Chapter 27 Labor And delivery

Question 1

Bloody Show

a. Begins with complete dilation at 10 cm and ends with the birth of the baby
b. Involuntary uterine contractions that signal the beginning of labor
C. lurns and adjustments that occur as the fetus moves through the maternal pelvis
d. Vaginal drainage and blood-tinged mucus typically increase as term approaches
e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Answer 1

d. Vaginal drainage and blood-tinged mucus typically increase as term approaches

Rational

bloody show - This is matched with definition (d): Vaginal drainage and blood-tinged mucus typically increase as term approaches. The bloody show is a sign that labor may soon begin.

Question 2

Effacement

a. Begins with complete dilation at 10 cm and ends with the birth of the baby
b. Involuntary uterine contractions that signal the beginning of labor
C. lurns and adjustments that occur as the fetus moves through the maternal pelvis
d. Vaginal drainage and blood-tinged mucus typically increase as term approaches
e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Answer 2

e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Rational

effacement - This matches with definition (e): Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both. Effacement refers to the cervix becoming thinner and shorter as labor approaches.

Question 3

Primary Powers

a. Begins with complete dilation at 10 cm and ends with the birth of the baby
b. Involuntary uterine contractions that signal the beginning of labor
C. lurns and adjustments that occur as the fetus moves through the maternal pelvis
d. Vaginal drainage and blood-tinged mucus typically increase as term approaches
e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Answer 3

b. Involuntary uterine contractions that signal the beginning of labor

Rational

primary powers - This goes with definition (b): Involuntary uterine contractions that signal the beginning of labor. Primary powers are the contractions that help to open the cervix and push the baby out.

Question 4

Cardinal Movements of labor

a. Begins with complete dilation at 10 cm and ends with the birth of the baby
b. Involuntary uterine contractions that signal the beginning of labor
C. lurns and adjustments that occur as the fetus moves through the maternal pelvis
d. Vaginal drainage and blood-tinged mucus typically increase as term approaches
e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Answer 4

C. lurns and adjustments that occur as the fetus moves through the maternal pelvis

Rational
This corresponds to definition (c): Turns and adjustments that occur as the fetus moves through the maternal pelvis. These movements help the baby navigate through the birth canal.

Question 5

Second stage of labor

a. Begins with complete dilation at 10 cm and ends with the birth of the baby
b. Involuntary uterine contractions that signal the beginning of labor
C. lurns and adjustments that occur as the fetus moves through the maternal pelvis
d. Vaginal drainage and blood-tinged mucus typically increase as term approaches
e. Thinning and shortening or obliteration of the cervix that occurs during late pregnancy, labor, or both

Answer 5

a. Begins with complete dilation at 10 cm and ends with the birth of the baby

Rational

second stage of labor - This matches with definition (a): Begins with complete dilation at 10 cm and ends with the birth of the baby. The second stage involves the pushing and delivery of the baby.

Question 6

About 2 weeks before the due date, a nullipara patient reports that the “lightening” that was described in the prenatal classes has occurred.
Which physical change is likely to occur because of the lightening?

1. Urinary frequency
2. Decreased fetal movement
3. Shortness of breath
4. Leakage of amniotic fluid

Answer 6

1. Urinary frequency

Rational

Lightening refers to the baby dropping lower into the pelvis before childbirth, which typically occurs a few weeks before labor in first-time mothers (nullipara). As the baby descends, there is less pressure on the diaphragm, which can alleviate shortness of breath, but it increases pressure on the bladder.

This increased pressure on the bladder often leads to urinary frequency as the space in the pelvic area becomes more crowded. The other options listed, such as decreased fetal movement, shortness of breath, and leakage of amniotic fluid, are not directly associated with lightening.

Final Answer: 1. Urinary frequency

Question 7

The patient is 34 weeks gestation and reports an irregular tightening of the uterus and the health care provider (HCP) informs her that these are Braxton Hicks contractions. What additional information would the nurse give the patient?

1. Anticipate bloody show with Braxton
   Hicks contractions.
2. Call the HCP if the tightening sensations become painful and regular.
3. Anticipate that a headache and backache will accompany these contractions.
4. Expect leaking amniotic fluid will occur with Braxton Hicks contractions.

Answer 7

2. Call the HCP if the tightening sensations become painful and regular.

Rational

Braxton Hicks contractions are often referred to as “false labor” contractions. They are usually irregular, infrequent, and not painful. They do not lead to cervical dilation and are considered a normal part of pregnancy as the body prepares for labor.

