Labor Delivery Flashcards

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Terms Definitions
hCG
human Chorionic Gonadotropin
Trial of labor (TOL)
Premature labor
Regular contractions between 20
Amniotomy
Artificial Rupture of Membranes. Pitocin/Oxytocin/Cervidil/Cytotec
Dystocia
Difficult labor. Fetal or pelvic factors.
Amnioinfusion
Infusion of warm sterile saline into the uterus in an attempt to increase the fluid around the umbilical cord to prevent cord compression during labor contractions; also used to dilute thick meconium-stained amniotic fluid.
External (cephalic) Version (ECV)
Procedure involving external manipulation of the abdomen to change the presentation of the fetus from breech to cephalic.
Nullipara (Para 0)
Woman who has not had children
Bishop score
A prelabor scoring system to assist in predicting whether an induction of labor may be successful.
Which pregnancy-related physiologic change would place the client with a history of cardiac disease at the greatest risk for developing severe cardiac problems?
A. Decreased heart rate
B. Decreased cardiac output
C. Increased plasma volume
D. Incr
c Rationale: Pregnancy increases plasma volume and expands the uterine vascular bed, possibly increasing the heart rate and cardiac output. These changes may cause cardiac stress, especially during the second trimester. Blood pressure during early pregnancy may decrease, but it gradually returns to prepregnancy levels.
Cesarean Section
Birth of a fetus accomplished by performing a surgical incision through the abdomen & uterus.
What is engagement?
When largest diameter of presenting part reaches or passes through pelvic inlet - upper diameter of pelvis
Labor graph (Friedman’s curve)
Cervical dilation at a steady pace.
Bishop score
A prelabor scoring system to assist in predicting whether an induction of labor may be successful.
Which stages can be seen?
Extension, external rotation & expulsion
What is flexion?
Occurs as head meets resistance from musculature & soft tissue.
To ensure that the breast-feeding neonate's weight loss remains within the expected parameter of 5% to 10%, the nurse should initially establish which type of feeding schedule?
A. Maintain the neonate on an every-2-hours feeding schedule.
B. Put the n
D Rationale: Breast-feeding schedules should respond to the demands of the neonate, at a minimum of every 4 hours. An infant may not be hungry or willing to eat every 2 hours. Every 4 hours may be too long for the neonate. Using supplementary bottles may interfere with the mother's milk production and cause nipple confusion.
How does the mothers psyche effect labor & birth?
Physical preparation, sociocultural heritage, previous experience, support system, emotional integrity
What is engagement & descent?
head enters inlet in occiput transverse position because the inlet is widest from side to side
When performing a nursing assessment of a client's episiotomy, the nurse would especially assess for:
A. location.
B. discharge and odor.
C. edema and approximation.
D. subinvolution.
c Rationale: Episiotomies should be assessed for edema and approximation of the incision. An edematous perineum causes more tension of the suture line and increases pain. Although the sutures may be difficult to visualize, the suture line should be intact. Episiotomy location is important but not as important as the presence of edema. Discharge and odor refer to an assessment of the lochia. Subinvolution refers to the complete return of the uterus to its prepregnancy size and shape.
30-year-old primigravida tells the nurse that her hemorrhoids have become itchy and painful. After instructing the client about relief measures, the nurse determines that the client needs further instructions when she says:
A. "I should sit in a wa
d Rationale: The client needs further instructions when she says she should decrease her fluid intake. Constipation further aggravates hemorrhoid pain and should be avoided through increased fluid and fiber intake. Warm sitz baths, topical ointments, and ice packs all can be helpful measures to reduce the pain, swelling, and itchiness.
Initial client assessment information includes the following: blood pressure 160/110 mm Hg, pulse 88 beats/minute, respiratory rate 22 breaths/minute, reflexes +3/+4 with 2 beat clonus. Urine specimen reveals +3 protein, negative sugar and ketones. Based
a Rationale: The client is exhibiting signs of preeclampsia. In addition to hypertension and hyperreflexia, most preeclamptic clients have edema. Headache and blurred vision are indications of the effects of the hypertension. Abdominal pain, urinary frequency, diaphoresis, nystagmus, dizziness, lethargy, chest pain, and shortness of breath are inconsistent with a diagnosis of preeclampsia.
