occur after the 37th week. Dystocia refers to a difficult labor. Precipitate labor is one that is completed in less than 3 hours from start of contraction to birth.
A young couple is anxious about the birth of their first child. The nurse discusses the options, including elective induction of labor for nulliparas. The nurse determines that additional teaching is necessary when the couple identifies which condition is being associated with this procedure? a. neonatal resuscitation b. shorter hospitalizations c. increased rates of cesarean sections d. postpartum hemorrhage
b. shorter hospitalizations Elective induction of labor can lead to the birth of an infant too early, long labor, exposure to a high-alert medication with its potential side effects, unnecessary cesarean birth, and maternal and neonatal morbidity. Elective induction has a cascade of related interventions, such as an intravenous line, continuous electronic fetal monitoring, confinement to bed, amniotomy, pharmacologic labor-stimulating agents, parental pain medications, and regional anesthesia, each with its own set of potential complications and risks. These risks apply to all women having the procedure; however, for nulliparous women before 41 weeks of gestation with an unfavorable cervix, the main risk is cesarean birth after unsuccessful labor induction with the potential for maternal and neonatal morbidity and increased health care costs.
A nurse practitioner conducts an in-service education program for a group of nurses working in the labor and birth unit. The program focuses on interpreting FHR patterns. The nurse practitioner determines that the teaching was successful when the group identifies which patterns indicate abnormal fetal acid-base status? Select all that apply. a. minimal variability b. sinusoidal pattern c. recurrent late decelerations d. fetal tachycardia e. fetal bradycardia
b. sinusoidal pattern c. recurrent late decelerations e. fetal bradycardia FHR patterns that are predictive of abnormal fetal acid-base status include fetal bradycardia, sinusoidal pattern, and recurrent late decelerations. Fetal tachycardia and minimal variability, although each needs evaluation and continued monitoring, are not predictive of abnormal fetal acid-base status.
A nurse is discussing the advantages and disadvantages of intermittent and continuous fetal heart rate monitoring with a colleague. What would the nurse cite as being able to be detected when using continuous monitoring but not intermittent monitoring? Select all that apply. a. changes in baseline b. types of decelerations c. rhythm d. FHR baseline e. variability
b. types of decelerations e. variability Intermittent FHR auscultation can be used to detect FHR baseline and rhythm and changes from baseline. However, it cannot detect variability and types of decelerations like electronic fetal monitoring (EFM) can.
A nurse teaches a woman in her third trimester about Braxton-Hicks contractions. When describing these contractions, which information would the nurse likely include? Select all that apply. a."They go away when you walk around or change position." b. "They usually feel like a tightening across the top of your uterus." c. "They often spread downward before they go away." d. "They typically last for about 3 minutes each time you have them." e. "They usually happen in a regular pattern."
c. "They often spread downward before they go away." d. "They typically last for about 3 minutes each time you have them." e. "They usually happen in a regular pattern." Braxton Hicks contractions are typically felt as a tightening or pulling sensation of the top of the uterus. They occur primarily in the abdomen and groin and gradually spread downward before relaxing. In contrast, true labor contractions are more commonly felt in the lower back. These contractions aid in moving the cervix from a posterior position to an anterior position. They also help in ripening and softening the cervix. However, the contractions are irregular and can be decreased by walking, voiding, eating, increasing fluid intake, or changing position. Braxton Hicks contractions usually last about 30 seconds but can persist for as long as 2 minutes. As birth draws near and the uterus becomes more sensitive to oxytocin, the frequency and intensity of these contractions increase. However, if the contractions last longer than 30 seconds and occur more often than four to six times an hour, the woman should be advised to contact her health care provider to be evaluated, especially if she is less than 39 weeks' pregnant.
During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used. a. -2 station b. 0 station c. -4 station d. +2 station e. +4 station
c. -4 station a. -2 station b. 0 station d. +2 station e. +4 station Progressive fetal descent (-5 to +4) is the expected norm during labor, moving downward from the negative stations to zero station to the positive stations in a timely manner.
Following the birth, the nurse is responsible for assessing the cord pH. The nurse recognizes which value would be considered a normal pH? a. 6.8 b. 7 c. 7.2 d. 7.4
c. 7.2 Umbilical cord blood acid-base analysis is considered the most reliable indication of fetal oxygenation and acid-base condition at birth. The normal mean pH value range is 7.2 to 7.3.
Which assessment would indicate that a woman is in true labor? a. Membranes are ruptured and fluid is clear. b. Presenting part is engaged and not floating. c. Cervix is 4 cm dilated, 90% effaced. d. Contractions last 30 seconds, every 5 to 10 minutes.
c. Cervix is 4 cm dilated, 90% effaced. True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. These contractions bring about progressive cervical dilation and effacement. Thus, a cervix dilated to 4 cm and 90% effaced indicates true labor. Rupture of membranes may occur before the onset of labor, at the onset of labor, or at any time during labor and thus is not indicative of true labor. Engagement occurs when the presenting part reaches 0 station; it typically occurs 2 weeks before term in primigravidas and several weeks before the onset of labor or at the beginning of labor for multiparas. Contractions of true labor typically last 30 to 60 seconds and occur approximately every 4 to 6 minutes.
