OB - Exam 2 - Questions Flashcards
A client reports that her last menstrual period was November 10. She asks the nurse, “When will my baby be due?” What is the best answer?
- “July 3”
- “August 30”
- “Around the middle of September”
- “Around the third week of August”
- “Around the third week of August”
According to Nagele’s rule, count back 3 months from the date of the last menstrual period and add 7 days to determine the estimated date of conception. About 35% of all women will deliver within 5 days of (either before or after) this date. (p. 330)
A pregnant client asks the nurse in the clinic when she will be able to begin to feel the fetus move. The nurse responds by telling the mother that fetal movements will be noted between which weeks of gestation?
- 6 and 8
- 8 and 10
- 10 and 12
- 14 and 18
- 14 and 18
Quickening is fetal movement that is felt by the mother. In the multiparous woman this may occur as early as the fourteenth to sixteenth weeks. The nulliparous woman may not notice these sensations until the eighteenth week or later. Options 1, 2, and 3 are incorrect time frames because quickening does occur this early during pregnancy.
(p. 294)
A maternity nurse should be aware of which fact about the amniotic fluid?
a. It serves as a source of oral fluid and as a repository for waste from the fetus.
b. The volume remains about the same throughout the term of a healthy pregnancy.
c. A volume of less than 300 ml is associated with gastrointestinal malformations.
d. A volume of more than 2 L is associated with fetal renal abnormalities.
a. It serves as a source of oral fluid and as a repository for waste from the fetus.
Choice A is an accurate statement. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.
Which time span delineates the appropriate length for a normal pregnancy?
a. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days
b. 10 lunar months, 9 calendar months, 40 weeks, 280 days
c. 9 calendar months, 10 lunar months, 42 weeks, 294 days
d. 9 calendar months, 38 weeks, 266 days
b. 10 lunar months, 9 calendar months, 40 weeks, 280 days
Rationale: The time span in choice A is just short of a term pregnancy. Choice B is correct. Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth. The time span in choice C is longer than the average length of a pregnancy and would be considered postterm.
Choice D is incorrect. Because conception occurs approximately 2 weeks after the first day of the LMP, this represents the post-conception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.
A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates:
a. The fetus is at risk for Down syndrome
b. The woman is at high risk for developing preterm labor
c. Lung maturity
d. Meconium is present in the amniotic fluid
c. Lung maturity
Rationale: The presence of surface-active phospholipids is not an indication of Down syndrome. The result of the amniocentesis in no way indicates risk for preterm labor. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. Meconium should not be present in the amniotic fluid.
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her:
a. “You don’t need to modify your exercising any time during your pregnancy.”
b. “Stop exercising, because it will harm the fetus.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
d. “Jogging is too hard on your joints; switch to walking now.”
c. “You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month.”
Rationale: A is incorrect: the nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. B is incorrect: physical activity promotes a feeling of well-being in pregnant women. Exercising improves circulation, promotes relaxation and rest, and counteracts boredom. C is the correct answer: typically, running should be replaced with walking around the seventh month of pregnancy. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be:
a. Constipation
b. Alteration in the pattern of fetal movement
c. Heart palpitations
d. Edema in the ankles and feet at the end of the day
b. Alteration in the pattern of fetal movement
Rationale: Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her:
a. “Because you’re in your second trimester, there’s no problem with having one drink with dinner.”
b. “One drink every night is too much. One drink three times a week should be fine.”
c. “Because you’re in your second trimester, you can drink as much as you like.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
d. “Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.”
Rationale: Regardless of which trimester the woman has reached, no amount of alcohol during pregnancy has been deemed safe for the fetus. Neither one drink per night nor three drinks per week is a safe recommendation. Although the first trimester is a crucial period of fetal development, pregnant women of all gestations are counseled to eliminate all alcohol from their diet. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.
Which behavior indicates that a woman is “seeking safe passage” for herself and her infant?
a. She keeps all prenatal appointments.
b. She “eats for two.”
c. She drives her car slowly.
d. She wears only low-heeled shoes.
a. She keeps all prenatal appointments.
