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Edge Reading, Writing and Language: Level CDavid W. Moore, Deborah Short, Michael W. Smith 304 solutions Technical Writing for Success3rd EditionDarlene Smith-Worthington, Sue Jefferson 468 solutions Technical Writing for Success3rd EditionDarlene Smith-Worthington, Sue Jefferson 468 solutions What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? a.Altered fetal cerebral blood flow b.Umbilical cord compression c.Uteroplacental insufficiency d.Spontaneous rupture of membranes A Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur? a.Maternal fever b.Umbilical cord prolapse c.Regional anesthesia d.Magnesium sulfate administration A While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the 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? a.Change the woman's position. b.Notify the health care provider. c.Assist with amnioinfusion d.Insert a scalp electrode. A What is the most likely cause for variable FHR decelerations? a.Altered fetal cerebral blood flow b.Umbilical cord compression c.Uteroplacental insufficiency d.Fetal hypoxemia B
The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations? a.Altered cerebral blood flow b.Umbilical cord compression c.Uteroplacental insufficiency d.Meconium fluid C Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion? a.Variable decelerations b.Late decelerations c.Fetal bradycardia d.Fetal tachycardia A Which FHR finding is the most concerning to the nurse who is providing care to a laboring client? a.Accelerations with fetal movement b.Early decelerations c.Average FHR of 126 beats per minute d.Late decelerations D
What three measures should the nurse implement to provide intrauterine resuscitation? a.Call the provider, reposition the mother, and perform a vaginal examination. b.Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids. c.Administer O2 to the mother, increase IV fluids, and notify the health care provider. d.Perform a vaginal examination, reposition the mother, and provide O2 via face mask. B 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? a.Early FHR decelerations b.Fetal arrhythmias c.Uteroplacental insufficiency d.Spontaneous rupture of membranes C What are the legal responsibilities of the perinatal nurses? a.Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes b.Greeting the client on arrival, assessing her status, and starting an IV line c.Applying the external fetal monitor and notifying the health care provider d.Ensuring that the woman is comfortable A
The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition? a.Hypotension b.Cord compression c.Maternal drug use d.Hypoxemia D 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? a."Don't worry about that machine; that's my job." b."The baby's heart rate will fluctuate in response to what is happening during labor." c."The top line graphs the baby's heart rate, and the bottom line lets me know how strong the contractions are." d."Your physician will explain all of that later." B Which statement best describes a normal uterine activity pattern in labor? a.Contractions every 2 to 5 minutes b.Contractions lasting approximately 2 minutes c.Contractions approximately 1 minute apart d.Contraction intensity of approximately 500 mm Hg with relaxation at 50 mm Hg A The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement regarding this method of surveillance is accurate? a.The nurse can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b.The best course is to use the descriptive terms associated with EFM when documenting results. c.If the heartbeat cannot be immediately found, then a shift must be made to EFM. d.Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor. D What is a distinct advantage of external EFM? a.The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the FHR. b.The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions. c.The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d.Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions. C Which client would not be a suitable candidate for internal EFM? a.Client who still has intact membranes b.Woman whose fetus is well engaged in the pelvis c.Pregnant woman who has a comorbidity of obesity d.Client whose cervix is dilated to 4 to 5 cm A During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period. Which statement best describes the status of this fetus? a.Bradycardia b.Normal baseline heart rate c.Tachycardia d.Hypoxia B 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? a.Periodic fetal sleep state b.Extreme prematurity c.Fetal hypoxemia d.Preexisting neurologic injury A Which definition of an acceleration in the fetal heart rate (FHR) is accurate? a.FHR accelerations are indications of fetal well-being when they are periodic. b.FHR accelerations are greater and longer in preterm gestations. c.FHR accelerations are usually observed with breech presentations when they are episodic. d.An acceleration in the FHR presents a visually apparent and abrupt peak. D Which characteristic correctly matches the type of deceleration with its likely cause? a.Early deceleration—umbilical cord compression b.Late deceleration—uteroplacental insufficiency c.Variable deceleration—head compression d.Prolonged deceleration—unknown cause B Which information related to a prolonged deceleration is important for the labor nurse to understand? a.Prolonged decelerations present a continuing pattern of benign decelerations that do not require intervention. b.Prolonged decelerations constitute a baseline change when they last longer than 5 minutes. c.A disruption to the fetal oxygen supply causes prolonged decelerations. d.Prolonged decelerations require the customary fetal monitoring by the nurse. C In which situation would the nurse be called on to stimulate the fetal scalp? a.As part of fetal scalp blood sampling b.In response to tocolysis c.In preparation for fetal oxygen saturation monitoring d.To elicit an acceleration in the FHR D Part of the nurse's role is assisting with pushing and positioning. Which guidance should the nurse provide to her client in active labor? a.Encourage the woman's cooperation in avoiding the supine position. b.Advise the woman to avoid the semi-Fowler position. c.Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d.Instruct the woman to open her mouth and close her glottis, letting air escape after the push. A In which clinical situation would the nurse most likely anticipate a fetal bradycardia? a.Intraamniotic infection b.Fetal anemia c.Prolonged umbilical cord compression d.Tocolytic treatment using terbutaline C Which nursing intervention would result in an increase in maternal cardiac output? a.Change in position b.Oxytocin administration c.Regional anesthesia d.IV analgesic A The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next? a.Call for help. b.Insert a Foley catheter. c.Start administering Pitocin. d.Immediately notify the care provider. D The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding? a.Narcotics b.Barbiturates c.Methamphetamines d.Tranquilizers C What is the correct placement of the tocotransducer for effective EFM? a.Over the uterine fundus b.On the fetal scalp c.Inside the uterus d.Over the mother's lower abdomen A What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids? a.Maintaining normal maternal temperature b.Preventing normal maternal hypoglycemia c.Increasing the oxygen-carrying capacity of the maternal blood d.Expanding maternal blood volume D The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant? a.Respiratory b.Metabolic c.Mixed d.Turbulent A In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Which clinical situation warrants this additional testing? (Select all that apply.) a.Low 5-minute Apgar score b.Intrauterine growth restriction (IUGR) c.Maternal thyroid disease d.Intrapartum fever e.Vacuum extraction A,B,C,D According to the National Institute of Child Health and Human Development (NICHD) Three-Tier System of FHR Classification, category III tracings include all FHR tracings not categorized as category I or II. Which characteristics of the FHR belong in category III? (Select all that apply.) a.Baseline rate of 110 to 160 beats per minute b.Tachycardia c.Absent baseline variability not accompanied by recurrent decelerations d.Variable decelerations with other characteristics such as shoulders or overshoots e.Absent baseline variability with recurrent variable decelerations f.Bradycardia B,D,E,F Which FHR decelerations would require the nurse to change the maternal position? (Select all that apply.) a.Early decelerations b.Late decelerations c.Variable decelerations d.Moderate decelerations e.Prolonged decelerations B,C,E A tiered system of categorizing FHR has been recommended by professional organizations. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. What is the correct nomenclature for these categories? (Select all that apply.) a.Reassuring b.Category I c.Category II d.Nonreassuring e.Category III B,C,E The baseline FHR is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the client's most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change? (Select all that apply.) a.Spontaneous fetal movement b.Compression of the fetal head c.Placental abruption d.Cord around the baby's neck e.Maternal supine hypotension C,E An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The client states, "My contractions are so strong, I don't know what to do." Before making a plan of care, what should the nurse's first action be? a.Assess for fetal well-being. b.Encourage the woman to lie on her side. c.Disturb the woman as little as possible. d.Recognize that pain is personalized for each individual. D 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 at this time? a.Notify the woman's health care provider. b.Administer the prescribed narcotic analgesic. c.Assure her that her labor will be over soon. d.Assist her with simple breathing and relaxation instructions. D Nursing care measures are commonly offered to women in labor. Which nursing measure reflects the application of the gate-control theory? a.Massage the woman's back. b.Change the woman's position. c.Give the prescribed medication. d.Encourage the woman to rest between contractions. A Breathing patterns are taught to laboring women. Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes? a.Slow-paced breathing b.Deep abdominal breathing c.Modified-paced breathing d.Patterned-paced breathing A A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before giving birth. Which medication should be available to reduce the postnatal effects of meperidine on the neonate? a.Fentanyl (Sublimaze) b.Promethazine (Phenergan) c.Naloxone (Narcan) d.Nalbuphine (Nubain) C What should the laboring client who receives an opioid antagonist be told to expect? a.Her pain will decrease. b.Her pain will return. c.She will feel less anxious. d.She will no longer feel the urge to push. B A client is in early labor, and her nurse is discussing the pain relief options she is considering. The client states that she wants an epidural "no matter what!" What is the nurse's best response? a."I'll make sure you get your epidural." b."You may only have an epidural if your physician allows it." c."You may only have an epidural if you are going to deliver vaginally." d."The type of analgesia or anesthesia used is determined, in part, by the stage of your labor and the method of birth." D What is the role of the nurse as it applies to informed consent? a.Inform the client about the procedure, and ask her to sign the consent form. b.Act as a client advocate, and help clarify the procedure and the options. c.Call the physician to see the client. d.Witness the signing of the consent form. B 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? a."The two medications, together, reduce complications." b."Sedatives enhance the effect of the pain medication." c."The two medications work better together, enabling you to sleep until you have the baby." d."This is what your physician has ordered for you." B The nurse should be cognizant of which physiologic effect of pain? a.Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen. b.Referred pain is the extreme discomfort experienced between contractions. c.Somatic pain of the second stage of labor is more generalized and related to fatigue. d.Pain during the third stage is a somewhat milder version of the pain experienced during the second stage. A Which statement correctly describes the effects of various pain factors? a.Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth. b.Upright positions in labor increase the pain factor because they cause greater fatigue. c.Women who move around trying different positions experience more pain. d.Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural childbirth. D Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients. Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor, when they become more vocal and request pain relief? a.Chinese b.Arab or Middle Eastern c.Hispanic d.African-American C Anxiety is commonly associated with pain during labor. Which statement regarding anxiety is correct? a.Even mild anxiety must be treated. b.Severe anxiety increases tension, increases pain, and then, in turn, increases fear and anxiety, and so on. c.Anxiety may increase the perception of pain, but it does not affect the mechanism of labor. d.Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity. B Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program? a.Childbirth preparation programs increase the woman's sense of control. b.Childbirth preparation programs prepare a support person to help during labor. c.Childbirth preparation programs guarantee a pain-free childbirth. d.Childbirth preparation programs teach distraction techniques. C Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. Which information regarding nonpharmacologic pain relief isaccurate? a.Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine. b.Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time. c.Effleurage is permissible, but counterpressure is almost always counterproductive. d.Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins. D The nurse should be cognizant of which important information regarding nerve block analgesia and anesthesia? a.Most local agents are chemically related to cocaine and end in the suffix -caine. b.Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once. c.Pudendal nerve block is designed to relieve the pain from uterine contractions. d.Pudendal nerve block, if performed correctly, does not significantly lessen the bearing-down reflex. A A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. Which statement regarding this procedure is correct? a.The application of nitrous oxide gas is not often used anymore. b.An inhalation of gas is likely to be used in the second stage of labor, not during the first stage. c.An application of nitrous oxide gas is administered for pain relief. d.The application of gas is a prelude to a cesarean birth. C According to professional standards (the Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN], 2007), which action cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia? a.Monitoring the status of the woman and fetus b.Initiating epidural anesthesia c.Replacing empty infusion bags with the same medication and concentrate d.Stopping the infusion, and initiating emergency measures B Conscious relaxation is associated with which method of childbirth preparation? a.Grantly Dick-Read childbirth method b.Lamaze method c.Bradley method d.Psychoprophylactic method A A woman in labor has just received an epidural block. What is the most important nursing intervention at this time? a.Limit parenteral fluids. b.Monitor the fetus for possible tachycardia. c.Monitor the maternal blood pressure for possible hypotension. d.Monitor the maternal pulse for possible bradycardia. C A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is approximately twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. Which intervention should the nurse immediately initiate? a.Contact the woman's physician. b.Tell the woman to slow her pace of her breathing. c.Administer oxygen via a mask or nasal cannula. d.Help her breathe into a paper bag. D A client is experiencing back labor and complains of intense pain in her lower back. Which measure would best support this woman in labor? a.Counterpressure against the sacrum b.Pant-blow (breaths and puffs) breathing techniques c.Effleurage d.Conscious relaxation or guided imagery A A woman has requested an epidural 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. The nurse reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for this woman? a.She is too far dilated. b.She is anemic. c.She has thrombocytopenia. d.She is septic. C Which alterations in the perception of pain by a laboring client should the nurse understand? a.Sensory pain for nulliparous women is often greater than for multiparous women during early labor. b.Affective pain for nulliparous women is usually less than for multiparous women throughout the first stage of labor. c.Women with a history of substance abuse experience more pain during labor. d.Multiparous women have more fatigue from labor and therefore experience more pain. A The nurse should be aware of what important information regarding systemic analgesics administered during labor? a.Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. b.Effects on the fetus and newborn can include decreased alertness and delayed sucking. c.Intramuscular (IM) administration is preferred over IV administration. d.IV patient-controlled analgesia (PCA) results in increased use of an analgesic. B Developing a realistic birth plan with the pregnant woman regarding her care is important for the nurse. How would the nurse explain the major advantage of nonpharmacologic pain management? a.Greater and more complete pain relief is possible. b.No side effects or risks to the fetus are involved. c.The woman will remain fully alert at all times. d.Labor will likely be more rapid. B What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum? a.Epidural b.Pudendal c.Local d.Spinal block B The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to administer spinal anesthesia. The nurse is aware of and prepared for the greatest risk of administering general anesthesia to the client. What is this risk? a.Respiratory depression b.Uterine relaxation c.Inadequate muscle relaxation d.Aspiration of stomach contents D What is the rationale for the use of a blood patch after spinal anesthesia? a.Hypotension b.Headache c.Neonatal respiratory depression d.Loss of movement B Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could the nurse use to increase the client's blood pressure? (Select all that apply.) a.Place the woman in a supine position. b.Place the woman in a lateral position. c.Increase IV fluids. d.Administer oxygen. e.Perform a vaginal examination. B,C,D Which alternative approaches to relaxation have proven successful when working with the client in labor? (Select all that apply.) a.Aromatherapy b.Massage c.Hypnosis d.Cesarean birth e.Biofeedback A,B,C,E 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.) a.Ability to move freely is limited. b.Orthostatic hypotension and dizziness may occur. c.Gastric emptying is not delayed. d.Higher body temperature may occur. e.Blood loss is not excessive. A,B,D The class of drugs known as opioid analgesics (butorphanol, nalbuphine) is not suitable for administration to women with known opioid dependence. The antagonistic activity could precipitate withdrawal symptoms (abstinence syndrome) in both mothers and newborns. Which signs would indicate opioid or narcotic withdrawal in the mother? (Select all that apply.) a.Yawning, runny nose b.Increase in appetite c.Chills or hot flashes d.Constipation e.Irritability, restlessness A,C,E While developing an intrapartum care plan for the client in early labor, which psychosocial factors would the nurse recognize upon the client's pain experience? (Select all that apply.) a.Culture b.Anxiety and fear c.Previous experiences with pain d.Intervention of caregivers e.Support systems A,B,C,E 1. Which statement by the client will assist the nurse in determining whether she is in true labor as opposed to false labor? a. "I passed some thick, pink mucus when I urinated this morning." C When a nulliparous woman telephones the hospital to report that she is in labor, what guidance should the nurse provide or information should the nurse obtain? a. Tell the woman to stay home until her membranes rupture. D 3. 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? a. Intrauterine infection A The uterine contractions of a woman early in the active phase of labor are assessed by an internal uterine pressure catheter (IUPC). The uterine contractions occur every 3 to 4 minutes and last an average of 55 to 60 seconds. They are becoming more regular and are moderate to strong. Based on this information, what would a prudent nurse do next? a. Immediately notify the woman's primary
health care provider. C Which action is correct when palpation is used to assess the characteristics and pattern of uterine contractions? a. Placing the hand
on the abdomen below the umbilicus and palpating uterine tone with the fingertips C When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective? a. Dilation of the cervix A The nurse performs a vaginal examination to assess a client's labor progress. Which action should the nurse take next? a. Perform an examination at least once every hour during
the active phase of labor. D A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurse's highest priority in this situation? a. Prepare the woman for imminent birth. D Under which circumstance should the nurse assist the laboring woman into a hands-and-knees position? a. Occiput of the fetus is in a posterior position. A 10. A nulliparous woman has just begun the latent phase of the second stage of her labor. The nurse should anticipate which behavior? a. A nulliparous woman will experience a strong urge to bear down. C Which clinical finding indicates that the client has reached the second stage of labor? a. Amniotic membranes rupture. C Through a vaginal examination, the nurse determines that a woman is 4 cm dilated. The external fetal monitor shows uterine contractions every to 4 minutes. The nurse reports this as what stage of labor? a. First stage, latent phase B What is the most critical nursing action in caring for the newborn immediately after the birth? a. Keeping
