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Pediatrics/ Maternity > Maternity- Labor And Delivery Process > Flashcards

Maternity- Labor And Delivery Process Flashcards

1
Q

Who does an intrapartum Nurse care for during each labor and delivery

A

The fetus mother and family unit

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2
Q

What are pre-monetary signs preceding labor

A

Back ache
weight loss
lightening
contractions
increase vaginal discharge or bloody show
energy burst
G.I. changes

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3
Q

Pre-monetary signs during labor of backache

A

Constant Low Dalbec a caused by pelvic muscle relaxation

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4
Q

How much weight should you lose during labor

A

0.5 to 1.5 kg weight loss
1-3 lbs

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5
Q

What is lightening

A

Fetal head descends to true pelvis about 14 days before labor
feeling like fetus has dropped
causes easier breathing
more pressure on bladder
more pronounced in first pregnancy

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6
Q

What are contractions

A

Irregular uterine contractions (Braxton Hicks) that eventually progress in strength and regularity

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7
Q

Premonitory signs of labor increase vaginal discharge or bloody show

A

Explosion of cervical mucus plug may occur
bloody tinged mucous plug from onset of dilation and effacement

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8
Q

What is an energy burst

A

Premonitory sign of labor
sometimes called nesting response

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9
Q

What G.I. changes can you have in the premonitory signs of labor

A

Nausea vomiting indigestion

less common

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10
Q

What is the first stage of labor consist of

A

The Latent stage
active phase
transition phase

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11
Q

What happens in the Latent stage of labor

A

Last 6 to 4 hours
cervical is dilated 0 to 3 cm
onset of contractions occur
mild to moderate irregular
occur 5 to 30 minutes and last 30 to 45 seconds
some dilation in effacement
woman is talkative and eager

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12
Q

What happens during the active phase of labor

A

3 to 2 hours
4 to 7 cm dilated
contractions more regular moderate strong
occur 3 to 5 minutes last 40 to 70 seconds rapid dilation in effacement
some fetal dissent
feeling helplessness with anxiety as contractions become stronger

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13
Q

What happens during the transition phase of labor

A

Last 20 to 40 minutes
dilated 8 to 10 cm
contractions very strong
occur 2 to 3 minutes less 45 to 90 seconds
complete dilation occurs
tired restless irritable states cannot continue
urge to push
most difficult part of the labor

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14
Q

What is the second stage of labor

A

Full dilation
contractions every 1 to 2 minutes
birth occurs

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15
Q

What happens during the third stage of labor

A

Delivery of the placenta


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16
Q

What is Schultz’s Presentation

A

Shiny fetal surface of placenta emerges first

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17
Q

What is Duncan presentation

A

Dull maternal surface of placenta emerges first

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18
Q

What is the fourth stage of labor

A

Maternal stabilization of vital signs
Return to homeostasis

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19
Q

What is cervical ripening

A

Cervix become soft opens and partially effaced
can begin to dilate

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20
Q

What happens during the rupture of membranes

A

The water breaks can initiate labor or occur any time during labor
Common during transition phase

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21
Q

How long after the rupture of membranes do you go into labor

A

Within 24 hours after rupture

if greater than 24 hours fetus can lead to infection

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22
Q

What should the nurse do immediately after a rupture of membranes

A

Assess the FHR for abrupt decelerations

indicative of fetal distress to rule out umbilical cord prolapse

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23
Q

What should the amniotic fluid look like

A

Watery clear and have a slight yellow tinge
No foul odor
alkaline between 6.5 to 7.5

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24
Q

What are the five “P” that affect in define labor process

A

Passenger (fetus + placenta)
passageway (birth canal)
powers (contractions)
position (of the woman)
physiological response

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25
Q

What is the passenger of labor

A

Fetus and placenta

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26
Q

What affects the ability of the fetus to navigate the birth canal

A

Fetal position
Fetal lie
fetal attitude
fetal presentation

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27
Q

What is the presentation of a fetus

A

The part of the fetus that is entering the pelvic inlet first 

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28
Q

What is the presentation of a fetus back of the head

A

occiput

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29
Q

What is the fetal position chin

A

Mentum

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30
Q

What is the fetal Presentation of the shoulder

A

Scapula

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31
Q

What is the fetus presentation of breech

A

Sacrum or feet

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32
Q

What is the fetus presentation for cephalic

A

Head down

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33
Q

What is the fetal lie

A

The relationship of maternal spine to the fetus spine

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34
Q

What is a transverse lie

A

Fetus spine is horizontal informs a right angle to the maternal spine
will not accommodate vaginal birth require a cesarean it fetus does not rotate