Immediately after a spontaneous rupture of the membranes, the nurse observes a loop of umbilical cord protruding from the vagina. The first nursing action would be to:
A. administer oxygen.
B. notify the physician.
C. document the deceleration.
D.
d Rationale: The first nursing action would be to elevate the hips on two pillows. The primary goal with prolapse of the umbilical cord is to remove the pressure from the cord. Changing the maternal position is the first intervention. Acceptable positions include knee-chest, side-lying, and elevation of the hips. The nurse may also perform a vaginal examination and attempt to push the presenting part of the cord while being careful not to add any pressure to the cord. Administering oxygen benefits the fetus only if circulation through the cord has been reestablished. The nurse does notify the physician and document the deceleration, care provided, and outcome but only after providing the initial emergency care to the client.
When magnesium sulfate is administered to a client in labor, its action occurs at which of the following sites?
A. Neural-muscular junctions
B. Distal renal tubules
C. Central nervous system (CNS)
D. Myocardial fibers
A Rationale: Because magnesium has chemical properties similar to those of calcium, it will assume the role of calcium at the neural muscular junction. It doesn't act on the distal renal tubules, CNS, or myocardial fibers.
Cephalopelvic Disproportion (CPD)
A condition in which the fetal head is of such a shape or size, or in such a position, that it cannot pass through the pelvis.
What is associated with breech presentation?
Decreased weight of baby, increased mortality & anomalies, more common with placenta previa, multiple gestation & grand multiparity. Possible head entrapment, increased chance of cord prolpse. Passage of merconium due to compression of intestines.
Which of the following is the approximate time that the blastocyst spends traveling to the uterus for implantation?
A. 2 days
B. 7 days
C. 10 days
D. 14 weeks
b Rationale: The blastocyst takes approximately 1 week to travel to the uterus for implantation. The other options are incorrect.
A 35-year-old multigravida at 16 weeks’ gestation tells the nurse that she has had frequent mood swings during this pregnancy. The nurse should suggest that the patient:
A. seek professional counseling.
B. keep her feelings to herself.
C. try to av
C Rationale: Mood swings are thought to be related to the altered hormonal levels associated with pregnancy. The nurse should suggest that the patient try to avoid fatigue and stress because these factors can exacerbate mood swings. The patient doesn’t need professional counseling unless symptoms of psychosis are present. Telling the patient to keep her feelings to herself or to decrease her narcissistic behaviors would be inappropriate.
Which of the following correctly defines puerperium?
A. The 1st hour after birth
B. The 6 weeks following birth
C. The days spent in the hospital
D. The duration of breast-feeding
b Rationale: Puerperium is defined as the 6 weeks postpartum. The other options are incorrect.
Which of the following hormones is responsible for the let-down reflex?
A. Oxytocin
B. Prolactin
C. Estrogen
D. Progesterone
a Rationale: Oxytocin is responsible for milk let-down, the process that brings milk to the nipple. The other hormones mentioned contribute indirectly to the lactation process. Prolactin stimulates lactation. Estrogen stimulates development of the duct in the breast. Progesterone acts to increase the lobes, lobules, and alveoli of the breasts.
What is the obstetric conjugate?
Determined by subtracting 1.5 to 2 cm from diagonal. Smallest diameter through which the fetus must pass. Can be measured by x-ray, should be >10 cm.
What is internal rotation?
Fetus rotates 45 to 90 degrees to fit the widest anterior/posterior diameter of the outlet
In performing a routine fundal assessment, the nurse finds a client's fundus to be "boggy." The nurse should first:
A. call the physician.
B. massage the fundus.
C. assess lochia flow.
D. start methylergonovine as ordered.
B Rationale: The nurse should begin to massage the uterus so that the uterus will be stimulated to contract. Lochia flow can be assessed while the uterus is being massaged. The client shouldn't be left while the nurse calls the physician. If the fundus remains boggy and the uterus continues to bleed, the nurse should use the call light to ask another nurse to call the physician. An order for methylergonovine may be obtained at this time if needed, or the nurse may administer methylergonovine as written.
When assessing the fetal heart rate tracing, the nurse becomes concerned about the fetal heart rate pattern. In response to the loss of variability, the nurse repositions the client to her left side and administers oxygen. These actions are likely to impr
a Rationale: These actions, which will improve fetal hypoxia, increase the amount of maternal circulating oxygen by taking pressure created by the uterus off the aorta and improving blood flow. These actions won't improve the contraction pattern, free a trapped cord, or improve maternal comfort.
Which condition could a mother have and still be allowed to breast-feed her child?
