POEP Module 04 – Process of Labor and Birth (Normal) Already Passed

POEP Module 04 – Process of Labor and Birth (Normal) Already Passed You are working with nursing students on the L&D unit. One of the students recalls reading about progesterone levels affecting labor and asks if you could explain this. What is your best response? a. Decreased progesterone levels allow estrogen to stimulate uterine contractility. With lowered levels of progesterone, the myometrium gains resistance as uterine contractions act on the resistance of the cervix. b. Decreased progesterone levels allow estrogen to stimulate uterine contractility. With lowered levels of progesterone, the myometrium loses resistance as uterine contractions act on the resistance of the cervix. c. Increased progesterone levels allow estrogen to stimulate uterine contractility. With higher levels of progesterone, the myometrium gains resistance as uterine contractions act on the resistance of the cervix. d. Increased progesterone levels allow estrogen to stimulate uterine contractility. With Decreased progesterone levels allow estrogen to stimulate uterine contractility. With lowered levels of progesterone, the myometrium loses resistance as uterine contractions act on the resistance of the cervix. Maria, a 21 year old, G1P0 at 39 2/7 weeks gestation presents to the OB triage with complaints of contractions. You apply the fetal monitor and perform a cervical examination. The cervical examination revealed that Maria is 1 cm dilated and 50% effaced. Maria stated that her cervical examination two days ago at her doctors appointment was the same. Maria asks you what signs to look for to know if she is in labor. What is your best response? (Select all that apply.) A. It is hard to say since this is your first baby. Labor takes time. B. You may experience pain that begins in your lower back and gradually sweep around to your lower abdomen. C. You may feel like the baby has dropped down in the pelvis. This is referred to as lightening. D. You may feel more tired than normal. This is referred to as nesting. B, C Other signs: bloody show, increased energy and cervical dilation, lower back pain , weight loss Match the fetal lie with correct definition. a. Transverse b. Longitudinal c. Oblique 1. occurs less frequently and usually converts to a different fetal lie during labor 2. occurs when the long axis of the fetus is at a right angle, or perpendicular, to that of the mother 3. occurs when the long axis of the fetus is parallel to the long axis of the mother a- 2 b. - 3 c. - 1 Abby, G2P1 at 39 3/7 weeks gestation presents to the OB triage with complaints of "her water leaking". You apply the fetal monitor. Abby's vitals are as follows: BP 158/98 mm Hg, P 82 bpm, R 22 bpm, Temp 100.4°F (38°C). Abby has a positive pH paper test indicating her membranes are ruptured and her cervical examination is 3cm dilated and 70% effaced. The FHR is 165 bpm, minimal variability, and recurrent variable decelerations are present. Abby is contracting every 3-4 minutes, 60-70 seconds in duration, the contractions palpate moderate, and her resting tone is soft. What assessment findings indicate immediate provider notification? a. Hypertension, elevated temperature, and indeterminant FHR pattern b. Hypertension, elevated temperature, PPROM, and indeterminant FHR pattern c. Hypertension, elevated temperature, PPROM, cervical dilation, and indeterminant FHR pattern d. Hypertension, elevated temperature, ruptur You are caring for Sonya, G1P0 at 40 weeks gestation who was admitted in active labor. Sonya's membranes spontaneously ruptured 30 minutes ago. You are orientating a new nurse and he asks you how often Sonya's vital signs should be taken. What is your best response? a. We should take Sonya's pulse, respirations, and blood pressure at least every 4 hours and take her temperature every hour. b. We should take Sonya's pulse, respirations, and blood pressure at least every 4 hours and take her temperature every 2 hours. c. We should take Sonya's pulse, respirations, blood pressure, and temperature at least every 4 hours unless we start oxytocin then we will take them more frequently. d. We should take Sonya's pulse, respirations, blood pressure, and temperature at least every 4 hours until she gets an epidural then we will take them more frequently. We should take Sonya's pulse, respirations, and blood pressure at least every 4 hours and take her temperature every hour. Match the mechanism of labor with the correct definition. 1. Engagement 2. Descent 3. Flexion a. occurs when the descending fetal head meets resistance from the cervix, the pelvic wall, or the pelvic floor b. the process of movement of the presenting part through the pelvis and depends on the intraamniotic pressure and the force exerted on the fundus by uterine contractions c. occurs as the biparietal diameter of the fetal head passes through the pelvic inlet d. takes place as the fetal head continues to descend from the pelvic inlet through the midpelvis to the pelvic outlet A baseline FHR is defined as a. a FHR baseline range that is 120-160 bpm. b. an approximate FHR range that excludes accelerations, and decelerations, and periods of marked variability. c. an approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding accelerations, and decelerations, and periods of marked variability. d. an approximate mean FHR rounded to increments of 10 bpm during a 20-minute segment, excluding accelerations, and decelerations, and periods of marked variability. an approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding accelerations, and decelerations, and periods of marked variability. FHR variability is defined as a. irregular fla. uctuations along the FHR baseline that represent the fetal sympathetic nervous system and the presence of marked variability is indicative of normal fetal acid-base status at the time noted. b. irregular fluctuations in a 10-minute window excluding FHR accelerations and decelerations that represent the fetal sympathetic and parasympathetic nervous systems reactivity. c. irregular fluctuations in a 20-minute window excluding FHR accelerations and decelerations. d. visually interpreted and is described as flat, minimal, moderate, and saltatory. irregular fluctuations in a 10-minute window excluding FHR accelerations and decelerations that represent the fetal sympathetic and parasympathetic nervous systems reactivity. Match the FHR category with the correct definition. 1. Predictive of normal fetal acid-base balance at the time of observation 2. Associated with abnormal fetal acid-base status at the time of observation 3. Not predictive of abnormal fetal acid-base status Category I Category II Category III 1-a 2-c 3-b You are caring for Melody, a G3 P2 at 39 weeks gestation who was admitted in active labor. The FHR characteristics are as follows: baseline 125, variability minimal, no accelerations and intermittent late decelerations. Uterine activity frequency is every 3-4 minutes, lasting 60-80 seconds, firm with palpation, and resting tone is soft. What category would this FHR pattern be considered? Category I Category II Category III Category II Abigail a G5P4 at 38 5/7 weeks gestation presents to the L&D unit in active labor. Her cervical examination reveals that she is 5 cm dilated and 80% effaced with the fetal head at a -1 station. Abigail has a history of opioid use and is currently on a methadone treatment. She is requesting an epidural for pain relieve. What is your best response? A nonpharmacologic management approach is a better choice for you because the medication used with an epidural will interfere with the methadone. Because you are on a methadone treatment program, we can only offer you nitrous oxide for pain relieve. Once we discontinue your methadone treatment you are able to get your epidural. We can use nonpharmacologic interventions until the anesthesia provider arrives to insert the epidural. We can use nonpharmacologic interventions until the anesthesia provider arrives to insert the epidural. The student nurses on the L&D unit ask you to explain why delayed cord clamping is important. What is your best response? Delayed cord clamping is used for preterm and term newborns to improve outcomes. Delayed cord clamping is used for preterm and term newborns to improve outcomes, however, it has been associated with an increase in postpartum hemorrhage. Delayed cord clamping is used only for preterm newborns to improve circulation, decreases the need for blood transfusions, and lowers the risk of necrotizing enterocolitis. Delaying cord clamping is used only for term newborns to increase hemoglobin levels. Delayed cord clamping is used for preterm and term newborns to improve outcomes.