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35
Q

What is a Parallel or longitudinal lie

A

Fetal spine is parallel to maternal spine either cephalic or breech presentation

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36
Q

Breech presentation can require what

A

A cesarean birth

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37
Q

What is the fetal attitude

A

Relationship of fetal body parts to one another

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38
Q

What is Fetal flexion

A

Chin flex into chest extremities flexed into torso

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39
Q

What is fetal extension

A

Chin extended away from chest extremities extended

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40
Q

Fetopelvic or fetal position is what

A

The relationship of the presenting part of the fetus in reference to its directional position as it relates to one of the four maternal pelvic quadrants

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41
Q

What is the preferred fetal position

A

occiput

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42
Q

What does the first letter of reference in fetal position

A

The side of the maternal pelvis
right or left

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43
Q

What does the second letter reference in fetal position

A

The presenting part of the fetus

occiput sacrum mentum or scapula

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44
Q

What does the third letter refrence in fetal position

A

The part of the maternal pelvis

anterior posterior or transverse

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45
Q

What is station

A

Measurement of fetal descent in CM with station 0 being the level of imaginary line of the ischial spine

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46
Q

What does a negative station mean

A

superior (above) to the ischial of spine

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47
Q

What does a postive station mean

A

Inferior (below) the ischial spine

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48
Q

What is the passageway of birth

A

The birth canal
size and shape must be adequate to allow the fetus to pass through
Cervix must dilate and efface in response to contractions

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49
Q

What is powers of birth

A

Uterine contractions which caused effacement and dilation

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50
Q

What is effacement

A

Shortening and thinning of the cervix

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51
Q

What is dilation

A

Enlargement or widening of the cervical opening and Canal

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52
Q

What is position of birth

A

Client should engage in frequent position changes during birth
whatever the maternal preference is

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53
Q

What helps aid in the fetal descent

A

Gravity

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54
Q

What is the physiological response of birth

A

Maternal stress tension and anxiety can produce physiological changes and impair progress of labor

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55
Q

What is a Leopold maneuver

A

Abdominal palpation of the fetal presenting part lie attitude descent and probable location where the fetal heart tones can be best auscultated

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56
Q

What is a Toko transducer

A

External electronic monitoring that is applied to the maternal abdomen over the fundus 

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57
Q

What does external electronic monitor
(Tocotransducer) 

A

Measures uterine activity
displays uterine contraction patterns

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58
Q

What is an external fetal monitor 

A

Transducer applied to the abdomen to assess FHR patterns during labor and birth

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59
Q

When do you obtain Group B streptococcus culture

A

Screen at 35 to 37 weeks

if results not available obtain culture at birth 

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60
Q

What does a postive Group B streptococcus culture mean

A

Start IV prophylactic antibiotic

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61
Q

What can a urinalysis in labor determine

A

Dehydration
ketonuria
proteinuria
glycosuria (implies gestational diabetes)
UTI (common in diabetes mellitus)

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62
Q

How often should you assess maternal vital signs

A

Check maternal temperature every two hours if membranes are ruptured

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63
Q

How do you assess uterine labor contractions

A

Placing a hand over the fundus to assess contraction frequency duration and intensity

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64
Q

What is frequency of a contraction

A

From the beginning of one contraction to the beginning of the next

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65
Q

What is duration of a contraction

A

Time between the beginning of a contraction to the end of the same contraction

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66
Q

What is intensity of a contraction

A

Strength of contraction at its peak described as mild moderate or strong

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67
Q

What is the resting tone of a uterine contraction

A

Tone of the uterine muscle in between contractions

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68
Q

What kind of contraction can reduce blood flow to the placenta resulting in fetal hypoxia and decreased FHR

A

 contraction duration (greater than 90 seconds ) or two frequent contractions (more than five and 10 minute periods) without suefficient time for uterine relaxation (less than 30 seconds)

