Nursing OB Exam 2 Top Questions and answers, 100% Accurate, graded A+

Nursing OB Exam 2 Top Questions and answers, 100% Accurate, graded A+ Labor and birth are affected by the five Ps: - -passenger, passageway, powers, position of the woman, and psychologic response. The first stage of labor lasts from - -The time dilation begins to the time when the cervix is fully dilated. The second stage of labor lasts from - -The time of full cervical dilation to the birth of the infant. The third stage of labor lasts from - -The infant's birth to the expulsion of the placenta. The fourth stage of labor - -Is the first 2 hours after birth. The cardinal movements of the mechanism of labor are - -engagement, descent, flexion, internal rotation, extension, restitution and external rotation, and expulsion of the infant. A primigravida asks the nurse about signs she can look for that would indicate that the onset of labor is getting closer. The nurse should describe: A) weight gain of 1 to 3 lbs. B) quickening. C) fatigue and lethargy. D) bloody show. - -D) Bloody show Women usually experience a weight loss of 1 to 3 lbs. Quickening is the perception of fetal movement by the mother, which occurs at 16 to 20 weeks of gestation. Women usually experience a burst of energy or the nesting instinct. Passage of the mucous plug (operculum) also termed pink/bloody show occurs as the cervix ripens. The nurse should tell a primigravida that the definitive sign indicating that labor has begun would be: A) progressive uterine contractions with cervical change. B) lightening. C) rupture of membranes. D) passage of the mucous plug (operculum). - -A) progressive uterine contractions with cervical change. Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer On completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. What is a correct interpretation of the data? A) The fetal presenting part is 1 cm above the ischial spines. B) Effacement is 4 cm from completion. C) Dilation is 50% completed. D) The fetus has achieved passage through the ischial spines. - -A) The fetal presenting part is 1 cm above the ischial spines. Station of -1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Progress of effacement is referred to by percentages, with 100% indicating full effacement and dilation by centimeters, with 10 cm indicating full dilation. Passage through the ischial spines with internal rotation would be indicated by a plus station such as +1. In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: A) The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions. B) Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. C) Having the woman point her toes reduces leg cramps. D) The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. - -D) The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain. The nurse knows that the second stage of labor, the descent phase, has begun when: A) the amniotic membranes rupture. B) the cervix cannot be felt during a vaginal examination. C) the woman experiences a strong urge to bear down. D) the presenting part is below the ischial spines. - -C) the woman experiences a strong urge to bear down. Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm of dilation. Nurses can help their clients by keeping them informed about the distinctive stages of labor. What 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) Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours C) Lull: no contractions; dilation stable; duration of 20 to 60 minutes D) Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours - -B) Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. No official "lull" phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes. Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A) Semirecumbent B) Sitting C) Squatting D) Side-lying - -C) Squatting A semirecumbent position does not assist in increasing the size of the pelvic outlet. Although sitting may assist with fetal descent, this position does not increase the size of the pelvic outlet. Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet. A side-lying position is unlikely to assist in increasing the size of the pelvic outlet. Concerning the third stage of labor, nurses should be aware that: A) the placenta eventually detaches itself from a flaccid uterus B) the duration of the third stage may be as short as 3 to 5 minutes C) it is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface D) the major risk for women during the third stage is a rapid heart rate - -B) the duration of the third stage may be as short as 3 to 5 minutes. The placenta cannot detach itself from a flaccid (relaxed) uterus. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases. The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are: (Select all that apply.) A) passenger. B) placenta. C) passageway. D) psychologic response. E) powers. F) position. - -At least five factors affect the process of labor and birth. These are easily remembered as the five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychologic response. Nurses can advise their patients that which of these signs precede labor? (Select all that apply.) A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions D. A decline in energy, as the body stores up for labor E. Uterus sinks downward and forward in first-time pregnancies. - -A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions E. Uterus sinks downward and forward in first-time pregnancies. After lightening a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Before the onset of labor, it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor. In first-time pregnancies, the uterus sinks downward and forward about 2 weeks before term. The maternity nurse should notify the health care provider about which assessment findings during labor? (Select all that apply.) A. Positive urine drug screen B. Blood glucose level of 78 mg/dL C. Increased systolic blood pressure during first stage D. Elevated white blood cell count E. Oral temperature of 99.8° F F. Respiratory rate of 10 breaths/min - -A. Positive urine drug screen C. Increased systolic blood pressure during first stage F. Respiratory rate of 10 breaths/min The health care provider should be alerted to a positive urine drug screen, because certain drugs will have an effect on pain medications that can be safely administered. The respiratory rate usually increases during labor. A rate of 10 is low and needs to be reported. Decreased blood glucose levels (due to exertion and glucose consumption for energy), and increased systolic blood pressure, elevated white blood cell count (due to stress response), and a slightly elevated temperature (up to 100.4° F) are expected findings during labor. Referred pain occurs - -when pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, gluteal area, thighs, and lower back. A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. encourage the woman to breathe more slowly. B. help the woman breathe into a paper bag. C. turn the woman on her side. D. administer a sedative. - -B. help the woman breathe into a paper bag. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression since this woman, being in the transition phase, is near the birth process. The side-lying position would be appropriate for supine hypotension. A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A. Encourage her to empty her bladder. B. Decrease her intravenous (IV) rate to a keep vein-open rate. C. Turn the woman to the left lateral position or place a pillow under her hip. D. No action is necessary since a decrease in the woman's blood pressure is expected. - -C. Turn the woman to the left lateral position or place a pillow under her hip. Encouraging the woman to empty her bladder will not help the hypotensive state and may cause her to faint if she ambulates to the bathroom. The IV rate should be kept at the current rate or increased to maintain the appropriate perfusion. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken. A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: A. fentanyl (Sublimaze). B.promethazine (Phenergan). C. butorphanol tartrate (Stadol). D. nalbuphine (Nubain). - -A. fentanyl (Sublimaze). Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs' undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: A. counterpressure against the sacrum. B. pant-blow (breaths and puffs) breathing techniques. C. effleurage. D. biofeedback. - -A. counterpressure against the sacrum. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. Pant-blow breathing techniques are usually helpful during contractions per the gate-control theory. Effleurage is light stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used as a distraction from contraction pain; however, it is unlikely to be effective for back labor. Biofeedback-assisted relaxation techniques are not always successful in reducing labor pain. Using this technique effectively requires strong caregiver support. Nurses should be aware of the difference experience can make in labor pain, such as: A. sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. affective pain for nulliparous women usually is 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. sensory pain for nulliparous women often is greater than for multiparous women during early labor. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue. With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. either hot or cold applications may provide relief, but they should never be used together in the same treatment. B. acupuncture can be performed by a skilled nurse with just a little training. C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations. - -C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. Heat and cold may be applied in an alternating fashion for greater effect. Unlike acupressure, acupuncture, which involves the insertion of thin needles, should be done only by a certified therapist. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body. With regard to systemic analgesics administered during labor, nurses should be aware that: 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. IM administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic. - -B. effects on the fetus and newborn can include decreased alertness and delayed sucking. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic. After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. visceral. B. referred. C. somatic. D. afterpain. - -B. referred. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A. Maternal blood pressure of 108/79 B. Maternal heart rate of 98 C. Respiratory rate of 14 breaths/min D. Fetal heart rate of 100 beats/min Correct E. Minimal variability on a fetal heart monitor Correct - -D. Fetal heart rate of 100 beats/min E. Minimal variability on a fetal heart monitor After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given. After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? (Select all that apply.) A. Keeping the head of bed elevated at all times B. Administration of oral analgesics