NUR-230 EXAM 2 WITH COMPLETE EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (LATEST UPDATE 2026) A!!

NUR-230 EXAM 2 WITH COMPLETE EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (LATEST UPDATE 2026) A!! Which of theNUR-230 EXAM 2 WITH COMPLETE EXAM QUESTIONS AND ANSWERS (VERIFIED ANSWERS) (LATEST UPDATE 2026) A!! 1. Positivity 2. Psyche 3. Position 4. Power 5. Pressure - ANSWER Psyche, Position, and Power The 5 P's essential for Labor and Birth - ANSWER 1. passageway/passage: pelvis and cervix 2. Passenger: fetal head, attitude, lie, and presentation 3. Position: station, engagement, and position 4. Powers: primary and secondary 5. Psyche: emotions, energy, support What factors determine the size and type of maternal pelvis? - ANSWER Passage or Passageway What is the ability of the cervix to do during childbirth? - ANSWER Dilation and effacement What must the vaginal canal and external opening of the vagina do during childbirth? - ANSWER Distend Based of the following pelvic and fetal assessment, which should BEST indicate probable success for a vaginal delivery? A. Anthropoid B. Gynecoid C. Platypelloid D. Android - ANSWER B. Gynecoid Which of the following pelvic types would MOST likely lead to cesarean delivery? A. Anthropoid B. Gynecoid C. Platypelloid D. Android - ANSWER C. Platypelloid Which of the following accurately describes the progression of A: cervical dilation and B: cervical effacement? 1. -5 to +5; 0-10 cm 2. 0-10 cm; 0-100% 3. 0-100%; 0-10 cm 4. 0-100%' -5 to +5 - ANSWER 2. 0-10 cm; 0-100% Which sign indicates that labor is beginning? 1. involuntary contractions 2. full cervical dilation 3. 100% cervical effacement 4. pain in pelvic joints - ANSWER 1. involuntary contractions What is dilation in cervical changes? - ANSWER Dilation is the opening of the cervix, measured from 0 cm (closed) to 10 cm (fully dilated). What is effacement in cervical changes? - ANSWER Effacement is the softening, thinning, and shortening of the cervix, measured from 0% (long and thick) to 100% (fully effaced). Which occurs faster during labor, dilation or effacement? - ANSWER The cervix usually dilates faster than it effaces. Do all systemic medications used for pain relief during labor cross the placental barrier? - ANSWER Yes. Why is fetal liver and kidney excretion inadequate for metabolizing medications during labor? - ANSWER Because it is not fully developed. When should systemic analgesia be administered during labor? - ANSWER When the woman is comfortable, with a well-established labor pattern, regular contractions, significant duration of contractions, and moderate to strong intensity. What is the generic name for Stadol? - ANSWER Butorphanol Tartrate What routes can Butorphanol Tartrate (Stadol) be administered? - ANSWER IM or IV What is the typical dose of Butorphanol Tartrate (Stadol) for adults? - ANSWER 1 to 2 mg IM or IV every 2-4 hours What is the onset of action for Butorphanol Tartrate (Stadol) when administered IV? - ANSWER Rapid onset What is the peak effect time for Butorphanol Tartrate (Stadol) when given IV? - ANSWER 30-60 minutes What is the duration of action for Butorphanol Tartrate (Stadol)? - ANSWER 3-4 hours What are some maternal side effects of Butorphanol Tartrate (Stadol)? - ANSWER Drowsiness, dizziness, fainting, hypotension What is a potential neonatal side effect of Butorphanol Tartrate (Stadol)? - ANSWER Respiratory depression What is the generic name for Nubain? - ANSWER Nalbuphine Hydrochloride What are the routes of administration for Nalbuphine Hydrochloride? - ANSWER IV, IM, or Subcutaneous What type of medication is Nalbuphine Hydrochloride? - ANSWER Opioid analgesic What is the typical dose range for Nalbuphine Hydrochloride? - ANSWER 10-20 mg What is the onset of action for Nalbuphine Hydrochloride when administered IV? - ANSWER 2-3 minutes What is the peak effect time for Nalbuphine Hydrochloride? - ANSWER 15-20 minutes What is the duration of action for Nalbuphine Hydrochloride? - ANSWER 3 to 6 hours What are some maternal adverse effects of Nalbuphine Hydrochloride? - ANSWER Respiratory depression, drowsiness What are the neonatal effects of Nalbuphine Hydrochloride? - ANSWER Respiratory depression What is the generic name for Demerol? - ANSWER Meperidine What routes can Meperidine (Demerol) be administered? - ANSWER IM or IV What is the dosage range for Meperidine (Demerol) when administered IM? - ANSWER 50 to 100 mg What is the dosage range for Meperidine (Demerol) when administered IV? - ANSWER 25 to 50 mg every 2 to 4 hours What are some maternal side effects of Meperidine (Demerol)? - ANSWER Respiratory depression, constipation, dizziness, itching What are some neonatal effects of Meperidine (Demerol)? - ANSWER Neurobehavioral depression, more respiratory acidosis What is the generic name for Sublimaze? - ANSWER Fentanyl What are the routes of administration for Fentanyl? - ANSWER IM or IV What type of drug is Fentanyl? - ANSWER Short acting opiate What is the typical dose of Fentanyl? - ANSWER 500-100 mcg every 2 hours What is the onset time for Fentanyl when administered IV? - ANSWER Immediate What is the onset time for Fentanyl when administered IM? - ANSWER 7 to 15 minutes What is the peak time for Fentanyl's effects? - ANSWER 30 to 60 minutes What is the duration of Fentanyl's effects? - ANSWER 30 to 60 minutes What are some maternal side effects of Fentanyl? - ANSWER Hypotension, nausea, vomiting, respiratory depression How does Fentanyl's neonatal neurobehavioral depression compare to Demerol? - ANSWER Less neurobehavioral depression than Demerol What is Naloxone commonly known as? - ANSWER Narcan What type of drug is Naloxone? - ANSWER Opiate antagonist What is the maternal dose of Naloxone? - ANSWER 0.4-2 mg IV, may be repeated What is the neonatal dose of Naloxone? - ANSWER 0.1 mg/kg IM, may be repeated What does Naloxone reverse? - ANSWER Mild respiratory depression associated with fentanyl, butorphanol tartrate, and nalbuphine hydrochloride Is Naloxone effective for reversing respiratory depression caused by meperidine? - ANSWER No Regional Anesthesia - ANSWER temporary and reversible loss of sensation prevents initiation and transmission of nerve impulses for pain control types: epidural, spinal, combined epidural and spinal, pudendal block, local anesthesia What is an advantage of an epidural during labor? - ANSWER Produces good analgesia. What is another advantage of an epidural during labor? - ANSWER The woman is fully awake during labor and birth. How does continuous epidural technique benefit labor? - ANSWER Allows different blocking for each stage of labor. Can the dose of an epidural be adjusted? - ANSWER Yes, the dose can be adjusted. What is a disadvantage of an epidural related to maternal health? - ANSWER Maternal hypotension. What is a potential post-delivery issue associated with epidurals? - ANSWER Post delivery back pain. What serious infection can be a risk from an epidural? - ANSWER Meningitis. What is a rare but serious complication of an epidural? - ANSWER Cardio-respiratory arrest. What is a possible side effect of an epidural that affects balance? - ANSWER Vertigo. How long may it take for analgesia to onset after receiving an epidural? - ANSWER Onset of analgesia may not occur for up to 30 minutes. Spinal - ANSWER Advantages: immediate onset of anesthesia, relative ease of administration, smaller drug volume Disadvantages: high incidence of hypotension, greater potential for fetal hypoxia, short acting Combined spinal-epidural - ANSWER Advantages: spinal agent has faster onset, medication can be added to increase the effectiveness, most drugs are used in low dose Disadvantages: higher incidence of nausea, Pruritus Pudendal Block (perineal anesthesia) - ANSWER second stage of labor and episiotomy repair Advantages: ease of administration, absence