OB test 1 Chapter 19

Question 1

What is the first stage of labor

Answer 1

begins with the onset of regular uterine contraction and ends with full cervical effacement and dilation.

Question 2

How many phases are in the first stage of labor

Answer 2

3

latent phase
active phase
and transition phase

Question 3

Latent phase

Answer 3

through 3 cm of dilation

Question 4

active phase

Answer 4

4-7 cm of dilation

Question 5

transition phase

Answer 5

8-10 cm of dilation

Question 6

True labor

Answer 6

contractions:
Occur regularly, becoming stronger and closer together

become more intense while walking

are usully felt in the lower back, radiating to the lower portion of the abdomen

continue despite use of comfor measures

Cervix-
show progressive change (softening, effacement, and dilation signaled by the appearance of the bloody show

moves to an increasingly anterior position

Fetus-Presenting part usually becomes engaged in the pelvis which results in increased ease of breathing; at the same time, it compresses the bladder resulting in urinary frequency

Question 7

False Labor signs

Answer 7

contractions-
occur irregularly or becomes regular only temporary

often stop while walking or position change

can be felt in the back or abdomen above the navel

can be stopped through comfort measures

Cervix-
may be soft with no significant change in effacement or dilation or evidence of the bloody show

Fetus-
Presenting part is usually not engaged in the pelvis

Question 8

Prenatal Data

Answer 8

the nurse reviews the prenatal record to identify the womans individual needs and risks

Question 9

Interview

Answer 9

the womans primary reason for coming to the hospital is determined in the interview

Question 10

fern test

Answer 10

can determine if the membranes have ruptured

Question 11

bloody show

Answer 11

is distinguished from bleeding by the fact that it is pink and feels sticky because of its mucoid nature

Question 12

The womans general apperance and behavior (and that of her partner) provide

Answer 12

valuable clues to the type of supportive care that she will need

Question 13

Women with a history of sexual abuse

Answer 13

labor can trigger memories of sexual abuse, especially during intrusive procedures such as vaginal exams

Question 14

nurses should be committed to providing culturally sensitive care and

Answer 14

developing an appreciation and respect for cultural diversity.

Question 15

If a special request contradicts usual practices in that setting, the woman or the nurse can ask the womans

Answer 15

primary health provider to write an order to accomodate the special request

Question 16

Who should be the interpreter in non english speaking people

Answer 16

interpretation services via phone
a female if possible
never the kids
ask if it is ok to speak to family as an interpreter never assume it is ok

Question 17

Physical Exam

Answer 17

the initial physical exam includes a general systems assessment and an assessment of the fetal status

Question 18

general systems assessment

Answer 18

on admission, the nurse should perform a breif systems assessment.

this includes an assessment of the heart, lungs, and skin and examination to determine the presence of and extent of edema of the face, hands, sacrum, and legs.

vital signs

weight

fetal heart rate

position of fetus

uterine contractions

Question 19

Uterine contractions

Answer 19

are assessed by palpation or by using a external or internal electric monitor.

descibed by
frequency
intensity
duration
resting tone

Question 20

vaginal exam

Answer 20

revals whether the woman is in true labor or if membranes have ruptured

Question 21

Labs

Answer 21

urine checks-
hydration
nutrition
infection
pre-eclampsia (protein in the urine)

Blood tests-
CBC- may be ordered if a woman has a history of an infection, anemia, gestational hypertension, or other disorders

Question 22

What is an amniotomy

Answer 22

artificial rupture of membranes AROM

Question 23

What is the second stage of labor

Answer 23

is the stage at which the infant is born.

the stage begins with full dilation and complete effacement and ends at the babys birth.