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69
Q

What do you look for in a vaginal examination during labor

A

Cervical dilation and effacement
decent of fetus the birth canal
fetal position presenting part + lie membranes are intact or ruptured

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70
Q

What is the mechanism of labor in vertex presentation

A

The adaptations of the fetus makes as it progresses through the birth canal

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71
Q

What is engagement of labor

A

Occurs when the presenting part passes the pelvic inlet at the level of isheal spine station 0

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72
Q

What is the descent of labor

A

The process of the presenting part through the pelvis

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73
Q

What is flexion during labor

A

The fetal head meets resistance of the cervix pelvic wall
the head flexes bringing the chin close to the chest 

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74
Q

What is internal rotation of labor

A

The fetal occiput Ideally rotates to a lateral anterior position as it progresses from the ischeal spine to the lower pelvis

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75
Q

What is extension of labor

A

The fetus passes under the symphysis pubis where the head is deflected anteriorly and born

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76
Q

What is external rotation of labor

A

After the head is born it rotates to the position it occupied as it entered the pelvic inlet

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77
Q

What is birth by expulsion

A

After birth of head and shoulders the trunk of the neonate is born

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78
Q

What is the order that labor proceeds in

A

Engagement
descent
flexion
internal rotation
extension
external rotation
Birth by expulsion

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79
Q

How many times do we assess blood pressure and pulse after birth

A

Obtain blood pressure and pulse every 15 minutes after the first two hours of birth

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80
Q

When should be assessed temperature after birth

A

Temperature should be assessed every four hours for the first eight hours after birth and at least every eight hours

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81
Q

When should you assess the fundus in Lochia after birth

A

Every 15 minutes for the first hour

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82
Q

How can you prevent hemorrhage after birth

A

Massage the uterine fundus

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83
Q

Characteristics of true labor

A

Contractions begin irregularly but become Regular and frequent stronger less longer and are more frequent walking can increase contraction intensity progression in dilation in effacement

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84
Q

Characteristics of false labor

A

Painless irregular contractions decrease in frequency and intensity with walking stop with sleep or emptying bladder
no significant change in dilation or effacement

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85
Q

A client calls the providers office and reports having contractions for two hours that increase with activity and did not decrease with rest and hydration the client denies leaking of vaginal fluid but did notice blood when wiping after voiding which of the following manifestations of the client experiencing

Braxton Hicks contractions
rupture of membranes
fetal decent
true contractions

A

True contractions

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86
Q

A nurse is caring for a client having contractions every eight minutes that are 30 to 40 seconds in duration the client cervix is 2 cm dilated 50% effaced in the fetus is at -2 station with an FHR around 140 which of the following stages and phases of labor is this client experiencing

First stage latent phase
first stage active face
first stage transition phase
2nd stage of labor

A

First stage latent phase 

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87
Q

A nurse is caring for a client who is 40 weeks of gestation and reports having a large gush of fluid from the vagina while walking from the bathroom which of the following action should the nurse take first

Examine the amniotic fluid for meconium
check the FHR
dry the client and make them comfortable
apply a tocotransducer

A

Check the FHR

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88
Q

A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagina for two days which of the following conditions is the client at risk for developing

Cord prolapse
infection
postpartum hemorrhage
Hydramnios

A

Infection

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89
Q

A nurse is caring for a client who is an active labor irritable and reports urge to have a bowel movement the client vomits and states I’ve had enough I can’t do this anymore which of the following stages of labor is the client experiencing

Second stage
fourth stage
transition phase
latent phase

A

Transition phase

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90
Q

Is pain subjective or objective

A

Subjective Everyone’s is unique

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91
Q

What is the first consideration when planning pain management

A

Safety of the mother and fetus

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92
Q

What kind of pain happens in the first stage of labor

A

Internal visceral pain felt in back and leg

Caused by dilation effacement and contractions

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93
Q

What kind of pain occurs in the second stage of labor

A

Pain that occurs with fetal dissent and
expulsion

feels like pulling burning splitting and tearing

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94
Q

What kind of pain occurs in the third stage of labor

A

Pain with expulsion of placenta similar to first stage

caused by contractions and pulling

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95
Q

What causes pain in the fourth stage of labor

A

Caused by dissension in stretching of the vagina feels like splitting burning and tearing

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96
Q

What should the nurse look for that can affect the clients pain management

A

Cultural beliefs and behaviors

97
Q

What slows the progression of labor

A

Fear tension and anxiety

98
Q

What are indications of pain

A

Crying moaning screaming
increase blood pressure
tachycardia
hyperventilation
vomiting

99
Q

What is the Gate- Control Theory of pain?

