Prep u Intrapartum Care
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? -1 cm/hour for cervical dilation -2 cm/hour for cervical dilation -1/2 cm/hour for cervical dilation -1/4 cm/hour for cervical dilation
-1 cm/hour for cervical dilation
The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth? -"The baby is coming. I'll explain what's happening and guide you." -"Do you want me to call in your family?" -"The baby is coming. Relax and everything will turn out fine." -"Even though the baby is coming, the health care provider will be here soon."
"The baby is coming. I'll explain what's happening and guide you."
How does a woman who feels in control of the situation during labor influence her pain? -Feelings of control are inversely related to the client's report of pain. -Feeling in control shortens the overall length of labor. -There is no association between the two factors. -Decreased feeling of control helps during the third stage.
Feelings of control are inversely related to the client's report of pain.
Assessment reveals that the fetus of a client in labor is in the vertex presentation. The nurse determines that which part is presenting? -buttocks -brow -shoulders -occiput
Occiput
A nurse is educating a group of nursing students about the molding of the fetal skull during the birth process. What would the nurse include as the usual cause of molding? -well-ossified bones of the face -poorly ossified bones of the cranial vault -rigid bones at the base of the skull -tight membranous attachments
Poorly ossified bones of the skull
The nurse is providing a report on a gravida 3 para 2 client. The nurse states that the client is fully effaced, 7 cm dilated, +1 station, and contractions every 8 minutes. Which nursing action is most important at this time? -Record tocodynamometer readings. -Obtain vital signs. -Discuss contraction intensity. -Ambulate the client in the hall.
Record tocodynamometer readings.
Which client outcome during active and transitional labor is best? -The client will state a pain level of 7 and under during contractions. -The client will practice breathing techniques during contractions. -The client will walk in the hall for 15 minutes every 2 hours. -The client will tolerate 8 oz (240 ml) of clear liquids during labor process.
The client will practice breathing techniques during contractions.
A nurse caring for a pregnant client in labor observes that the fetal heart rate (FHR) is below 110 beats per minute. Which interventions should the nurse perform? Select all that apply. -Assess client for underlying causes. -Administer oxygen by mask. -Reduce intravenous (IV) fluid rate. -Ignore questions from the client. -Turn the client on her left side.
Turn the client on her left side. Administer oxygen by mask. Assess client for underlying causes.
A nurse is assisting a client who is in the first stage of labor. Which principle should the nurse keep in mind to help make this client's labor and birth as natural as possible? -The support person's access to the client should be limited to prevent the client from becoming overwhelmed. -A woman should be allowed to assume a supine position. -Women should be able to move about freely throughout labor. -Routine intravenous fluid should be implemented.
Women should be able to move about freely throughout labor.
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 as which form of therapy? -acupressure -acupuncture -biofeedback -effleurage
acupressure
A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor in the client? -dilation (dilatation) of cervix diameter to 10 cm -diffuse abdominal cramping -rupturing of fetal membranes -start of regular contractions
dilation (dilatation) of cervix diameter to 10 cm
Which intervention would be least effective in caring for a woman who is in the transition phase of labor? -providing one-to-one support -having the client breathe with contractions -urging her to focus on one contraction at a time -encouraging the woman to ambulate
encouraging the woman to ambulate
A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: -assess blood pressure and pulse to detect placental bleeding. -ask her to push with the next contraction so birth is rapid. -attach a fetal monitor to determine fetal status. -place a hand gently on the fetal head to guide birth.
place a hand gently on the fetal head to guide birth.
A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic? -progesterone -oxytocin -relaxin -prolactin
relaxin
A nurse is conducting an in-service program for a group of nurses working in the prenatal clinic. When discussing the theories about the onset of labor, the nurse points out which factor as a possible cause? Select all that apply. -fall in the estrogen at 34 to 35 weeks of pregnancy -prostaglandin production in the myometrium -release of oxytocin by the pituitary -decrease in the fetal cortisol levels -increase in the production of progesterone
release of oxytocin by the pituitary prostaglandin production in the myometrium
A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation? -the 41-year-old client who conceived by in vitro fertilization -the 27-year-old client who gave birth to twins 2 years ago -the 38-year-old client whose spouse is a triplet -the 19-year-old client diagnosed with polycystic ovary syndrome
the 41-year-old client who conceived by in vitro fertilization
Which consideration is a priority when caring for a mother with strong contractions 1 minute apart? -Maternal request for pain medication -Maternal heart rate and blood pressure -The station in which the fetus is located -Fetal heart rate in relation to contractions
Fetal heart rate in relation to contractions
The client in active labor overhears the nurse state the fetus is ROA. The nurse should explain this refers to which component when the client becomes concerned? -Fetal attitude -Fetal size -Fetal position -Fetal station
Fetal position
The nurse is admitting a client who is in early labor. After determining that the birth is not imminent, which assessment should the nurse perform next? -Fetal status -Maternal obstetrical history -Risk factors -Maternal status
Fetal status
The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best? -"The analgesia will limit your ability to be out of bed without assistance." -"The analgesia will allow for a pain-free birth experience." -"The analgesia will block pain sensation and limit your ability to push." -"The analgesia will reduce the sensation of pain for a limited period of time."
