Prep U module 5
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?
Practicing effleurage on the abdomen
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
The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?
merperidine
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 reduce the sensation of pain for a limited period of time"
A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?
"The injection is given in the space outside the spinal cord"
During labor, progressive fetal descent occurs. Place the stations listed in their proper sequence from first to last. All options must be used.
-4 station -2 station 0 station +2 station +4 station
A client in labor has requested the administration of opioids to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do?
Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor
A nurse is assigned to conduct an admission assessment on the phone for a pregnant client. Which information should the nurse obtain from the client?
Appearance of vaginal blood Characteristics of contractions Estimated due date
A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?
Assist the client to a semi-Fowler position, assess the fetal heart rate, state an IV bolus of 500 mL, and administer oxygen via face mask
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 fluctuates from 6 to 25 bpm
Which complication occurs as a result of ineffective breathing patterns?
Hyperventillation
A nurse is caring for a client who has been administered an epidural block. Which should the nurse assess next?
Respiratory rate
To assess the frequency of a woman's labor contractions, the nurse would time:
The beginning of one contraction to the beginning of the next
The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods?
These methods are a technique to prevent the painful stimuli from entering the brain
The nurse explains Leopold maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply
determining the presentation of the fetus determining the position of the fetus determining the lie of the fetus
The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use?
external electronic fetal monitoring
A gravida 1 client is admitted in the active phase of stage 1 labor with the fetus in the LOA position. The nurse anticipates noting which finding when the membranes rupture?
Clear to straw-colored fluid
The nurse is preparing a young couple for the upcoming birth of their child, and the mother expresses concern for needing pain medication and the effects on the fetus. When counseling the couple about pain relief, the nurse would incorporate which information in the teaching about measures to help to decrease the requests for pain medication?
Continuou support through the labor process helps decrease the need for pain medication
The nursing instructor is preparing a class discussing the role of the nurse during the labor and birthing process. Which intervention should the instructor point out has the greatest effect on relieving anxiety for the client?
Continuous labor support