Exam Two

Question 1

What are some examples of health promotion that should be provided to patient about childbirth and perinatal education?

Answer 1

Diet
Exercise
Rest
Avoid unsafe practices
Fetal growth and development
Signs and symptoms of labor
options for birth
family planning
infant nutrition

Question 2

a psychoprophylactic (“mind prevention”) method of preparing for labor and birth that promotes the use of specific breathing and relaxation techniques…

Answer 2

Lamaze Method

Question 3

various exercises and slow, controlled abdominal breathing to accomplish relaxation

Answer 3

Bradley (Partner-coached) method

Question 4

focus on fear reduction via knowledge and abdominal breathing techniques

Answer 4

Dick-Read

Question 5

List pros and cons of breast feeding

Answer 5

Pros:
bonding between mother and child
free
extra calories are used
oxytocin is released
sucking helps to develop muscles in the infant’s jaw
food allergies are less likely to develop

Cons:
breast discomfort
sore nipples
mastitis
engorgement
breast abscess
milk stasis
flat or inverted nipples
vaginal dyness
decreased libido

Question 6

Pros and cons for bottle feeding

Answer 6

Pros:
Anyone can feed baby

Cons:
Not free, can become costly

Question 7

During the last trimester of pregnancy, estrogen levels ____ and progesterone levels ____.

Answer 7

During the last trimester of pregnancy, estrogen levels increase and progesterone levels decrease.

Question 8

Signs and Symptoms of true labor

Answer 8

Pain in back radiates to front
regular rhythmic contractions that increase with ambulation
Progressive cervical dilation

Question 9

SIGNS AND SYMPTOMS OF FALSE LABOR

Answer 9

Irregular contractions
No progression/dilation
tightening but not painful
change in position or activity usually slows contractions down

Question 10

Signs before labor

Answer 10

cervical changes
lightening
increased energy level
nesting
Blood show
Braxton hicks contractions
Spontaneous ROM

Question 11

The _______ is the route through which the fetus must travel to be born vaginally.

Answer 11

The birth passageway is the route through which the fetus must travel to be born vaginally.

Question 12

Which type of pelvis is not favorable and male shaped for child birth
Gynecoid
Android
Anthropoid
Platypelloid

Answer 12

Android

Question 13

As contractions increase, what happens to cervix?

Answer 13

cervix grows and thins but then disappears

Question 14

If a doctor says, “patient is 7/80/+1” what does this mean? Using this statement is patient close to giving birth or has she just begun the labor process?

Answer 14

Patient is 7cm dilated, 80% effaced and has a station of +1. Patient is closer to giving birth

Question 15

What feature in a baby’s head or skull helps identify the position of the fetal head during vaginal examination?

Answer 15

Sutures

Question 16

What refers to the posturing (flexion or extension) of the joints and the relationship of fetal parts to one another

Answer 16

Fetal attitude

Question 17

What refers to the relationship of the long axis (spine) of the fetus to the long axis (spine) of the mother. There are three possible lies: longitudinal (the most common), transverse, and oblique.

Answer 17

Fetal lie

Question 18

What refers to the body part of the fetus that enters the pelvic inlet first

Answer 18

Fetal presentation

Question 19

How do you identify fetal lie? if the baby is transverse, what type of delivery will the mother have?

Answer 19

Leopold’s manuever

C-section

Question 20

What type of position is the baby if they ROA?

Answer 20

Right occiput anterior

Question 21

What type of position is the baby if they are lOT

Answer 21

Left occiput transverse

Question 22

What type of position is the baby if they are ROP

Answer 22

Right occiput posterior

Question 23

The fetus goes through many positional changes as it travels through the passageway. These positional changes are known as

Answer 23

The fetus goes through many positional changes as it travels through the passageway. These positional changes are known as the cardinal movements of labor

Question 24

What are maternal physiologic responses to labor

Answer 24

Heart rate increases by 10-20 bpm
Cardiac output increases
Blood pressure increases
WBC increases
RR increase
gastric motility and food absorption decrease
Slight temperature elevation
decreased glucose levels

Question 25

Fetal physiologic responses to labor

Answer 25

Periodic FHR accelerations and slight decelerations decrease in circulation and perfusion Increase in arterial carbon dioxide pressure (PCO2) Decrease in fetal breathing movements throughout labor Decrease in fetal oxygen pressure with a decrease in the partial pressure of oxygen (PO2)