of maternal hypotension Disadvantages: urge to bear down may be decreased What is a local analgesic used for perineal anesthesia? - ANSWER 1% lidocaine or similar medication injected into perineum What effect does perineal anesthesia have during the second stage of labor? - ANSWER Decrease of pressure in second stage What procedure can be performed without analgesia due to perineal anesthesia? - ANSWER Repair of episiotomy or laceration General Anesthesia - ANSWER - emergent deliveries - low platelet count requiring cesarean delivery - scheduled cesarean delivery and unable to place spinal Cricoid Pressure for general anesthesia - ANSWER diminish the chance of aspiration during placement of endotracheal tube What is a potential problem of general anesthesia related to fetal health? - ANSWER Fetal respiratory depression, with lower 1 minute APGAR scores. What is a risk associated with maternal intubation during general anesthesia? - ANSWER Higher risk of aspiration. What is a potential complication of general anesthesia regarding postpartum health? - ANSWER Higher risk of postpartum hemorrhage. How does general anesthesia affect a mother's feeling of control during childbirth? - ANSWER It can lead to less feeling of control. What is a concern regarding the presence of support persons during general anesthesia? - ANSWER The support person may not be present. What cognitive effect can general anesthesia have on the mother? - ANSWER Maternal amnesia. Which of the following procedures need to be completed prior to starting an induction of labor? A. Bishop Score B. Non-reactive NST C. Sterile Vaginal Exam D. Informed consent E. Vital Signs - ANSWER A, C, D, E Which of the following Bishop Scores indicates the hiest likelihood of having a vaginal delivery? A. 2 B. 5 C. 8 D. 12 - ANSWER D. 12 A bishop score is related to cervical changes. The higher score the more likely the patient is to have a successful vaginal delivery without complications. Bishop Score factors - ANSWER cervical dilation cervical effacement fetal station cervical consistency cervical position Use for an amniotomy include which of the following? SATA A. labor induction B. labor augmentation C. Access for chronic villus sampling D. placement of the TOCO monitor E. Placement of the FSE monitor - ANSWER A, B, E What should the nurse do first after a woman complains of leaking amniotic fluid? A. check her temperature B. Document rupture time C. palpate the uterus for any contractions D. Assess the FHR - ANSWER D. assess the FHR all of these assessments and documentations will be done but the question is asking for the first thing or priority. We need to ensure that the fetus is stable and so that involves checking vitals Teaching for a client is effective is she states that advantages for cervical ripening include which of the following? SATA A. Shorter labor B. Helps speed up cervical effacement C. Lowers the incidence of postpartum hemorrhage D. increases the risk of uterine rupture E. less risk for fetal intolerance to labor - ANSWER A, B Teaching for a cline is not effective is she states the following about receiving prostaglandins for labor induction? A. dinoprostone is given vaginally to stimulate contractions B. dinoprostone is removed by pulling a string C. Misoprostol may be used simultaneously with oxytocin D. Misoprostol may also be given after delivery to help with bleeding - ANSWER C A midwife strips a clients membrane in the office. The primary purpose of this is to do which of the following? A. separate the amniotic membranes from the lower uterine segment B. release oxytocin to stimulate contractions C. cause a tiny tear in the amniotic sac to stimulate labor D. relieve sacral pressure - ANSWER A Labor augmentation is supported by which of the following interventions? SATA A. Stripping membranes B. Amniotomy C. Oxytocin D. Ambulation E. Pudendal Anesthesia - ANSWER A, B, C, D A G3P2 presented to the hospital in active labor 8 hours ago. After receiving her epidural, her contractions have decreased in frequency and intensity, and she has not made any cervical change in the last 2 hours. The doctor has ordered Oxytocin to be initiated. This is considered? A. Labor indiction B. Labor Augmentation - ANSWER B A nurse is caring for a patient with an ongoing amnioinfusion. He notes that there is a moderate amount of clear fluid on the pad every hour. He: A. stops the amnioinfusion B. calls the provider to report the finding C. starts oxytocin a 2mU/min D. documents this as a normal finding - ANSWER D If a laboring patient with ROM has a fever, what FHR change would you likely see? A. early decelerations B. late decelerations C. fetal tachycardia D. fetal bradycardia - ANSWER C A client has been pushing for 3 hours and is exhausted. She pleads the provider to use forceps. Which of the following statements is true? A. the provider will place the suction cup on top of the baby's head will a small amount of pressure B. the client will not push with contractions so the provider can guide the head out C. the provider will apply traction when the client pushes D. the nurse only documents when the forceps are removed - ANSWER C Indications for a cesarean section include which of the following? SATA A. low lying placenta previa B. Cephalopelivc disproportion C. Placental Abruption D. Active chlamydial infection E. Umbilical cord prolapse F. failure to progress in labor - ANSWER B, C, E, F True or false: when documenting a cesarean section, the skin incision will always match the uterine incision? - ANSWER False Factors needed to consider a VBAC delivery include all of the following except? A. adequate pelvis B. No history of myomectomy C. Anesthesia in house D. previous classical incision - ANSWER D For which reason would the nurse administer a preanesthetic fluid bolus to a client who is prescribed spinal anesthesia in preparation for cesarean delivery? A. prevent maternal hypotension B. maintain fluid balance C. prevent neonatal hypoglycemia D. enhance anesthesia effect - ANSWER A Which of the following would be contraindications to administering systemic analgesia to your laboring patient? SATA A. B/P: 142/83 B. FHR with moderate variability C. Pt is 10 cm with urge to push D. bloody show noted on pad E. category III FHR tracing - ANSWER C, E After administering 25 mg Demerol IV to a laboring patient, what FHR changes would be expected? A. increased FHR baseline B. late decelerations C. decreased FHR variability D. frequent accelerations - ANSWER C Which action would the nurse take is a clients systolic blood pressure drops to 95 mmHg after administration of the prescribes anesthesia and there is a late deceleration in the fetal heart rate? SATA A. Administer oxygen via non rebreather facemask B. turn the client to her left side C. administer prescribed ephedrine D. initiate an IV bolus of LR E. raise the HOB to 90 degrees - ANSWER A, B, C, D The nurse is aware of possible complications following epidural placement including all of the following except: A. precipitous (fast) labor B. hypotension C. urinary retention D. itching - ANSWER A oxytocin administration is NOT acceptable in which of the following situations? SATA A. latent phase, stage 1 B. Significant variable decelerations C. early decelerations D. Late decelerations E. end of third stage of labor - ANSWER B, D A nurse evaluates the FHR tracing and notes the baseline at 115 with moderate variability, contractions are every 2 minutes with recurrent decelerations that drop in the 90's after the acme of the contraction and return to baseline 40 seconds after the end of the contraction. What is the nursing priority? A. decrease the oxytocin B. administer oxygen via nasal conula C. discontinue the oxytocin D. preform acoustic stimulation - ANSWER C In which clinical situation would the nurse immediately