Question 8

Premature rupture of membranes increases the risk for which complication?

1. Infection for mother and fetus
2. Failure to progress
3. Uterine hemorrhage
4. Precipitous labor

Answer 8

1. Infection for mother and fetus

Rational

Premature rupture of membranes (PROM) is when the amniotic sac breaks before labor begins. This condition significantly increases the risk of infection for both the mother and the fetus because the protective barrier of the amniotic sac is compromised, allowing bacteria to enter the uterine cavity. Therefore, prompt medical evaluation and management are critical to reduce the risk of infection.

Question 9

Which behaviors/ symptoms would be considered normal and expected a few days before onset of true labor?

1. Depression and fatigue
2. Vomiting and loss of appetite
3. A loss of 5-10 pounds
4. Renewed energy for cooking and cleaning

Answer 9

4. Renewed energy for cooking and cleaning

Rational

The behavior/symptom that would be considered normal and expected a few days before the onset of true labor is:

This is often referred to as “nesting.”

Question 10

Which patients may be candidates for cesarean delivery? Select all that apply.

1. Cephalopelvic disproportion is present.
2. Mother is a nullipara.
3. Mother has a cardiac condition.
4. Prolapse of cord is present.
5. Presentation is breech.
6. Fetus has a heart rate of 140 bpm.

Answer 10

1. Cephalopelvic disproportion is present.
2. Mother has a cardiac condition.
3. Prolapse of cord is present.
4. Presentation is breech.

Rational

1. Cephalopelvic disproportion is present: This condition occurs when the baby’s head or body is too large to pass through the mother’s pelvis. It is a common indication for cesarean delivery.
2. Mother has a cardiac condition: Certain cardiac conditions can increase the risk of complications during vaginal delivery, making cesarean delivery a safer option.
3. Prolapse of cord is present: This is an obstetric emergency where the umbilical cord slips ahead of the presenting fetal part. It often requires an immediate cesarean delivery.
4. Presentation is breech: Breech presentation, where the baby is positioned feet or buttocks first, is often an indication for cesarean delivery, especially if it is a first pregnancy or other complicating factors are present.

Question 11

The HCP informs the nurse that there is a prolapsed umbilical cord. What would the nurse do first?

1. Assist the mother into a high Fowler’s position.
2. Apply a fetal monitoring device and count heart rate.
3. Prepare the mother for a cesarean birth.
4. Ensure that the HCP has sterile gloves.

Answer 11

4. Ensure that the HCP has sterile gloves.

Rational

In the case of a prolapsed umbilical cord, the primary concern is the risk of compromised blood flow to the fetus. The immediate action should aim to alleviate pressure on the cord and improve fetal circulation.

The most effective immediate action is to reposition the mother to relieve cord compression. Typically, placing the mother in a knee-chest position or Trendelenburg position (where the woman’s hips are elevated) is recommended to reduce pressure on the cord.

Final Answer: None of the given options are correct for immediate action. The nurse should reposition the mother to relieve pressure on the prolapsed cord, often using knee-chest or Trendelenburg position.

Question 12

The nurse is caring for a patient who has completed the third stage of labor. What is the purpose and goal of massaging the fundus?

1. Achieve uterine atony
2. Facilitate separation of the placenta
3. Regain uterine muscle tone
4. Determine the number and size of clots

Answer 12

3. Regain uterine muscle tone

Rational

3. “Regain uterine muscle tone” is correct because the purpose of massaging the fundus is to help the uterus contract and regain its tone, preventing postpartum hemorrhage.

Question 13

The nurse is encouraging the mother to make frequent position changes during labor. Which position facilitates the second stage of labor by increasing the pelvic outlet?

1. Lateral side-lying
2. Squatting
3. Knee-chest
4. Lithotomy

Answer 13

2. Squatting

Rational

To facilitate the second stage of labor by increasing the pelvic outlet, the squatting position is most effective. This position helps widen the pelvis, allowing for easier passage of the baby through the birth canal. It uses gravity to assist in the descent of the baby and can also help align the baby optimally for birth.

Question 14

Assessment of the amniotic fluid reveals yellow staining. What is the significance of this finding?

1. This is associated with hydramnios.
2. This finding is suggestive of intrauterine infection.
3. This color is common with abruptio placentae.
4. This staining is typical with meconium passage in utero.

Answer 14

2. This finding is suggestive of intrauterine infection.

Question 15

On examination, the patient is found to be 8 cm dilated with contractions every 3 minutes that last for 70 seconds. Which behavior is likely to occur in this transitional phase?

