The nurse is explaining the physiology of uterine contractions to a group of nursing students. Which statement best explains the maternal-fetal exchange of oxygen and waste products during a contraction?
Diminishes as the spiral arteries are compressed
The nurse is directing an unlicensed assistive personnel (UAP) to obtain maternal vital signs between contractions which statement is the appropriate rationale for assessing maternal vital signs between contractions rather than at another interval
Maternal circulating blood volume increases temporarily during contractions
Uncontrolled maternal hyperventilation during labor results in
Respiratory alkalosis
Which mechanism of labor occurs when the largest diameter of the fetal presenting part passes the pelvic inlet
Engagement
The laboring patient asks the nurse how the labor contractions cause the cervix to dilate the nurse responds that labor contractions facilitate cervical dilation by
pulling the cervix over the fetus and amniotic sac.
Pregnant patients can usually tolerate the normal blood loss associated with childbirth because
of which physiologic adaptation to pregnancy?
Increased blood volume
The nurse is assessing the duration of a patient’s labor contractions. Which method does the nurse implement to assess the duration of labor contractions?
Assess from the beginning to the end of each contraction.
Which physiologic event is the key indicator of the commencement of true labor?
Cervical dilation and effacement
Which factor ensures that the smallest anterior-posterior diameter of the fetal head enters the pelvis?
Flexion
An increase in urinary frequency and leg cramps after the 36th week of pregnancy are an indication of
lightening.
A patient just delivered her baby via the vaginal route. The patient asks the nurse why the baby's head is not round but oval which explanation should the nurse provide the patient
This results from molding.
A patient whose cervix is dilated to 6 cm is considered to be in which phase of labor?
Active phase
The nurse is assessing a patient in the active phase of labor. What should the nurse expect during this phase?
The patient is requesting pain medication.
A laboring patient asks the nurse how she will know that the contraction is at its peak. The nurse explains that the contraction peaks during which stage of measurement?
The acme
A patient in labor presents with a breech presentation. The nurse understands that a breech presentation is associated with
umbilical cord compression
The primary difference between the labor of a nullipara and that of a multipara is
total duration of labor.
Which maternal factor may inhibit fetal descent during labor
A full bladder
Which assessment finding would cause a concern for a patient who had delivered vaginally?
Patient complains of fingers tingling
On admission to the labor and birth unit, a 38-year-old female gravida 4 para 3 at term in early labor is found to have a transverse lie on vaginal examination. What is the priority intervention at this time?
Notify the health care provider.
Which assessment finding indicates that cervical dilation and/or effacement has occurred?
Bloody mucus drainage from vagina
If a notation on the patient’s health record states that the fetal position is LSP, this indicates that the
buttocks are in the left posterior quadrant of the pelvis.
To determine if the patient is in true labor, the nurse would assess for changes in
cervical dilation.
The health care provider for a laboring patient makes the following entry into the patient’s record: 3/50%/+1. What instruction will the nurse implement with the patient?
Breathe with me slowly, in through your nose and out through your mouth.
The examiner indicates to the labor nurse that the fetus is in the left occiput anterior (LOA) position. To facilitate the labor process, how will the nurse position the laboring patient?
On her left side
The primiparous patient at 39 weeks’ gestation states to the nurse, “I can breathe easier now.”What is the nurse’s most appropriate response?
That process is called lightening. Do you have to urinate more frequently?”
The nurse assesses a laboring patient’s contraction pattern and notes the frequency at every 3 to 4 minutes, duration 50 to 60 seconds, and the intensity is moderate by palpation. What is
MSC: Patient Needs: Health Promotion and Maintenance
the most accurate documentation for this contraction pattern?
Stage 1, active phase
A laboring patient states to the nurse, “I have to push!” What is the next nursing action?
Examine the patient’s cervix for dilation.
After birth of the placenta the patient states, “All of a sudden I feel very cold.” What is the
most appropriate nursing action at this time?
Place a warm blanket over the patient.
A 28-year-old gravida 1, para 0 patient who is at term calls the labor and birth unit stating that she thinks she is in labor. She states that she does have some vaginal discharge and feels wet; however, it is not bloody in nature. She relates a contraction pattern that is irregular, ranging from 5 to 7 minutes and lasting 30 seconds. Which questions should the nurse pose to the patient during this telephone triage (Select all that apply.)
Does she think that her membranes have ruptured?
Tell her to come into the hospital for evaluation
A patient asks the nurse how she can tell if labor is real. Which information should the nurse provide to this patient? (Select all that apply.)
In true labor, the cervix begins to dilate
In true labor contractions often resemble menstrual cramps during early labor
in true labor your contractions tend to increase in frequency duration and intensity with walking
the nurse who elects to practice in the area of obstetrics often hears discussion regarding the four P's What are the Ps that interact during childbirth (SATA)
powers
passage
passenger
psyche
the nurse is planning care for a patient during the fourth stage of labor which interventions should the nurse plan to implement (SATA)
Offer the patient a warm blanket
Place an ice pack on the perineum
massage the uterus if it is boggy
which clinical finding should the nurse expect to assess in the third stage of labor that indicates the placenta has separated from the uterine wall (SATA)
A gush of blood appears
The uterus rises upward in the abdomen
The cord descends further from the vagina
The clinical nurse educator is providing instruction to a group of new nurses during labor orientation. Which information regarding the factors that have a role in the initiation of labor should the educator include in this teaching session?(SATA)
Natural oxytocin in conjunction with other substances plays a role
Stretching pressure and irritation of the uterus and cervix increase
Childbirth preparation can be considered successful if which of the following outcomes is achieved
The patient rehearsed labor and practiced skills to master pain.
