Test 2 OB- for final exam
A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. What is the nurse's ideal response? "Don't worry about it. You'll do fine." "It's normal to be anxious about labor. Let's discuss what makes you afraid." "Labor is scary to think about, but the actual experience isn't." "You can have an epidural. You won't feel anything."
"It's normal to be anxious about labor. Let's discuss what makes you afraid."
A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP) unit for the birth of their first child. The nurse applies the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the baby's heart rate should be. What is the nurse's best response? "Don't worry about that machine; that's my job." "The baby's heart rate will fluctuate in response to what is happening during labor." "The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are." "Your physician will explain all of that later."
"The baby's heart rate will fluctuate in response to what is happening during labor."
A first-time mother is concerned about the type of medications she will receive during labor. The client is in a fair amount of pain and is nauseated. In addition, she appears to be very anxious. The nurse explains that opioid analgesics are often used along with sedatives. How should the nurse phrase the rationale for this medication combination? "The two medications, together, reduce complications." "Sedatives enhance the effect of the pain medication." "The two medications work better together, enabling you to sleep until you have the baby." "This is what your physician has ordered for you."
"Sedatives enhance the effect of the pain medication."
A client is experiencing back labor and reports intense pain in her lower back. Which measure provided by the woman's labor coach would best support this woman in labor? Counterpressure against the sacrum Pant-blow (breaths and puffs) breathing techniques Effleurage Conscious relaxation or guided imagery
Counterpressure against the sacrum
A woman has requested an epidural block for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's IV fluid for a preprocedural bolus. Before the initiation of the epidural, the woman should be informed regarding the disadvantages of an epidural block. Which concerns should the nurse share with this client? (Select all that apply.) Ability to move freely is limited. Orthostatic hypotension and dizziness may occur. Gastric emptying is not delayed. Higher body temperature may occur.
Ability to move freely is limited, orthostatic hypotension and dizziness may occur, higher body temperature may occur
You are a new nurse on the OB unit, you are learning to read external fetal monitor strips and you hear another nurse describe her patients strip as a category I fetal heart rate pattern. You know that this means... All findings related to this fetal heart rate are within normal limits. The fetal heart rate is showing major signs of deterioration and she will need a c-section. The fetal heart rate is not within normal limits in all criteria, but is responding to interventions and requires continued monitoring. The fetal heart rate requires immediate intervention.
All findings related to this fetal heart rate are within normal limits.
What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? Altered fetal cerebral blood flow Umbilical cord compression Uteroplacental insufficiency Spontaneous rupture of membranes
Altered fetal cerebral blood flow
When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective? Dilation of the cervix Descent of the fetus to -2 station Rupture of the amniotic membranes (ROM) Increase in bloody show
Dilation of the cervix
Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant? Assessing the infant for signs of trauma. Administering prophylactic antibiotic agents to the infant. Applying a cold pack to the infant's scalp. Measuring the circumference of the infant's head
Assessing the infant for signs of trauma.
A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth classes. What is the optimal intervention for the nurse to provide initially? Notify the woman's health care provider. Administer the prescribed narcotic analgesic. Assure her that her labor will be over soon. Assist her with simple breathing and relaxation instructions.
Assist her with simple breathing and relaxation instructions.
The nurse has received a report regarding a client in labor. The woman's last vaginal examination was recorded as 3 cm, 30%, and -2. What is the nurse's interpretation of this assessment? Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
Which client would not be a suitable candidate for internal electronic fetal monitoring (EFM)? Client who still has intact membranes Woman whose fetus is well engaged in the pelvis Pregnant woman who has a comorbidity of obesity Client whose cervix is dilated to 4 to 5 cm
Client who still has intact membranes
What are the legal responsibilities of the perinatal nurses? Correctly interpreting fetal heartrate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes Greeting the client on arrival, assessing her status, and starting an IV line Applying the external fetal monitor and notifying the health care provider Ensuring that the woman is comfortable
Correctly interpreting fetal heartrate (FHR) patterns, initiating appropriate nursing interventions, and documenting the outcomes
The nurse performs a vaginal examination to assess a client's labor progress. Which action should the nurse take next? Perform an examination at least once every hour during the active phase of labor. Perform the examination with the woman in the supine position. Wear two clean gloves for each examination. Discuss the findings with the woman and her partner.
Discuss the findings with the woman and her partner.
The uterine contractions of a woman early in the active phase of labor are assessed by an external fetal monitor (the toco). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and palpate moderate to strong. Based on this information, what would a prudent nurse do next? Immediately notify the woman's primary health care provider. Prepare to administer an oxytocic to stimulate uterine activity. Document the findings because they reflect the expected contraction pattern for the active phase of labor. Prepare the woman for the onset of the second stage of labor.
Document the findings because they reflect the expected contraction pattern for the active phase of labor.
A pregnant woman's amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurse's highest priority? Elevating the presenting part off of the cord. Covering the cord in sterile gauze soaked in saline. Preparing the woman for a cesarean birth. Starting oxygen by face mask
Elevating the presenting part off of the cord.
A woman's position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client? The supine position, which is commonly used in the United States, increases blood flow. The laboring client positioned on her hands and knees ("all fours" position) is hard on the woman's back. Frequent changes in position help relieve fatigue and increase the comfort of the laboring client. In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder
Frequent changes in position help relieve fatigue and increase the comfort of the laboring client.
When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. Which instruction best describes these measures? Encouraging the woman to try various upright positions, including squatting and standing Telling the woman to start pushing as soon as her cervix is fully dilated. Continuing an epidural anesthetic so pain is reduced and the woman can relax. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction
Encouraging the woman to try various upright positions, including squatting and standing
Which statement regarding the care of a client in labor is correct and important to the nurse in the formulation of the plan of care? Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation. The woman's blood pressure will increase during contractions and fall back to prelabor normal levels between contractions. The use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. Having the woman point her toes will reduce leg cramps.