1. Alert and talkative
2. Confused and disoriented
3. Less talkative and focused on breathing
4. Irritable and deeply focused

Answer 15

4. Irritable and deeply focused

Rational

In the transitional phase of labor, which occurs when the cervix is 8-10 cm dilated, the intensity of contractions increases and they occur every 2-3 minutes, lasting about 60-90 seconds. During this phase, it’s common for patients to experience strong physical and emotional responses due to the intensity and frequency of contractions.

4. “Irritable and deeply focused” reflects the common emotional and mental state during intense labor.

Question 16

The baby is assessed after birth and the following are noted: heart rate 124 bpm; respiratory effort good, crying; some flexion of the extrem-ities; grimacing; body pink, extremities bluish.
Based on this information, what is the Apgar score?

Answer 16

Answer is 7

Rational

1. Heart Rate:
   
   • 0 points: Absent
   • 1 point: Below 100 bpm
   • 2 points: At or above 100 bpm
   • In this case: 124 bpm = 2 points
2. Respiratory Effort:
   
   • 0 points: Absent
   • 1 point: Slow or irregular
   • 2 points: Good, crying
   • In this case: Good, crying = 2 points
3. Muscle Tone:
   
   • 0 points: Limp
   • 1 point: Some flexion of extremities
   • 2 points: Active motion
   • In this case: Some flexion = 1 point
4. Reflex Irritability (Response to stimulation):
   
   • 0 points: No response
   • 1 point: Grimacing
   • 2 points: Cough or sneeze or cry
   • In this case: Grimacing = 1 point
5. Color:
   
   • 0 points: Blue, pale
   • 1 point: Body pink, extremities blue
   • 2 points: Completely pink
   • In this case: Body pink, extremities bluish = 1 point

Add up the points: 2 (heart rate) + 2 (respiratory effort) + 1 (muscle tone) + 1 (reflex irritability) + 1 (color) = 7

Question 17

A new nurse is performing fundal massage.
When would the supervising nurse intervene?

1. Explains to patient that rationale is to help placenta to deliver
2. Supports uterus from below with one hand
3. Uses upper hand to apply firm downward pressure
4. Observes perineum for number and size of clots

Answer 17

1. Explains to patient that rationale is to help placenta to deliver

Rational

In the context of fundal massage after childbirth, the primary purpose is to help the uterus contract and prevent postpartum hemorrhage, not to assist in delivering the placenta. Therefore, the supervising nurse would need to intervene if the new nurse incorrectly explains to the patient that the rationale is to help the placenta to deliver.

Question 18

The woman received general anesthesia for a cesarean section. Because the mother has increased risk for uterine relaxation, which action will the nurse perform?

1. Administer glycopyrrolate as prescribed.
2. Monitor for increased abdominal pain.
3. Monitor for postpartum hemorrhage.
4. Administer magnesium sulfate.

Answer 18

3. Monitor for postpartum hemorrhage.

Rational

In this scenario, the woman who received general anesthesia for a cesarean section is at increased risk for uterine relaxation. Uterine relaxation post-cesarean section can lead to postpartum hemorrhage, which is a potential complication. Therefore, the nurse should focus on monitoring for signs of postpartum hemorrhage to ensure the mother’s safety and timely intervention if needed.

Question 19

Which questions would be most important for the admission assessment of a patient in labor?
Select all that apply.

1. “When did the contractions begin?”
2. “How far apart are the contractions?”
3. “Did you take your prenatal vitamin today?”
4. “Did your water break?”
5. “Do you plan to have the baby circumcised if it is a male?”
6. “Have you noted any vaginal bleeding?”
7. “How long do you plan to breastfeed your baby?”

Answer 19

1. “When did the contractions begin?”
2. “How far apart are the contractions?”
3. “Did your water break?”
4. “Have you noted any vaginal bleeding?”

Rational

For the admission assessment of a patient in labor, the most important questions focus on understanding the labor process and any immediate risks or needs. Here’s a breakdown of each option:

1. “When did the contractions begin?” - Important to assess the stage and progression of labor.
2. “How far apart are the contractions?” - Crucial for evaluating the frequency and intensity of labor.
3. “Did your water break?” - Key to knowing if the amniotic sac has ruptured, which has implications for labor progression and infection risk.
4. “Have you noted any vaginal bleeding?” - Important for identifying potential complications like placental issues or other risks.