OB- Labor and Delivery Ch. 26

A client asks how to tell the difference between true and false labor. The nurse correctly responds: (Select all that apply) 1. "True labor contractions usually occur at regular intervals." 2. "True labor contractions often feel like period cramps." 3. "False labor contractions do not usually increase in duration and intensity." 4. "False labor contractions usually go away with rest."

1, 3, 4." Rationale: True labor contractions are usually regular, and are felt most strongly in the back and radiate to the abdomen. They do not usually decrease with rest. False labor contractions will often decrease with rest. Answer 2 is incorrect; false labor contractions usually occur in the lower abdomen.

Early signs of Braxton Hicks contractions during labor are: (Select all that apply) 1. irregular tightening of uterus 2. Do dilate the cervix 3. begins in the first trimester and increase in frequency, duration and intensity as pregnancy progresses 4. effacement thinning shortening of the cervix 5. false labor

1,2,5 1. irregular tightening of the uterus because of the uterine muscles tightening for one to two minutes and not part of the processes of effacement of the cervix and can be relieved from lying down on the left side to ease the pain of contractions. 2. begins in the first trimester (6 weeks) and increases in frequency, duration, and intensity as pregnancy progresses 5. false labor are much less noticeable during movement, whereas real contractions are noticeable during movement.

A pregnant client is admitted with vaginal bleeding. The nurse performs a nitrazine test to confirm that the membrane have ruptured. The nitrazine tape remains yellow to olive green, with pH between 5.0 & 6.0 What does this indicate? 1. Acidic 2. Alkaline 3. Bloody show, insufficient amniotic fluid, or semen

1. Acidic. Presence of vaginal fluid and membranes probably intact. 2. If nitrazine tape remains blue to green pH 6.5- 7.5 or blue to gray, the membranes probably ruptured and ready for true labor. 3. Bloody show, insufficient amniotic fluid or semen physical findings show false test results. Always provide pericare as needed, remove gloves and wash hands. Document results (positive or negative) after nitrazine testing.

What are the 4 types of pelvis shapes for determination of vaginal delivery?

1. Gynecoid 2. Android 3. Antrhopoid 4. Platypelloid

A laboring client is complaining of severe nausea and increased rectal pressure. She is thrashing about and cries, "I can't do this anymore. Please help me!" This client is most likely in which phase of labor?

1. Latent 2. Second 3. Transitional 4. Active

What are the 6 premonitory signs of labor?

1. Lightening Usually occurs 2 weeks before labor in prima/nulli/paras. May not occur until onset of labor in multiparas 2. Urinary frequency and ability to breathe more normally because the abdominal cavity has more space. Multiparas may not experience this change until active labor. 3. Ruptured membrane a sudden outflow of fluid from the vagina is tested with a nitrazine paper to distinguish between amniotic fluid and clear vaginal discharge pH. 4. Bloody show, vaginal drainage of blood tinged mucus as a mucous plug in pregnancy increases during last weeks of the pregnancy. 5.Sudden burst of energy: Known as nesting. Usually occurs 24-48 hours before the start of labor. 6.Other signs: Loss of 1-3 pounds. Diarrhea, indigestion, nausea, and vomiting may occur prior to the onset of labor.

When caring for the mother with premature rupture of the membranes, the nurse monitors the mother and fetus for indications of 1. choriamniotnitis 2. placenta previa 3. hemorrhage 4. arrest of descent

1. Loss of the protective barrier provided by the membranes increases the risk of infection (chorioamnionitis) . The likelihood of placenta previa, hemorrhage, and arrest of descent are not increased by rupture of the membranes.

What are the 5 p's a nurse examines to help understand the process of labor and delivery?

1. Passageway : The pelvis and soft tissue 2. Passenger: The fetus 3. Powers: Contractions 4. Position of mother: Standing, squatting, side lying, walking, on hands and knees 5. Psyche: Psychological response

A client asks how to tell the difference between true and false labor. The nurse correctly responds: (Select all that apply)

1. True labor contractions usually occur at regular intervals." 2. True labor contractions often feel like period cramps." 3 False labor contractions do not usually increase in duration and intensity." 4. False labor contractions usually go away with rest."

A pregnant women with sepsis can not deliver within the specified time during labor, what emergency is most likely performed? 1. impending caesarean section 2. vaginal birth

1. impending caesarean section to avoid risk of injury to the mother and the fetus. Check for informed consent and administer preop medications if prescribed.

How long does delivery occur after membrane rupture during impending labor? 1. 12 hours 2. 24 hours 3. 48 hours

2. 24 hours . Deliver should occur within 24 hours after membrane rupture because prolonged rupture membranes puts the woman and her fetus at risk for infection.

