Quiz #2 CH 26 & 27.

A pregnant woman arrives for a visit to the physician. The nurse applies an amplified stethoscope to the abdomen and can hear the fetal heart tone. The nurse assesses that the fetus is at the fetal developmental week of:

16

The nurse uses a diagram to show the development of the embryonic stage of pregnancy, which usually lasts about:

8 weeks.

The father asks how soon the sex of the baby can be confirmed. The nurse answers that the genitalia are well defined at:

9 weeks

11. During the second stage of labor, the nurse should monitor the fetal heart rate every: a. 5 minutes. b. 10 minutes. c. 15 minutes. d. 20 minutes.

ANS: A Fetal heart rate should be assessed every 5 minutes during the second stage of labor. REF: Page 819 TOP: Fetal heart rate

10. Using Leopold's maneuvers to assess fetal position, the nurse finds a soft rounded prominence at the level of the fundus, a hard round prominence just above the symphysis pubis, and nodulations on the left side of the uterus. The fetal position is: a. right occiput anterior (ROA), vertex. b. left occiput anterior (LOA), vertex. c. right occiput transverse (ROT), breech. d. left occiput anterior (LOA) breech.

ANS: A Fetal position can be determined by Leopold's maneuver, which defines the relationship of presenting part to maternal pelvis quadrant. REF: Pages 809-810, Figures 26-3, 26-4 and 26-5 TOP: Fetal position

4. The pelvis is divided into two parts, the false and true pelvis. The nurse explains that the size of the true pelvis is most important because: a. the fetal head must pass through this part. b. these are the mother's measurements. c. the false pelvis can change. d. it needs to be larger.

ANS: A The size of the true pelvis is more important because the fetal head must be able to pass through. REF: Page 807 TOP: True pelvis

1. A woman who is 38 weeks pregnant tells the nurse that the baby has dropped and she is having urinary frequency again. The nurse recognizes this as: a. lightening. b. Braxton-Hicks contractions. c. initiation of labor. d. engagement.

ANS: A The symptoms of lightening are a return of urinary frequency, and the patient is able to breathe more normally. REF: Page 805 TOP: Lightening

13. When observing the fetal heart monitor, the nurse recognizes the fetal heart rate (FHR) decreases to 120 beats per minute at the beginning of a contraction and returns to a baseline of 155 beats per minute at the end of the contraction. This indicates: a. early deceleration due to head compression. b. that the fetus is in acute distress. c. variable decelerations due to cord compression. d. that these are late decelerations.

ANS: A This indicates early decelerations due to head compression. REF: Page 825, Figure 26-18 TOP: Fetal monitoring

14. The first-time mother has been told by the nurse that the first stage of labor is the longest. An appropriate nursing intervention for comfort during this time would be: a. cool fluids to drink. b. a backrub in the sacral area. c. assisting to lie in a supine position. d. decreasing illumination in the room.

ANS: B Backache in the sacral area is a common complaint during the first stage of labor. REF: Page 818 TOP: First stage of labor

23. During labor, the patient screams at her husband to get out of her sight. The nurse's most appropriate action would be to: a. encourage the husband to stay. b. assure the husband that such behavior is normal. c. remind the patient that the husband wants to help. d. change the patient's position.

ANS: B During labor the patient frequently becomes angry and outspoken. It is a normal occurrence, but the husband needs to be reassured that such behavior is normal. REF: Page 830 TOP: Care during labor

20. The nurse is assessing the printout from the fetal monitor. The nurse is legally responsible for: a. recognizing deviations and taking appropriate action to prevent harm to the fetus. b. recognizing deviations and notifying the physician. c. recognizing and documenting deviations. d. providing technical assessment.

ANS: B Nurses are responsible for the timely notification of the primary caregiver in the event of an abnormal fetal heart rate (FHR) pattern. REF: Page 826 TOP: Fetal monitoring

19. The nurse is alarmed as she assesses a protruding umbilical cord from the vagina. The immediate action the nurse should take is: a. to monitor intensity of contractions. b. place the patient in the knee-chest position. c. notify the charge nurse. d. ask the patient to perform a Valsalva maneuver.