the airway clear A What is the rationale for the administration of an oxytocic (e.g., Pitocin, Methergine) after expulsion of the placenta? a. To relieve pain B . Which description of the phases of the first stage of labor is most accurate? a. Latent: mild, regular contractions; no dilation; bloody show B Which information regarding the procedures and criteria for admitting a woman to the hospital labor unit is important for the nurse to understand? a. Client is considered to be in active labor when she arrives at the facility with contractions. A Which component of the physical examination are Leopold's maneuvers unable to determine? a. Gender of the fetus A Where is the point of maximal intensity (PMI) of the FHR located? a. Usually directly over the fetal
abdomen C The nurse should be aware of which information related to a woman's intake and output during labor? a. Traditionally, restricting the laboring woman to clear
liquids and ice chips is being challenged because regional anesthesia is used more often than general anesthesia. A Which technique is an adequate means of controlling the birth of the fetal head during delivery in a vertex presentation? a. Ritgen maneuver A Which collection of risk factors will most likely result in damaging lacerations, including episiotomies? a. Dark-skinned woman who has had more than one pregnancy, who is
going through prolonged second-stage labor, and who is attended by a midwife D Which statement concerning the third stage of labor is correct? a. The placenta eventually
detaches itself from a flaccid uterus. B A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy, 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light, and asks for her nurse right away, stating "I'm bleeding a lot." What is the most likely cause of postpartum hemorrhaging in this client? a. Retained placental fragments C In recovery, if a woman is asked to either raise her legs (knees extended) off the bed or flex her knees, and then place her feet flat on the bed and raise her buttocks well off the bed, the purpose of this exercise is to assess what? a. Recovery from epidural or spinal anesthesia A A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor. She may fight the labor process and react with pain or anger. The nurse can implement a number of 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? a. Tell the client to relax and that it won't hurt much. B As the United States and Canada continue to become more culturally diverse, recognizing a wide range of varying cultural beliefs and practices is increasingly important for the nursing staff. A client is from which country if she requests to have the baby's father in attendance? a. Mexico A The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and a tightening of the abdominal muscles. When is it appropriate to instruct the client to use this maneuver? a. During the second stage to enhance the movement of the fetus D 28. The first 1 to 2 hours after birth is sometimes referred to as what? a. Bonding period C 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? a. Encouraging the woman to try various upright positions, including squatting and standing A 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? a. The placenta has separated. A After an emergency birth, the nurse encourages the woman to breastfeed her newborn. What is the primary purpose of this activity? a. To facilitate maternal-newborn interaction B 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? a. "Don't worry about it. You'll do fine." B Which characteristic of a uterine contraction is not routinely documented? a. Frequency: how often contractions occur D Under which circumstance would it be unnecessary for the nurse to perform a vaginal examination? a. Admission to the hospital at the start of labor B Which description of the phases of the second stage of labor is most accurate? a. Latent phase: Feeling sleepy; fetal station 2+ to 4+; duration of 30 to 45 minutes C A woman who is gravida 3 para 2 arrives on the intrapartum unit. What is the most important nursing assessment at this time? a. Contraction pattern, amount of discomfort, and pregnancy history B . A primigravida at 39 weeks of gestation is observed for 2 hours in the intrapartum unit. The FHR has been normal. Contractions are 5 to 9 minutes apart, 20 to 30 seconds in duration, and of mild intensity. Cervical dilation is 1 to 2 cm and uneffaced (unchanged from admission). Membranes are intact. What disposition would the nurse anticipate? a. Admitted and prepared for a cesarean birth D . A laboring woman is reclining in the supine position. What is the most appropriate nursing action at this time? a. Ask her to turn to one side. A Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. Fetal head is felt at 0 station during vaginal examination. C What is the primary rationale for the thorough drying of the infant immediately after birth? a. Stimulates crying and lung expansion C Emergency conditions during labor that would require immediate nursing intervention can arise with startling speed. Which situations are examples of such an emergency? (Select all that apply.) a. Nonreassuring or abnormal FHR pattern A,B,C,E