A woman with a known heroin habit is admitted in early labor. Which drug is contraindicated with opiate-dependent patients?
Nalbuphine (Nubain)
A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5 minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment When is the best time to ask questions or perform procedures?
After the contraction is over
Childbirth pain is different from other types of pain in that it is
associated with a physiologic process.
Excessive anxiety during labor heightens the patient’s sensitivity to pain by increasing
muscle tension.
Which fetal position may cause the laboring patient increased back discomfort?
Left occiput posterior
A major advantage of nonpharmacologic pain management is
there are no side effects or risks to the fetus.
The best time to teach nonpharmacologic pain control methods to an unprepared laboring patient is during which stage
Latent phase
The primary side effect of maternal narcotic analgesia in the newborn is
respiratory depression.
The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)
pudendal.
The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?
It may result in decreased placental perfusion.
Which patient will most likely have increased anxiety and tension during labor?
Gravida 2 who delivered a stillborn baby last year
Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?
Breathing and relaxation techniques
A laboring patient who imagines her body opening to let the baby out is using a mental technique called
imagery
When administering a narcotic to a laboring patient, which statement explains why the nurse should inject the medication at the beginning of a contraction?
Less medication will be transferred to the fetus
The method of anesthesia in labor that is considered the safest for the fetus is
local infiltration.
To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should
place a wedge under the woman’s right hip.
Which physiologic effect may occur in the presence of increased maternal pain perception during labor?
Decreased perfusion to the placenta in response to catecholamine secretion
Which of the following factors would affect pain perception or tolerance for the laboring patient?
Right occiput posterior fetal position during labor
A patient in labor is approaching the transition stage and already has an epidural in place. An additional dose of medication has been prescribed and administered to the patient. Which priority intervention should be performed in order to evaluate the clinical response to treatment?
Document maternal blood pressure and fetal heart rates following medication administration and observe for any variations.
The process of labor places significant metabolic demands on the obstetric patient. Which physiologic findings would be expected?
Increased maternal demand for oxygen
A labor patient, gravida 2, para 1, at term has received meperidine (Demerol) for pain control during labor. Her most recent dose was 15 minutes ago and birth is now imminent. Maternal vital signs have been stable and the EFM tracing has not shown any baseline changes. Which medication does the nurse anticipate would be required in the birth room for administration?
Naloxone (Narcan)
Which statement is true with regard to the type of pain associated with childbirth experience?
Pain associated with childbirth is self-limiting
A patient in labor reports a feeling of burning pain during the second stage of labor. This type of pain is associated with
somatic pain.
A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely apprehensive because this is her first childbirth experience and asks for an epidural to be administered now. What is the priority nursing response based on this patient assessment?
Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth
A labor patient has brought in a photograph of her two children and asks the nurse to place it on the wall so that she can look at it during labor contractions. This is an example of
focal point.
A pregnant woman in labor is quite anxious and has been breathing rapidly during contractions. She now complains of a tingling sensation in her fingers. What is the priority nursing intervention at this time?
Instruct the patient to breathe into her cupped hands.
A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation strategy for pain management. The nurse would
apply a heat pack to lower back.
To relieve a mild postdural puncture headache, the nurse should encourage the intake of
tea or coffee.
Which patient will be most receptive to teaching about nonpharmacologic pain control methods?
Gravida 1 para 0 dilated 2 cm 80% effaced
The nurse is providing care to a patient in the active phase of the first stage of labor. The patient is crying out loudly with each contraction. What is the nurse’s most respectful approach for this patient?
Ask the patient’s labor coach if this is a usual expression of pain for her.
A multipara’s labor plan includes the use of jet hydrotherapy during the active phase of labor. What is the priority patient assessment prior to assisting the patient with this request?
Maternal temperature
A patient in active labor requests an epidural for pain management. What is the nurse’s most appropriate intervention at this juncture?
Initiate an IV infusion of lactated Ringer’s solution at 2000 mL/hour over 30 minutes.
You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)
Have ephedrine available at bedside during catheter placement.
Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration.
While developing an intrapartum care plan for the patient, in early labor it is important that the nurse recognize that psychosocial factors may influence a woman’s experience of pain. These include which of the following? (Select all that apply.
Culture
Anxiety and fear
support systems
preparation for childbirth
previous experience with pain
The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply
Administer a normal saline bolus as prescribed.
Administer oxygen at 8 to 10 L/minute per face mask.
Administer IV ephedrine in 5- to 10-mg increments as prescribed.
The nurse is preparing a patient for a cesarean birth scheduled to be performed under general anesthesia. Which should the nurse plan to administer, if ordered by the health care provider, to prevent aspiration of gastric contents (SATA)
Citric acid (Bicitra)
Ranitidine (Zantac)
Glycopyrrolate( Phenergran)