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R:Chapter 66: Normal Labor, Delivery, and Postpartum Care

Terms in this set (30)

A pregnant woman states that she wants to have her baby at home on her "own territory." What type of professional would be most likely to attend a home birth?
A) Nurse practitioner
B) Physician
C) Registered nurse
D) Certified nurse midwife
D) Certified nurse midwife
A nurse is informing a client about different choices available to pregnant women choosing a birth setting. Which of the following birth settings promote safe, satisfying, and the most cost-effective childbirth?
A) Free-standing birth centers
B) Labor and delivery unit
C) Home setting
D) Birthing room
A) Free-standing birth centers
The certified nurse midwife is discussing the birth plan with a client. Which of the following data would most likely be documented in the plan? Select all answers that apply.
A) The woman's choice of a partner for support during labor
B) The woman's living will or advance directives
C) The type of pain relief measures desired
D) The parents' choice of birth announcements
E) The outcome of labor and delivery
F) The woman's feelings about fetal monitoring
A) The woman's choice of a partner for support during labor
C) The type of pain relief measures desired
F) The woman's feelings about fetal monitoring
The nurse assessing a laboring client documents that the client is in stage II of labor. What typically occurs during this stage?
A) Dilation of the cervix
B) Movement of fetus to the birth canal
C) Delivery of the baby through the vaginal opening
D) Delivery of the placenta following delivery of the newborn
C) Delivery of the baby through the vaginal opening
The nurse practitioner examining a pregnant woman in labor notes that the fetal spine is parallel to the woman's spine. What is the term for this relationship of the fetal body to the maternal body?
A) Lie
B) Presentation
C) Station
D) Engagement
A) Lie
The nurse assisting with deliveries is aware that which of the following clients is most at risk for having a difficult delivery and possibly cesarean section.
A) A woman whose baby is in a longitudinal lie
B) A woman whose baby has a cephalic presentation
C) A woman whose baby has engaged prior to labor
D) A woman whose baby is in the footling breech position
D) A woman whose baby is in the footling breech position
The obstetrical nurse checks the station of a laboring pregnant woman and documents +5 on the patient chart. What does this number mean in terms of the delivery?
A) The baby is "floating" above the mother's ischial spines.
B) The fetal head is at the vaginal opening.
C) The lowest part of the fetal skull is at the level of the mother's ischial spines.
D) The presenting part is 5 cm above the level of the ischial spines.
B) The fetal head is at the vaginal opening.
A client is in labor, and the nurse palpates her abdomen to assess the presentation of the fetus.
Which of the following presentations indicates normal labor?
A) Breech presentation
B) Shoulder presentation
C) Brow presentation
D) Vertex presentation
D) Vertex presentation
The husband of a pregnant woman in labor is coaching her to perform breathing exercises to distract her from the pain. Which of the four P's of labor would the parents be?
A) Passage
B) Passenger
C) Powers
D) Psyche
D) Psyche
A primigravida who is 2 weeks away from her delivery date tells the obstetrical nurse that she feels like "the baby has dropped." What would be the nurse's best response to this client?
A) "This feeling may be a sign that there is a complication with your pregnancy."
B) "This feeling is called lightening and means that the fetus has settled into the pelvis."
C) "This is a normal feeling at this stage and it is called 'Braxton-Hicks' contractions."
D) "This is a normal feeling called lightening signaling that labor has begun."
B) "This feeling is called lightening and means that the fetus has settled into the pelvis."
A pregnant client in her 38th week of gestation complains of abdominal pains and suspects she is
in labor. Which of the following findings are characteristic of true labor contractions?
A) Contractions are short and irregular.
B) Contractions are generally felt low in the abdomen.
C) Contractions help create effacement and dilation of the cervix.
D) Contractions are relieved by change of position or activity.
C) Contractions help create effacement and dilation of the cervix.
A nurse is caring for a client in labor. During assessment, which of the following should the nurse
consider to be a common discomfort of labor?
A) Exaggerated fetal movement
B) Pain in the lower back
C) Prolonged slowing of the fetal heart rate
D) Irregular fetal heartbeat
B) Pain in the lower back
The nurse is caring for a laboring woman who has been given oxytocin to induce labor. She is having contractions at an interval of every 2 minutes with 90 seconds duration in between. What would be the appropriate intervention in this situation?
A) Encourage the woman's coach to help her with breathing exercises.
B) Provide a back rub for the woman when the pain is at its greatest intensity.
C) Check her pain medication preferences and administer an analgesic, if indicated.
D) Report this emergency situation to the birth attendant.
D) Report this emergency situation to the birth attendant.
The obstetrical nurse is administering oxytocin for her client to induce labor. Which of the following is a recommended guideline for administration of the drug?
A) For labor induction: Initial dose of 1 to 2 mU; increased 1 to 2 mU/min until an adequate labor pattern is achieved.
B) For labor augmentation: Initial dose: 1.5 to 2.0 mU; increased 1 to 2 mU/min until an adequate labor pattern is achieved.
C) For labor induction and labor augmentation: Maximum recommended dose is 25 mU/min.
D) For postpartum: 15 to 25 mU IM or IV after delivery of the placenta.
A) For labor induction: Initial dose of 1 to 2 mU; increased 1 to 2 mU/min until an adequate labor pattern is achieved.
A nurse is assessing a pregnant client whose membranes have ruptured. Which of the following
findings may indicate an infection?
