NM704 Exam 3 - Questions & Expert-Verified Answers
When does active labor begin? Right Ans - Active labor beings when the
rate of cervical dilation sharply increases
What does contemporary research believe to be the rate of dilation when
active labor beings? Right Ans - 5-6 cm dilation
Describe anticipatory guidance you would give to one in labor onset and early
labor Right Ans - -guidance during the prenatal period can help pregnant
persons prepare for the onset of labor
-give specific instructions on when and how to contact the provider for SDM
when labor starts
-this emphasizes that labor onset is a gradual process and difficult to
distinguish
-consider all factors in decision making (support persons, coping status,
comfort level leaving the birth site, transportation, weather, how far they live,
will they get rest at home)
-explain lack of labor rooms and/or staff to accommodate people not needing
medical care during early labor
-address diet, rest, coping strategies, benefits of continuous labor support
during early labor
What are the components of the history and chart review you would evaluate
for a person presenting in possible onset of labor? Right Ans - -Uterine
contractions (onset, when, frequency, length, strength, interrupts activity,
sleep, where are they felt, coping strategies, any other pains)
-Vaginal fluids (spotting, bleeding, leaking fluid)
-Fetal status (movement, is it the same or has it changed)
-Fatigue (recent sleep activity, rest and activity)
-Hydration (eating and drinking normally, recent food and drink intake,
appetite, N/V, voiding at a normal amount, urine light/dark or concentrated)
-Environment/Transportation/Support (time of day, how far away do they
live, access to transportation, is home quiet for rest)
-Coping (affect, how do they sound, stop talking with contractions, sound
anxious/relaxed/energetic/exhausted, general appearance, coping in the
providers/patients view, what have they been doing)
-Other: signs of UTI (stimulate contractions), recent sexual intercourse or
digital vaginal exam (spotting/bleeding),
,What are the components of a Physical Exam for a person presenting for onset
of labor? Right Ans - -Head to Toe exam
-Maternal vital signs
-FHR assessment
-Urine dip for proteins or ketones
-Leopold's maneuver
-Abdominal Palpation
What are the components of a Pelvic Exam for a person presenting for onset of
labor? Right Ans - -Digital Vaginal exam for cervical dilation, effacement,
position and consistency
-Fetal Station
-If possibility of ROM deferre digital exam and use a speculum to assess for
pooling of fluid or to obtain laboratory specimens
-Performing serial cervical exams with cervical changes noted is a more
accurate indication of labor
What are the components of preforming a speculum exam to diagnose SROM?
Right Ans - -Fluid leaking from the cervical os (cough or Valsalva maneuver,
sit up for 30 minutes and reevaluate)
-Color (clear, straw or cloudy, white creamy flecks of vernix)
-Smell (has a distinct musty odor, foul-smelling indicates infection)
-Bleeding
-observe vaginal walls for discharge
-not visible cervical dilation, length and effacement or a bulging bag
Describe the arborization (fern) test Right Ans - -dried fluid will give
"ferning" appearance under the microscope
-collect fluid from posterior cervix
-let dry for 10 minutes and then look
-fern pattern is caused by crystallization due to high sodium chloride and
protein concentrations in amniotic fluid
-ferning is not affected by meconium presence, small amounts of blood or pH
changes
What can cause false positives in the Arborization test? Right Ans - cervical
mucus
fingerprints
, significant amount of blood
semen
-these can all show fern-like patterns
What can cause false negatives in the Arborization test? Right Ans - not
enough residual amniotic fluid
Describe the ph test (nitrazine test) Right Ans - pH paper to test for
presence of fluid which is typically alkaline
-if present paper will turn DARK BLUE
-collect from posterior cervix and swab onto the paper
-can also touch the paper to the labia or perineum where you see fluid
What can cause a false positive in the pH test (nitrazine test)? Right Ans -
blood
semen
urine
bacterial vaginosis
trichomoniasis
-can use a wet prep to determine the presence of these as they can coexist
with ruptured membranes
What can cause a false negative in the pH test (nitrazine test)? Right Ans -
not enough residual amniotic fluid present
Describe the Rapid Immunoassay test (AmniSure) Right Ans - -Vaginal fluid
collected and swished in a tube with solvent. Then a test strip is inserted into
a vial
-2 line = POSITIVE
-1 line= Negative
-There are high rates of false positives with this test
-Consider this test ancillary to standard methods of diagnosis
What can cause false positives in rapid immunoassay test? Right Ans -
significant bleeding
higher vaginal concentration of a biomarker with labor