Rationale: The goal of prenatal care is to foster a safe birth for the infant and mother. Keeping all prenatal appointments is a good indication that the woman is indeed seeking “safe passage.” Although eating properly is a healthy measure that all mothers can take, obtaining prenatal care is the optimal method for providing safety for both mother and baby. Although driving carefully is important at any time, obtaining prenatal care is the optimal method for providing safety for both mother and baby. Using proper body mechanics and wearing appropriate footwear during pregnancy are healthy measures that all pregnant women should take.
What type of cultural concern is the most likely deterrent to many women seeking prenatal care?
a. Religion
b. Modesty
c. Ignorance
d. Belief that physicians are evil
b. Modesty
Rationale: Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group or religion to which she belongs. A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Ignorance is not likely to be a deterrent to women seeking prenatal care. For many cultural groups a physician is deemed appropriate only in times of illness. Because pregnancy is considered a normal process and the woman is in a state of health, the services of a physician are considered inappropriate.
In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that:
a. Nonacceptance of the pregnancy very often equates to rejection of the child
b. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes
c. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers
d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth
b. Mood swings most likely are the result of worries about finances and a changed lifestyle, as well as profound hormonal changes
Rationale: A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Mood swings are natural and are likely to affect every woman to some degree. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. These conflicts need to be resolved. The baby ends the pregnancy but not all the issues.
With regard to the father’s acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that:
a. The father goes through three phases of acceptance of his own
b. The father’s attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth
c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home
d. Typically men remain ambivalent about fatherhood right up to the birth of their child
a. The father goes through three phases of acceptance of his own
Rationale: A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. The father-child attachment can be as strong as the mother-child relationship and can begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father’s ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and focusing on his role.
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that:
a. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus
b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester
c. Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible
d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus
a. Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus
Rationale: Choice A is the correct answer, and it is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.
Which statement about multifetal pregnancy is not accurate?
a. The expectant mother often develops anemia because the fetuses have a greater demand for iron.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
c. The mother should be counseled to increase her nutritional intake and gain more weight.
d. Backache and varicose veins are often more pronounced.
b. Twin pregnancies come to term with the same frequency as single pregnancies.
Rationale: A woman with a multifetal pregnancy often develops anemia due to the increased demands of two fetuses. This should be monitored closely throughout her pregnancy. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention is likely to cause backache and leg varicosities. Maternal support hose should be recommended.
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that:
a. She will have to give birth at home
b. She must see an obstetrician as well as the midwife during pregnancy
c. She will not be able to have epidural analgesia for labor pain
d. She must be having a low risk pregnancy
d. She must be having a low risk pregnancy
Rationale: Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited. Midwives usually see low risk obstetric clients. Nurse-midwives must refer clients to physicians for complications.
An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that:
a. Intercourse should be avoided if any spotting from the vagina occurs afterward
b. Intercourse is safe until the third trimester
c. Safer-sex practices should be used once the membranes rupture
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present
d. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present
Rationale: Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.
A pregnant woman demonstrates understanding of the nurse’s instructions regarding relief of leg cramps if she:
a. Wiggles and points her toes during the cramp
b. Applies cold compresses to the affected leg
c. Extends her leg and dorsiflexes her foot during the cramp
d. Avoids weight bearing on the affected leg during the cramp
c. Extends her leg and dorsiflexes her foot during the cramp
Rationale: Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Extending the leg and dorsiflexing the foot is the appropriate relief measure for a leg cramp. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.
An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. “One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?” The nurse’s best response is:
a. “This is normal behavior and should begin to subside by the second trimester.”
b. “She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know.”
c. “This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
d. “You seem impatient with her. Perhaps this is precipitating her behavior.”
c. “This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant.”
Rationale: Although the statement made in choice A is appropriate, it does not answer the father’s question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. Choice C is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. The statement made in choice D is judgmental and not appropriate.
A nursing student is assigned to care for a client in labor. The nursing instructor asks the student to describe fetal circulation, specifically the ductus venosus. Which statement is correct regarding the ductus venosus?
a. Connects the pulmonary artery to the aorta
b. Is an opening between the right and left atria
c. Connects the umbilical vein to the inferior vena cava
d. Connects the umbilical artery to the inferior vena cava
c. Connects the umbilical vein to the inferior vena cava
Rationale:
The ductus venosus connects the umbilical vein to the inferior vena cava. The foramen ovale is a temporary opening between the right and left atria. The ductus arteriosus joins the aorta and the pulmonary artery.