A. Positive for human immunodeficiency virus (HIV)
B. Active tuberculosis (TB)
C. Endometritis
D. Cardiac disease
c Rationale: Of the listed conditions, endometritis is the only one in which a mother can continue to breast-feed provided that the antibiotics she's taking aren't contraindicated. A mother who has HIV or active TB is strongly discouraged from breast-feeding because of concerns about transmitting the infection to the neonate. Clients with cardiac disease are also discouraged from breast-feeding because of the strain on the mother's defective heart.
When a client being seen in a fertility clinic doesn't respond to the clomiphene citrate, the physician prescribes I.M. menotropins (Pergonal). This drug increases her risk of producing multiple follicles that could mature to ovulation. To reduce the high
a Rationale: The objective of menotropins therapy is to produce one or two healthy follicles; by carefully monitoring the client's ultrasound study results and serum estradiol levels, the nurse can determine the number of maturing follicles. Serum progesterone levels indicate whether ovulation has occurred and correlate well with basal body temperature changes but don't indicate the number of follicles. The test to detect urinary levels of LH is a hormonal assessment of ovulatory function — not an assessment of the number of maturing cells. Serum levels of HCG indicate whether the corpus luteum is producing enough estrogen and progesterone to maintain the pregnancy until the placenta develops further.
A client, now 37 weeks pregnant, calls the clinic because she's concerned about being short of breath and is unable to sleep unless she places three pillows under her head. After listening to her concerns, the nurse should take which action?
A. Make an
b Rationale: The nurse must distinguish between normal physiologic complaints of the latter stages of pregnancy and those that need referral to the health care provider. In this case, the client indicates normal physiologic changes due to the growing uterus and pressure on the diaphragm. The client doesn't need to be seen or admitted for delivery. The client's signs aren't indicative of heart failure.
The nurse is providing care for a pregnant client in her second trimester. Glucose tolerance test results show a blood glucose level of 160 mg/dl. The nurse should anticipate that the client will need to:
A. start using insulin.
B. start taking an ora
d Rationale: The client's blood glucose level should be controlled initially by diet and exercise, rather than insulin. The client will need to watch her overall diet intake to control her blood glucose level. Oral antidiabetic drugs aren't used in pregnant females. Urine sugars aren't an accurate indication of blood glucose levels.
What are the fetal positions?
O - Vertex or occiput - normal fetal position, M - face, chin or mentum presenting, S - breech, sacrum presenting, A - shoulder, scapula or acromion process presenting.
What are the different types of cephalic presentation?
Vertex - neck completely flexed, most common - smallest diameter of head presents, Military - neck neither flexed or extended - head & neck is straight, Brow - neck partially extended - head tipped slightly back, Face - neck hyperextended
A client who is 12 weeks pregnant is complaining of severe left lower quadrant pain and vaginal spotting. She's admitted for treatment of an ectopic pregnancy. Of the following nursing diagnoses, the nurse should give the highest priority to:
A. Risk fo
a Rationale: A ruptured ectopic pregnancy is a medical emergency due to the large quantity of blood that may be lost in the pelvic and abdominal cavities. Shock may develop from blood loss, and large quantities of I.V. fluids are needed to restore intravascular volume until the bleeding is surgically controlled. All the other nursing diagnoses are relevant for a woman with an ectopic pregnancy, but fluid volume loss through hemorrhage is the greatest threat to her physiological integrity and must be stopped. Anxiety may be due to such factors as the risk of dying and the fear of future infertility. Pain may be caused by a ruptured or distended fallopian tube or blood in the peritoneal cavity. Impaired gas exchange may result from the loss of oxygen-carrying hemoglobin through blood loss.
Which of the following describes a preterm neonate?
A. A neonate weighing less than 2,500 g (5 lb, 8 oz)
B. A low-birth-weight neonate
C. A neonate born at less than 37 weeks' gestation regardless of weight
D. A neonate diagnosed with intrauterine
C Rationale: A preterm infant is a neonate born at less than 37 weeks' gestation regardless of what the neonate weighs. Infants weighing less than 2,500 g are described as low-birth-weight neonate. A full-term neonate can be diagnosed with intrauterine growth retardation.
Which of the following should be the nurse's initial action immediately following the birth of the neonate?
A. Aspirating mucus from the neonate's nose and mouth
B. Drying the infant to stabilize the neonate's temperature
C. Promoting parental bondi
b Rationale: The nurse's first action is to dry the neonate and stabilize the neonate's temperature. Aspiration of the infant's nose and mouth occurs at the time of delivery. Promoting parental bonding and identifying the neonate are appropriate after the neonate has been dried.
