OB Evolve Questions Test 4

Question 1

Concerning the third stage of labor, nurses should be aware that:

Answer 1

the duration of the third stage may be as short as 3 to 5 minutes

The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits. The third stage of labor lasts from birth of the fetus until the placenta is delivered. The placenta cannot detach itself from a flaccid (relaxed) uterus. Which surface of the placenta comes out first is not clinically important. The major risk for women during the third stage of labor is postpartum hemorrhage. The risk of hemorrhage increases as the length of the third stage increases.

Question 2

The charge nurse on the maternity unit is orienting a new nurse to the unit and explains that the 5 Ps of labor and birth are: Select all that apply.

1. passenger.
2. placenta.
   3 .passageway.
   4 .psychological response.
   5 .powers.
   6 .position.

Answer 2

A. passenger. 
C. passageway. 
D. psychologic response. 
E. powers. 
F. position. 

At least five factors affect the process of labor and birth. These are easily remembered as the five Ps: passenger (fetus and placenta), passageway (birth canal), powers (contractions), position of the mother, and psychological response.

Question 3

After a pelvic examination of a pregnant woman, the nurse concludes that the client may require a forceps-assisted delivery. What pelvic finding would support this conclusion?

Answer 3

Subpubic arch is narrow

The presence of a narrow subpubic arch indicates that the client has either an android pelvis or an anthropoid pelvis. In such situations, the fetus may not easily pass through the birth canal and the client may require a forceps-assisted delivery. The presence of a slightly ovoid pelvis with moderate depth and blunt ischial spines indicates a gynecoid pelvis. Women with gynecoid pelvises have wider subpubic arches, which allow the fetus to more easily pass through the birth canal. These clients may not require forceps-assisted deliveries.

Question 4

The nurse is briefing a patient who is pregnant for the first time about lightening. Which statement should the nurse mention to describe lightening to the patient?

Answer 4

It allows the patient to breathe more easily.

When the fetal head descends into the true pelvis during lightening, the patient will feel less congested and can breathe more easily. In a first-time pregnancy, lightening occurs about 2 weeks before term. In a multiparous pregnancy, lightening may not take place until after the uterine contractions are established and the true labor is in progress. This shift increases the pressure on the bladder and causes a return of urinary frequency.

Question 5

The nurse assisting a patient in the second stage of labor asks the patient to avoid the Valsalva maneuver. What is the effect of the Valsalva maneuver?

Answer 5

Causes fetal hypoxia

The nurse advises the patient to avoid the Valsalva maneuver for pushing during the second stageof labor, because it can result in fetal hypoxia. The Valsalva maneuver involves holding the breath and tightening the abdominal muscles. This activity increases the cardiac output and blood pressure, and the pulse rate slows down temporarily. This process is reversed when the patient takes a breath.

Question 6

What are the common signs that are observed in the days preceding labor? Select all that apply.

Answer 6

Persistent low backache
Blood-tinged cervical mucus
profuse vaginal mucus

Common signs that precede labor include persistent low backache and sacroiliac distress as a result of relaxation of the pelvic joints. Brownish or blood-tinged cervical mucus may be passed. The vaginal mucus becomes more profuse in response to the extreme congestion of the vaginal mucous membranes. In the days preceding labor, women generally have a sudden surge of energy. They also experience a loss of 0.5 to 1.5 kg in weight. This is caused by water loss resulting from electrolyte shifts that in turn are produced by changes in estrogen and progesterone levels.

Question 7

The nurse is assisting a patient in labor. What neurologic changes does the nurse expect in the laboring patient?

Answer 7

Amnesia and sedation

The patient experiences amnesia between contractions in the second stage of labor. Endogenous endorphins produced by the body cause sedation. This also raises the pain threshold. Pressure of the presenting part causes physiologic anesthesia of the perineal tissues. This decreases the perception of pain. At the start of labor, the patient may be euphoric. Euphoria first gives way to increased seriousness. Second, it gives way to amnesia between contractions. Finally, it leads to elation or fatigue after giving birth.

Question 8

Nurses can help their patients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?

Answer 8

Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours

The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours. The latent phase is characterized by mild to moderate, irregular contractions; dilation up to 3 cm; brownish to pale pink mucus; and a duration of 6 to 8 hours. No official “lull” phase exists in the first stage. The transition phase is characterized by strong to very strong, regular contractions; 8 to 10 cm dilation; and a duration of 20 to 40 minutes.

Question 9

In order to assess the health of the mother accurately during labor, the nurse should be aware that:

Answer 9

the endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation.

Physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother’s perception of pain. Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor because of a number of potentially unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself.