A

Sensory nerve pathways that pain sensations use to travel to the brain will allow only a limited number of sensations to travel at any given time

By sending alternate signals through these pathways the pain signals can be blocked

100
Q

What do you do if your patient is hyper ventilating

A

Have client breathe into a paper bag or cup hands

101
Q

What are sensory stimulation strategies for nonpharmacological pain relief

A

Aromatherapy
breathing
music

102
Q

What are cutaneous stimulation strategies for nonpharmacological pain techniques

A

Back massage
walking
application of heat or cold
shower
acupuncture

103
Q

What is effleurage

A

Play gentle circular stroking of the clients abdomen with fingertips and rhythm with breathing during contractions

104
Q

What is sacral counterpressure

A

Consistent pressure is applied by the support person using the heel of the hand or fest against the client sacral area to counteract pain in the lower back

105
Q

 Are sedatives used for pain management

A

Not typically because cause respiratory depression

should not be administered if birth is anticipated within 12 hours

106
Q

What Opioid is used as a pain relief that does not cause significant respiratory depression in mother or fetus

A

butorphanol and nalbuphine

107
Q

What should be readily available to reverse opioid induced respiratory depression

A

 naloxone

108
Q

What does metoclopramide do

A

Control nausea and anxiety

does not relieve pain

109
Q

What is a pudendal block 

A

Local anesthetic that is administered transvaginal
has no maternal or fetal systematic affects
provides anesthesia to the perineum vulva and rectum 

110
Q

When do you give a pudenal block

A

During the late second stage of labor 10 to 20 minutes before delivery

111
Q

What is an epidural block

A

Illuminate pain from the Level Of the umbilicus to the thighs relieving the discomfort of uterine contractions

does not remove pressure sensation

112
Q

When do you give an epidural block

A

In active labor and dilated to at least 4 cm

113
Q

Nursing actions for an epidural block

A

Please Patient into sitting or side lying position 

assessed for orthostatic hypotension

114
Q

What is a spinal block

A

Local anesthetic that Eliminates all sensations from the level of the nipples to the feet

common in cesarean births

115
Q

When do you give a spinal block

A

Before cesarean birth

116
Q

What is an adverse reaction of a spinal block

A

 potential headache from leakage of cerebral spinal fluid

117
Q

 important nursing action for spinal block

A

Assessed maternal vital signs every 10 minutes

118
Q

When is general anesthesia used in labor

A

Rarely used only if there’s a delivery complication or emergency patient
has nothing by mouth maintain airway
check for decreased uterine in town

119
Q

A nurse is caring for a client who is 40 weeks of gestation and is experiencing contractions every 3 to 5 minutes and becoming stronger a vaginal exam reveals the client service is 3 cm dilated 80% effaced and -1 station the client asked for pain medication which of the following action should the nurse take (select)

Encourage use of pattern breathing techniques
insert indwelling urinary catheter administer opioid analgesics medication suggest application of cold
provide ice chips

A

Encourage use of pattern breathing techniques
administer opioid analgesic medication
suggest application of cold

120
Q

A nurse is caring for a client who is an active labor the client reports lower back pain the nurse suspects that this pain is related to a persistent occiput Posterior fetal position which of the following Nonpharmacological nursing intervention should the nurse recommend to the client

Abdominal effeurage
Sacral counter pressure
Showering if not contraindicated
Back rub and massage


A

Sacral counter pressure

121
Q

A nurse is caring for a client following administration of an epidural block and is preparing to administer an IV fluid bolus the clients partner asked about the purpose of the IV fluids which of the following statements should the nurse make

It is needed to promote increase urine output
it is needed to counteract respiratory depression
it is needed to counteract hypotension 
it is needed to prevent oligohydramnios 

A

It is needed to counteract hypotension

122
Q

A nurse is caring for a client who is in the second stage of labor the clients labor has been progressing and a vaginal delivery is expected in 20 minutes the provider is preparing to administer lidocaine for pain relief and perform an episiotomy The nurse should know that which of the following types of regional anesthetic black should be administered