The nurse should include which statement to a pregnant client found to have a gynecoid pelvis?
a. “Your type of pelvis has a narrow pubic arch.”
b. “Your type of pelvis is the most favorable for labor and birth.”
c. “Your type of pelvis is a wide pelvis, but has a short diameter.”
d. “You will need a cesarean section because this type of pelvis is not favorable for a vaginal delivery.”
b. “Your type of pelvis is the most favorable for labor and birth.”
Rationale:
A gynecoid pelvis is a normal female pelvis and is the most favorable for successful labor and birth. An android pelvis (resembling a male pelvis) would be unfavorable for labor because of the narrow pelvic planes. An anthropoid pelvis has an outlet that is adequate, with a normal or moderately narrow pubic arch. A platypelloid pelvis (flat pelvis) has a wide transverse diameter, but the anteroposterior diameter is short, making the outlet inadequate.
The nurse is performing an assessment of a pregnant client who is at 28 weeks of gestation. The nurse measures the fundal height in centimeters and expects which finding?
a. 22 cm
b. 30 cm
c. 36 cm
d. 40 cm
b. 30 cm
Rationale:
During the second and third trimesters (weeks 18 to 30), fundal height in centimeters approximately equals the fetus’ age in weeks ± 2 cm. At 16 weeks, the fundus can be located halfway between the symphysis pubis and the umbilicus. At 20 to 22 weeks, the fundus is at the umbilicus. At 36 weeks, the fundus is at the xiphoid process.
The nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Which are probable signs of pregnancy? Select all that apply.
a. Ballottement
b. Chadwick’s sign
c. Uterine enlargement
d. Braxton Hicks contractions
e. Fetal heart rate detected by a nonelectronic device
f. Outline of fetus via radiography or ultrasonography
a. Ballottement
b. Chadwick’s sign
c. Uterine enlargement
d. Braxton Hicks contractions
Rationale:
The probable signs of pregnancy include uterine enlargement, Hegar’s sign (compressibility and softening of the lower uterine segment that occurs at about week 6), Goodell’s sign (softening of the cervix that occurs at the beginning of the second month), Chadwick’s sign (violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4), ballottement (rebounding of the fetus against the examiner’s fingers on palpation), Braxton Hicks contractions, and a positive pregnancy test for the presence of human chorionic gonadotropin. Positive signs of pregnancy include fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation, active fetal movements palpable by the examiner, and an outline of the fetus by radiography or ultrasonography.
The nurse is providing instructions to a pregnant client with genital herpes about the measures that are needed to protect the fetus. Which instruction should the nurse provide to the client?
a. Total abstinence from sexual intercourse is necessary during the entire pregnancy.
b. Sitz baths need to be taken every 4 hours while awake if vaginal lesions are present.
c. Daily administration of acyclovir (Zovirax) is necessary during the entire pregnancy.
d. A cesarean section will be necessary if vaginal lesions are present at the time of labor.
d. A cesarean section will be necessary if vaginal lesions are present at the time of labor.
Rationale:
For women with active lesions, either recurrent or primary at the time of labor, delivery should be by cesarean section to prevent the fetus from being in contact with the genital herpes. The safety of acyclovir has not been established during pregnancy, and it should be used only when a life-threatening infection is present. Clients should be advised to abstain from sexual contact while the lesions are present. If this is an initial infection, clients should continue to abstain until they become culture-negative because prolonged viral shedding may occur in such cases. Keeping the genital area clean and dry promotes healing.
The nurse is reviewing the record of a client who has just been told that a pregnancy test is positive. The health care provider has documented the presence of Goodell’s sign. This finding is most closely associated with which characteristic?
a. A softening of the cervix
b. The presence of fetal movement
c. The presence of human chorionic gonadotropin in the urine
d. A soft blowing sound that corresponds to the maternal pulse during auscultation of the uterus
a. A softening of the cervix
Rationale:
At the beginning of the second month of gestation, the cervix becomes softer as a result of increased vascularity and hyperplasia, which cause Goodell’s sign. Cervical softening is noted by the examiner during pelvic examination. Goodell’s sign does not indicate the presence of fetal movement. Human chorionic gonadotropin noted in maternal urine is a probable sign of pregnancy. A soft blowing sound that corresponds to the maternal pulse may be auscultated over the uterus and is caused by blood circulating through the placenta.