Question 10

The nurse is studying the chart of a patient in labor. If the patient's chart indicates "RMA," what is the presenting part?
1
Chin
2
Sacrum
3
Scapula
4
Occiput

Answer 10

Chin

The chin or mentum is the presenting part of the fetus if the chart indicates “RMA.” If the sacrum is the presenting part, the middle letter is S. If the scapula is the presenting part, the middle letter is Sc. If the occiput is the presenting part, the middle letter is O.

Question 11

The nurse assisting a laboring patient is aware that the birth of the fetus is imminent. What is the station of the presenting part?

1
-1
2
\+1
3
\+3
4
\+5

Answer 11

+5

Station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines. The placement of the presenting part is measured in centimeters above or below the ischial spines. Birth is imminent when the presenting part is at +4 to +5 cm. When the lowermost portion of the presenting part is 1 cm above the spine, it is noted as minus (-)1. When the presenting part is 1 cm below the spine, the station is said to be plus (+)1. At +3, the presenting part is still descending the birth canal. Birth is imminent when the presenting part is at +4 to +5 cm.

Question 12

When assessing a patient for the possibility of a vaginal birth, what must the nurse keep in mind about the coccyx of the bony pelvis?
1
It is the part above the brim of the bony pelvis.
2
It is movable in the latter part of the pregnancy.
3
It has three planes: the inlet, midpelvis, and outlet.
4
It is ovoid and bound by the pubic arch anteriorly.

Answer 12

2- It is moveable in the latter part of the pregnancy

The coccyx is movable in the latter part of the pregnancy, unless it has been broken and fused to the sacrum during healing. The bony pelvis is separated by the brim into the false and the true pelves. The false pelvis is the part above the brim and plays no part in childbearing. The true pelvis is involved in birth and is divided into three planes: inlet, midpelvis, and outlet. The pelvic outlet is the lower border of the true pelvis. Viewed from below it is the ovoid. It is shaped somewhat like a diamond and bound by the pubic arch anteriorly, the ischial tuberosities laterally, and the tip of the coccyx posteriorly.

Question 13

What will the nurse mention about the effect of secondary powers during labor to the patient?
1
Contractions are expulsive in nature.
2
The intraabdominal pressure is decreased.
3
Contractions move downward in waves.
4
Contractions begin at pacemaker points

Answer 13

contractions are expulsive in nature

As soon as the presenting part of the fetus touches the pelvic floor, the patient uses secondary powers or bearing-down efforts. This results in contractions that are expulsive in nature. The voluntary bearing-down efforts of the patient also result in increased intraabdominal pressure. Primary powers signal the beginning of labor with involuntary contractions that move downward over the uterus in waves. These contractions begin at pacemaker points in the thickened muscle layers of the upper uterine segment.

Question 14

During the vaginal examination of a laboring patient, the nurse analyzes that the fetus is in the right occiput anterior (ROA) position at -1 station. What is the position of the lowermost portion of the fetal presenting part?
1
2 cm above the ischial spine.
2
1 cm above the ischial spine.
3
at the level of the ischial spine.
4
1 cm below the ischial spine.

Answer 14

1 cm above the ischial spine

When the lowermost portion of the presenting part is 1 cm above the ischial spine, it is noted as being minus (-)1. When positioned 2 cm above the ischial spine, it is -2 station. At the level of the spines the station is referred to as 0 (zero). When the presenting part is 1 cm below the spines, the station is said to be plus (+)1

Question 15

The nurse is monitoring the fetal heart rate (FHR) of a patient in week 20 of gestation. What FHR can the nurse expect at this stage?
1
100 beats/min
2
120 beats/min
3
140 beats/min
4
160 beats/min

Answer 15

160 beats/min

The FHR is higher earlier in the gestation. At 20 weeks’ gestation, the FHR on an average is 160 beats/min approximately. The rate decreases progressively as the maturing fetus reaches term. An FHR of 100 beats/min is below the normal FHR. The normal range of FHR is 110 to 160 beats/min. An FHR of 120 beats/min at 20 weeks’ gestation is not normal. The average FHR at term is 140 beats/min.

Question 16

The nurse should tell a primigravida that the definitive sign indicating that labor has begun is

Answer 16

progressive uterine contractions with cervical change.

Regular, progressive uterine contractions that increase in intensity and frequency are the definitive sign of true labor along with cervical change. Lightening is a premonitory sign indicating that the onset of labor is getting closer. Rupture of membranes usually occurs during labor itself. Passage of the mucous plug is a premonitory sign indicating that the onset of labor is getting closer

Question 17

What intervention must the nurse perform when assisting a patient in labor who has been administered nitrous oxide for analgesia?
1
Monitor fetal heart rate (FHR) every 2 minutes.
2
Monitor maternal blood pressure every 2 minutes.
3
Instruct the patient to inhale after contraction begins.
4
Instruct the patient to breathe normally between contractions.

Answer 17

Instruct the patient to breathe normally between contractions.