Pudendal
Epidural
Spinal
Paracervixal 

A

Pudendal

123
Q

A nurse is caring for a client who is using pattern breathing during labor of the client reports numbness and tingling of the fingers which of the following action should the nurse take

Administer oxygen via nasal cannula a 2 L per minute
apply a warm blanket
assist the client to side lying position place in oxygen mask over the clients nose and mouth

A

Place an oxygen mask over the clients nose and mouth

124
Q

How frequent are contractions in the Latent phase 

A

5 to 30 minutes

125
Q

How long do contractions last in the latent phase 

A

30 to 45 seconds

126
Q

How dilated are you in the latent phase 

A

0-3 cm

127
Q

How frequent are your contractions in the active face

A

3 to 5 minutes

128
Q

How long do your contractions last in the active face

A

40 to 70 seconds

129
Q

How dilated are you in the active phase

A

4 to 7 cm

130
Q

How frequent are contractions in the transition phase

A

2 to 3 minutes

131
Q

How long do contractions last in the transition phase

A

45 to 90 seconds

132
Q

How dilated are you in the transition phase

A

Completely dilated

133
Q

When do you avoid vaginal examination

A

In the presence of vaginal bleeding or until placenta previa or abruptio are ruled out

134
Q

What is the most important indicator of the progress of labor

A

Cervical dilation

135
Q

What is crowning

A

Appearance of presenting part, fetal head at the perineum

136
Q

If there is a suspected rupture of membranes what do you first assess

A

FHR

137
Q

Why do you perform a bladder palpation on a regular basis

A

To prevent bladder distention which can impede Fido descent through the birth canal

138
Q

How often should you encourage voiding
During the active phase

A

Every two hours 

139
Q

What does it mean when the client expresses they need to have a bowel movement

A

This sensation is a finding of complete dilation and fetal dissent 

prepare the client for birth

140
Q

How often should you monitor vital signs in the latent phase 

A

Every 30 to 60 minutes

141
Q

How often should you monitor vital signs in the active and transitional

A

Every 15 to 30 minutes

142
Q

How often should you monitor contractions in The transition phase

A

Every 10 to 15 min

143
Q

What is first-degree Peroneal lacerations

A

Laceration extends through the skin of the perineum and does not involve the muscle

144
Q

What is second-degree lacerations

A

Laceration extends through the skin in the muscle into the perineum but not the anal sphincter

145
Q

What is third-degree perineum Laceration

A

Laceration extends through the skin muscle perineum an external anal sphincter to the muscle

146
Q

What is fourth-degree peroneal laceration

A

Laceration extends through the skin muscle in anal sphincter and anterior rectal wall

147
Q

How often should you check vitalsigns in the second stage of labor

A

Every 5 to 30 minutes

148
Q

How often should you check the fetal heart rate in the second stage of labor

A

Every 5 to 15 minutes

149
Q

How often should you check vital signs in the third stage of labor

A

Every 15 minutes

150
Q

What are the clinical findings in the third stage of labor

A

Placenta separated from the uterus indicated by
fundus firming
umbilical cord appears to lengthen placenta descends

151
Q

 why do you administer oxytocics In the third stage of labor

A

Simulate the uterus to contract and those preventing hemorrhage

152
Q

When do you check vital signs in the fourth stage of labor

A

Every 15 minutes for the first two hours

153
Q

G A nurse is caring for a client and partner during the second stage of labor the client‘s partner asks the nurse to explain how to know when crowning occurs which of the following responses should the nurse make

The placenta will protrude from the vagina
your partner will report a decrease in the intensity of contractions
the vagina area will bulge in your babies head will appear
your partner will report less rectal pressure

A

The vagina area will bulge as the babies head appears

154
Q

The nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions which of the following action should the nurse make

Assist the client to the bathroom
prepare for in pending delivery
prepare to remove a fecal impaction encourage the client to take deep cleansing breaths

A

Prepare For an impending delivery

155
Q

A nurse is caring for a client in the third stage of labor which of the following findings indicates placenta separation (select)

Lengthening of the umbilical cord
swift gush of clear amniotic fluid
softening of the lower uterine segment appearance of dark blood from the vagina
fundus firm upon palpation

A

Lengthening of the umbilical cord appearance of dark blood from the vagina
fundus firm upon palpation

