Labor Delivery 2 Flashcards

Fetal heart rate
Terms Definitions
Augmentation of labor
VBAC
Vaginal birth after cesarean
Hypotonic uterine dysfunction
Weak ineffective contractions
Premature labor
Regular contractions between 20
Dystocia
Difficult labor. Fetal or pelvic factors.
External (cephalic) Version (ECV)
Procedure involving external manipulation of the abdomen to change the presentation of the fetus from breech to cephalic.
Precipitate Labor
Labor lasting less than 3 hours.
Malposition
Abnormal position of the fetus in the birth canal.
Uterine Inversion
Prolapse of the uterine fundus through the cervix and into the vagina. May occur prior to or during expulsion of the placenta; associated with massive hemorrhage, requiring emergency treatment.
Malposition
Abnormal position of the fetus in the birth canal.
What is station?
Relationship of presenting part to imaginary line drawn between the ischial spines, graded at + or -.
Uterine rupture
Tearing of the muscle wall of the uterus.
Induction of Labor
The process of causing or initiating labor by use of medication or surgical rupture of membranes.
What is cephalic presentation?
Head first, 97% of term births.
Primipara (Para 1)
Woman who has carried a pg to viability - term interchangeably with primigravida - Para 1
When determining maternal and fetal well-being, which assessment is least important?
A. Signs of postural hypotension
B. Fetal heart rate and activity
C. The mother's acceptance of the growing fetus
D. Signs of facial or digital edema
a Rationale: Postural hypotension doesn't occur until late in the pregnancy and is easily correctable. Collection of other assessment data, such as fetal heart rate and activity, the mother's acceptance of the growing fetus, and signs of edema, should be started early in the pregnancy because abnormalities can put the mother or the fetus at risk for significant physiological and psychological problems.
How is intensity rated?
Mild - fingertips can easily indent fundus - cheek, moderate - can indent sligntly - chin, strong/hard - cannot indent - forehead.
What is presentation?
What part is first in the maternal pelvis.
When assessing a pregnant client with diabetes mellitus, the nurse is alert for signs and symptoms of a vaginal infection or urinary tract infection (UTI). Which condition makes this client more susceptible to such infections?
A. Electrolyte imbalances
d Rationale: Glycosuria predisposes the pregnant diabetic client to vaginal infections (especially Candida) and UTIs, because the hormonal changes of pregnancy affect the pH of the vagina and the urine. Electrolyte imbalances and hypoglycemia aren't associated with vaginal infections or UTIs. Insulin requirements may decrease in early pregnancy; however, as the client's food intake improves and maternal and fetal glycogen stores increase, insulin requirements also rise.
Following a precipitous delivery, examination of the client's vagina reveals a fourth-degree laceration. Which of the following would be contraindicated when caring for this client?
A. Applying cold to limit edema during the first 12 to 24 hours
B. In
b Rationale: Using two or more peripads would do little to reduce the pain or promote perineal healing. Cold applications, sitz baths, and Kegel exercises are important measures when the client has a fourth-degree laceration.
Thirty minutes after birth, the nurse assesses a client's fundus and lochia flow and notes an increased amount of lochia rubra and a few large clots. The client experienced a prolonged stage of labor before delivery. The uterine fundus remains midline and
d Rationale: Retained placental fragments cause uterine bleeding. The client may need to be sent to surgery for a dilation and curettage procedure to remove the placental fragments. If the fundus is firm, the amount of oxytocin in the I.V. fluids should be adequate. A prolonged second stage of labor or a primiparous status has no effect on uterine bleeding.
What is the diagonal conjugate?
The distance between the lower border of the symphysis pubis to sacral promontory. Should be >11.5 cm for pelvic inlet to be adequate. Measured by hand during pelvic exam.
How is the transition phase characterized?
Cervical dilation 8-10 cm, contraction longer & stronger, may experience nausea & possible vomiting, mother becoming tired, frustrated & unable to cope, need to focus mom and have her concentrate
Infertility in a 25-year-old couple is defined as which of the following?
A. The couple's inability to conceive after 6 months of unprotected attempts
B. The couple's inability to sustain a pregnancy
C. The couple's inability to conceive after 1 yea
c Rationale: The determination of infertility is based on age. In a couple younger than 30 years old, infertility is defined as failure to conceive after 1 year of unprotected intercourse. In a couple age 30 or older, the time period is reduced to 6 months of unprotected intercourse.