A client arrives at the clinic for the first prenatal assessment. She tells the nurse that the first day of her last menstrual period was October 19, 2014. Using Nägele’s rule, which expected date of delivery should the nurse document in the client’s chart?
a. July 12, 2015
b. July 26, 2015
c. August 12, 2015
d. August 26, 2015
b. July 26, 2015
Rationale:
Accurate use of Nägele’s rule requires that the woman have a regular 28-day menstrual cycle. Subtract 3 months and add 7 days to the first day of the last menstrual period, and then add 1 year to that date: first day of the last menstrual period, October 19, 2014; subtract 3 months, July 19, 2014; add 7 days, July 26, 2014; add 1 year, July 26, 2015.
The nurse is performing an assessment of a primigravida who is being evaluated in a clinic during her second trimester of pregnancy. Which finding concerns the nurse and indicates the need for follow-up?
a. Quickening
b. Braxton Hicks contractions
c. Fetal heart rate of 180 beats/minute
d. Consistent increase in fundal height
c. Fetal heart rate of 180 beats/minute
Rationale:
The normal range of the fetal heart rate depends on gestational age. The heart rate is usually 160 to 170 beats/minute in the first trimester and slows with fetal growth. Near and at term, the fetal heart rate ranges from 110 to 160 beats/minute. Options 1, 2, and 4 are normal expected findings.
The nurse has performed a nonstress test on a pregnant client and is reviewing the fetal monitor strip. The nurse interprets the test as reactive. How should the nurse document this finding?
a. Normal
b. Abnormal
c. The need for further evaluation
d. That findings were difficult to interpret
a. Normal
Rationale:
A reactive nonstress test is a normal result. To be considered reactive, the baseline fetal heart rate must be within normal range (120 to 160 beats/minute) with good long-term variability. In addition, two or more fetal heart rate accelerations of at least 15 beats/minute must occur, each with a duration of at least 15 seconds, in a 20-minute interval.
A pregnant client asks the nurse about the types of exercises that are allowable during pregnancy. The nurse should tell that client that which exercise is safest?
a. Swimming
b. Scuba diving
c. Low-impact gymnastics
d. Bicycling with the legs in the air
a. Swimming
Rationale:
Non–weight-bearing exercises are preferable to weight-bearing exercises during pregnancy. Exercises to avoid are shoulder standing and bicycling with the legs in the air because the knee-chest position should be avoided. Competitive or high-risk sports such as scuba diving, water skiing, downhill skiing, horseback riding, basketball, volleyball, and gymnastics should be avoided. Non–weight-bearing exercises such as swimming are allowable.
The nurse has instructed a pregnant client in measures to prevent varicose veins during pregnancy. Which statement by the client indicates a need for further instructions?
a. “I should wear panty hose.”
b. “I should wear support hose.”
c. “I should wear flat nonslip shoes that have good support.”
d. “I should wear knee-high hose, but I should not leave them on longer than 8 hours.”
d. “I should wear knee-high hose, but I should not leave them on longer than 8 hours.”
Rationale:
Varicose veins often develop in the lower extremities during pregnancy. Any constrictive clothing, such as knee-high hose, impedes venous return from the lower legs and places the client at risk for developing varicosities. The client should be encouraged to wear support hose or panty hose. Flat nonslip shoes with proper support are important to assist the pregnant woman to maintain proper posture and balance and to minimize falls.
A pregnant client calls a clinic and tells the nurse that she is experiencing leg cramps that awaken her at night. What should the nurse tell the client to provide relief from the leg cramps?
a. “Bend your foot toward your body while flexing the knee when the cramps occur.”
b. “Bend your foot toward your body while extending the knee when the cramps occur.”
c. “Point your foot away from your body while flexing the knee when the cramps occur.”
d. “Point your foot away from your body while extending the knee when the cramps occur.”
b. “Bend your foot toward your body while extending the knee when the cramps occur.”