Women who have participated in childbirth education classes often bring a birth plan with them to the hospital. Which items might this plan include? (Select all that apply.) a. Presence of companions A,B,C,D A new mother asks the nurse when the "soft spot" on her son's head will go away. What is the nurse's best response, based upon her understanding of when the anterior frontal closes? a. 2 months D The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another? a. Lie C When assessing the fetus using Leopold's maneuvers, the nurse feels a round, firm, and movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mother's right side close to midline. What is the position of the fetus? a. ROA C Which statement by the client would lead the nurse to believe that labor has been established? a. "I passed some thick, pink mucus when I urinated this morning." C 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? a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. B 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? a. Weight gain of 1.5 to 2 kg (3 to 4 lb) D Which stage of labor varies the most in length? a. First A The nurse expects which maternal cardiovascular finding during labor? a. Increased cardiac output A What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor? a. Lightening B Which presentation is accurately described in terms of both the resenting part and the frequency of occurrence? a. Cephalic: occiput, at least 96% A A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal? a. Fetal attitude describes the angle at which the fetus exits the uterus. C 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? a. The supine position, which is commonly used in the United States, increases blood flow. C Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity is not part of this process? a. Fetal lung fluid is cleared from the air passages during labor and vaginal birth. D Which description of the four stages of labor is correct for both the definition and the duration? a. First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours A Nurses should be cognizant of what regarding the mechanism of labor? a. Seven critical movements must progress in a more or less orderly sequence. C Which statement related to fetal positioning during labor is correct and important for the nurse to understand? a. Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal. B Which basic type of pelvis includes the correct description and percentage of occurrence in women? a. Gynecoid: classic female pelvis; heart shaped; 75% D What is the nurse's understanding of the appropriate role of primary and secondary powers? a. Primary powers are responsible for the effacement and dilation of the cervix. A Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care? a. The woman's blood pressure will increase during contractions and fall back to
prelabor normal levels between contractions. D Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction? a. The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced. C Which statement is the best rationale for assessing the maternal vital signs between uterine contractions? a. During a contraction, assessing the fetal heart rate is the priority. B What is the primary difference between the labor of a nullipara and that of a multipara? a. Amount of cervical dilation B Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. Fetal head is felt at 0 station during the vaginal examination. C Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which description of the phases of the first stage of labor is accurate? a. Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B Which changes take place in the woman's reproductive system, days or even weeks before the commencement of labor? (Select all that apply.) a. Lightening A,C,D Which factors influence cervical dilation? (Select all that apply.) a. Strong uterine contractions A,B,D,E At least five factors affect the process of labor and birth. These are easily remembered as the five Ps. Which factors are included in this process? (Select all that apply.) a. Passenger A,B,C,E Because of its size and rigidity, the fetal head has a major effect on the birth process. Which bones comprise the structure of the fetal skull? (Select all that apply.) a. Parietal A,B,D Which clinical finding indicates that the client has reached the second stage of labor?The second stage of labor begins with full cervical dilation. Many women may have an urge to bear down when the presenting fetal part is below the level of the ischial spines.
What signals the end of the second stage of labor?The second stage of labor begins once your cervix is fully dilated, and ends when your baby is born. It may take anywhere from a few minutes to a few hours. It's possible that this stage could take longer if you find it harder to push from the numbness of an epidural, or if it's your first time giving birth.
What is an indication of the second stage of labor quizlet?The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
What is the second stage of labor characterized by?What happens in the second stage of labor? In the second stage of labor, your cervix is fully dilated and ready for childbirth. This stage is the most work for you because your provider wants you to start pushing your baby out. This stage can be as short as 20 minutes or as long as a few hours.
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Which clinical finding indicates that the client has reached the second stage of labor quizlet?
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