The nurse palpates a multipara's fundus immediately after delivery of the placenta and assesses that it's boggy. The nurse massages the client's uterus until it's firm. Which medication would the nurse anticipate to administer if the uterus becomes boggy
A Rationale: Oxytocin would be given to cause the uterus to maintain a firm contraction. When the uterus remains boggy, the myometrium isn't contracted, and bleeding occurs at the placental attachment site. Ibuprofen has anti-inflammatory properties but doesn't prevent a boggy uterus. RhoGAM is given to prevent Rh isoimmunization. Magnesium sulfate is given to stop preterm labor contractions because it causes the uterine smooth muscle to relax.
When assessing a neonate, the nurse observes a vaguely outlined area of scalp edema. Which term should the nurse use when documenting this observation?
A. Cephalhematoma
B. Petechiae
C. Subdural hematoma
D. Caput succedaneum
d Rationale: Caput succedaneum refers to a vaguely outlined area of scalp edema that crosses the suture lines and typically clears within a few days after birth. Cephalhematoma is a swelling of the head that results from subcutaneous bleeding caused by pressure exerted on the soft tissues during delivery; it's characterized by sharply demarcated boundaries that don't cross the suture lines. Petechiae are minute, circumscribed, hemorrhagic areas of the skin. A subdural hematoma is an accumulation of blood between the dura and the brain tissue.
Which instructions should the nurse give to a client who is 26 weeks pregnant and complains of constipation?
A. Encourage her to increase her intake of roughage and to drink at least six 8 oz glasses of water per day.
B. Tell her to ask her caregiver
a Rationale: The best instruction is to encourage the client to increase her intake of high-fiber foods (roughage) and to drink at least six glasses of water per day. Mild laxatives and stool softeners may be needed, but dietary changes should be tried first. Straining during defecation and diarrhea can stimulate uterine contractions, but telling the client to go to the evaluation unit doesn't address her concern.
Prevention of preterm births is vital for which reason?
A. It's costly to care for these neonates.
B. Preterm birth causes more than half of the neonatal deaths in the United States.
C. These neonates usually wind up with long-term health care needs
b Rationale: Prematurity is the leading cause of neonatal deaths in the United States; other industrialized nations have fewer premature births and fewer neonatal deaths than the United States does. Although the other three answers are complications of prematurity, prevention is the outcome nurses must focus on while providing care to their clients.
The nurse is assessing a pregnant woman in the clinic. In the course of the assessment, the nurse learns that this woman smokes one pack of cigarettes per day. The first step the nurse should take to help the woman stop smoking is to:
A. assess the clie
a Rationale: Before planning any intervention with a client who smokes, it's essential to determine whether the client is willing or ready to stop smoking. Commonly, a pregnant woman will agree to stop for the duration of the pregnancy. This gives the nurse an opportunity to work with her over time to help with permanent smoking cessation.
A 20-year-old woman's pregnancy is confirmed at a clinic. She says her husband will be excited, but is concerned because she herself isn't excited. She fears this may mean she'll be a bad mother. The nurse should respond by:
A. referring her to counseli
b Rationale: Misgivings and fears are common in the beginning of pregnancy. It doesn't necessarily mean that she requires counseling at this time. Exploring her feelings may help her understand her concerns more deeply, but won't provide reassurance that her feelings are normal. She may benefit by discussing her feelings with her husband, but he also needs to be reassured that these feelings are normal at this time.
How does the passenger affect labor & birth?
Head size, attitude, lie, presentation, position & implantation site of placenta.
A primigravida at 36 weeks' gestation tells the nurse that she has moderate breast tenderness. After providing the client with some suggestions for relief measures, the nurse determines that the client needs further instructions when she says:
A. "
b Rationale: The client needs further instructions when she says she should clean her nipples with soap. Soap can be extremely irritating to sensitive nipples. The client should wear a supportive bra at all times, change her sleeping position, and clean up the colostrum with water.
A client is being admitted to the labor unit. Because she's well advanced in labor, the nurse must prioritize the admission questions. Which information is most important to obtain when birth is imminent?