discontinue oxytocin for a client whose labor is being augmented with it? A. uterine contractions every 3-5 minutes B. client needing to void C. rupture of the amniotic sac D. FHR 175 bpm with absent variability - ANSWER D The nurse would assess for which complication before planning care for a client who has undergone a forceps assisted delivery? A. increased pelvic muscle tone B. presence of vaginal lacerations C. decreased urinary frequency D. decreased vaginal secretions - ANSWER B Which prenatal teaching strategy would the nurse include when teaching pregnant clients how to best reduce anxiety regarding pain that may be experienced during labor? A. explore different relaxation techniques B. Avoid discussing negative feelings C. explain that pain is to be expected D. discuss the stages of labor - ANSWER A What is one cause of Premature Rupture of Membranes (PROM)? - ANSWER Infection What previous history is a risk factor for Premature Rupture of Membranes (PROM)? - ANSWER Previous history of PPROM What condition characterized by excess amniotic fluid is a risk factor for PROM? - ANSWER Hydramnios What type of pregnancy increases the risk of Premature Rupture of Membranes (PROM)? - ANSWER Multiple pregnancy What type of infection is a risk factor for PROM? - ANSWER Urinary tract infections How long usually is the first stage in the active phase? - ANSWER Nullipara: 4.6 hours Multipara: 2.4 hours How long usually is the first stage in the transition phase? - ANSWER Nullipara: 3 hours Multipara: less than 1 hour How long does the second stage of labor usually last? - ANSWER Nullipara: up to 3 hours Multipara: less than one hour (less than 15 minutes) How long can the fourth stage of labor last? - ANSWER From the time of delivery of placenta until up to 4 hours after birth What is a key advantage of external electronic fetal heart monitoring? - ANSWER Produces a continuous graphic recording. What can external electronic fetal heart monitoring show? - ANSWER Baseline, baseline variability, and changes in the fetal heart rate (FHR). Is external electronic fetal heart monitoring invasive? - ANSWER No, it is noninvasive. Does external electronic fetal heart monitoring require rupture of membranes? - ANSWER No, it does not require rupture of membranes. What is a disadvantage of external electronic fetal heart monitoring? - ANSWER It is susceptible to interference from maternal and fetal movement. What issue may arise with the signal during external electronic fetal heart monitoring? - ANSWER It may produce a weak signal. What can happen to the tracing in external electronic fetal heart monitoring? - ANSWER The tracing may become sketchy and difficult to trace. What is a Tocodynamometer (Toco)? - ANSWER A device used for external electronic uterine monitoring. What are the advantages of using a Tocodynamometer? - ANSWER Noninvasive, easy to place, can be used before and after rupture of membranes, can be used intermittently, provides permanent continuous recording, and allows the nurse to palpate contractions for intensity. What are the disadvantages of using a Tocodynamometer? - ANSWER The nurse must compare subjective findings with the monitor, the belt may become uncomfortable and require frequent readjustment, the mother may feel limited in movement, and it does not provide information on intensity. What are the advantages of internal electronic fetal heart monitoring? - ANSWER Clearer tracings, provides better information about variability, and the nurse can place. What are the disadvantages of internal electronic fetal heart monitoring? - ANSWER Infection, injury, requires ruptured membranes, and sufficient cervical dilation. What are the advantages of internal electronic uterine monitoring? - ANSWER Provides pressure measurements for contraction intensity and uterine resting tone, allows for very accurate timing of contractions, provides a permanent record of uterine activity. What are the disadvantages of internal electronic uterine monitoring? - ANSWER Membranes must be ruptured, adequate cervical dilation must be achieved, it is invasive, increases the risk of uterine infection or perforation, and is contraindicated in cases with active infections. Nitrazine Tape: Testing for ROM - ANSWER - Negative: yellow color, urine? - Positive: deep blue color, amniotic fluid - alkaline Ferning Test: Testing for ROM - ANSWER Positive test- ferning present in amniotic fluid (slide under microscope) What is the first step in the Amnisure testing process for ROM? - ANSWER Collect a sample of vaginal discharge with a sterile collection swab for 1 minute. What is the second step in the Amnisure testing process for ROM? - ANSWER Transfer the sample to a solvent vial by rinsing the specimen in the vial and discarding the swab within 1 minute. What is the third step in the Amnisure testing process for ROM? - ANSWER Insert the test strip into the vial to initiate the PAMG-1 detection process. A positive result is indicated by two visible lines on the strip. How long does it take to call a negative result in the Amnisure test? - ANSWER 5 minutes. What should you do after removing the test strip from the vial in the Amnisure test? - ANSWER Observe and record the results, and do not read the strip after 15 minutes have passed since dipping it into the vial. How should faint or broken lines be interpreted in the Amnisure test? - ANSWER They should always be read as positive. Fetal heart rate - ANSWER - baseline FHR is 110-160 and must be observed for 10 minutes - Changes in FHR: accelerations, decelerations (early, late, variable, prolonged or sinusoidal pattern) - episodic: not associated with uterine contractions - periodic: associated with uterine contractions - Variability: absent, minimal, moderate, marked - fetal bradycardia - fetal tachycardia What are early decelerations usually related to? - ANSWER Head compression In early decelerations, when does the nadir of deceleration occur? - ANSWER At the peak of contraction What is the duration from onset to nadir in early decelerations? - ANSWER Greater than 30 seconds What are late decelerations usually related to? - ANSWER Uteroplacental insufficiency How do the onset, nadir, and recovery of late decelerations relate to contractions? - ANSWER They follow the beginning, peak, and end of the contraction. What is the duration from onset to nadir in late decelerations? - ANSWER Greater than 30 seconds What are variable decelerations usually related to? - ANSWER Cord compression What is the duration of onset to nadir for variable decelerations? - ANSWER Less than 30 seconds What is the criteria for the drop in heart rate during variable decelerations? - ANSWER A drop of 15 bpm below baseline for 15 seconds or more but less than 2 minutes Prolonged deceleration - ANSWER /= 2 min but 10 minutes baseline change - a decrease or increase in hr 10 minutes FHR variability - ANSWER absent = amplitude range undetectable minimal = 5 bpm moderate = 6-25 bpm marked = 25 bpm baseline bradycardia - ANSWER FHR less than 110 bpm fetal tachycardia - ANSWER FHR 160 bpm What are variable decelerations in fetal heart rate patterns? - ANSWER Variable decelerations are non-reassuring patterns characterized by abrupt decreases in fetal heart rate. What are late decelerations in fetal heart rate patterns? - ANSWER Late decelerations are non-reassuring patterns that occur after a contraction and can be of any magnitude. What are prolonged decelerations in fetal heart rate patterns? - ANSWER Prolonged decelerations are non-reassuring patterns where the fetal heart rate drops for an extended period. What does absence of variability in fetal heart rate patterns indicate? - ANSWER Absence of variability indicates a non-reassuring fetal heart rate pattern with no fluctuations. What is a sinusoidal pattern in fetal heart rate? - ANSWER A sinusoidal pattern is a non-reassuring fetal heart rate pattern characterized by a smooth, wave-like pattern. What is considered severe bradycardia in fetal heart rate patterns? - ANSWER Severe bradycardia is defined as a marked decrease in fetal heart rate, typically below 110 beats per minute. What is prolonged tachycardia in fetal heart rate patterns? - ANSWER Prolonged tachycardia is a non-reassuring pattern where the fetal heart rate is elevated for an extended period. Indications of imminent birth - ANSWER - bulging of the perineum - uncontrollable urge to bear down - increased bloody show Immediate post-birth danger signs - ANSWER - hypotension - tachycardia - uterine atony - excessive bleeding - hematoma Which of the following is NOT a test to determine ROM? A. Nitrazine B. Amnisure C. Fern D. MVU - ANSWER D. MVU Which of the following should be noted about ROM? SATA A. time B. Color C. odor D. Amount - ANSWER All of the above Rupture of membranes - ANSWER COAT Color: clear, bloody, meconium Odor: odorless or malodorous Amount: trickle, copious Time: when dis water break? 