156
Q

A nurse is planning care for a newly admitted client who reports I am in labor and I have been having virginal bleeding for two weeks which of the following should the nurse include in the plan of care

Inspect the introutis For a prolapsed cord
perform a test to identify the ferning pattern
monitor station of presenting part
defer vaginal examination

A

Defer Vaginal examination’s

157
Q

A nurse is caring for a client who is in the first stage of labor and is encouraging the client to avoid every two hours which of the following statements should the nurse make

A full bladder increases the risk for fetal trauma
a full bladder increases the risk for bladder infections
a distended bladder will traumatized by the frequent pelvic exams
a distended bladder reduce his pelvic space needed for birth

A

Distended bladder reduces pelvic space needed for birth

158
Q

What is external cephalic version

A

Hands on procedure to externally manipulate the fetus into cephalic lie

Performed at 37 to 38 weeks

high risk of placenta abruption, umbilical cord compression, emergency c- section

159
Q

What is the indication for external cephalic version

Why does it happen

A

A male position feet is in a breach or transverse position in late gestation

160
Q

When do you give Rho{D}

A

28 weeks gestation

161
Q

What should you monitor and external cephalic version

A

Monitor FHR patterns for bradycardia decelerations or decrease fetal activity

162
Q

What is Bishop score

A

A score use to determine maternal readiness for labor by evaluating whether the cervix is favorable 

163
Q

How do you determine Bishop score

A

You rate
cervical dilation
cervical effacement
cervical consistency
cervical position
station Of presenting part

164
Q

When do you use Bishop score

A

In any condition which augmentation or induction of labor is indicated

165
Q

What is a good Bishop score

A

A score of eight or more is indicative of successful induction

client must be 39 weeks

166
Q

What is cervical ripening

A

Increases cervical readiness for labor through Promotion of cervical softening dilation and effacement

167
Q

When do you use Cervical ripening

A

In any condition which argumentation or induction of labor is indicated
Failure of the cervix dilate and efface failure of labor to progress

168
Q

Should you avoid before or after cervical Ripening

A

Void prior to the procedure

169
Q

If client becomes tachysystole What medication do you administer

A

Subcutaneous terbutaline 

170
Q

If fetal goes into fetal distress during surgical ripening what do you do

A

Position the client on left side

171
Q

What is induction of labor

A

Deliberate initiation of uterine contractions to stimulate labor before spontaneous onset to bring about birth by chemical or mechanical means

172
Q

When do you induce labor

A

At least 39 weeks
dystocia (prolonged difficult labor) due to inadequate uterine contractions
Prolong ruptured membranes

173
Q

Should you void prior to induction of labor

A

Yes void prior to the procedure

174
Q

Where does the fetus have to be engaged prior to the administration of oxytocin in the induction of labor

A

Fetus has to be engaged in the birth canal at minimum of station 0

175
Q

 What is the desired contraction pattern in induction of labor

A

Contraction frequency of 2 to 3 minutes contraction duration of 80 to 90 seconds contraction intensity of 40 to 90

176
Q

What should you do if the contraction pattern is greater than desired outcome in induction of labor (tachsytole)

A

Discontinue oxytocin

177
Q

What is argumentation of labor

A

Simulation of hypotonic contractions once lever has spontaneously begun but progress is inadequate

178
Q

What is amniotomy 

A

Artificial rupture of amnionic membranes by provider using hook clamp or other sharp instruments

179
Q

How soon after an amniotomy should labor begin

A

12 hours

180
Q

What is the client at risk for after receiving an amniotomy

A

Cord prolapse or infection

181
Q

Why would you give an amniotomy

A

Labor progression is too slow

182
Q

What must Happen before and amniotomy

A

Presenting part of the fetus is engaged to prevent cord prolapse

183
Q

What should you monitor right after an amniotomy

A

Fetal heart rate

184
Q

After in amniotomy what vital sign is important

A

Temperature check every two hours

185
Q

What is an amnioinfusion

A

Normal Celine or lactated ringers is instilled into the Amniotic cavity through transcervical catheter

Used to supplement the amount of amniotic fluid

186
Q

What does an amnio infusion reduce

A

The severity of variable to celebration caused by a cord compression

187
Q

Why would you give an amnioinfusion

A

Oligohydramnios (scant amount or absence of amniotic fluid)