The nurse notes the presence of transient fetal accelerations on the fetal monitoring strip. Which intervention would be most appropriate? a. Reposition the client on the left side. b. Begin 100% oxygen via face mask. c. Document this as indicating a normal pattern. d. Call the health care provider immediately.
c. Document this as indicating a normal pattern. Fetal accelerations denote an intact central nervous system and appropriate oxygenation levels demonstrated by an increase in heart rate associated with fetal movement. Accelerations are a reassuring pattern, so no intervention is needed. Turning the woman on her left side would be an appropriate intervention for a late deceleration pattern. Administering 100% oxygen via face mask would be appropriate for a late or variable deceleration pattern. Since fetal accelerations are a reassuring pattern, no orders are needed from the health care provider, nor does the health care provider need to be notified of this reassuring pattern.
When managing a client's pain during labor, nurses should: a. Make sure the agents given do not prolong labor b. Know that all pain relief measures are similar c. Support the client's decisions and requests d. Not recommend nonpharmacologic methods
c. Support the client's decisions and requests The entire focus of the labor and birth experience is for the family to make decisions, not the caretakers. The nurse's role is to respect and support those decisions. Decisions about pain management are not based on length of the various stages of labor, but rather on what provides effective pain relief for the laboring woman. Pain relief measures differ. Each individual responds differently and uniquely to various pain relief measures. Not recommending nonpharmacologic measures demonstrates bias on the nurse's part; it is not the nurse's decision to make, but rather the client's.
The shortest but most intense phase of labor is the: a. Latent phase b. Active phase c. Transition phase d. Placental expulsion phase
c. Transition phase During the active phase, the contractions are stronger, and frequency is increased at this time in the laboring process. There is relatively minimal discomfort and/or intensity of contractions during the latent phase, the breaking of membranes, and the placental expulsion phase.
Which of the following observations would suggest that placental separation is occurring? a. Uterus stops contracting altogether. b. Umbilical cord pulsations stop. c. Uterine shape changes to globular. d. Maternal blood pressure drops
c. Uterine shape changes to globular. After the placenta separates from the uterine wall, the shape of the uterus changes from discoid to globular. The uterus continues to contract throughout the placental separation process and the umbilical cord continues to pulsate for several minutes after placental separation occurs. Maternal blood pressure is not affected by placental separation because the maternal blood volume has increased dramatically during pregnancy to compensate for blood loss during birth.
A 19-year-old woman presents to the emergency department in the late stages of active labor. Assessment reveals she received no prenatal care. As part of her examination, a rapid HIV screen indicates she is HIV positive. To reduce the perinatal transmission to her infant, which intravenous medication would the nurse anticipate administering? a. benzodiazepine b. antibiotic c. antiretroviral d. ataractic
c. antiretroviral Women who are HIV-positive are given a combination of antiretroviral drugs. To further reduce the risk of perinatal transmission, ACOG and the U.S. Public Health Service recommend that women who are infected with HIV and have plasma viral loads of more than 1,000 copies/mL be counseled regarding the benefits of elective cesarean birth. Antibiotics would not be used. Ataractics and benzodiazepines would be used for systemic analgesia.
A new dad is alarmed at the shape of his newborn's head. When responding to the dad, the nurse reminds him this is due to: a. prolonged labor. b. a congenital defect. c. cranial bones overlapping at the suture lines. d. extreme pressure in the vaginal vault.
c. cranial bones overlapping at the suture lines. This is due to molding, which results from overlapping the cranial bones at the suture lines. It is a temporary situation that will correct itself. It is due to the fetus passing through the pelvis. Molding does not result from extreme pressure, a congenital defect, or prolonged labor.
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 that occur concurrently. Based on the nurse's conceptualization of their sequential occurrence, list the cardinal movements of labor in the correct order that the nurse would expect the fetus to move. All options must be used. a. expulsion b. internal rotation c. engagement d. extension e. flexion
c. engagement e. flexion b. internal rotation d. extension a. expulsion 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. Although cardinal movements are conceptualized as separate and sequential, the movements are typically concurrent. They are engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.
A woman is in the fourth stage of labor. During the first hour of this stage, the nurse would assess the woman's fundus at which frequency? a. every 20 minutes b. every 5 minutes c. every 15 minutes d. every 10 minutes
c. every 15 minutes During the first hour of the fourth stage of labor, the nurse would assess the woman's fundus every 15 minutes and then every 30 minutes for the next hour.