Endogenous endorphins released during labor will raise the woman's pain threshold and produce sedation.
What is the rationale for the use of a blood patch after spinal anesthesia? Preventing related hypotension Minimizing the effects of a spinal headache Eliminating neonatal respiratory depression Limiting the loss of movement
Minimizing the effects of a spinal headache
Which description most accurately describes the augmentation of labor? Is part of the active management of labor that is instituted when the labor process is unsatisfactory. Relies on more invasive methods when oxytocin and amniotomy have failed. Is a modern management term to cover up the negative connotations of forceps-assisted birth. Uses vacuum cups
Is part of the active management of labor that is instituted when the labor process is unsatisfactory.
A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical? Prostaglandins are used to soften and thin the cervix. Labor can sometimes be induced with balloon catheters or laminaria tents. Oxytocin is less expensive and more effective than prostaglandins but creates greater health risks. Amniotomy can be used to make the cervix more favorable for labor.
Labor can sometimes be induced with balloon catheters or laminaria tents.
Which characteristic correctly matches the type of deceleration with its likely cause? Early deceleration—umbilical cord compression Late deceleration—uteroplacental insufficiency Variable deceleration—head compression Prolonged deceleration—unknown cause
Late deceleration—uteroplacental insufficiency
A woman who has a history of sexual abuse may have several traumatic memories triggered during labor. She may fight the labor process and react with pain or anger. The nurse can implement appropriate care measures to help her client view the childbirth experience in a positive manner. Which intervention is key for the nurse to use while providing care? Tell the client to relax and that it won't hurt much. Limit the number of procedures that invade her body. Reassure the client that, as the nurse, you know what is best. Allow unlimited care providers to be with the client.
Limit the number of procedures that invade her body.
A woman in labor has just received an epidural block. What is the most important nursing intervention at this time? Limit parenteral fluids. Monitor the fetus for possible tachycardia. Monitor the maternal blood pressure for possible hypotension. Monitor the maternal pulse for possible bradycardia.
Monitor the maternal blood pressure for possible hypotension.
Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? Occiput of the fetus is in a posterior position. Fetus is at or above the ischial spines. Fetus is in a vertex presentation. Membranes have ruptured.
Occiput of the fetus is in a posterior position.
The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate? Early fetal heart rate (FHR) decelerations Fetal arrhythmias Uteroplacental insufficiency Spontaneous rupture of membranes
Spontaneous rupture of membranes
A woman is having her first child. She has been in labor for 15 hours. A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part of the fetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is associated with this description? Prolonged latent phase Protracted active phase Secondary arrest Protracted descent
Secondary arrest
Anxiety is commonly associated with pain during labor. Which statement regarding anxiety is correct? Even mild anxiety must be treated. Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on. Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.
Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on.
Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction? It diminishes as the spiral arterioles are compressed. The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced. This exchange of oxygen and waste products is not significantly affected by contractions. This maternal-fetal exchange increases as the blood pressure decreases.
The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced.
When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular in shape. A gush of dark red blood comes from her vagina. What is the nurse's assessment of the situation? The placenta has separated. A cervical tear occurred during the birth. The woman is beginning to hemorrhage. Clots have formed in the upper uterine segment.
The placenta has separated.
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? To enhance uteroplacental perfusion in an aging placenta To increase amniotic fluid volume To ripen the cervix in preparation for labor induction To stimulate the amniotic membranes to rupture
To ripen the cervix in preparation for labor induction
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? To stimulate fetal surfactant production To reduce maternal and fetal tachycardia associated with ritodrine administration. To suppress uterine contractions. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy
To stimulate fetal surfactant production
While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the fetal heart rate (FHR) for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. What is the nurse's first priority? Change the woman's position. Notify the health care provider. Assist with amnioinfusion Insert a scalp electrode.
change the womens position
The nurse is caring for a client in early labor. Membranes ruptured approximately 2 hours earlier. This client is at increased risk for which complication? Intrauterine infection Hemorrhage Precipitous labor Supine hypotension
hemorrhage
What is the most critical nursing action in caring for the newborn immediately after the birth? Keeping the airway clear Fostering parent-newborn attachment Drying the newborn and wrapping the infant in a blanket Administering eye drops and vitamin K
keep airway clear
Which changes take place in the woman's reproductive system, days or even weeks before the commencement of labor? (Select all that apply.) Lightening Exhaustion Bloody show Decreased fetal movement
lightening, bloody show
What is a maternal indication for the use of forceps-assisted birth? Wide pelvic outlet Maternal exhaustion History of rapid deliveries Failure to progress past station 0
maternal exhaustion
Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur? Maternal fever Umbilical cord prolapse Regional anesthesia Magnesium sulfate administration
maternal fever
What is the correct placement of the tocotransducer for effective electronic fetal monitoring (EFM)? Over the uterine fundus On the fetal scalp Inside the uterus Over the mother's lower abdomen
on the fetal scalp
A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign? Periodic fetal sleep state Extreme prematurity Fetal hypoxemia Preexisting neurologic injury
periodic fetal sleep state
A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that "labor is getting close to starting." Which finding is an indication that labor may begin soon? Weight gain of 1.5 to 2 kg (3 to 4 lb) Increase in fundal height Urinary retention Surge of energy
surge of energy
What is the primary difference between the labor of a nullipara and that of a multipara? Amount of cervical dilation Total duration of labor Level of pain experienced Sequence of labor mechanisms
total duration of labor