A. Duration of previous labor
B. Frequency of
d Rationale: Because birth is imminent, the most important information is the expected due date because it will help the health care team prepare to meet the special needs of a preterm or postterm infant. The duration of previous labor, frequency of contractions, and presence of bloody show aren't significant because birth is imminent and these factors don't affect the provision of safe care during childbirth.
A female neonate delivered by elective cesarean birth to a 25-year-old mother weighs 3,265 g (7 lb, 3 oz). The nurse places the neonate under the warmer unit. In addition to routine assessments, the nurse should closely monitor this neonate for which of t
b Rationale: The squeezing action of the contractions during labor enhances fetal lung maturity. Neonates who aren't subjected to contractions are at an increased risk for developing respiratory distress. The type of birth has nothing to do with temperature or glucose stability, and acrocyanosis is a normal finding.
A multigravida at 37 weeks' gestation is scheduled to undergo amniocentesis. The nurse determines that she needs further explanation when the client says:
A. "About 2 tsp of amniotic fluid will be removed."
B. "A sonogram will be done d
A Rationale: The client needs further instructions when she says about 2 tsp will be removed. Refined analysis requires 15 to 20 ml of amniotic fluid. A sonogram is used in amniocentesis, and pressure may be felt when the needle is inserted. The client should have a full bladder before the procedure.
Which of the following describes the term fetal position?
A. Relationship of the fetus's presenting part to the mother's pelvis
B. Fetal posture
C. Fetal head or breech at cervical os
D. Relationship of the fetal long axis to the mother's long axi
a Rationale: Fetal position refers to the relationship of the fetus's presenting part to the mother's pelvis. Fetal posture refers to "attitude." Presentation refers to the part of the fetus at the cervical os. Lie refers to the relationship of the fetal long axis to that of the mother's long axis.
The nurse is providing care for a pregnant 16-year-old client. The client says that she's concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying:
A. "Now isn't a good time to begin dieting because you'
c Rationale: Depriving the developing fetus of nutrients can cause serious problems and the nurse should discuss this with the client. The client isn't eating for two; this is a misconception. Exploring feelings helps the client understand her concerns, but she needs to be aware of the risks at this time. The vitamins are supplements and don't contain everything a mother or baby needs; they work in congruence with a balanced diet.
Which of the following would be least likely to affect the parent-child relationship?
A. Readiness for the pregnancy
B. Nature of the pregnancy
C. Maturity of the parents
D. Grandparent support
d Rationale: Extended family is important to the social development of the infant but doesn't affect the parent-child relationship. Readiness for pregnancy, a healthy and uncomplicated pregnancy, and parental maturity are factors that promote a positive parent-child relationship.
A client has just expelled a hydatidiform mole. She's visibly upset over the loss and wants to know when she can try to become pregnant again. Which of the following would be the nurse's best response?
A. "I can see you're upset. Why don't we discu
B Rationale: Clients who develop a hydatidiform mole must be instructed to wait at least 1 year before attempting another pregnancy, despite testing that shows they have returned to normal. A hydatidiform mole is a precursor to cancer, so the client must be monitored carefully for 12 months by an experienced health care provider. Discussing this situation at a later time and checking with the physician to give the client something to relax ignore the client's immediate concerns. Saying to wait until all tests are normal is vague and provides the client with little information.
What are the 4 P's impacting labor & birth?
Passage, Passenger, Power & Psyche
What are the risks associated with face presentation?
Increased risk of CPD - cephalopelvic disproportion - head won't fit through pelvis, facial edema
When caring for a client during the second stage of labor, which action would be least appropriate?
A. Assisting the client with pushing
B. Ensuring the client's legs are positioned appropriately
C. Allowing the client clear liquids
D. Monitoring
c Rationale: During this time, the client is usually offered ice chips rather than clear liquids. Nursing care for the client during the second stage of labor should include assisting the mother with pushing, helping position her legs for maximum pushing effectiveness, and monitoring the fetal heart rate.
A client has come to the clinic for her first prenatal visit. The nurse should include which statement about using drugs safely during pregnancy in her teaching?
A. "During the first 3 months, avoid all medications except ones prescribed by your ca
d Rationale: Because all medications can be potentially harmful to the growing fetus, telling the client to consult with her health care provider before taking any medications is the best teaching. The client needs to understand that any medication taken at any time during pregnancy can be teratogenic.