A nurse states to a pregnant women "The cervix may soften, but with little or not change in effacement or dilation," Which type of labor is described? 1. True 2. False

2. False Labor because when the cervix softens, effaces and dilates its considered True labor.

A client at 39 weeks gestation calls the clinic nurse with complaints of pelvic pressure, diarrhea, nausea and vaginal secretions. The nurse would correctly interpret these as signs and symptoms of: 1.Vaginal infection. 2. Impending labor. 3. Urinary tract infection. 4. Rupture of membranes.

2. Impending Labor. Pelvic pressure, diarrhea, nausea and vaginal secretions are symptoms of impending labor. Vaginal infection may be recognized by an odor to the vaginal secretions, along with back or abdominal pain and fever. Urinary tract infection will present with a strong odor to the urine, along with pain and/or burning upon urination with possible fever. Although rupture of membranes precedes labor in 12% of cases, it likely would be accompanied by the expulsion of large amounts of amniotic fluid.

The fetal skull is the highest concern during delivery. The primary care practitioner palpates _______ and ______to determine the fetus during labor and prevent complications. 1. molding and sutures 2. sutures and fontanelles 3. molding and fontanelles

2. Sutures and fontanelles. The major bones of the skull are joined by the membranous spaces called sutures and where the sutures meet are larger membranous areas called fontanelles. Molding is the reshaping of the skull bones due to pressure against the maternal pelvis.

A nurse examines a pregnant women for vaginal examination and notices an oval wide brim, narrow subpubic arch, narrow ischial spines and can deliver with forceps vaginally. What is the pelvic type? 1. gynecoid 2 platypelloid 3. anthropoid 4. android

3. Anthropoid. Gynecoid has round brim so the head easily engages, round sacro-sciatic notches , rounded subpubic arch , tendency to eversion of ischial spines. Everything is round. Platypelloid has flat brim, wide ischial spines,. Android is heart-shape angulated brim, wide subpubic arc, vaginal delivery difficulty with forceps and usually cesarean.

What true pelvis test examines using a pelvic meter externally to estimate the distance between the ischia spine or the bony prominences internally to determine pelvic adequacy? 1. ultrasound scan 2. pelvimetry 3. palpation

3. Palpation. Pelvimetry x-ray may be done for a women who is not currently pregnant but seeking preconception care and may be performed for women who had injury or developmental problems such as rickets. Ultrasound scan has sound waves above the range of human hearing to estimate pelvic adequacy. DOES NOT involve use of radiation and is the safest for the fetus. Ultrasound scan can show soft tissue and gather information regarding fetal growth, multiple pregnancy, placental location and abnormal presentation that may complicate delivery.

What soft tissue occurs when contractions of the muscular upper segment apply downward pressure and results to uterine effacement and dilates the cervix during labor? 1. vagina 2. uterine tissues 3. cervical tissues 4. perineum

3. Rationale 3. Cervical tissue of the cervix change allows the passage of the fetus. Vagina is capable of stretching (dilating) to allow passage of the fetus in response to hormonal changes during pregnancy such as increased blood supply (vascularity) due to the primary hormone estrogen, increased thickness of mucosa, loosening of the connective tissue, and enlargement (hypertrophy) of smooth muscle cells. Perineum muscles of the pelvic floor are stretched and thinned by the pressure of uterine. The anus may appear dilated and bulging at this time.

A client at 38 weeks gestation complains of leg cramps, increased pelvic pressure, and increased urinary frequency. The nurse recognizes: 1. The client may be having preterm labor. 2. The client may have a urinary tract infection. 3. The client may need more iron in her diet. 4. The client is most likely experiencing lightening.

4, Rationale: Lightening describes the effects of the fetus moving down in the pelvis, and leg cramps, increased pelvic pressure, and increased urinary frequency are common symptoms associated with lightening. In a client with a preterm gestation, these symptoms would warrant further evaluation. Answer 1 is incorrect; in this case, the client is at term. Answer 2 is incorrect; frequency is a common pregnancy symptom in the first and third trimesters. Answer 3 is incorrect; leg cramps are not associated with iron deficiency, but it is theorized that leg cramps may be associated with a calcium and phosphorus imbalance

Before discharging a client from the Antepartum Triage Unit, the nurse reinforces the teaching plan about the difference between Braxton Hicks contractions and true labor contractions. Which statement by the client indicates the teaching has been effective? 1. Brackton Hicks contractions begin irregular and become regular 2. Brackton Hicks contractions cause cervical dilation and effacement 3. Braxton Hicks contractions begin in the lower back and radiate to the abdomen 4. Braxton Hicks contractions begin in the abdomen and remain irregular

4.Braxton Hicks contractions begin and remain irregular. They're felt in the abdomen and remain confined to the abdomen and groin. They commonly disappear with the ambulation and don't dilate the cervix. True contractions begin irregularly but become regular and predictable, causing cervical effacement and dilation. True contractions are left initially in the lower back and radiate to the abdomen in a wavelike motion.