18 hours increases likeleihood of infection What is the goal for Montevideo units (MVUs) using an intrauterine pressure catheter (IUPC) in 10 minutes? - ANSWER Sum /= 200 MVUs but not exceeding 300 MVUs What should the resting tone be when using an intrauterine pressure catheter (IUPC)? - ANSWER Resting tone should be 25 mmHg What is the ideal duration and frequency of contractions (CTX's) when using an intrauterine pressure catheter (IUPC)? - ANSWER CTX's lasting 120 seconds and no more than 5 CTX's in 10 minutes; ideal is q 2-3 minutes After preforming a sterile vaginal assessment, the nurse is concerned that the presenting part is a foot. Which of the following interventions can the Nurse do to help identify fetal position? A. ultrasound B. Amniocentesis C. Speculum exam D. Leopold's Maneuvers - ANSWER D. Leopold's maneuver It has been determined that the fetus is in the ROA position. Where should then nurse place the ultrasound transducer on the moms abdomen? - ANSWER RLQ True or false: labor duration is usually shorter for a primipara when compared to a multipara? - ANSWER false A multigravida presents to the labor and delivery triage are and states that she feels as though she needs to push. What is the priority? - ANSWER preform a sterile vaginal exam 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 of these measure is most helpful? A. coaching the woman to utilize 10-15 second closed glottis bearing down efforts with each contraction B. the client should begin pushing as soon as the cervix is completely dilated C. the nurse will consult with the anesthesiologist to make sure the epidural is properly dosed to manage the clients pain D. The client should push with her urge using a combination of 6-8 seconds open and closed glottis efforts - ANSWER D. the client should push with her urge using a combination of 6-8 seconds and open and closed glottis efforts What causes early decelerations? - ANSWER head compression Which position or action would the nurse suggest for labor if the pelvic outlet needs to be increased? SATA A. squatting B. encourage the use of an episiotomy C. make sure the clients bladder is empty D. use a peanut ball between the legs in various positions E. place the client on her hands and knees F. use of internal fetak and contraction monitors - ANSWER A, C, D, and E A nurse is reviewing the fetal heart rate tracing and contraction pattern on a client being triaged for spontaneous labor. The Toco monitor is not registering any contractions. The client is tearful and thrashing from side to side. The SVE is 2/50/-2. What is the priority in this scenario? A. reassure the client that she is doing well with breathing through her contractions B. readjust the toco monitor C. palpate the fundus D. notify the health provider - ANSWER C. palpate the fundus What is the purpose of labor induction? - ANSWER To promote labor in a non-laboring patient. what is PROM - ANSWER premature rupture of membranes (before labor starts) what is PPROM - ANSWER preterm premature rupture of membranes explain this possible cause of PROM: infection - ANSWER weakens sac explain this possible cause of PROM: previous history of PPROM - ANSWER increases risk of happening again if it happened before explain this possible cause of PROM: hydramnios - ANSWER too much fluid can increase pressure explain this possible cause of PROM: multiple pregnancy - ANSWER increase of pressure explain this possible cause of PROM: UTI - ANSWER infections weakens explain this possible cause of PROM: amniocentesis - ANSWER needle can cause issues explain this possible cause of PROM: placenta previa - ANSWER bleeding explain this possible cause of PROM: abrupt placentae - ANSWER bleeding explain this possible cause of PROM: trauma - ANSWER trauma itself can rupture explain this possible cause of PROM: incompetent cervix - ANSWER cervix opens too early explain this possible cause of PROM: LEEP history - ANSWER thins servix explain this possible cause of PROM: bleeding during pregnancy - ANSWER causes inflammation explain this possible cause of PROM: maternal genital tract anomalies - ANSWER membrane cans be stretched wrong explain this newborn risk: respiratory distress - ANSWER not enough time for lungs to mature explain this newborn risk: fetal sepsis - ANSWER water breaking = infection risk explain this newborn risk: malpresentation - ANSWER baby does not have fluid to float in explain this newborn risk: prolapse of the umbilical cord - ANSWER cord could slip out with fluid gush explain this newborn risk: non-reassuring FHR pattern - ANSWER lots of issues that can go wrong explain this newborn risk: compression of umbilical cord - ANSWER so fluid for cord to float in explain this newborn risk: premature birth - ANSWER ruptured membrans will start labor what are some important nursing interventions for PROM/PPROM - ANSWER gestational age, how long has water been broken, stay hydrated, progesterone, tocolytics, left side lying to help with placental perfusion define preterm labor - ANSWER labor between 20-36 weeks list 7 S/S of preterm labor - ANSWER pelvic pain, backache, contractions (4 in 20 or 8 in 60), period like cramping, vaginal discharge changes, ROM, cervical changes what are 4 strong predictors of preterm birth - ANSWER infection, previous preterm labor, cervical shortening (less than 25), + fibronectin explain fetal fibronectin - ANSWER glue to holds placenta to uterine wall what meds do we give mom during preterm labor to stop contractions - ANSWER tocolytics (nifedipine, mag, terbutaline, progesterone) why do we want to stop contractions - ANSWER to help keep baby in for as long as possible what do we give to help with fetal lung maturity - ANSWER beta or dexamethasone how do methasones work - ANSWER increase surfactant production what is cervical insufficiency - ANSWER painless dilations and shortening of cervix w/o contractions what are medical treatments for cervical insufficiency - ANSWER antibiotics throughout pregnancy, bed rest, progesterone, ultrasound assessments what are surgical treatments for cervical insufficiency - ANSWER cerclage, suture cervix together when would a cerclage be used - ANSWER prophylaxis for multiple regency, risk for insufficiency when should transvaginal ultrasounds begin - ANSWER 16-28 weeks what are warning signs to teach cervical insufficiency patients... call HCP if these happen - ANSWER changes in vaginal discharge, lower back pain, pelvic pain, bleeding after cerclage what is a placenta previa - ANSWER placenta is covering cervical opening what causes placenta previas - ANSWER lots of previous pregnancies, high gestational age, prior c-section, male fetus, cigarette smoking, recent abortion describe this type of placenta previa: complete - ANSWER fully covers cervix describe this type of placenta previa: partial - ANSWER partially covering cervical opening describe this type of placenta previa: marginal - ANSWER right by the edge of the opening describe this type of placenta previa: low lying - ANSWER on side of uterine wall as part of the nursing staff, what should we know should not be done with placenta previa patients - ANSWER no vaginal exams if patient is actively bleeding, what should we anticipate - ANSWER blood transfusion why is it important to assess moms vitals - ANSWER bleeding can happen, we want to make sure there is no hemorrhage who else do we need to assess - ANSWER BABY What procedure can increase the risk of Premature Rupture of Membranes (PROM)? - ANSWER Amniocentesis What condition involving the placenta can lead to PROM? - ANSWER Placenta previa What condition involving the separation of the placenta can cause PROM? - ANSWER Abruptio placentae What type of event can lead to Premature Rupture of Membranes (PROM)? - ANSWER Trauma What cervical condition can increase the risk of PROM? - ANSWER Incompetent cervix What surgical history can be a risk factor for PROM? - ANSWER History of laser conization or LEEP procedure What symptom during pregnancy can be a risk factor for PROM? - ANSWER Bleeding during pregnancy What type of anomalies can increase the risk of Premature Rupture of Membranes (PROM)? - ANSWER Maternal genital tract anomalies Fetal Newborn risk with PROM - ANSWER respiratory distress syndrome fetal sepsis malpresentation prolapse of umbilical cord non reassuring FHR pattern compression of the umbilical cord premature birth Preterm labor (PTL) or Premature onset of labor (POL) - ANSWER - labor that occurs between 20-36 weeks completed Signs and symptoms include: uterine contractions that are at least 4 every 20 min or 8 every 1 hour, cervical change or dilation, mild menstrual like cramps felt low in the abdomen, constant or intermittent feelings of pelvic pressure, rupture of membranes, low dull backache that can be constant or intermittent, and increased vaginal discharge Strongest predictors of preterm birth - ANSWER - Fetal fibronectin: positive result- increased risk for preterm birth - cervical length measurement via US probe: shortening/thinning, less than 25 mm before term is abnormal - history of preterm birth - presence of infection Tocolytic Medications use - ANSWER Stop contractions Procardia (Nifedipine) - ANSWER 10-20 mg po q 4 hours. Monitor BP closely tocolytic Magnesium Sulfate - ANSWER 4-6 gram bolus load (20-30 min), then 2-4 grams/hr - monitor alertness, respirations, BP, reflexes and I/O closely tocolytic What is an advantage of labor induction? - ANSWER Labor usually occurs in 24-48 hours. What is a disadvantage of labor induction? - ANSWER Contractions may begin less gradually. What is another disadvantage of labor induction? - ANSWER Dysfunctional uterine contractions. What is a potential side effect of labor induction? - ANSWER Increased bloody discharge. What should be obtained before labor induction? - ANSWER A reactive non-stress test. What is the Bishop score used for? - ANSWER To assess the readiness of the cervix for labor induction. What vital assessments are needed before labor induction? - ANSWER Data base, vital signs, and consents. What is amniotomy? - ANSWER Amniotomy is the artificial rupture of membranes (AROM). How is amniotomy performed? - ANSWER Amniotomy is performed by making a small tear in the amniotic membrane using an amnihook. Who can perform an amniotomy? - ANSWER Only a nurse or midwife can perform an amniotomy. What are the uses of amniotomy? - ANSWER Amniotomy is used for labor induction, labor augmentation, and allows access to the fetus and uterus for internal monitoring. What are the nursing interventions for an Amniotomy? - ANSWER - check fetal heart rate - note date and time - note fluid - clear, bloody, meconium - note amount - scant, moderate, copious - note any foul odor What are the advantages of cervical ripening? - ANSWER Cervical effacement, shorter labor, lower requirements for oxytocin during labor induction, vaginal birth is achieved within 24 hours for most women, reduced incidence of cesarean birth. What are the risks associated with cervical ripening? - ANSWER Uterine hyperstimulation, non-reassuring fetal status, higher incidence of postpartum hemorrhage, uterine rupture. What is Cytotec (Misoprostol) used for? - ANSWER To stimulate contractions and thin the cervix. What is the dosage for Cytotec (Misoprostol)? - ANSWER 25mcg every 6 hours. How long should you wait to start Pitocin after the last dose of Cytotec? - ANSWER At least 4 hours. What is Cervidil (Dinoprostone) used for? - ANSWER To stimulate contractions and thin the cervix. What is the dosage for Cervidil (Dinoprostone)? - ANSWER 10mg vaginal insert over 12 hours. What should a patient do after receiving a dose of Cervidil? - ANSWER Rest for 2 hours after the dose, then may go to the bathroom. How should a patient care for themselves after voiding with Cervidil? - ANSWER Pat dry after voiding. How is Cervidil (Dinoprostone) removed? - ANSWER By pulling the string. What is the purpose of stripping the membranes during labor? - ANSWER To separate the amniotic membranes from the lower uterine segment. What do prostaglandins released during membrane stripping do? - ANSWER They stimulate contractions. Is stripping of the membranes a pharmacologic or non-pharmacologic method? - ANSWER Non-pharmacologic. What is a common side effect of stripping the membranes? - ANSWER It can be uncomfortable. What may occur after the procedure of stripping the membranes? - ANSWER Some vaginal bleeding. Who is authorized to perform membrane stripping? - ANSWER Only an OB, Nurse midwife, or NP. What is Pitocin? - ANSWER Pitocin is a synthetic form of oxytocin. What is the primary use of Pitocin? - ANSWER Induction or augmentation of labor. What are the risks associated with Pitocin? - ANSWER Tachysystole contractions, uterine rupture, water intoxication, non-reassuring fetal heart rate patterns. What is required before starting Pitocin? - ANSWER A reactive non-stress test (NST). What assessment is needed before administering Pitocin? - ANSWER A vaginal exam with Bishop score. Can Pitocin be used with a Foley bulb in place? - ANSWER Yes, it may be used with a Foley bulb in place. What type of monitoring is required during Pitocin administration? - ANSWER Continuous fetal monitoring. How is Pitocin titrated? - ANSWER Increase by 1-2 mu/min every 30 minutes. Pitocin Infusion - ANSWER Give 1 mu of pitocin per minute. Each IV bag contains 20 units of Pitocin/1000 ml of LR Labor Augmentation - ANSWER to stimulate labor that is naturally occuring-hypotonic contractions - pitocin - AROM What is amnioinfusion? - ANSWER Warmed sterile normal saline (NS) or lactated Ringer's (LR) is placed into the uterus via intrauterine pressure catheter (IUPC). What is one purpose of amnioinfusion? - ANSWER Replacement of loss or absent amniotic fluid. What condition can amnioinfusion help address during labor? - ANSWER Repetitive variable decelerations with increasing intensity. What is a benefit of amnioinfusion related to meconium? - ANSWER Meconium dilution. Episiotomy - ANSWER surgical incision of the perineum to enlarge the vaginal outlet Types: midline and Mediolateral What are some factors for using forceps-assisted birth? - ANSWER Heart disease, acute pulmonary edema or pulmonary compromise, intrapartum infection, prolonged second stage, exhaustion, non-reassuring fetal strip What defines mid forceps in childbirth? - ANSWER Fetal head engaged What defines low forceps in childbirth? - ANSWER Fetal head at +2 station What defines outlet forceps in childbirth? - ANSWER Fetal head at perineum What are the maternal risks associated with