A client who is 24 weeks pregnant and diagnosed with preeclampsia is sent home with orders for bed rest and a referral for home health visits by a community health nurse. Which comment made by the client should indicate to the nurse that the client unders
c Rationale: Community health nurses provide skilled nursing care, such as assessing and monitoring blood pressure, providing treatments and education, and communicating with the physician. For the prenatal client with preeclampsia this may include monitoring the therapeutic effects of antihypertensive medications, assessing fetal heart tones, and providing nutrition counseling. The professional nurse doesn't fix meals in the home; this service may be provided by a home health aide or housekeeper. The community health nurse teaches the client to take her own medications, including the proper time, dose, frequency, and adverse effects. The community health nurse doesn't replace the care provided by the client's physician.
The nursery nurse is teaching a small-group teaching session to new parents in preparation for discharge. To comply with the law, the nurse instructs the parents that for the automobile trip home, the neonate should be in an approved car seat in the:
A.
c Rationale: Neonates up to 20 pounds should be placed in an approved car seat in the back seat facing the back. This position provides the most protection for the baby in the event of an accident. Infants facing the front might be thrown forward in an accident. Infants in the front seat are at a greater risk for injury during an accident.
For a client who is fully dilated, which of the following actions would be inappropriate during the second stage of labor?
A. Positioning the mother for effective pushing
B. Preparing for delivery of the baby
C. Assessing vital signs every 15 minute
d Rationale: In most cases, the membranes have ruptured (spontaneously or artificially) by this stage of labor. Positioning for effective pushing, preparing for delivery, and assessing vital signs every 15 minutes are appropriate actions at this time.
A healthy term white neonate male should weigh approximately:
A. 7 lb (3.2 kg).
B. 8 lb (3.6 kg).
C. 7½ lb (3.4 kg).
D. an amount that varies with length of pregnancy
C Rationale: The normal weight for a term neonate white male should be about 7½ lb. White females should weigh about 7 lb. Neonates of Asian or Black mothers often weigh less.
What are the 3 types of breech presentation?
Complete - fetus sitting indian style, Frank - butt first with legs & feet straight up by head, Footling - single or double feet present first.
The nurse is caring for a client who spontaneously aborted an 8-week-old fetus. The client is sobbing and moaning after the expulsion of the fetus. A priority goal for this client is that she'll:
A. verbalize her feelings related to the pregnancy loss.
a Rationale: A pregnancy loss can precipitate the grieving process. Verbalizing her feelings about the pregnancy loss is important for the client so that she may recover from the grief process. Expressing decreased pain and increased comfort is important but not a priority at this time. Discussing the causes of the spontaneous abortion isn't helpful at this time. The client should avoid inserting anything into the vagina for at least 2 weeks.
When caring for a client who is a primigravida, the nurse would expect that the second stage would normally last how long?
A. Approximately 2 hours
B. Less than 1 hour
C. 4 hours
D. 3 hours
a Rationale: The average length of time a primigravida needs to push is approximately 2 hours. Longer than that might mean the client is experiencing an arrest in descent. Few primigravidas have a second stage of labor shorter than 1 hour.
What is the most common type of pelvis?
Gynecoid or round, 50% of females have this type
For a client who is moving into the active phase of labor, the nurse should include which of the following as the priority of care?
A. Offer support by reviewing the short-pant form of breathing.
B. Administer narcotic analgesia.
C. Allow the mother
A Rationale: By helping the client use the pant form of breathing, the nurse can help the client manage her contractions and reduce the need for narcotics and other forms of pain relief, which can have an effect on fetal outcome. The nurse may administer narcotic analgesia and will observe for rupture of membranes but these don't take priority. In the active phase, the mother most likely is too uncomfortable to walk around the unit.
A client is a gravida 1 para 1001 who has vaginally delivered a full-term infant without complications. After the first postpartum day, she tells the postpartum nurse that she's afraid something is wrong because she's perspiring and urinating more than no
C Rationale: It's common for a woman to experience diuresis and diaphoresis after giving birth. The body loses the excess fluid that accumulated during pregnancy. Also common is an elevated temperature (up to 100.4° F [38° C]) that can be attributed to dehydration. During labor, the client isn't allowed anything by mouth, which can lead to dehydration. Offering to report the symptoms or temperature to the physician or suggesting that the client is exhibiting signs of diabetes isn't appropriate.
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