Which of the following is the most important aspect of nursing care in the postpartum period?
A. Supporting the mother's ability to successfully feed and care for her neonate
B. Involving the family in the teaching
C. Providing group discussions on
a Rationale: Most of the nursing interventions during the postpartum period are directed toward helping the mother successfully adapt to the parenting role. Although family involvement in teaching, group discussions on infant care, and lochia monitoring are important aspects of care, the mother's ability to feed and care for her infant takes priority.
A 28-year-old client gave birth 1 hour ago to a full-term male neonate. Which finding should the nurse expect when palpating the client's fundus?
A. Soft, at the level of the umbilicus
B. Firm, ¨ú¡È (1.9 cm) below the umbilicus
C. Firm, at the l
c Rationale: Within 1 hour after delivery, the fundus should be firm and at the level of the umbilicus. A soft or boggy fundus isn't contracting well because of such factors as a full bladder or retained pieces of placenta, and places the postpartum client at risk for hemorrhage.
client is experiencing an early postpartum hemorrhage. Which action is inappropriate?
A. Inserting an indwelling urinary catheter
B. Fundal massage
C. Administration of oxytoxics
D. Pad count
D Rationale: By the time the client is hemorrhaging, a pad count is no longer appropriate. Inserting an indwelling urinary catheter eliminates the possibility that a full bladder may be contributing to the hemorrhage. Fundal massage is appropriate to ensure that the uterus is well contracted, and oxytoxics may be ordered to promote sustained uterine contraction.
A neonate girl is admitted to the nursery following a long and difficult labor. Admission vital signs are temperature 96.5° F (35.8° C), heart rate 168 beats/minute, and respiratory rate 64 breaths/minute. After placing the infant under the radiant heat
B Rationale: Maintenance of a blood sugar level at 50 mg or greater is required to ensure enough glucose for the brain and metabolism. Neonates who are cold stressed are at high risk for low blood sugars, a condition that requires immediate intervention to prevent damage to the neurologic system. Performing a full assessment, reviewing the pregnancy and delivery history, and contacting the pediatrician are done after the blood glucose level is obtained.
A nurse in a prenatal clinic is assessing a 28-year-old woman who is 24 weeks pregnant. Which findings would lead this nurse to suspect that the client has mild preeclampsia?
A. Glycosuria, hypertension, seizures
B. Hematuria, blurry vision, reduced u
D Rationale: The typical findings of mild preeclampsia are hypertension, edema, and proteinuria. Seizures are a sign of eclampsia. Abdominal pain, blurry vision, and reduced urine output are signs of severe preeclampsia. The other findings aren't typically found in women with preeclampsia.
What is the most favorable type of pelvis?
Gynecoid or round, anthropoid or oval is usually adequate
The nurse is caring for a neonate 12 hours after birth. Which clinical manifestation would be the earliest indication that the neonate may have cystic fibrosis?
A. Steatorrhea
B. Meconium ileus
C. Decreased sodium levels
D. Rhinorrhea
B Rationale: In cystic fibrosis, the small intestine becomes blocked with thick meconium; therefore, meconium ileus is the earliest indication that a neonate has the disorder. Steatorrhea may be present later and may be used as a guideline for administration of pancreatic enzymes. Infants and children with this disorder have increased sodium levels, and rhinorrhea isn't usually present.
When does the third stage of labor end?
A. When the neonate is born
B. When the client is fully dilated
C. After the birth of the placenta
D. When the client is transferred to her postpartum bed
C Rationale: The third stage of labor ends with the birth of the placenta. The first stage of labor ends with complete cervical dilation and effacement. The second stage of labor ends with the birth of the neonate. The fourth stage of labor comprises the first 4 hours after birth.
The nurse is caring for a client with mild active bleeding from placenta previa. Which assessment factor indicates that an emergency cesarean section may be necessary?
A. Increased maternal blood pressure of 150/90 mm Hg
B. Decreased amount of vaginal
C Rationale: A drop in fetal heart rate signals fetal distress and may indicate the need for a cesarean delivery to prevent neonatal death. Maternal blood pressure, pulse rate, respiratory rate, intake and output, and description of vaginal bleeding are all important assessment factors; however, changes in these factors don't always necessitate the delivery of the neonate.
What is the second stage of delivery?
This is when the mom feels the need to push, doctor may do episiotomy at this time, contractions are less painful since cervix is completely dilated
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