forceps assisted birth? - ANSWER Vaginal and cervical lacerations, periurethral lacerations, extension of a median episiotomy into the anus, anal sphincter injury, perineal edema. What are the neonatal risks associated with forceps assisted birth? - ANSWER Ecchymosis, edema along the sides of the face, caput succedaneum or cephalhematoma, transient facial paralysis, brachial plexus injury, cerebral hemorrhage, fractures (clavicle), elevated neonatal bilirubin levels. What is vacuum extraction in childbirth? - ANSWER A procedure using a suction cup placed on the fetal occiput. What is used to create suction in vacuum extraction? - ANSWER A pump. What is applied during vacuum extraction to assist delivery? - ANSWER Traction. What should happen to the fetal head with each contraction during vacuum extraction? - ANSWER The fetal head should descend. What should be documented during vacuum extraction? - ANSWER The length of time the vacuum is used. Cesarean Birth - ANSWER Indications: complete placenta previa, CPD, placental abruption, active genital herpes, umbilical cord prolapse, failure to progress in labor, benign and malignant tumors that obstruct the birth canal, breech presentation, previous cesarean birth, major congenital anomalies, non-reassuring fetal status Nursing management before: assist with epidural or spinal, Pepcid 20 mg iv and Reglan 10 mg iv - if unscheduled, Bicitra 30 ml (within 30 min of incision), monitor maternal vital signs, obtain fetal heart rate, insert indwelling urinary catheter, prepare abdomen and perineum, make sure all necessary personnel and equipment are present Nursing Management during: position the woman of the operating table - wedge to left tilt prior to delivery, support the couple, instrument count (before, during, and after), time out, documentation of all times Nursing management after: normal newborn post delivery care, monitor vital signs very 15 minutes, check the surgical dressing, palpate the fundus and checking the lochia, monitor intake and output, administrate IV oxytocin and pain management What is the goal of pharmacologic analgesia during labor? - ANSWER To provide maximum relief at minimum risk for the mother or fetus. Terbutaline (Brethine) - ANSWER 0.25 mg SQ (acute use 48-72 hours) tocolytic Progesterone therapy to sustain pregnancy - ANSWER prometrium suppository as HS tocolytic What is a medication used for fetal lung development? - ANSWER Maternal corticosteroid What is the goal time frame for administering corticosteroids for fetal lung development? - ANSWER Steroid window = 48 hours past 1st dose What is the dosage and administration schedule for Betamethasone for fetal lung development? - ANSWER 12 mg IV x 2 doses; 12-24 hrs apart What is the dosage and administration schedule for Dexamethasone for fetal lung development? - ANSWER 6 mg IV q 12 hours x 4 doses What is cervical insufficiency? - ANSWER Painless dilation of the cervix without contractions due to a cervical defect. What is a key measurement indicating cervical insufficiency? - ANSWER Shortened cervical length of less than 25mm before term. What previous medical history is associated with cervical insufficiency? - ANSWER Previous spontaneous abortion (SAB) without contractions. What is cerclage? - ANSWER A surgical closure of the cervix using suture as a treatment for cervical insufficiency. When can cerclage be performed prophylactically? - ANSWER In multiple pregnancies such as triplets. What should be monitored after cerclage? - ANSWER Bleeding. What are the options for delivery after cerclage? - ANSWER The suture may be cut for a vaginal birth or left in place for a cesarean birth. What is Placenta Previa? - ANSWER Placenta Previa is the placental implantation in the lower uterine segment. What happens to the placental villi during contractions and dilation in Placenta Previa? - ANSWER The placental villi are torn from the uterine wall. What type of bleeding occurs with Placenta Previa? - ANSWER Bright red, painless bleeding occurs. What are some causes of Placenta Previa? - ANSWER High gravidity, increasing age, advanced maternal age, prior cesarean birth, recent spontaneous or induced abortion, cigarette smoking, and it is seen more with male fetus. What re the types of placenta previa? - ANSWER complete, partial, marginal, and low lying What can you not do in a patient with placenta previa? - ANSWER Vaginal exams Abruptio Placentae - ANSWER - premature separation of normally implanted placenta from the uterine wall - cause is largely unknown Marginal Abruptio placentae - ANSWER - placenta separates at its edges - grade 1 severity (48%): mild separation, slight vaginal bleeding Central abruptio placentae - ANSWER placenta separates centrally - concealed bleeding - grade 2 (27%)- partial abruption with moderate bleeding Complete abruptio placentae - ANSWER total separation - massive vaginal bleeding grade 3 (24%)- complete separation with moderate to severe bleeding Multiple gestation maternal and fetal risk - ANSWER - preterm labor - uterine dysfunction - abnormal fetal presentations - instrumental or cesarean birth - postpartum hemorrhage - higher mortality rate than for single fetus - decreased intrauterine growth rate - increased incidence of fetal anomalies - increase in cord accidents - increase in cerebral palsy What is the normal range of amniotic fluid volume? - ANSWER 600-1000 ml What is hydramnios (polyhydramnios)? - ANSWER More than 2000 ml of amniotic fluid What are the risks associated with hydramnios? - ANSWER Risk of preterm labor and possible need for removal of excess fluid What is oligohydramnios? - ANSWER Less than 500 ml of amniotic fluid What are the monitoring requirements for oligohydramnios? - ANSWER Close monitoring of the fetus What fetal risks are associated with oligohydramnios? - ANSWER Renal and urinary malformations, fetal skin and skeletal abnormalities, pulmonary hypoplasia, and cord compression What is Amniotic Fluid Embolism also known as? - ANSWER Anaphylactoid Syndrome How does Amniotic Fluid Embolism occur? - ANSWER Amniotic fluid leaks into the maternal circulation through a small tear in the amnion or chorion of the uterus during placental separation or through cervical tears under pressure from the contracting uterus. What does Amniotic Fluid Embolism block? - ANSWER It blocks vessels of the lungs. What is the mortality rate associated with Amniotic Fluid Embolism? - ANSWER 80%-90% Is Amniotic Fluid Embolism a common or rare labor complication? - ANSWER It is a rare labor complication. What is hypertonic contractions in the context of dysfunctional labor patterns? - ANSWER Tachysystolic labor or tachysystole, defined as more than 5 contractions in a 10 minute period. What are hypotonic contractions in the context of dysfunctional labor patterns? - ANSWER Fewer than 2-3 contractions in a 10 minute period, characterized by low intensity contractions. Post term pregnancy - ANSWER pregnancy has gone beyond estimated date of birth (EDB) care management: assess fetal well being, maternal daily fetal movements assessed, non-stress test, biophysical profile, induction of labor Maternal risk of post term pregnancy - ANSWER - perineal damage - hemorrhage - increased risk of cesarean birth - anxiety - emotional fatigue - persistence of normal discomforts Fetal risk of port term pregnancy - ANSWER - decreased profusion - oligohydramnios - small for gestational age - macrosomia - increased risk for meconium stained fluid Malposition - ANSWER persistant occiput posterior presentation Malpresentation - ANSWER shoulder presentation brow presentation face presentation breech Version - ANSWER turning of the fetus in utero - external cephalic version (ECV): external manipulation of maternal abdomen to change fetus from breech to cephalic position - Podalic Version (internal): used