The nurse must instruct the patient to remove the mask and breathe normally between contractions. The use of nitrous oxide does not depress uterine contractions or cause adverse reactions in the fetus and newborn. The nurse need not monitor FHR or maternal blood pressure every 2 minutes. The patient must place the mask over the mouth and nose or insert the mouthpiece 30 seconds before the onset of a contraction (if regular), or as soon as a contraction begins (if irregular).

Question 18

The nurse is caring for a Native-American patient during labor. What does the nurse keep in mind about the patient's cultural approach to pain? The patient may:
1
Not exhibit reactions to pain.
2
Be vocal in response to pain.
3
Use remedies from indigenous plants.
4
Express pain vocally late in labor

Answer 18

Use remedies from indigenous plants

The Native-American patient may use medications or remedies made from ethnic plants. They are often stoic in response to labor pain. Hispanic patients may be stoic until late in labor, when they may become vocal and request pain relief. Chinese patients may not exhibit reactions to pain. Arabian or Middle Eastern patients may be vocal in response to labor pain and request medication for pain relief.

Question 19

Nurses should be aware of the difference experience can make in labor pain, such as:
1
sensory pain for nulliparous women often is greater than for multiparous women during early labor.
2
affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor.
3
women with a history of substance abuse experience more pain during labor.
4
multiparous women have more fatigue from labor and therefore experience more pain.

Answer 19

A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor.

Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous women during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

Question 20

Which factors contribute to an increase in a patient's pain tolerance level? Select all that apply.
1 
Need for epidural analgesia
2 
Use of relaxation techniques
3 
Desire for natural vaginal birth
4 
Quiet and relaxed ambience
5 
Use of pharmacologic methods

Answer 20

2 
Use of relaxation techniques
3 
Desire for natural vaginal birth
4 
Quiet and relaxed ambience

Question 21

What does the nurse ensure while following the procedure of the intradermal water block?
1
Administer the second injection after 15 minutes.
2
Ensure that a bleb appears on the skin after injection.
3
Inject in two locations on the lower back for pain relief.
4
Use a fine-gauge needle to inject 0.5 mL of sterile water.

Answer 21

Ensure that a bleb appears on the skin after injection

The nurse ensures that a bleb appears on the skin after the injection. An intradermal water block involves the injection of small amounts of sterile water (0.05 to 0.1 mL) by using a fine- gauge needle. Sterile water is injected into four locations on the lower back: two over each posterior superior iliac spine (PSIS) and two 3 cm below and 1 cm medial to the PSIS. The injections must be administered simultaneously to decrease the pain of the injections.

Question 22

When caring for a patient in the first phase of labor, the nurse observes that the patient is experiencing visceral pain. In which area does visceral pain occur?
1
Abdominal wall and thighs
2
Gluteal area and iliac crests
3
Lumbosacral area of the back
4
Lower portion of the abdomen

Answer 22

Lower portion of the abdomen

Visceral pain in the first stage of labor occurs in the lower portion of the abdomen. Visceral pain is a result of distention of the lower uterine segment and stretching of cervical tissue as it effaces and dilates. Pressure and traction on uterine tubes, ovaries, ligaments, nerves, and uterine ischemia also cause visceral pain. Pain that originates in the uterus radiates to the gluteal area, iliac crests, abdominal wall, thighs, lumbosacral area of the back, and lower back. This pain is called referred pain.

Question 23

The nurse is caring for a nulliparous patient in labor. How is the experience for a nulliparous patient different from that of a multiparous patient? The patient experiences:
1
Less sensory pain during early labor.
2
Greater sensory pain in the second stage of labor.
3
Greater fatigue due to longer duration of labor.
4
Greater affective pain in the second stage of labor.

Answer 23

Greater fatigue due to longer duration of labor

Parity influences the perception of labor pain. The nulliparous patient often has longer labor and therefore, greater fatigue. Sensory pain for nulliparous women is often greater than that for multiparous women during early labor, because their reproductive tract structures are less supple. Affective pain in the nulliparous patient is greater in the first stage as compared to a multiparous patient. It decreases for both patients during the second stage of labor. During the second stage of labor, the multiparous patient may experience greater sensory pain than the nulliparous patient. This is because tissues of the multiparous patient are more supple and increase the speed of fetal descent, thereby intensifying the pain.

Question 24

What does the nurse teach a group of expectant mothers about slow-paced breathing? It is:
1
Performed at half the normal breathing rate.
2
Initiated at the onset of the first stage of labor.
3
Beneficial if performed with full concentration.
4
Repeated at the onset of the second stage of labor.

Answer 24

Performed at half the normal breathing rate.

Slow-paced breathing is performed at approximately half the patient’s normal breathing rate. It is initiated in the first stage of labor when the patient can no longer walk or talk through contractions. Patterned-pace breathing, not slow-paced breathing, is performed during the onset of the second stage of labor. Modified-paced breathing requires the patient to remain alert and concentrate more fully on breathing.