ANS: B The knee-chest position reduces the pressure on the cord with the pull of gravity. REF: Page 811 TOP: Cord prolapse

7. The nurse points out the largest diameter of the fetal skull is the: a. transverse. b. biparietal. c. lateral. d. frontal-occipital.

ANS: B The largest transverse diameter of the fetal skull is the biparietal measurement. REF: Page 808 TOP: Passageway

2. Braxton-Hicks contractions, which may begin in the first trimester and become increasingly stronger during the pregnancy, differ from labor contractions in that they: a. last several minutes. b. are always regular. c. do not dilate the cervix. d. are only mild.

ANS: C Braxton-Hicks contractions do not dilate the cervix. REF: Page 806 TOP: Braxton-Hicks contractions

3. The nurse differentiates false from true labor by explaining that in true labor: a. discomfort of the contraction is in the fundus. b. contractions do not follow a pattern. c. contractions get stronger with ambulation. d. contractions may stop with ambulation.

ANS: C Contractions get stronger with ambulation in true labor. REF: Page 806 TOP: True labor

24. A primigravida patient is admitted to the labor and delivery unit. During initial assessment, the baby is found to be engaged. The nurse recognizes this means that the: a. narrowest diameter of the presenting part has reached the pelvic outlet. b. descending part is being initiated through the midpelvis. c. widest diameter of the presenting part has reached the pelvic outlet. d. narrowest diameter of the presenting part is at the ischial spines.

ANS: C Engagement occurs when the biparietal diameter of the fetal head reaches the pelvic outlet. REF: Page 816 TOP: Engagement

15. When monitoring the fetal heart rate (FHR), the nurse recognizes indications that the FHR is nonreassuring. This indicates to the nurse that the fetus is experiencing fetal distress most likely related to: a. birth trauma. b. strong contractions. c. hypoxia. d. aspiration.

ANS: C Fetal distress resulting from hypoxia is indicated by a nonreassuring FHR. REF: Page 826 TOP: Fetal distress

5. The nurse reassures the patient that the method used to determine the size of the true pelvis for over 20 years with no detrimental effects to the fetus is: a. pelvimetry. b. palpation. c. ultrasonography. d. x-ray.

ANS: C In more than 20 years of use, ultrasonography has had no detrimental effects on the fetus. REF: Page 808 TOP: Ultrasound

18. A patient arrives at the hospital and is not sure if she is in true labor. The nurse does an assessment and assures her she is in true labor because: a. there is no dilatation. b. the contractions are in the fundus. c. the cervix has softened and effaced. d. the contractions are irregular.

ANS: C One sign of true labor is when the cervix has softened and effaced. REF: Page 806 TOP: Effacement

17. The patient's membranes have just ruptured. The nurse is with her and knows that the first thing that must be done is to: a. turn the patient on the left side. b. perform a Nitrazine test. c. check the fetal heart rate (FHR). d. perform a vaginal examination.

ANS: C The FHR should be assessed immediately after rupture of the membranes to determine the well-being of the baby. REF: Page 819 TOP: Ruptured membranes

21. A mother is in early labor and asks the nurse how long this will last. The nurse explains that the first stage of labor lasts from the beginning of regular contractions until the: a. cervix is completely effaced. b. baby is in position. c. cervix is fully dilated. d. woman begins pushing.

ANS: C The first stage of labor begins with regular contractions and ends with complete dilatation of the cervix. REF: Page 818 TOP: Labor and delivery

9. The relationship of fetal body parts to one another during labor is called fetal attitude. The nurse explains that the ideal attitude for the fetal body is: a. extension. b. lateral. c. flexion. d. transverse.

ANS: C The ideal attitude for the fetal body is flexion. REF: Page 809 TOP: Attitude

16. A woman is admitted in active labor, and the nurse assesses the fetal heart rate (FHR) at 124 beats per minute. Based on that assessment, the nurse should: a. position patient on her left side. b. start oxygen per nasal cannula. c. reassure the mother the rate is normal. d. notify the physician at once.

ANS: C The normal FHR is 120 to 160 beats per minute. REF: Page 819 TOP: Fetal heart rate (FHR)

8. The nurse teaches a group of primigravidas that during delivery, pressure on the fetal skull may produce changes in the shape of the skull called: a. pressure response. b. overlapping. c. molding. d. spacing.