"The analgesia will reduce the sensation of pain for a limited period of time."
A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? -Administer oxytocin diluted as a "piggyback" infusion. -Administer oxytocin in a 20 cc bolus of saline. -Administer oxytocin diluted in the main intravenous fluid. -Administer oxytocin in two divided intramuscular sites.
Administer oxytocin diluted as a "piggyback" infusion.
During which time is the nurse correct to document the end of the third stage of labor? -When pushing begins -Following fetal birth -At the time of placental delivery -When the mother is moved to the postpartum unit
At the time of placental delivery
The nurse is assessing a woman at 37 weeks' gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the Nitrazine paper? -Blue -Yellow -Pink -White
Blue
Touch and massage can be helpful during labor. Which touch and massage methods are used in labor? Select all that apply. -water therapy -effleurage -patterned breathing -counterpressure
Effleurage Counterpressure
Which nursing action prevents a complication associated with the lithotomy position for the birth of the fetus? -Providing a paper bag -Massaging the client's lower back -Rubbing the client's legs -Placing a wedge under the hips
Placing a wedge under the hips
A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using? -pain pathway blockage -effleurage -abdominal imagery -massage
Effleurage
The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? -Experience of additional back pain -Necessity for vacuum extraction for birth -Shorter dilation (dilatation) stage of labor -Need to have the baby manually rotated
Experience of additional back pain
While assessing the progress of the labor, the nurse explains that the fetal heart rate variability is moderate. Which explanation is best to use with the parents? -FHR fluctuation range is undetectable. -FHR fluctuates over 25 beats per minute. -FHR fluctuates less than 5 beats per minute. -FHR fluctuates from 6 to 25 beats per minute.
FHR fluctuates from 6 to 25 beats per minute.
Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? -McGeorge maneuver -McDonald maneuver -McRonald maneuver -McRoberts maneuver
McRoberts maneuver
During the second stage of labor, a woman is generally: -anxious to have people around her. -turning inward to concentrate on body sensations. -no longer in need of a support person. -very aware of activities immediately around her.
Turning inward to concentrate on body sensations
A primigravida client at 39 weeks' gestation calls the OB unit questioning the nurse about being in labor. Which response should the nurse prioritize? -Arrange for the woman to come to the hospital for labor evaluation. -Emphasize that food and fluid should stop or be light. -Tell the woman to stay home until her membranes rupture. -Ask the woman to describe why she believes that she is in labor.
Ask the woman to describe why she believes that she is in labor.
A nurse is teaching a couple about patterned breathing during their birth education. Which technique should the nurse suggest for slow-paced breathing? -Punctuated breathing by a forceful exhalation through pursed lips every few breaths. -Inhale slowly through nose and exhale through pursed lips. -Inhale and exhale through the mouth at a rate of 4 breaths every 5 seconds. -Hold breath for 5 seconds after every 3 breaths.
Inhale slowly through nose and exhale through pursed lips.
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? -Neonatal depression is possible. -The client is more sensitive to preanesthetic medications. -Fetal hypersensitivity to anesthetic is possible. -The client is less sensitive to inhalation anesthetics.
Neonatal depression is possible.
The nurse is instructing on maternal hormones which may impact the onset of labor. Which hormones are included in the discussion? Select all that apply. -Testosterone -Oxytocin -Thyroxine -Progesterone -Prostaglandins -Insulin
Oxytocin Progesterone Prostaglandins
A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? -Administering a sedative such as secobarbital or pentobarbital -Immersing the client in warm water in a pool or hot tub -Administering an opioid such as meperidine or fentanyl -Practicing effleurage on the abdomen
Practicing effleurage on the abdomen
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 2030 related to women in labor? -Reduce the rate of cesarean births among low-risk women. -Encourage women with previous cesareans to always have a cesarean. -Ensure all couples receive preconception genetic counseling. -Ensure care during labor includes immunizations.
-Reduce the rate of cesarean births among low-risk women.
A pregnant client wants to know why the labor of a primigravida usually lasts longer than that of a woman who has already given birth once and is pregnant a second time. What explanation should the nurse offer the client? -The cervix takes around 12 to 16 hours to dilate during first pregnancy. -Braxton Hicks contractions are not strong enough during first pregnancy. -Spontaneous rupture of membranes occurs during first pregnancy. -Contractions are stronger during the first pregnancy than the second.
The cervix takes around 12 to 16 hours to dilate during first pregnancy.
When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful? -The characteristics of labor pain follow a pattern. -If the woman is in too much pain, a cesarean section is an option. -All pain is the same. -Women innately know how to deal with labor pain.
The characteristics of labor pain follow a pattern.