Question 25

A patient asks the nurse about the use of transcutaneous electrical nerve stimulation (TENS). What does the nurse teach about TENS?
1
It involves the use of one pair of electrodes.
2
It is kept at low intensity during contractions.
3
It releases continuous low-intensity impulses.
4
It is useful for pain in the second stage of labor.

Answer 25

It releases continuous low-intensity impulses

When TENS is applied for pain relief, the electrodes provide continuous low-intensity electrical impulses or stimuli from a battery-operated device. TENS is most useful for lower back pain during the early first stage of labor. TENS involves the placing of two pairs of flat electrodes on either side of the woman’s thoracic and sacral spine. During a contraction, the patient increases the stimulation from low to high intensity by turning the control knobs on the device.

Question 26

The nurse is caring for a patient who will have a cesarean birth. An anesthesiologist has been called to inject the epidural anesthesia (block). Where does the nurse expect the anesthesiologist to inject the anesthesia?
1
L1 to L3
2
T8 to S1
3
L3 to L5
4
T10 to S

Answer 26

T8 to S1

If a cesarean birth is to be conducted an epidural anesthesia (block) is administered from at least T8 to S1. A block from T10 to S5 is required for relieving the discomfort of labor and vaginal birth. In spinal anesthesia (block), an anesthetic solution containing a local anesthetic alone or in combination with an opioid agonist analgesic is injected between L3 to L5. L1 to L3 is not blocked for anesthesia.

Question 27

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's most appropriate analgesic for pain control is:
1
fentanyl (Sublimaze).
2
promethazine (Phenergan).
3
butorphanol tartrate (Stadol).
4
nalbuphine (Nubain).

Answer 27

a. fentanyl (Sublimaz
Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use. Phenergan is not an analgesic. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of those drugs’ undesirable effects. Stadol is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use. Nubain is an opioid agonist-antagonist analgesic. Its use may precipitate withdrawals in a patient with a history of opiate use.

Question 28

A patient who is pregnant for the first time is anxious about the pain related to labor. Which physiologic factor does the nurse relate that may increase the intensity of pain during childbirth?
1
History of dysmenorrhea
2
Low level of prostaglandin
3
Cramps during menstruation
4
High level of β-endorphins

Answer 28

History of dysmennorrhea

Patients with a history of dysmenorrhea may experience increased pain during childbirth. These patients are known to have high levels of prostaglandin. Low levels of prostaglandin do not increase the intensity of pain during labor. The level of beta (β) endorphins increases during pregnancy and birth. β endorphins are endogenous opioids that reduce pain. Back pain associated with menstruation also increases the likelihood of contraction-related low back pain.

Question 29

What care must the nurse take when assisting a laboring patient with hydrotherapy?
1
Initiate hydrotherapy in the first stage of labor at 3 cm.
2
Ensure water is warm at 32.5° to 34° C (90.5° to 93.2°F).
3
Check the fetal heart rate (FHR) with internal electrodes.
4
Obtain the approval of the primary health care provider.

Answer 29

Obtain the approval of the primary health care provider

Agency policy must be consulted to determine if the approval of the laboring woman’s primary health care provider is required. The nurse must ensure that all criteria are met in terms of the status of the maternal and fetal unit. Hydrotherapy is usually initiated when the patient is in active labor, at approximately 5 cm. This reduces the risk of a prolonged labor. FHR monitoring is done by Doppler, fetoscope, or wireless external monitor when hydrotherapy is in use. Use of internal electrodes for monitoring FHR is contraindicated in jet hydrotherapy. The temperature of the water should be maintained at 36° to 37° C (96.8° to 98.6° F).

Question 30

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response should be to:
1
encourage the woman to breathe more slowly.
2
help the woman breathe into a paper bag.
3
turn the woman on her side.
4
administer a sedative.

Answer 30

help the woman breathe into a paper bag

The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level. Telling her to breathe more slowly does not ensure a change in respirations. Turning her on her side will not solve this problem. Administration of a sedative could lead to neonatal depression because this woman, being in the transition phase, is near the birth process. The side-lying position is appropriate for supine hypotension.

Question 31

The nurse is teaching a class on childbirth. What does the nurse teach about signs of local anesthetic toxicity? Select all that apply.
1 
Tinnitus
2 
Metallic taste
3 
Slurred speech
4 
Long stage II labor
5 
Increased use of oxytocin

Answer 31

tinnitus, metallic taste, slurred speech,

The central nervous system can be affected if a local anesthetic agent is injected accidentally into a blood vessel leading to local anesthetic toxicity . Signs include metallic taste, tinnitus, and slurred speech. Longer stage II labor and increased use of oxytocin are side effects of epidural and spinal anesthesia.