OB Exam 2 Flashcards
A client in the first stage of labor asks her nurse for medication for pain. Which nursing action should be performed FIRST?
Obtain a vaginal exam to determine labor progress.
A nurse is caring for a client who just entered the third stage of labor. Which nursing action is the PRIORITY at this time?
Observe the perineum for a gush of blood and lengthening of the cord.
What do the following strategies have in common?
- Transcutaneous Electronic Nerve Stimulation (TENS)
- Aromatherapy
- Abdominal effleurage
- Warm compresses
They all use the gate-control theory.
A nurse caring for a client in labor at full term notes repeated smooth decreases in the fetal heart beat after every contraction.
Which nursing action should the nurse take FIRST?
Change the patient’s position to lateral or hands and knees.
A nurse is performing a non-stress test (NST) on a client with a full term pregnancy and decreased fetal movement. The nurse notes baseline fetal heart rate of 160 with minimal variability, no decelerations, and no accelerations. Which documentation and action are correct?
Non-reactive NST. The nurse should obtain a prescription for CST.
A pregnant client at full term calls the hospital thinking she is in labor. When should the nurse urge the client to come to the hospital immediately?
Strong contractions every 4 minutes, lasting about 1 minute.
A fetal presenting part is palpated at 2 cm ABOVE the ischial spines. Which documentation of fetal station is correct?
-2
Which of the seven cardinal movements is occurring immediately after the fetal head is born?
External rotation
The nurse is evaluating a client at full term who describes underwear wet with clear fluid an hour ago. Which finding would suggest intact fetal membranes?
Absence of ferning pattern on microscope slide of dried vaginal fluid.
A nurse performs a vaginal exam on a client in labor, noting the cervix is 2 cm dilated and 50% effaced at -2 station. What characteristics should the nurse anticipate during this phase of labor?
Talkative, eager, and calm between contractions.
A nurse has assisted her exhausted client with vacuum delivery of the fetal head. What action will the nurse anticipate next?
McRoberts maneuver
A nurse monitoring a patient in labor notes a sudden drop in fetal heart rate, then the patient stops breathing. What action should the nurse take?
Perform CPR
What are the 5 P’s of labor?
- Passenger
-Passageway
-Powers
-Position of mother
-Psychological response
What would 0 station indicate?
The presenting part of the fetus is even w/ the ischial spines.
What are the 5 obstetric emergencies?
- Meconium-Stained Amniotic Fluid (MSAF)
- Shoulder Dystocia (baby stuck)
- Prolapsed Umbilical Cord
- Rupture of Uterus
- Amniotic Fluid Embolism
A nurse is caring for a patient that is in active labor. The nurse sees the umbilical cord before the head, what is the priority action?
Elevate the fetal head your fingers.
A patient is having her 2nd baby and says she is sad that she can’t deliver vaginally because she previously had a C-Section. How should the nurse respond?
Inform the patient that it is possible to deliver vaginally after Cesarean. This is called Vaginal Birth After Cesarean (VBAC).
What characterizes a normal baseline fetal heart rate.
Baseline is average of rate over a 10 minute period, excluding accelerations/decelerations, makes variability, and areas of baseline that vary more than 25 bpm. (Use straight edge)
For the 5 P’s of labor, what factors facilitate a normal vaginal birth?
- Cephalic presentation, longitudinal lie, general flexion, R or L occiput anterior
- Station +4 or +5, fully effaced and dilated
- Contractions and involuntary pushing (Ferguson Reflex)
- Standing or squatting
- Has support, is where she wants to be, is properly prepared for birth, and fears have been addressed.
A nurse is caring for a patient on the OB unit. The patient is having irregular contractions that change based on activity, has no discharge or bleeding, and has not had any progressing cervical changes. What type of labor is this?
False labor.
What is a main difference to consider when determining true vs. false labor?
Someone in true labor has progressing cervical changes, someone in false labor will not.
A nurse hears a co-worker discussing “back labor”. The nurse should know that this is related to what fetal position?
Occiput posterior.
A nurse is caring for a mother and fetus on the unit. The occiput of the fetus is in a posterior position, what is the best position for the mother?
Hands and knees.
T or F: If a patient’s water breaks, that means they are in labor.
False.
A patient on the unit begins having contractions and states that she can’t believe she’s already in labor. How should the nurse respond?
Educate the patient by informing her that contractions do not determine labor.
The nurse understands that the first stage of labor begins with:
Onset of regular uterine contractions AND change in cervix.
A patient in the unit is having regular contractions and on the most recent cervical assessment she was dilated 7cm. What stage/ phase is she in?