ANS: C The reshaping of the skull bones in response to pressure is called molding. REF: Page 808 TOP: Molding

6. The nurse plans to use a picture to show the area of the uterus that provides the force during a contraction, which is the: a. lower portion. b. middle portion. c. upper portion. d. cervical portion.

ANS: C The upper portion of the uterus provides the force during contractions. REF: Page 808 TOP: Passageway Step: Planning

22. The nurse is admitting a patient to the labor and delivery unit. While performing the initial assessment, it is most important to assess: a. food and drug allergies. b. when the baby is due. c. when the patient last ate. d. the timing of contractions.

ANS: D Assessment begins with timing the contractions on admission to form a database. REF: Page 835, Box 26-5 TOP: Admission of labor patient

12. The nurse clarifies that the type of monitor that will assess the intensity of the contractions is a(n): a. external monitor. b. fetal monitor. c. maternal monitor. d. internal monitor.

ANS: D Internal monitoring is used to monitor intensity of contractions. REF: Page 823 TOP: Fetal monitoring

Nursing actions after the rupture of the membranes

After the rupture of the membranes, delivery should occur within 24 hours to reduce the risk of infection. The healthcare provider should monitor for signs of infection and take appropriate actions.

Amniocentesis

Amniocentesis is a prenatal test that can confirm the sex of the baby and check for chromosomal abnormalities, overall health status, and fetal lung maturity.

Episiotomy

An episiotomy is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth to minimize tearing and facilitate the delivery of the baby.

A woman who has just discovered she is pregnant states that the first day of her last menstrual period was July 10. The nurse tells her that her expected date of birth (EDB) will be:

April 17.

Immunity to baby from maternal antibodies

Around week 33 of gestation, maternal antibodies are transferred to the baby, providing passive immunity and protection against certain infections.

Assessing fundal height

Assessing fundal height involves measuring the height of the growing uterus from the pubic bone to the top of the uterus, which provides an indication of fetal growth and the duration of pregnancy.

Braxton Hicks contractions

Braxton Hicks contractions are irregular contractions that occur during pregnancy but do not lead to the dilation of the cervix. They are often referred to as 'practice contractions.'

Chloasma

Chloasma is the irregular darkening of the cheeks, forehead, and nose that can occur during pregnancy due to hormonal changes.

Alcohol

Consuming alcohol during pregnancy can cause fetal alcohol syndrome, which can result in physical, behavioral, and cognitive abnormalities in the baby.

Decelerations

Decelerations in the fetal heart rate (FHR) can occur during labor. Early decelerations are considered normal, while late decelerations and variable decelerations are non-reassuring and require close monitoring and intervention.

Monitoring FHR during labor

During labor, the fetal heart rate (FHR) should be monitored regularly. In the first stage of labor, FHR should be assessed every 15-30 minutes, and in the second stage, it should be assessed every 5 minutes. FHR should also be assessed immediately after the rupture of membranes.

Force of contraction

During labor, the force of contraction originates in the upper portion of the uterus (fundus) and travels downward, helping to push the baby through the birth canal.

Changes in mother related to increased circulating volume

During pregnancy, the mother's blood volume increases by 30-40%, which is necessary to support the growing fetus and meet its oxygen and nutrient needs.

Comfort measures during the first stage of delivery

During the first stage of delivery, different comfort measures can be used depending on the phase of labor. In the latent phase, mild pain can be managed with techniques such as massages. In the active phase, pain management techniques may be used. In the transitional phase, pain medication may be requested if needed.

False labor

False labor refers to contractions that do not follow a regular pattern and do not cause significant changes in the cervix. These contractions are often referred to as 'Braxton Hicks contractions' and are not indicative of true labor.

When can fetal heart tones be heard?

Fetal heart tones can be heard using a Doppler device or ultrasound around 10-12 weeks of pregnancy.

When is fetal movement detected by the mother?

Fetal movement is typically detected by the mother between weeks 16-18 of pregnancy, especially in multigravida women who have experienced pregnancy before.

Frequent urination in early pregnancy

Frequent urination in early pregnancy is caused by increased circulating volume and pressure on the bladder due to hormonal changes and the growing uterus.

A woman tells the nurse that this is her third pregnancy. She has had twin girls at full term and one miscarriage. The nurse records this information as:

G3, T1, A1, L2.