Rationale:
Leg cramps occur when the pregnant client stretches her leg and plantar flexes her foot. Dorsiflexion of the foot while extending the knee stretches the affected muscle, prevents the muscle from contracting, and stops the cramping. Options 1, 3, and 4 are not measures that provide relief from leg cramps.
The nurse in a health care clinic is instructing a pregnant client how to perform “kick counts.” Which statement by the client indicates a need for further instructions?
a. “I will record the number of movements or kicks.”
b. “I need to lie flat on my back to perform the procedure.”
c. “If I count fewer than 10 kicks in a 2-hour period I should count the kicks again over the next 2 hours.”
d. “I should place my hands on the largest part of my abdomen and concentrate on the fetal movements to count the kicks.”
b. “I need to lie flat on my back to perform the procedure.”
Rationale:
The client should sit or lie quietly on her side to perform kick counts. Lying flat on the back is not necessary to perform this procedure, can cause discomfort, and presents a risk of vena cava (supine hypotensive) syndrome. The client is instructed to place her hands on the largest part of the abdomen and concentrate on the fetal movements. The client records the number of movements felt during a specified time period. The client needs to notify her health care provider if she feels fewer than 10 kicks over two, 2-hour intervals or as instructed by her HCP.
With regard to primary and secondary powers, the maternity nurse should understand that:
a. Primary powers are responsible for effacement and dilation of the cervix
b. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies
c. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation
d. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs
a. Primary powers are responsible for effacement and dilation of the cervix
Rationale: The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus. Effacement generally is well ahead of dilation in first-timers; they are more concurrent in subsequent pregnancies. Scarring of the cervix may slow dilation. Pushing is more effective and less fatiguing when the woman begins to push only after she has the urge to do so.
Nurses can advise their clients that all are signs that precede labor except:
a. A return of urinary frequency as a result of increased bladder pressure
b. Persistent low backache from relaxed pelvic joints
c. Stronger and more frequent uterine (Braxton Hicks) contractions
d. A decline in energy, as the body stores up for labor
d. A decline in energy, as the body stores up for labor
Rationale: After lightening a return of the frequent need to urinate occurs as the fetal position causes increased pressure on the bladder. In the run-up to labor, women often experience persistent low back-ache and sacroiliac distress as a result of relaxation of the pelvic joints. Prior to the onset of labor it is common for Braxton Hicks contractions to increase in both frequency and strength. Bloody show may be passed. A surge of energy is a phenomenon that is common in the days preceding labor.
In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that:
a. The woman’s blood pressure increases during contractions and falls back to prelabor normal between contractions
b. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia
c. Having the woman point her toes reduces leg cramps
d. The endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation
d. The endogenous endorphins released during labor raise the woman’s pain threshold and produce sedation
Rationale: Blood pressure increases during contractions but remains somewhat elevated between them. Use of the Valsalva maneuver is discouraged during second stage labor for a number of unhealthy outcomes, including fetal hypoxia. Pointing the toes can cause leg cramps, as can the process of labor itself. Choice D is a correct statement. In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother’s perception of pain.
The nurse knows that the second stage of labor, the descent phase, has begun when:
a. The amniotic membranes rupture
b. The cervix cannot be felt during a vaginal examination
c. The woman experiences a strong urge to bear down
d. The presenting part is below the ischial spines
c. The woman experiences a strong urge to bear down
Rationale: Rupture of membranes has no significance in determining the stage of labor. The second stage of labor begins with full cervical dilation. During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down. Many women may have an urge to bear down when the presenting part is below the level of the ischial spines. This can occur during the first stage of labor, as early as 5 cm dilation.
All statements about normal labor are true except:
a. A single fetus presents by vertex
b. It is completed within 8 hours
c. A regular progression of contractions, effacement, dilation, and descent occurs
d. No complications are involved
b. It is completed within 8 hours
Rationale: In normal labor, a single fetus presents by vertex. Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours. A regular progression of contractions, effacement, dilation, and descent is the trajectory that the nurse expects for a woman experiencing a normal labor. A normal labor usually presents with no complications.
Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate?
a. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours
b. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours
c. Lull: no contractions; dilation stable; duration of 20 to 60 minutes
d. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours
b. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours
Rationale: 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. The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 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.