Fetal cord compression 

188
Q

What must happen before you can give an amnioinfusion

A

Membranes must have rupture to perform

189
Q

What is a vacuum assisted delivery

A

Using a couple like suction device that is attached to the fetal head traction is applied during contractions to assist in the descent in birds of the head after the vacuum is released and removed proceeding delivery of the fetal body

190
Q

Why would you need a vacuum assisted delivery

A

Maternal exhaustion and ineffective pushing efforts fetal distress during second stage
generally not used to assess birth before 34 weeks

191
Q

What is Caput
succedaneum

A

Swelling of the scalp in a newborn that usually disappears within 3 to 5 days caused by vacuum assisted delivery

192
Q

What is forceps assisted birth

A

Using an instrument with two curve spoon like blades to assist the delivery of a fetal head
traction is applied during contractions

193
Q

Why would you use forceps assisted birth

A

Prolong second stage of labor need to shorten duration fetal distress
Abnormal presentation
Breech position require delivery of the head

194
Q

 Must what must happen before forceps assistant birth

A

Bladder empty
fetuses engage
membranes have ruptured

195
Q

Fetal heart rate decreases during forceps assisted birth what do you do

A

Forceps are removed and reapply

196
Q

What is a Episiotomy

A

Incision me to the perineum to enlarge the vaginal opening to facilitate birth and minimize soft tissue damage

197
Q

What is the median midline episiotomy

A

Laceration from vaginal outlet toward rectum most commonly use
easily repaired

198
Q

What is the medial lateral episiotomy

A

Laceration extends from vaginal outlet posterolateral either to the left or the right
Blood loss is greater
repair more difficult

199
Q

What is a cesarean birth

A

Delivery of the fetus through the transabdominal incision of the uterus to preserve the life or health of client

when there is evidence of complications

200
Q

What should you encourage after a C-section

A

Splitting of the incision with pillows and ambulation

201
Q

What can tender uterus and foul smelling lochia indicate

A

Endometriosis

202
Q

What is a vaginal birth after cesarean

A

Client delivers vaginally after having a previous cesarean birth

203
Q

Why would you have a vaginal birth after cesarean

A

If a client has cesarean due to dysfunctional labor fridge presentation or abnormal FHR which are all considered non-recurring events

204
Q

A nurse is caring for a client who is 42 weeks of gestation and is having an ultrasound for which of the following conditions should the nurse plan for an amnioinfusion (select)

oligohydramnios
Hydramnios
Fetal cord compression
hydration
fetal immaturity

A

Oligohydramnios
Fetal cord compression

205
Q

A nurse is caring for a client who has been in labor for 12 hours with intact membranes the nurse performs a vaginal examination to ensure which of the following prior to the performance of the Amniotomy

Fetal engagement
fetal lie
fetal attitude
fetal position

A

Fetal engagement

206
Q

A nurse is caring for a client who has had no prenatal care is Rh negative and will undergo an external version at 38 weeks of gestation which of the following medication should the nurse plan to administer prior to the version?

Prostaglandin gel
Magnesium sulfate
Rho(D)
Oxytocin

A

Rho(D)

207
Q

A nurse is caring for a client who is receiving oxytocin for indication of labor and has interuterine pressure catheter placed to monitor uterine contractions for which of the following contraction pattern should the nurse discontinue infusion of oxytocin

Frequency of every two minutes
duration of 90 to 120 seconds
intensity of 60 to 90
resting tone of 15

A

Duration of 90 to 120

208
Q

A nurse educator in labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly licensed nurses which of the following statements by the nurse indicates understanding of the teaching

They are tablets administered vaginally
they act by absorbing fluid from tissue
they promote dilation of the os
they include amniotomy

A

They are tablets administered vaginally

209
Q

What is a prolapse umbilical cord

A

Occurs when the umbilical cord is displaced preceding the presenting part of the fetus or protruding through the cervix

210
Q

What are some risk factors of a prolapsed umbilical cord

A

Rupture of amniotic membranes
abnormal fetal presentation
transverse lie
unusually long umbilical cord
small gestation

211
Q

What would you find if a client had prolapse umbilical cord

A

Client reports they’re feeling something coming through the vagina

212
Q

What do you do if a client has a prolapsed umbilical cord

A

Call for assistance immediately
do not leave
insert two fingers into the vagina and apply pressure to the cord reposition client to side