in delivery of second twin, less common Umbilical Cord prolapse - ANSWER umbilical cord precedes presenting fetal part and is compressed against the maternal pelvis Cephalopelvic Disproportion (CPD) - ANSWER Maternal risk: prolonged labor, increased risk of uterine rupture, forceps assisted birth, vacuum assisted birth, cesarean birth Fetal risk: increased risk of cord prolapse, excessive molding of fetal head, bruising, and nerve trauma If a true CPD deliver via caesarean birth Macrosomia - ANSWER large fetus- more than 4000 grams Risk: dysfunctional labor, uterine rupture, perineal lacerations, postpartum hemorrhage, and shoulder dystocia Shoulder Dystocia - ANSWER shoulders entrapped behind suprapubic bone Dangers: brain damage from hypoxia, brachia plexus damage, umbilical cord occlusion Retained Placenta - ANSWER retention of the placenta beyond 30 minutes after birth - bleeding can be excessive - may require manual removal of placenta - possible blood transfusion after depending on blood loss Lacerations - ANSWER - spontaneous tearing of the perineal area - suspected when bright red vaginal bleeding persist despite well-contracted uterus - 1st, 2nd, 3rd, 4th degree lacerations - assist during 4th stage of labor repair - observe for bleeding and approximation during the postpartum period Placenta Accreta, Increta, and Percreta - ANSWER - abnormal adherence of the placenta to the uterine wall - associated with maternal hemorrhage and failed placental separation after birth - high incidence of abdominal hysterectomy Labor Induction - ANSWER Starting labor in someone who is not yet in labor. Advantages of Induction - ANSWER Labor usually begins within 24-48 hours. Disadvantages of Induction - ANSWER Sudden intense contractions, dysfunctional patterns, increased bloody discharge. Pre-Induction Assessment - ANSWER Vital signs, consent, reactive NST, vaginal exam, Bishop score. Bishop Score - ANSWER Cervical dilation, effacement, station, consistency, position; higher score = greater chance of vaginal delivery. Amniotomy - ANSWER Artificial rupture of membranes using an amnihook. Uses of Amniotomy - ANSWER Induce or augment labor, allow internal monitoring. Nursing Care for Amniotomy - ANSWER Assess FHR immediately, document time, describe fluid. Foley Bulb Ripening - ANSWER Mechanical pressure on cervix to release prostaglandins. Foley Bulb Advantages - ANSWER Effacement, shorter labor, less oxytocin, lower C-section rate. Foley Bulb Risks - ANSWER Tachysystole, non-reassuring FHR, PPH, uterine rupture. Misoprostol (Cytotec) - ANSWER 25 mcg vaginally every 6 hours; avoid oxytocin for 4 hours. Dinoprostone (Cervidil) - ANSWER 10 mg vaginal insert for 12 hours; bedrest 2 hours after insertion. Stripping of Membranes - ANSWER Manual separation of membranes to release prostaglandins; causes cramping and light bleeding. Oxytocin (Pitocin) - ANSWER Induces/augments labor; risks include tachysystole, rupture, water intoxication, non-reassuring FHR. Pitocin Requirements - ANSWER Reactive NST, vaginal exam, continuous monitoring. Pitocin Titration - ANSWER Increase 1-2 mU/min every ~30 minutes. Labor Augmentation - ANSWER Strengthening weak contractions using oxytocin or amniotomy. Amnioinfusion - ANSWER Infusion of warm sterile fluid to replace low amniotic fluid or relieve variable decelerations. Episiotomy - ANSWER Surgical perineal incision; midline or mediolateral. Forceps Birth - ANSWER Instrument-assisted birth for maternal exhaustion, disease, infection, non-reassuring FHR. Forceps Maternal Risks - ANSWER Tears, urethral injury, sphincter damage, swelling. Forceps Fetal Risks - ANSWER Bruising, cephalhematoma, nerve injury, hemorrhage, jaundice. Vacuum Extraction - ANSWER Suction cup applied to fetal head; monitor scalp for redness/swelling. Cesarean Birth - ANSWER Surgical birth for previa, abruption, CPD, herpes, cord prolapse, failure to progress, breech, fetal distress. Uterine Incisions - ANSWER Low transverse, low vertical, classical vertical. C-Section Pre-op Care - ANSWER IV fluids, anesthesia, meds for acid reduction, fetal/maternal monitoring. C-Section Post-op Care - ANSWER VS q15 min, assess fundus and bleeding, pain control, IV oxytocin. VBAC - ANSWER Vaginal birth after cesarean; requires single low transverse incision, adequate pelvis, no other scars; risk of rupture. Systemic Analgesia - ANSWER Crosses placenta; avoid close to delivery. Butorphanol (Stadol) - ANSWER 1-2 mg q2-4h IM/IV; causes drowsiness. Nalbuphine (Nubain) - ANSWER 5-10 mg; sedation risk. Meperidine - ANSWER Causes prolonged newborn drowsiness. Fentanyl - ANSWER Short-acting; risk of hypotension/respiratory depression. Naloxone - ANSWER Reverses opioids except meperidine. Epidural - ANSWER Excellent pain relief; risks hypotension, delayed onset. Spinal - ANSWER Immediate effect; short duration. Combined Spinal-Epidural - ANSWER Rapid with ongoing dosing. Pre-Placement Care - ANSWER IV fluids, assess status, position patient. Post-Placement Care - ANSWER Monitor BP, FHR, breathing, bladder. Pudendal Block - ANSWER Numbs perineum for second stage or repair; may reduce urge to push. Local Infiltration - ANSWER Lidocaine injected for repair when no regional anesthesia. General Anesthesia - ANSWER Used for emergencies; causes fetal respiratory depression and maternal aspiration risk. PROM - ANSWER Rupture of membranes before labor. PPROM - ANSWER Rupture before 37 weeks. Prolonged ROM - ANSWER 18 hours. PROM Risk Factors - ANSWER Infection, history of PROM, polyhydramnios, multiples, UTI, amniocentesis, previa, abruption, trauma. Fetal Risks with PROM - ANSWER RDS, infection, malpresentation, cord prolapse, non-reassuring FHR, preterm birth. PROM Nursing Care - ANSWER Assess timing, gestational age, infection, fetal status; give corticosteroids if indicated. Preterm Labor - ANSWER Labor between 20-36+6 weeks. Warning Signs - ANSWER Contractions, cramping, pelvic pressure, back pain, ROM, increased discharge. Predictors - ANSWER Positive fFN, short cervix 25 mm, prior preterm birth, infection. Nifedipine - ANSWER Tocolytic; monitor BP. Magnesium Sulfate - ANSWER Loading 4-6 g then 2-4 g/hr; monitor reflexes, respirations, urine output. Terbutaline - ANSWER SC; avoid if HR 120; causes tremors/palpitations. Corticosteroid Window - ANSWER Greatest effect within 48 hours. Cervical Insufficiency - ANSWER Painless dilation with short cervix. Cervical Insufficiency Care - ANSWER Serial ultrasounds, progesterone, cerclage, education about early warning signs. Placenta Previa - ANSWER Placenta over or near cervix causing painless bright red bleeding. Previa Types - ANSWER Complete, partial, marginal, low-lying. Previa Care - ANSWER No vaginal exams; monitor bleeding; prepare for C-section. Placental Abruption - ANSWER Painful premature placental separation. Abruption Risk Factors - ANSWER Hypertension, trauma, cocaine, smoking, multiparity, fibroids. Abruption Symptoms - ANSWER Pain, firm uterus, possible concealed bleeding, fetal distress. Previa vs Abruption - ANSWER Previa painless; abruption painful with firm uterus. Abruption Care - ANSWER Continuous monitoring, DIC evaluation, stabilize mother, C-section if needed. Multiple Gestation - Maternal Risks - ANSWER Preterm labor, uterine dysfunction, malpresentation, hemorrhage. Multiple Gestation - Fetal Risks - ANSWER IUGR, anomalies, cord issues, higher mortality. Multiple Gestation Care - ANSWER Rest, nutrition, ultrasounds, evaluate all fetuses. Polyhydramnios - ANSWER 2000 mL fluid; risk of preterm labor; may need amnioreduction. Oligohydramnios - ANSWER 500 mL; risks include pulmonary hypoplasia and cord compression; needs close monitoring. Amniotic Fluid Embolism - ANSWER Amniotic fluid enters maternal circulation causing collapse. AFE Symptoms - ANSWER Chest pain, dyspnea, cyanosis, hypotension, hemorrhage. AFE