Standard obstetric terminology for GTPAL

GTPAL is a standard obstetric terminology that stands for Gravidity (number of pregnancies), Term births, Preterm births, Abortions, and Living children. It is used to describe a woman's obstetric history.

Prolapsed umbilical cord

In the case of a prolapsed umbilical cord, pressure on the cord should be relieved manually by the healthcare provider, and a position change should be made to relieve pressure on the cord until further interventions can be performed.

Stages of labor

Labor is divided into four stages: the first stage involves the dilation of the cervix, the second stage involves the delivery of the fetus, the third stage involves the delivery of the placenta, and the fourth stage is the stabilization period immediately after childbirth.

Lightening

Lightening refers to the descent of the baby's head into the pelvis, which typically occurs around 38 weeks of pregnancy. It can make breathing easier for the mother but may also cause a return of urinary frequency.

Molding

Molding refers to the overlapping of the fetal skull bones during birth, allowing the baby's head to change shape and adapt to the size and shape of the birth canal.

Expected date of birth calculation

Nagele's Rule is used to calculate the expected date of birth. It involves counting back 3 months from the first day of the last menstrual period and adding 7 days.

Treating morning sickness

One way to treat morning sickness is by eating a few dry crackers before getting up in the morning, as this can help alleviate nausea and settle the stomach.

Palpation of the fetal outline

Palpation of the fetal outline involves feeling the shape of the fetus through the mother's abdomen, which can provide information about the baby's position and size.

Positive signs of pregnancy

Positive signs of pregnancy are definitive signs that identify the presence of the fetus, such as palpation of the fetal outline, visualization through ultrasound, and detection of the fetal heartbeat.

Rubella

Rubella, also known as German Measles, is a teratogenic virus that can cause birth defects if a pregnant woman becomes infected.

Signs of serious symptoms to report during pregnancy

Serious symptoms during pregnancy that should be reported to a healthcare provider include vaginal bleeding, visual disturbances, headaches, edema, rapid weight gain, sudden abdominal pain, signs of infection, abrupt flow or vaginal fluid, persistent vomiting, muscular irritability or convulsions, and absence or decrease in fetal movement.

Sexual intercourse during pregnancy

Sexual intercourse during pregnancy is generally safe unless there are complications or ruptured membranes. It is important to consult with a healthcare provider for individual guidance.

Effects of smoking

Smoking during pregnancy has been proven to cause slow intrauterine growth and low birth weight in babies, as well as other adverse effects on maternal and fetal health.

Smoking

Smoking during pregnancy has been proven to cause slow intrauterine growth and low birth weight in babies.

Symptoms of 'lightening' at 38 weeks

Symptoms of 'lightening' at 38 weeks include the baby dropping their head down into the pelvis, which can lead to a return of urinary frequency for the mother and easier breathing.

Teratogens

Teratogens are agents that can cause harm to the fetus, especially during the first few weeks of pregnancy when the organs are forming.

Nitrazine test findings

The Nitrazine test is used to determine the pH of vaginal fluid and differentiate amniotic fluid from urine and pus. A positive Nitrazine test indicates the presence of amniotic fluid, which suggests rupture of membranes.

Length of embryonic stage

The embryonic stage of pregnancy lasts for the first 8 weeks, during which the major organs and structures of the fetus develop.

Location of fertilized ovum

The fertilized ovum implants in the fundus of the uterus, which is the upper part of the uterus.

Intrapartal period

The intrapartal period refers to the period from the onset of labor to the delivery of the placenta after childbirth.

Legal responsibility for nurse reading the fetal heart monitor

The legal responsibility of a nurse reading the fetal heart monitor is to accurately read and interpret the fetal heart rate tracings and promptly report any signs of distress or abnormalities to the healthcare provider.

Management of tubal pregnancy

The management of tubal pregnancy involves the surgical removal of the zygote, which is the fertilized egg, from the fallopian tube.

Normal range for FHR

The normal range for fetal heart rate (FHR) is typically between 120-160 beats per minute. Variations outside this range may indicate the need for further assessment.

Placenta barrier

The placenta acts as a barrier, blocking some bacteria and drugs from reaching the fetus, but it does not provide protection against viruses.