A) Nitrazine paper remains yellow
B) White or cloudy amniotic fluid
C) Clear and colorless amniotic fluid
D) Nitrazine paper turns blue
B) White or cloudy amniotic fluid
A pregnant woman is having moderately strong contractions every 3 minutes lasting 50 seconds. Her cervix is dilated 6 cm. What state of labor is she experiencing?
A) Stage I, latent phase
B) Stage I, active phase
C) Stage I, transitional phase
D) Stage II
B) Stage I, active phase
A client in the first stage of labor has an episode of bright-red bleeding. What is the best action for
the nurse to take?
A) Perform a vaginal examination per protocol.
B) Report any bleeding at once.
C) Perform an ultrasound examination, as ordered.
D) Inject vitamin K, as ordered, to stop bleeding.
B) Report any bleeding at once.
A client is in the second stage of labor. The nurse should record the following information in the
second stage:
A) The exact time of placental delivery
B) The nature of placental delivery
C) The side of placental presentation
D) The type of episiotomy on the client's chart
D) The type of episiotomy on the client's chart
The obstetrical nurse records the expulsion of the placenta in stage III labor as a Duncan presentation. What does this data represent?
A) The placenta is expelled with the dull side out.
B) The placenta is expelled with the shiny side out.
C) The placenta is not fully expelled.
D) The placenta contains placental fragments.
A) The placenta is expelled with the dull side out.
The nurse is caring for a client who just delivered a healthy 7 pound 9 ounce baby girl. What is the priority nursing intervention for this new mother?
A) Give the mother a bed bath.
B) Allow the mother a period of rest with no distractions.
C) Encourage bonding with the infant.
D) Perform a comprehensive assessment.
C) Encourage bonding with the infant.
A nurse is monitoring the fetal heart rate of a client. What signs of fetal distress on the fetal monitor should the nurse report immediately?
A) Accelerations of 15 bpm
B) Early decelerations
C) Decreased variability
D) Fetal heart rate above 100 bpm
C) Decreased variability
A fetus is experiencing variable decelerations in the fetal heart rate during contractions. What is the appropriate nursing intervention for this situation?
A) Have the pregnant woman walk around the room.
B) Change the woman's position and give oxygen.
C) Notify the healthcare practitioner immediately.
D) Administer prescribed pain medications.
B) Change the woman's position and give oxygen.
The nurse caring for a postpartum client explains the occurrence of lochia following delivery. Which of the following statements accurately describe a characteristic of this process?
A) "Lochia ruba, which is mostly red and bloody, is seen for the first week."
B) "Lochia serosa, which is pink or brown tinged, starts after the bleeding diminishes."
C) "Lochia alba, which is yellow or white, starts on about day 15.
D) "Lochia alba has a pungent, foul odor."
B) "Lochia serosa, which is pink or brown tinged, starts after the bleeding diminishes."
Following delivery, a client feels the urge to void, but is unable to do so after an extended period of time. What immediate action should the nurse take?
A) Report it to the practitioner.
B) Catheterize the bladder.
C) Apply suprapubic pressure.
D) Reassure the client.
A) Report it to the practitioner.
A nurse is performing fundal massage for a client. What precaution should the nurse take when giving a fundal massage?
A) Never massage a contracted fundus.
B) Avoid placing a hand over the symphysis pubis.
C) Report cramps immediately to physician.
D) Avoid applying heat to relieve cramps.
A) Never massage a contracted fundus.
The nurse performing a postpartum assessment on a client elicits the Homan's sign. For what condition is the nurse assessing?
A) Thrombophlebitis
B) Urinary distention
C) Soft, boggy uterus
D) Hematoma
A) Thrombophlebitis
The nurse is providing teaching to a new mother regarding changing her perineal pad. Which of
the following client statement indicates effective teaching?
A) "I will pull my underwear down and to the front."
B) "I will unhook my pad from the front first."
C) "I will remove the pad from the back to the front."
D) "I will apply the new pad by hooking it to the back first."
B) "I will unhook my pad from the front first."
The nurse is teaching a new mother breastfeeding techniques. What would be an appropriate measure to teach to help relieve engorgement?
A) Do not wear a bra or other constricting clothing.
B) Apply cold packs to the breast for 15 minutes before nursing.
C) Increase fluid intake by 30%.
D) Avoid manual expression or pumping breasts.
D) Avoid manual expression or pumping breasts.
The nurse is teaching a new mother about the advantages/disadvantages of breastfeeding versus
formula feeding. Which of the following statements accurately describe the process? Select all that apply.
A) Breast milk is readily available and convenient.
B) Breast milk is always the right temperature.
C) Nursing slows involution.
D) Breast milk contains antibodies.
E) Beast milk is more likely to cause allergic reactions.
F) Nursing ensures another pregnancy will not occur.
A) Breast milk is readily available and convenient.
B) Breast milk is always the right temperature.
D) Breast milk contains antibodies.
The nurse is discharging a new mother from the hospital. Which of the following is a recommended teaching guideline that should be discussed?
A) Tell the client to return for a follow-up examination in 1 month.
B) Advise the client to resume sexual intercourse as soon as it feels comfortable.
C) Tell the nonnursing client that menstruation should resume in 6 to 8 weeks.
D) Tell the nursing mother that contraception is not necessary until her period returns.
C) Tell the nonnursing client that menstruation should resume in 6 to 8 weeks.
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