Question 24

How many phases are in the second stage of labor

Answer 24

2

latent phase
and
the active pushing phase

Question 25

The latent phase

Answer 25

is a period of rest and is relatively calm. (laboring down)

Question 26

The active pushing phase

Answer 26

(descent) the woman has strong urges to bear down as the ferguson reflex is activated when the presenting part presses on the stretch receptors of the pelvic floor

Question 27

When does the urge to bear down intesify

Answer 27

as the descent progresses and the presenting part reaches the perineum

Question 28

Signs of an emergency situation include

Answer 28

abnormal fetal heart rate
inadequate uterine relaxation
vafinal bleeding
infection
prolapsed cord

Question 29

monitor the mothers breathing so that she does not hold her breath longer than

Answer 29

6-8 seconds at a time followed by a slight exhale.

no valsava maneuvers

Question 30

What are the mechanisms of birth: vertex presentation

Answer 30

1. birth of the head
2. birth of the shoulders
3. birth of the body and extremities

Question 31

What is crowning

Answer 31

occurs when the widest part of the head distends the vulva just before birth

Question 32

When should you apply fundal pressure?

Answer 32

Never

use suprapubic pressure instead

Question 33

Key points

the onset of labor may be difficult to determine for both nulliparous and multiparous women

Answer 33

the familiar environment of her home is most often the ideal place for a woman during the latent phase of her first stage of labor

Question 34

the nurse assumes most of the responsibility for assessing the progress of labor and for keeping the primary health care provider informed about progress in the labor and deviations from expected findings

Answer 34

the fetal heart rate and pattern reveal the fetal response to the stress of the labor process

Question 35

assessment of the laboring womans urinary output and bladder is critical to ensure her progress and to prevent injury to the bladder

Answer 35

regardless of the actual labor and birth experience, the womans or couples experience to the birth experience is most likely to be positive when events and performances are consistant with exectations, especially in terms of maintaining control and adequacy of pain relief

Question 36

the womans level of anxiety may increase when she does not understand what is being said to her about her labor because of the medical terminology used or becuase of the language barrier

Answer 36

coaching, emotional support, and comfor measures assist the woman to use her energy constructively in relaxing and working with contractions

Question 37

the progress of labor is enhanced when a woman changes her position frequently during the first stage of labor

Answer 37

doulas provide a continuous, supportive presence during labor that can have a positive effect on the process of child birth and its outcome

Question 38

the cultural beliefs and practices of a woman and her significant others, including her partner, can have a profound influence on their approach to labor and birth

Answer 38

siblings present for labor and birth need preparation and support for the event

Question 39

women with a history of sexual abuse often experience profound stress and anxiety during child birth

Answer 39

inability to palpate the cervix during a vaginal exam indicates complete effacement and full dilation have occured and is only certain, objective sign that second stage has begun

Question 40

women may have the urge to bear down at various times during labor; for some it maay be before the cervix is fully dilated and for others it may not come until the acive phase of the second stage of labor

Answer 40

when encouraged to respond to the rhythmic nature of the second stage of labor, the woman usually changes body positions, bears down spontaneously, and vocalizes open glottis pushing when she perceives the urge to push (furgusons reflex)

Question 41

Woman should bear down serveral times during contractions using the open glottis pushing method. they should avoid sustaind closed glottis pushing because this will inhibit oxygen transport to the fetus

Answer 41

nurses can use the role of the advocate to prevent routine use of episiotomy and to reduce the incident of lacerations by empowering women to take an active role in their birth and by educatiing health care providers about approaches to managing childbirth that reduce the incidence of perineal trauma

Question 42

objective signs indicate that the placenta has separated and is ready to be expelled; excessive traction (pulling) on the umbilical cord before the plaenta has separated can result in maternal injury

Answer 42

during the fouth stage of labor, the womans fundal tone, lochial flow, and vital signs she be assessed frequently to ensure that she is physically recovering well after giving birth

most parents/families enjoy being able to handle, hold, explore, and examine the baby immediately after birth

Question 43

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states:

A. “True labor contractions will subside when I walk around.”

B.”True labor contractions will cause discomfort over the top of my uterus.”

C. “True labor contractions will continue and get stronger even if I relax and take a shower.”

D. “True labor contractions will remain irregular but become stronger.”

Answer 43

C. “True labor contractions will continue and get stronger even if I relax and take a shower.”

True labor contractions occur regularly, become stronger, last longer, and occur closer together. They may become intense during walking and continue despite comfort measures. Typically true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen.