Question 26

``` Which stage of labor? Onset of contractions to full dilation 2 phases: latent and active latent--> 0-6cm and 6-8 hours active --> 6-10 cms and 3-6 hours Longest of all stages quicker for multipara than primipara patients Breathing techniques are encouraged ```

Answer 26

1st stage

Question 27

What stage of labor? 1-2 hr for multipara, 2-3 hr for primipara Complete dilation until birth of fetus maternal pushing Contractions are every 2-3 minutes and last 60-90 seconds

Answer 27

2nd stage

Question 28

What stage of labor? lasts 5-30 minutes Birth until placental separation placental separation and placental explusion

Answer 28

3rd stage

Question 29

What stage of labor? First 1-4 hours following develiery Post partum risk fo post-partum hemorrhage

Answer 29

4th labor

Question 30

What are active managements a nurse might do for post partum eating?

Answer 30

active management includes administration of a uterotonic agent after the birth, expulsion of the placenta with controlled traction of the cord, and uterine fundal message after placental expulsion

Question 31

The following signs of separation indicate that the placenta is ready to deliver:

Answer 31

The uterus rises upward. The umbilical cord lengthens. A sudden trickle of blood is released from the vaginal opening. The uterus changes its shape to globular.

Question 32

The focus during the 4th stage is to monitor the mother closely to prevent...

Answer 32

The focus during this stage is to monitor the mother closely to prevent hemorrhage, bladder distention, and venous thrombosis.

Question 33

What is the priority in triage?

Answer 33

Assessment is first priority | Place patient on monitor

Question 34

List nonpharmacologic measures that help with labor and pain management

Answer 34

``` Continuous labor support Hydrotherapy Ambulation and position changes Acupuncture nd acupressure Attention focusing and imagery Therapeutic touch and massage; effleurage Breathing techniques ```

Question 35

T/F Changing position frequently (every 30 minutes or so)—sitting, walking, kneeling, standing, lying down, getting on hands and knees, and using a birthing ball—helps relieve pain

Answer 35

True

Question 36

_______ is a light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. It is used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this.

Answer 36

Effleurage is a light, stroking, superficial touch of the abdomen, in rhythm with breathing during contractions. It is used as a relaxation and distraction technique from discomfort. External fetal monitor belts may interfere with the ability to accomplish this.

Question 37

_______ involves the use of one or more drugs administered orally, intramuscularly, or intravenously; they become distributed throughout the body via the circulatory system.

Answer 37

Systemic analgesia involves the use of one or more drugs administered orally, intramuscularly, or intravenously; they become distributed throughout the body via the circulatory system.

Question 38

Why would a patient being given opioids also be given an antiemetic?

Answer 38

For nausea and vomiting

Question 39

What route is systemic analgesic typically administered through?

Answer 39

Existing IV line, can be oral or IM also but PO is not preferred

Question 40

_______ provides pain relief without loss of consciousness. It involves the use of local anesthetic agents with or without added opioids to bring about pain relief or numbness through the drug’s effects on the spinal cord and nerve roots.

Answer 40

Regional analgesia provides pain relief without loss of consciousness. It involves the use of local anesthetic agents with or without added opioids to bring about pain relief or numbness through the drug’s effects on the spinal cord and nerve roots.

Question 41

An epidural is contraindicated for women with a previous history of...

Answer 41

spinal surgery or spinal abnormalities, coagulation defects, cardiac disease, obesity, infections, and hypovolemia. It is also contraindicated for the woman who is receiving anticoagulation therapy.

Question 42

Complications of epidural include

Answer 42

nausea and vomiting, hypotension, fever, pruritus, intravascular injection, maternal fever, allergic reaction, and respiratory depression.

Question 43

T/F General anesthesia is common and used similar to an epidural

Answer 43

FALSE, general is used only on emergencies

Question 44

What is important to indentify during a phone assessment of a patient who believes she is in labor

Answer 44

Identify S/S of true and false labor

Question 45

What are some things to ask during a phone assessment?

Answer 45

``` EDD Fetal movement; frequency other signs of labor GP time frame of previous labors characteristics of contractions bloody show and ROM status Presence of supportive adult in household or alone ```

Question 46

List nursing care and interventions that are done during the 1st stage of labor

Answer 46

Identifying the estimated date of birth from the client and the prenatal chart Validating the client’s prenatal history to determine fetal risk status Determining fundal height to validate dates and fetal growth Performing Leopold maneuvers to determine fetal position, lie, and presentation Checking FHR Performing a vaginal examination as appropriate to evaluate effacement and dilation progress Instructing the client and her partner about monitoring techniques and equipment Assessing fetal response and FHR to contractions and recovery time Interpreting fetal monitoring strips Checking FHR baseline for accelerations, variability, and decelerations Repositioning the client to obtain an optimal FHR pattern Recognizing FHR problems and initiating corrective measures Checking amniotic fluid for meconium staining, odor, and amount Comforting the client throughout the testing period and labor Documenting times of notification for team members if problems arise Knowing appropriate interventions when abnormal FHR patterns present Supporting the client’s decisions regarding intervention or avoidance of intervention Assessing the client’s support system and coping status frequently

Question 47

What are some things that are assessed throughot 1st stage of labor

Answer 47

``` VS Vaginal exam uterine contractions pain level coping ability FHR amniotic fluid ```

Question 48

An ______ is an incision made in the perineum to enlarge the vaginal outlet and theoretically to shorten the second stage of labor.

Answer 48

Episiotomy