213
Q

What can a prolapse umbilical cord mean for the fetus

A

Prolonged deceleration severe hypoxia

214
Q

If a patient has a prolapse umbilical cord what should you prepare for

A

Immediate vaginal birth if cervix is fully dilated or C-section

215
Q

What is meconium stained amniotic fluid

A

 poop in the amniotic fluid

216
Q

What would you find if your patient has meconium stained amniotic fluid

A

Green thick amniotic fluid
Often presented in breech 

217
Q

 What should you do during labor for a fetus inmeconium stand amniotic fluid

A

Have neonate and recitation team ready suction mouth and nose using bulb syringe if respiratory efforts are strong
if weak suction

218
Q

What is fetal distress

A

FHR below 110 or above 160

219
Q

What position should you put the client and if there is fetal distress

A

Left side lying position

220
Q

What is dystocia

A

Dysfunctional labor it is difficult or abnormal labor related to the five p

221
Q

What is hypotonic uterine contractions

A

Weak
inefficient or
completely absent

222
Q

What is hypertonic uterine contractions

A

Excessively frequent
uncoordinated
strong intensity with inadequate uterine relaxation

223
Q

What does a hypotonic uterus look like

A

Easily indentable at peak of contractions

224
Q

What does a hypertonic uterus look like

A

Cannot be indented even between contractions

225
Q

What position of the fetus prolongs labor

A

Occiput posterior

226
Q

What is precipitous labor 

A

Labor that last three hours or less from the onset of contractions to the time of delivery

227
Q

What do you do if the court is around the fetal neck during labor

A

Attempt to gently slip it over the head

228
Q

What is uterine rupture

A

Complete rupture involves the uterine wall peritoneal cavity and broad ligament internal bleeding present

Life threatening

229
Q

 what will a patient feel when they’re uterus ruptured

A

Ripping or tearing sharp pain uterine tenderness

230
Q

What are they at risk for in uterine rupture

A

Hypovolemic shock

231
Q

what is anaphylactoid syndrome of pregnancy

A

Amniotic fluid embolism

Occurs when there is a rupture in the amniotic sac accompanied by high intrauterine pressure that causes infiltration of the amniotic fluid into maternal circulation

232
Q

What kind of anaphylactoid syndrome deadly

A

Meconium stained Amniotic fluid circulating in the blood

233
Q

 patient needs what if anaphylactoid syndrome occurs

A

Emergency C-section

234
Q

A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions the nurse should identify this contraction pattern increases the risk of which of the following complications

Prolong labor
reduced fetal oxygen supply
delayed cervical dilation
increase maternal and stress

A

Reduced fetal oxygen supply

235
Q

A nurse is caring for a client who is an active labor and reports severe back pain during assessment the fetus is noted to be in the occiput posterior position which of the following maternal position should the nurse suggest to the client to Facilitate normal labor progress 

Hands and knees
lithotomy
Trendelenburg
supine with a roll towel under one hip

A

Hands and knees

236
Q

A nurse is caring for a client who is in labor with the use of Leopold maneuvers it is noted that the fetus is in breech position for which of the following possible complications should the nurse observe

precipitous labor
Premature rupture of membranes postmaturity syndrome
prolapsed umbilical cord

A

Prolapsed umbilical cord

237
Q

A nurse is caring for a client who is 42 weeks of gestation and an active labor which of the following findings is the fetus at risk for developing

Intrauterine growth restriction
Hyperglycemia
meconium aspiration
polyhydranios

A

Meconium aspiration

238
Q

A nurse is caring for a client and active labor when last examined two hours ago the clients cervix was 3 cm dilated 100% effaced membranes intact and the fetus was added negative to station the client suddenly states my water broke the motto revealed an FHR of 80 to 85 per minute the nurse performs a vaginal examination noticing clear fluid in a pushing loop of umbilical cord in the clients vagina which of the following action should the nurse perform first

Play slickline and Trendelenburg position apply pressure to the presenting part with the fingers
Administer oxygen at 10 L per minute via facemask
initiate IV fluid

A

Apply pressure to the presenting part with the fingers

Pediatrics/ Maternity (15 decks)

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