Question 44

Vaginal examinations should be performed by the nurse under all of these circumstances except:

A. An admission to the hospital at the start of labor

B. When accelerations of the fetal heart rate (FHR) are noted

C. On maternal perception of perineal pressure or the urge to bear down

D. When membranes rupture

Answer 44

B. When accelerations of the fetal heart rate (FHR) are noted

An accelerated FHR is a positive sign; variable decelerations, however, merit a vaginal examination.

Question 45

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include:

A. Encouraging the woman to try various upright positions, including squatting and standing

B. Telling the woman to start pushing as soon as her cervix is fully dilated

C. Continuing an epidural anesthetic so that pain is reduced and the woman can relax

D. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

Answer 45

A. Encouraging the woman to try various upright positions, including squatting and standing

Upright positions and squatting may enhance the progress of fetal descent.

Question 46

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period?

A. The healthy newborn should be taken to the nursery for a complete assessment.

B. After drying, the infant should be given to the mother wrapped in a receiving blanket.

C. Encourage skin-to-skin contact of mother and baby.

D. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

Answer 46

C. Encourage skin-to-skin contact of mother and baby.

The unwrapped infant should be placed on the woman’s bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding.

Question 47

Which description of the phases of the second stage of labor is accurate?

A. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes

B. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes

C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies

D. Transitional phase: woman “laboring down,” fetal station is 0, duration is 15 minutes

Answer 47

C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies

The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors.

Question 48

When performing vaginal examinations on laboring women, the nurse should be guided by what principle?
A. Cleanse the vulva and perineum before and after the examination as needed.

B. Wear a clean glove lubricated with tap water to reduce discomfort.

C. Perform the examination every hour during the active phase of the first stage of labor.

D. Perform an examination immediately if active bleeding is present.

Answer 48

A. Cleanse the vulva and perineum before and after the examination as needed.

Cleansing will reduce the possibility of secretions and microorganisms ascending into the vagina to the cervix. Maternal comfort will also be enhanced.

Question 49

Which test is performed to determine if membranes are ruptured?

A. Urine analysis
B. Fern test
C. Leopold maneuvers
D. AROM

Answer 49

B. Fern test

In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid.

Question 50

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman’s fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that:

A. The placenta has separated
B. A cervical tear occurred during the birth
C. The woman is beginning to hemorrhage
D. Clots have formed in the upper uterine segment

Answer 50

A. The placenta has separated

Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness.

Question 51

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse’s best response is:
A. “Don’t worry about it. You’ll do fine.”

B. “It’s normal to be anxious about labor. Let’s discuss what makes you afraid.”

C. “Labor is scary to think about, but the actual experience isn’t.”

D. “You may have an epidural. You won’t feel anything.”

Answer 51

B. “It’s normal to be anxious about labor. Let’s discuss what makes you afraid.”

This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool.

Question 52

For the labor nurse, care of the expectant mother begins with any or all of these situations except:

A. The onset of progressive, regular contractions
B. The bloody, or pink, show
C. The spontaneous rupture of membranes
D. Formulation of the woman’s plan of care for labor

Answer 52

D. Formulation of the woman’s plan of care for labor

Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment.

Question 53

If a woman complains of back labor pain, the nurse might best suggest that she:

A. Lie on her back for a while with her knees bent
B. Do less walking around
C. Take some deep, cleansing breaths
D. Lean over a birth ball with her knees on the floor

Answer 53

D. Lean over a birth ball with her knees on the floor

The hands-and-knees position, with or without the aid of a birth ball, should help with the back pain.

Question 54

In a variation of rooming-in, called couplet care, the mother and infant share a room and the mother shares the care of the infant with:
A. The father of the infant
B. Her mother (the infant’s grandmother)
C. Her eldest daughter (the infant’s sister)
D. The nurse

Answer 54

D. The nurse

In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care. This may also be known as mother-baby care or single-room-maternity-care.