First stage, active phase
How does the nurse determine a patient is in the latent phase of the first stage of labor?
Cervix is dilated up to 3 cm and dilates inconsistently.
How does a nurse determine if a patient is in active phase of the first stage of labor?
4 to 7 cm of dilation @ 1 cm/hr
A nurse should know that a patient with 8 to 10 cm dilation is in which phase of the first stage of labor?
Transition.
When does the second stage of labor. begin and end?
Begin: 10 cm dilation
End: Birth
When does the third stage of labor begin and end?
Begin: Birth of fetus
End: Delivery of placenta
When does the fourth stage of labor occur?
2 hours after delivery of the placenta.
The nurse is doing Leopold maneuvers and is monitoring cervical dilation, effacement, fetal station, and fetal presentation. It can be inferred that the mother is in which stage of labor?
First stage.
A patient is in the 2nd stage of labor, how often should the nurse obtain vital signs?
Every 5 to 30 minutes.
A mother in the 2nd stage of labor is having her vital signs measured every 5 to 30 minutes. How often should the FHR be monitored?
Every 5 to 15 minutes depending on fetal risk, and immediately following birth.
A mother gives birth vaginally and has a laceration that extends through the skin, muscles, and into the perineum but not the anal sphincter. How would the nurse classify this laceration?
Second degree laceration.
During postpartum assessment the nurse finds a laceration that extends through the skin, muscles, anal sphincter, and the anterior rectal wall. How should the nurse classify this finding?
Fourth degree laceration.
A nurse finds a laceration that only extends through the skin. The nurse classifies this as:
A first degree laceration.
What is the #1 assessment priority for mothers in the second stage of labor?
Watching constantly for signs of impending birth.
Priority assessments for third stage of labor?
- Vital signs every 15 minutes
- Fundal and bleeding checks.
Which assessment is related to the fourth stage of labor?
Postpartum assessment.
The following points are examples of what?
- Unacceptable for male to examine
- Take placenta home
- Specific nourishment, foods, and temperatures of things.
- Bathing can lead to infection.
- Episiotomy allows spirit to leave the body
These are examples of cultural and religious beliefs.
What three findings make contractions abnormal?
- Longer than 90 seconds
- More than 5 in 10 minutes
- Less than 30 seconds of rest between contractions.
What are the elements of initial assessment of a woman in labor?
- Determine if birth is imminent
- Review prenatal records
- Assess psychosocial status
- Assess for cultural factors
- Physical exam w/ fetal assessment
- Labs if needed.
Describe nursing actions for safe precipitous birth.
Do not leave the patient. Have “precip pack” (towels, scissors, clamps, and bulb syringe). Check for cord around the neck. Support mother and baby calmly. Clear airway by wiping face and dry the baby.
Which breathing technique includes slow deep breaths in through the nose, out the mouth?
Cleansing breath.
What is the main complication of epidural administration and how does the nurse prevent it?
Hypotension. The nurse can administer IVF bolus before procedure, monitor BP and VS during and after.
What analgesic types are used?
- Opioid agonist
- Opioid agonist-antagonist
What are the 3 types of anesthetics used?
- Local
- Pudendal
- Regional
The nurse is caring for a mother with hx of opioid dependency. Which medications should be avoided?
Opioid agonist-antagonists (Stadol and Nubain)
A nurse notes absent variability on the fetal monitor. What actions should they take?
- Reposition to lateral or hands and knees.
- IVF bolus
- 8 to 10 L/min NRB mask
What is a benefit of intermittent auscultation and external monitoring?
Not invasive
What are downsides of internal monitoring?
More invasive. Risk for injury.
What is the #1 risk factor of spontaneous preterm labor?
History of spontaneous preterm labor.
Others include: African American race, STIs.
Describe care of woman with post term pregnancy.
- Usually induce labor @ 41 weeks.
- May wait until 42 weeks w/ frequent assessment of fetal well-being (BPP, AFI, NST)
What is the #1 concern regarding a patient with PROM?
Infection.
Recognize medications used for preterm labor:
- Glucocorticoids: Betamethasone
- Tocolytics
- Mag sulfate
- Terbutaline
- Indomethacin
- Nifedipine
What are strategies for preventing STIs?
- Safer sex (barriers, fewer partners, knowledge of partner)
- Vaccinations and immunity (Hep B, HPV)
- Prophylaxis: HIV (PrEP
What is the most prevalent STI?
HPV
What its the most frequent reportable STI?
Chlamydia
How is Pelvic Inflammatory Disease diagnosed?
CMT and tests for microorganism