Respiratory organ

The placenta acts as a respiratory organ, facilitating the exchange of oxygen between the mother's blood and the fetal blood.

Excretory organ

The placenta also acts as an excretory organ, allowing the exchange of waste products from the fetal blood to the mother's blood.

Function of the placenta

The placenta is a fetal organ that is responsible for oxygen, nutrition, and excretory functions, providing essential support to the developing fetus.

Hormones secreted by the placenta

The placenta secretes hormones such as Human Chorionic Gonadotropin (hCG), estrogen, and progesterone, which are essential for maintaining pregnancy.

Presence of the fetal heartbeat

The presence of the fetal heartbeat is an important indicator of the baby's well-being and is usually detected using a Doppler device or ultrasound.

When can sex of the fetus be confirmed?

The sex of the fetus can usually be confirmed through ultrasound around 9 weeks of pregnancy.

True pelvis

The true pelvis refers to the lower portion of the pelvis through which the fetus must pass during vaginal delivery. It consists of the inlet, midpelvis, and outlet.

True labor

True labor refers to regular, rhythmic contractions that cause progressive effacement (thinning) and dilation of the cervix, leading to the eventual birth of the baby.

Which is a positive sign of pregnancy?

Ultrasonic tracing of the fetus

Relieving urinary frequency at the end of pregnancy

Urinary frequency at the end of pregnancy can be relieved as the uterus rises into the abdominal cavity, reducing pressure on the bladder.

Visualization

Visualization refers to the use of ultrasound to create an image or tracing of the fetus, allowing healthcare providers to assess its development and well-being.

The physician decides to send the mother for a test to determine the fetal lung maturity. This fetal well-being test is called a(n):

amniocentesis.

A woman entering the 22nd week of pregnancy complains to the nurse that feels she has become unsightly because of chloasma. The nurse recommends that to reduce the chloasma, the patient should:

avoid exposure to the sun.

The nurse is concerned about the patient who is in her first trimester of pregnancy and has been exposed to German measles, because this disease is capable of:

causing birth defects.

The pregnant woman asks about sexual activity during her pregnancy. The nurse states that sexual activity should be:

ceased in the case of vaginal bleeding.

The nurse explains that the increase in circulating volume experienced during pregnancy will cause:

decreased hemoglobin.

Early in the first trimester, a woman may complain of morning sickness. The nurse suggests that this may be relieved by:

eating dry crackers before getting up.

To assess an accurate fundal height, the nurse should instruct the patient to:

empty her bladder.

The nurse explains that implantation is the embedding of the fertilized ovum in the uterine mucosa. This implantation usually occurs in the:

fundus of the uterus.

The newly diagnosed primigravida who is 6 weeks pregnant states, "I don't feel like I have a real baby inside me." The nurse reassures her that at 6 weeks the embryo has a functioning:

heart

The nurse explains that the placenta functions as an endocrine gland, secreting estrogen, progesterone, and:

human chorionic gonadotropin (HCG).

When the patient complains of frequency of urination, the nurse explains that frequency of urination early in the pregnancy occurs due to:

increased circulating volume.

A newly confirmed pregnant patient asks the nurse what the dangers of smoking are to her baby. The nurse tells her that smoking can cause the fetus to have:

low birth weight.

The nurse explains that the maternity cycle is divided into three periods. The intrapartal period covers:

onset of labor to delivery of the placenta.

When lecturing to a class of prenatal women, the nurse explains that the fetus is protected from most bacterial invasions by the:

placental barrier.

When the patient is diagnosed with a tubal pregnancy, the nurse is aware that in this pregnancy, the patient will probably:

require surgery to remove the zygote.

The nurse concludes that the prenatal patient has no need for further instruction when she correctly states that amniocentesis can determine which of the baby's characteristics?

sex, maturity, health and genetic defects

During the final weeks of pregnancy, urinary frequency may return due to the enlarged uterus compressing the bladder against the pelvic bones. The nurse suggests that the patient should:

sleep on her side.

The nurse stresses that a sign of a complication of pregnancy that must be reported to the physician at the first occurrence is:

vaginal bleeding.

If a pregnant teenager presents with all the complaints below, the nurse recognizes that the one that could signal danger is:

visual disturbances.