Assessment of a client progressing through labor reveals the following findings. Order them in the most likely sequence in which they would have occurred. 1. Uncontrollable urge to push 2. Cervical dilation of 7 cm 3. 100% cervical effacement 4. Strong Braxton HIcks contractions 5. Mild contractions lasting 20 to 40 seconds

45231. Strong Braxton HIcks contractions typically occur prior to the onset of true labor and are considered a preliminary sign. During the latent phase of the first stage of labor, contractions are mild, lasting about 20 to 40 seconds. As the client progresses through labor, contractions increase in intensity and duration, and cervical dilation occurs. Cervical dilation of 7 cm indicates the client has entered the active phase of the first stage of labor. Cervical effacement also occurs, and effacement of 100% characterizes the transition phase of the first stage of labor. Progression into the second stage of labor is noted by the client's uncontrollable urge to push.

A patient is having Braxton Hicks contractions during the third trimester. What are some patient teachings ?

A nurse can teach the patient self care such as rest, change position, practice breathing exercises when contraction are bothersome and

Nurses can advise their patients that which of these signs precede labor? (Select all that apply.) A) A return of urinary frequency as a result of increased bladder pressure B) Persistent low backache from relaxed pelvic joints C) Stronger and more frequent uterine (Braxton Hicks) contractions D) A decline in energy, as the body stores up for labor E) Uterus sinks downward and forward in first-time pregnancies.

A) A return of urinary frequency as a result of increased bladder pressure B) Persistent low backache from relaxed pelvic joints C) Stronger and more frequent uterine (Braxton Hicks) contractions Rationale: After lightening a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term.

The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are: (Select all that apply.) A) passenger. B) placenta. C) passageway. D) psychologic response. E) powers. F) position.

A) passenger. C) passageway. D) psychological response. E) powers. F) position. Rationale: At least five factors affect the process of labor and birth. These are easily remembered as the five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response.

Which type of pelvis shape is not favorable for labor and birth... causing slow descent and midpelvic arrest

Android. Caesarean delivery is usual

11. Clariz arrives at the health care facility, stating that her bed linens were wet when she woke up this morning. She says no fluid is leaking but complains of mild abdominal cramps and lower back discomfort. Vaginal examination reveals cervical dilation of 3 cm, 100% effacement, and positive ferning. Based on these findings, the nurse concludes that the client is in which phase of the first stage of labor? a. Active phase b. Latent phase c. Expulsive phase d. Transitional phase

Answer B. The latent phase of the first stage of labor is associated with irregular, short, mild contractions; cervical dilation of 3 to 4 cm; and abdominal cramps or lower back discomfort. During the active phase, the cervix dilates to 7 cm and moderately intense contractions of 40 to 50 seconds' duration occur every 2 to 5 minutes. Fetal descent continues throughout the active phase and into the transitional phase, when the cervix dilates from 8 to 10 cm and intense contractions of 45 to 60 seconds' duration occur every 1½ to 2 minutes. The first stage of labor doesn't include an expulsive phase.

After a client enters the second stage of labor, nurse Blessy notes that her amniotic fluid is port-wine colored. What does this finding suggest? a. Increased bloody show b. Normal amniotic fluid c. Abruption placentae d. Meconium

Answer C. Port-wine-colored amniotic fluid isn't normal and may indicate abruption placentae. Increased bloody show is a normal finding and causes light pink amniotic fluid. Meconium turns amniotic fluid green

A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: A) weight gain of 1 to 3lbs. B) quickening. C) fatigue and lethargy. D) bloody show

D) bloody show Rationale: Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens.

What device do nurses use on newborns to maintain standard precautions and free airway during childbirth ?

DeLee oral suction device used to prevent newborn's mucus from getting into the mouth or airway.

When should a nurse wear gloves (sterile or clean) to avoid transmission of infection during childbirth?

During birth, standard precautions must be used that require contact with the women's genitalia and body fluids, including bloody show ( vaginal examination, amniotomy, hygienic care of the perineum, insertion of an internal scalp electrode and intrauterine pressure monitor and catheterization)

A nurse is reviewing the progress her client has made in labor. The fetal head engaged in a transverse position, fetal descent has been slow, and the nurse anticipates a forceps delivery. Which of the following pelvic types is the client most likely to have? Choose all that apply. 1.Gynecoid 2. Platypelloid 3. Anthropoid 4. Android

Gynecoid and anthropoid pelvis types are favorable for labor or delivery, whereas android and platypelloid pelvis types are not favorable. With both android and platypelloid, the fetal head is likely to engage in transverse position, and descent into the pelvis can be slow. In the platypelloid type, there is frequent delay of progress at the outlet.

Which type of pelvis is most favorable for a successful labor and birth

Gynecoid and anthropoid pelvis types are favorable for labor or delivery.

What type of shape does an Android pelvis have

Heart-shape or angulated, narrow and convergent