infection
alkaline fluid
When does active labor begin? Right Ans - Active labor beings when the
rate of cervical dilation sharply increases
What does contemporary research believe to be the rate of dilation when
active labor beings? Right Ans - 5-6 cm dilation
Describe anticipatory guidance you would give to one in labor onset and early
labor Right Ans - -guidance during the prenatal period can help pregnant
persons prepare for the onset of labor
-give specific instructions on when and how to contact the provider for SDM
when labor starts
-this emphasizes that labor onset is a gradual process and difficult to
distinguish
-consider all factors in decision making (support persons, coping status,
comfort level leaving the birth site, transportation, weather, how far they live,
will they get rest at home)
-explain lack of labor rooms and/or staff to accommodate people not needing
medical care during early labor
-address diet, rest, coping strategies, benefits of continuous labor support
during early labor
What are the components of the history and chart review you would evaluate
for a person presenting in possible onset of labor? Right Ans - -Uterine
contractions (onset, when, frequency, length, strength, interrupts activity,
sleep, where are they felt, coping strategies, any other pains)
-Vaginal fluids (spotting, bleeding, leaking fluid)
-Fetal status (movement, is it the same or has it changed)
-Fatigue (recent sleep activity, rest and activity)
-Hydration (eating and drinking normally, recent food and drink intake,
appetite, N/V, voiding at a normal amount, urine light/dark or concentrated)
-Environment/Transportation/Support (time of day, how far away do they
live, access to transportation, is home quiet for rest)
-Coping (affect, how do they sound, stop talking with contractions, sound
anxious/relaxed/energetic/exhausted, general appearance, coping in the
providers/patients view, what have they been doing)
-Other: signs of UTI (stimulate contractions), recent sexual intercourse or
digital vaginal exam (spotting/bleeding),
,What are the components of a Physical Exam for a person presenting for onset
of labor? Right Ans - -Head to Toe exam
-Maternal vital signs
-FHR assessment
-Urine dip for proteins or ketones
-Leopold's maneuver
-Abdominal Palpation
What are the components of a Pelvic Exam for a person presenting for onset of
labor? Right Ans - -Digital Vaginal exam for cervical dilation, effacement,
position and consistency
-Fetal Station
-If possibility of ROM deferre digital exam and use a speculum to assess for
pooling of fluid or to obtain laboratory specimens
-Performing serial cervical exams with cervical changes noted is a more
accurate indication of labor
What are the components of preforming a speculum exam to diagnose SROM?
Right Ans - -Fluid leaking from the cervical os (cough or Valsalva maneuver,
sit up for 30 minutes and reevaluate)
-Color (clear, straw or cloudy, white creamy flecks of vernix)
-Smell (has a distinct musty odor, foul-smelling indicates infection)
-Bleeding
-observe vaginal walls for discharge
-not visible cervical dilation, length and effacement or a bulging bag
Describe the arborization (fern) test Right Ans - -dried fluid will give
"ferning" appearance under the microscope
-collect fluid from posterior cervix
-let dry for 10 minutes and then look
-fern pattern is caused by crystallization due to high sodium chloride and
protein concentrations in amniotic fluid
-ferning is not affected by meconium presence, small amounts of blood or pH
changes
What can cause false positives in the Arborization test? Right Ans - cervical
mucus
fingerprints
, significant amount of blood
semen
-these can all show fern-like patterns
What can cause false negatives in the Arborization test? Right Ans - not
enough residual amniotic fluid
Describe the ph test (nitrazine test) Right Ans - pH paper to test for
presence of fluid which is typically alkaline
-if present paper will turn DARK BLUE
-collect from posterior cervix and swab onto the paper
-can also touch the paper to the labia or perineum where you see fluid
What can cause a false positive in the pH test (nitrazine test)? Right Ans -
blood
semen
urine
bacterial vaginosis
trichomoniasis
-can use a wet prep to determine the presence of these as they can coexist
with ruptured membranes
What can cause a false negative in the pH test (nitrazine test)? Right Ans -
not enough residual amniotic fluid present
Describe the Rapid Immunoassay test (AmniSure) Right Ans - -Vaginal fluid
collected and swished in a tube with solvent. Then a test strip is inserted into
a vial
-2 line = POSITIVE
-1 line= Negative
-There are high rates of false positives with this test
-Consider this test ancillary to standard methods of diagnosis
What can cause false positives in rapid immunoassay test? Right Ans -
significant bleeding
higher vaginal concentration of a biomarker with labor
infection
alkaline fluid