The nurse is caring for a client who is considered low-risk and in active labor. During the second stage, the nurse would evaluate the client's FHR by Doppler at which frequency? a. every 30 minutes b. every 20 minutes c. every 15 minutes d. every 10 minutes
c. every 15 minutes It is recommended that the FHR be assessed during the second stage of labor every 5-15 minutes min by Doppler or continuously by EFM.
By the end of the second stage of labor, the nurse would expect which of the following events? The a. cervix is fully dilated and effaced b. placenta is detached and expelled c. fetus is born and on mother's chest d. woman to request pain medication
c. fetus is born and on mother's chest The second stage of labor is defined as beginning with complete dilation of the cervix (10 cm) and ending with the expulsion of the fetus. Response A is incorrect because the cervix is fully dilated at the start of stage 2, not at the end of it. Response B is incorrect due to the fact that the third stage of labor is defined as the period following the birth of the newborn through the expulsion of the placenta. Response D is incorrect since typically most women desiring pain medication would be requesting it in the active phase of labor in stage 1.
Physiologic preparation for labor would be demonstrated by: a. decrease in Braxton hicks b. weight gain and inc in appetite by mother c. lightening whereby the fetus drops into true pelvis d. fetal heart rate accelerations and inc movements
c. lightening whereby the fetus drops into true pelvis Since as labor nears, the fetus gets into position by descending into the maternal true pelvis in preparation for birth. The woman will experience heaviness in her lower pelvis and urinary frequency when this occurs. Response A is incorrect since there is an increase in uterine contractions as the uterus becomes more irritable and readies for true labor. Response B is incorrect since most women experience a weight loss and a decrease in appetite close to the start of their labor. Response D is incorrect due to the fact that the fetus is in a cramped environment at term and has limited room to move around. The fetal heart rate would remain within the normal range of 110 to 160 bpm unless there is a problem.
A client calls the clinic asking to come in to be evaluated. She states that when she went to bed last night, the fetus was high in the abdomen, but this morning, it feels like it has dropped down. After asking several questions, the nurse explains this is probably due to: a. placenta previa. b. start of labor. c. lightening. d. rupture of the membranes.
c. lightening. Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into a more anterior position. In primiparas, lightening can occur two weeks or more before labor begins; among multiparas, it may not occur until labor. It is a premonitory sign of labor and is not associated with rupture of membranes or placental Previa.
A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? a. infection b. dystocia c. macrosomia d. hemorrhage
c. macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia are risk to the mother not the fetus.
After conducting a review class on the labor and birth process for a group of nurses working in the community clinic, the nurse determines that the teaching was successful when the group identifies which factors as affecting the labor process? Select all that apply. a. participation b. place c. passenger d. patience e. powers
c. passenger d. patience e. powers There are "five Ps" that affect the labor process. They are passageway, passenger, powers, position, and psychological response. There are an additional five that can also have an effect on the labor process. They include philosophy, partners, patience, client preparation, and pain control.
What is the Bishop score used to assess? a. Presence of bacterial vaginosis b. Amount of amniotic fluid present c. Overall feta; well-being in labor d. Cervical readiness for induction
d. Cervical readiness for induction The Bishop score is used to assess cervical readiness for induction. It does not detect bacterial vaginosis or the amount of amniotic fluid present. It also cannot give a full picture of fetal well-being during labor.
When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action? a. Leaving the parents alone. b. Removing the infant quickly. c. Contacting a grief counselor. d. Keeping the communication lines open.
d. Keeping the communication lines open. Failing to keep the lines of communication open with a bereaved client and her family closes off some of the channels to recovery and healing. Staff members that avoid dealing with the situation may imply that the problem will go away. As a result the family's needs go unrecognized, and they may feel isolated. The parents should be allowed to spend as much time as they need with the infant as it will help make the situation more real, help them in the grieving process, and allow them to say goodbye.
When is a client in labor fully dilated, which instruction would be most effective to assist her in encouraging effective pushing? a. Hold your breath and push through the entire contraction. b. Use chest breathing with the contraction. c. Pant and blow during each contraction. d. Wait until you feel the urge to push.
d. Wait until you feel the urge to push. Non Directed pushing, based on current research, leads to better outcomes for both mother and infant. Holding breath and pushing throughout the entire contraction reduce blood flow and oxygenation to the fetus. Chest breathing is not effective since it doesn't increase abdominal pressure to assist the uterus to contract. Panting and blowing are used to abstain from pushing, which is not what is needed to expel the fetus.
A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if signs and symptoms of which condition occurs? a. Hypertension b. Fetal distress c. Uterine hypotonicity d. Water intoxication
d. Water intoxication Oxytocin can lead to water intoxication and can cause hypotension. Uterine hypertonicity is a possible adverse effect of oxytocin administration. Oxytocin does not cross the placental barrier, and no fetal problems have been observed.
