NM 704 Exam 3: Detailed Questions & Expert Verified
Solutions
Effectiveness *Heat & Cold* for reducing pain & increasing comfort in labor:
Right Ans - ● Heat applied where fetal head presses (lower back or abdomen)
may decrease pain by causing increased circulation to affected tissue
● Cold application has a numbing effect
● Some find relief w/ cold if heat unsuccessful whereas some find alternating
between heat & cold most comforting
● No specific studies for effectiveness
● Multiple contraindications
- areas anesthetized by epidural
- fever
- raynauds
- sickle cell
Components of an admission *history* when a ♀ is in labor. Right Ans - ●
Age- extremes associated with increased risk for adverse outcomes
● Parity- influences labor progress and duration
● EDD and gestational weeks- Identifies potential newborn complications.
Allows for evaluating fetal size r/t gestational age
● Complications of current pregnancy including GBS status- identifies existing
and/or potential problems
● Major complications w/ previous pregnancies- identifies potential recurring
problems
● Previous labor experiences including duration- influences expectations and
identifies potential coping strategies
● Mode of previous births/deliveries- identifies operative, vaginal, and c-
section; influences management
● Size of previous babies- estimate of pelvic adequacy
● Fetal movement pattern- fetal well-being
● Vaginal bleeding- differentiated from bloody show; vaginal bleeding is
abnormal, contraindicative of digital cervical exam and indicates need for
collaboration
● Status of membranes- duration of ROM and characteristics of amniotic fluid
(meconium)
, ● Time of onset of contractions and characteristics (frequency, duration,
intensity, aggravating/relieving factors)-helps discriminate true from false
labor as well as establishes onset of labor
● Last oral intake- baseline energy and fluid status; useful for anesthesia in
case of need for surgery
Components of an admission *physical* when a ♀ is in labor. Right Ans - ●
VS (BP, Temp, HR, RR)
● Auscultation of heart and lungs
● Abdominal palpation
○ Determine contraction pattern
○ Assess fetal lie, presentation, position, and engagement
○ Estimated fetal weight and fundal height
● Visual inspection for abdominal scars
● Assessment for presence of peripheral edema
● Cervical Examination
○ Cervical effacement and dilation
○ Position of cervix
○ Station of fetal presenting part
○ Presence of molding or caput succedaneum
○ Fetal lie, presentation, position
○ Tone and elasticity of vagina and perineum
○ Confirmation of membrane status
○ Visual inspection of perineum
○ Assessment of FHR
recommended frequency for the assessment of maternal vital signs in the first
stage of labor. (w/o epidural) Right Ans - BP, HR, RR: q 1 hour
Temp: q2-4 hr when temp normal and membranes intact;
recommended frequency for the assessment of maternal temp Right Ans -
q 1-2 hr if temp abnormal &/or after ROM
recommendations for frequency of continuous FHR assessment during 1st
stage of labor. Right Ans - ● q30min (no complications)
○ Q15min if complications
recommendations for frequency of continuous FHR assessment during 2nd
stage of labor. Right Ans - ● q15min (no complications)
Solutions
Effectiveness *Heat & Cold* for reducing pain & increasing comfort in labor:
Right Ans - ● Heat applied where fetal head presses (lower back or abdomen)
may decrease pain by causing increased circulation to affected tissue
● Cold application has a numbing effect
● Some find relief w/ cold if heat unsuccessful whereas some find alternating
between heat & cold most comforting
● No specific studies for effectiveness
● Multiple contraindications
- areas anesthetized by epidural
- fever
- raynauds
- sickle cell
Components of an admission *history* when a ♀ is in labor. Right Ans - ●
Age- extremes associated with increased risk for adverse outcomes
● Parity- influences labor progress and duration
● EDD and gestational weeks- Identifies potential newborn complications.
Allows for evaluating fetal size r/t gestational age
● Complications of current pregnancy including GBS status- identifies existing
and/or potential problems
● Major complications w/ previous pregnancies- identifies potential recurring
problems
● Previous labor experiences including duration- influences expectations and
identifies potential coping strategies
● Mode of previous births/deliveries- identifies operative, vaginal, and c-
section; influences management
● Size of previous babies- estimate of pelvic adequacy
● Fetal movement pattern- fetal well-being
● Vaginal bleeding- differentiated from bloody show; vaginal bleeding is
abnormal, contraindicative of digital cervical exam and indicates need for
collaboration
● Status of membranes- duration of ROM and characteristics of amniotic fluid
(meconium)
, ● Time of onset of contractions and characteristics (frequency, duration,
intensity, aggravating/relieving factors)-helps discriminate true from false
labor as well as establishes onset of labor
● Last oral intake- baseline energy and fluid status; useful for anesthesia in
case of need for surgery
Components of an admission *physical* when a ♀ is in labor. Right Ans - ●
VS (BP, Temp, HR, RR)
● Auscultation of heart and lungs
● Abdominal palpation
○ Determine contraction pattern
○ Assess fetal lie, presentation, position, and engagement
○ Estimated fetal weight and fundal height
● Visual inspection for abdominal scars
● Assessment for presence of peripheral edema
● Cervical Examination
○ Cervical effacement and dilation
○ Position of cervix
○ Station of fetal presenting part
○ Presence of molding or caput succedaneum
○ Fetal lie, presentation, position
○ Tone and elasticity of vagina and perineum
○ Confirmation of membrane status
○ Visual inspection of perineum
○ Assessment of FHR
recommended frequency for the assessment of maternal vital signs in the first
stage of labor. (w/o epidural) Right Ans - BP, HR, RR: q 1 hour
Temp: q2-4 hr when temp normal and membranes intact;
recommended frequency for the assessment of maternal temp Right Ans -
q 1-2 hr if temp abnormal &/or after ROM
recommendations for frequency of continuous FHR assessment during 1st
stage of labor. Right Ans - ● q30min (no complications)
○ Q15min if complications
recommendations for frequency of continuous FHR assessment during 2nd
stage of labor. Right Ans - ● q15min (no complications)