Management - ANSWER CPR with uterine displacement, blood products, urgent delivery. Tachysystole - ANSWER 5 contractions in 10 minutes. Tachysystole Management - ANSWER Stop oxytocin, give terbutaline, reposition, support. Hypotonic Labor - ANSWER Weak infrequent contractions. Hypotonic Management - ANSWER Assess for CPD, hydrate, consider oxytocin. Post-Term Pregnancy - ANSWER 42 weeks. Post-Term Maternal Risks - ANSWER Hemorrhage, C-section, perineal trauma. Post-Term Fetal Risks - ANSWER Low fluid, placental aging, meconium aspiration. Post-Term Care - ANSWER Kick counts, NST/BPP, induction discussion. Occiput Posterior (OP) - ANSWER Causes back pain and prolonged pushing; use position changes or manual rotation. Malpresentation - ANSWER Shoulder, brow, face, or breech. Breech Types - ANSWER Frank, complete, footling. External Cephalic Version - ANSWER Manual turning of fetus to vertex. Internal Version - ANSWER Used mainly for second twin. Non-Reassuring Fetal Status - ANSWER Bradycardia, tachycardia, late/variable decelerations, decreased movement. Intrauterine Resuscitation - ANSWER Position change, fluids, stop oxytocin, oxygen per protocol. Cord Prolapse - ANSWER Cord descends before fetus and becomes compressed. Cord Prolapse Management - ANSWER Elevate presenting part, Trendelenburg/knee-chest, oxygen, urgent C-section. Cephalopelvic Disproportion (CPD) - ANSWER Fetus too large for pelvis. Macrosomia - ANSWER 4000 g; risk of shoulder dystocia. Shoulder Dystocia - ANSWER Shoulders stuck under pubic bone. Shoulder Dystocia Maneuvers - ANSWER McRoberts, suprapubic pressure; never fundal pressure. Retained Placenta - ANSWER Not delivered within 30 minutes. Subinvolution - ANSWER Uterus not returning to normal size. Perineal Lacerations - ANSWER Bright red bleeding with firm uterus suggests laceration. Placenta Accreta Spectrum - ANSWER Abnormal placental attachment requiring surgical readiness. Perinatal Loss Care - ANSWER Emotional support, memory-making, chaplain services, sensitive communication. What must occur before pushing can begin during labor? - ANSWER The cervix must be fully dilated and effaced before pushing can begin. A woman enters triage who states she "thinks" she is in labor. Which assessment BEST demonstrates TRUE labor? 1. fetus palpable 2. contractions are every 20-30 minutes 3. Change/progress in cervical dilation/effacement 4. fetal heart rate alterations - ANSWER 3. change/progress in cervical dilation/effacement Premonitory signs of impending labor - ANSWER - lightening - Braxton hicks contractions - cervical changes - bloody show/expulsion of mucus plugs - ROM (SROM) - sudden burst of energy - weight loss - GI upset What are the characteristics of contractions in true labor? - ANSWER Contractions are at regular intervals. How do the intervals between contractions change in true labor? - ANSWER Intervals between contractions gradually shorten. How does the duration and intensity of contractions change in true labor? - ANSWER Contractions increase in duration and intensity. Where does discomfort begin during true labor? - ANSWER Discomfort begins in the back and radiates around to the abdomen. What happens to cervical dilation and effacement during true labor? - ANSWER Cervical dilation and effacement are progressive. Do contractions decrease with rest or a warm tub bath in true labor? - ANSWER Contractions do not decrease with rest or a warm tub bath. What are the characteristics of contractions in false labor? - ANSWER Contractions are irregular. How does the timing between contractions change in false labor? - ANSWER There is usually no change in timing between contractions. How does the intensity or duration of contractions change in false labor? - ANSWER There is usually no change in intensity or duration of contractions. Where is discomfort usually felt during false labor? - ANSWER Discomfort is usually in the abdomen. What happens to cervical dilation or effacement during false labor? - ANSWER There is no change in cervical dilation or effacement. What can lessen contractions in false labor? - ANSWER Rest and a warm tub bath can lessen contractions. Passenger: Fetus - ANSWER - fetal head - fetal attitude - fetal lie - fetal presentation Which statement by the student indicates effective learning about the structure of the fetal head during labor and birth 1. fetal skull bones are firmly united during labor 2. fetal skull bones are united by membranous sutures 3. two important fontanels are the parietal and temporal 4. sutures and fontanels restrict brain growth after birth - ANSWER 2. Fetal skull bones are united by membranous sutures The biparietal diameter is the largest _________ diameter of the fetal skull - ANSWER transverse Position - ANSWER - station - engagement - fetal position Which station of the presenting part indicates that birth of the fetus is imminent? A. -1 B. +1 C. +2 D. +4 - ANSWER D. +4 When assessing fetal station during a vaginal examination the nurse should assess which pelvic structure? - ANSWER ischial spines What does the fetal position refer to in terms of orientation? - ANSWER Right (R) or left (L) side of the maternal pelvis What are the landmarks used in determining fetal position? - ANSWER Occiput (O), mentum (M), sacrum (S), or acromion process (A) (scapula) What are the possible orientations of the fetal position? - ANSWER Anterior (A), posterior (P), or transverse (T) True of False: A woman bearing down to push the baby out is an example of primary powers? - ANSWER False What are the primary forces in labor? - ANSWER Uterine muscular contractions until complete dilation. What are the phases of uterine contractions? - ANSWER Increment, acme, decrement. How are uterine contractions described? - ANSWER With frequency, duration, and intensity. What are the secondary forces in labor? - ANSWER Abdominal muscles used in pushing (bearing down). Frequency of contractions is noted by - ANSWER the beginning of one contraction to the beginning of the next contraction Mechanisms of labor - ANSWER A. descent B. Flexion C. Internal rotation D. extension E. external rotation Cardinal Movements - ANSWER Every Darn Fool In Egypt Eats Raw Eggs - Engagement: widest part of presenting part enters pelvis - Descent: head moves down into pelvis - Flexion: fetus tucks chin onto chest - Internal Rotation: fetus turns to face spine (OA) - Extension: head extends for delivery under pubic bone - External rotation: head rotates to OT position and shoulders align vertically with moms pelvis - Expulsion: anterior shoulder delivers then posterior shoulder and rest of baby Psyche - ANSWER - Fear and anxiety: pain of labor, loss of control, injury of self or infant - excitement: feelings of joy and anticipation - exhaustion - level of social support: is FOB involved? who is the support system? What is a potential abnormality affecting the passageway during labor? - ANSWER The passageway is too small. What is a potential abnormality affecting the passenger during labor? - ANSWER Malpresentation. What is a potential abnormality related to the position of the fetus during labor? - ANSWER Occiput posterior position. What is a potential abnormality related to the powers of labor? - ANSWER Inadequate contractions or pushing. What psychological factors can potentially affect the process of labor? - ANSWER Intense fear, anxiety, poor support system, exhaustion. What is the first stage of labor? - ANSWER Onset of labor until 10 cm dilated What is the latent phase of labor? - ANSWER Cervical dilation from 0-3 cm, often referred to as 'early labor' What feelings are common during the latent phase of labor? - ANSWER Able to cope with discomfort, relieved that labor has started, high excitement, and anxiety What is the active phase of labor? - ANSWER Cervical dilation from 4-7 cm What feelings ar