Labor & Delivery
This stage of labor begins with regular uterine contractions and ends when the cervix reaches 10 cm dilation?
The First stage of labor.
Rationale: The first stage begins with the onset of labor and ends with complete cervical dilation (10 cm). It includes the latent and active phases.
When the fetal monitor shows a baseline heart rate of 100 bpm for more than 10 minutes.
What is Fetal bradycardia?
Rationale: A baseline below 110 bpm for at least 10 minutes is classified as bradycardia. The nurse should assess maternal and fetal status and evaluate for possible causes.
Sasha is a 27 y.o. G2P1 34.4-week pregnant woman arriving to triage with vaginal bleeding, abdominal pain, and a hard, tender uterus. What OB emergency is she presenting with?
Placental abruption.
Rationale: Premature separation of the placenta from the uterine wall can cause painful bleeding, uterine tenderness, and fetal compromise. Bleeding may be concealed. This is an obstetric emergency requiring immediate maternal-fetal assessment and intervention.
The medication administered to prevent seizures in a patient with preeclampsia with severe features?
What is Magnesium sulfate?
Rationale: Magnesium sulfate is administered for seizure prophylaxis. It decreases the risk of progression to eclampsia.
This medication is commonly used when blood glucose remains elevated despite lifestyle changes?
What is Insulin?
Rationale: Insulin is commonly used during pregnancy because it effectively controls maternal glucose and does not cross the placenta in clinically significant amounts.
This stage of labor when the mother actively pushes and deliver the baby?
Second stage of labor.
Rationale: The second stage begins at complete cervical dilation (10 cm) and ends with the birth of the infant.
When the fetal heart rate increases at least 15 bpm above baseline and lasts at least 15 seconds in a fetus at 32 weeks.
What is an acceleration?
Rationale: Accelerations are generally reassuring and suggest fetal autonomic responsiveness. At 32 weeks or later, the standard 15-by-15 criteria apply.
When a pregnant patient reports a severe headache, blurred vision, and right upper quadrant pain.
What is Preeclampsia with severe features?
Rationale: These symptoms can indicate severe maternal disease and possible liver involvement or neurologic complications.
Routinley administered intravenously first to help prevent or treat uterine atony-related postpartum hemorrhage.
What is Oxytocin (Pitocin)?
Rationale: Oxytocin stimulates uterine contractions, helping compress blood vessels at the placental site and reduce bleeding.
Two pregnancy complications that are more common in patients of advanced maternal age.
What is Gestational diabetes and preeclampsia?
Rationale: Advanced maternal age is associated with increased risks of metabolic and hypertensive complications during pregnancy.
The cervix is completely thinned out.
What is Cervical Effacement?
Rationale: Effacement describes cervical thinning and shortening. It progresses from 0% to 100%.
When the fetal monitor shows fluctuations of 5 bpm or less around the baseline.
What is Minimal variability?
Rationale: Minimal variability is 5 bpm or less. It may be associated with fetal sleep cycles, medications, prematurity, or fetal hypoxia/acidemia. It must be interpreted with the entire tracing.
During vaginal delivery, the baby's head delivers but retracts tightly against the mother's perineum, sometimes called the turtle sign.
What is a Shoulder dystocia?
Rationale: Shoulder dystocia occurs when the fetal shoulders become impacted, most commonly behind the maternal pubic symphysis, after the head has delivered.
McRoberts maneuver is performed it involves hyperflexing the mother's hips toward her abdomen. This helps straighten the sacrum and increase the functional pelvic outlet.
When a patient has diminished deep tendon reflexes, a respiratory rate of 10 breaths per minute, and decreased urine output.
What is Magnesium sulfate toxicity?
Rationale: Magnesium toxicity can cause respiratory depression and loss of reflexes. The nurse should stop the infusion, notify the provider, support respiratory function as needed, and prepare to administer calcium gluconate as ordered.
A potential long-term health risks for a mother who has had gestational diabetes?
What is an Increased risk of developing type 2 diabetes later in life?
Rationale: Patients with a history of gestational diabetes should receive postpartum diabetes screening, typically with a 75-g, 2-hour oral glucose tolerance test at 4–12 weeks postpartum.
What cervical dilation is the patient considered completely dilated and ready to enter the second stage of labor?
What is 10 centimeters?
Rationale: Complete cervical dilation marks the beginning of the second stage, when pushing and birth occur.
When a patient's fetal monitor shows decelerations that begin after the contraction starts, with the lowest FHR occurring after the contraction's peak.
What is a Late deceleration?
Rationale: Late decelerations may indicate inadequate oxygen exchange between the mother and fetus associated with uteroplacental insufficiency. The nurse should:
Reposition the mother laterally.
Stop oxytocin if it is infusing.
Notify the provider and initiate further interventions as indicated.
Ectopic pregnancies are routinely implanted here.
What is the fallopian tube?
Rationale: Most ectopic pregnancies occur in the fallopian tube, particularly the ampullary portion.
Administered to ripen (soften and thin) the cervix and help initiate labor.
What is Misoprostol (Cytotec)?
Rationale: Misoprostol is a prostaglandin E1 analog that promotes cervical ripening and stimulates uterine contractions. It is used for cervical preparation and labor induction in appropriate patients.
What complication is a 9Lb infant at increased risk for during delivery when the mother has gestational diabetes?
What is Shoulder dystocia?
Rationale: Maternal hyperglycemia can cause fetal hyperinsulinemia and excessive fetal growth (macrosomia). Larger infants have an increased risk of shoulder dystocia and birth injuries.
When a pregnant woman reports contractions that disappear when she walks, changes positions, or rests.
What is False Labor?
Rationale: Braxton Hicks contractions may decrease or stop with rest, hydration, or position changes.
How should a Nurse catergorize a FHR strip that shows a baseline of 150 bpm, minimal variability, and recurrent variable decelerations?
What is Cat II (indeterminate)?
Rationale: Category II includes fetal heart rate patterns that do not meet the criteria for either Category I (normal) or Category III (abnormal). Minimal variability and recurrent variable decelerations place this tracing in Category II.
Typically painless, bright-red vaginal bleeding as opposed to painful vaginal bleeding with uterine tenderness or a rigid uterus.
What is the difference between placenta previa and placental abruption?
Rationale: Placenta previa involves placental implantation over or near the cervical opening. Placental abruption involves premature separation of the placenta from the uterine wall.
A patient receiving magnesium sulfate for preeclampsia develops absent deep tendon reflexes and respiratory depression. Which medication should the nurse anticipate administering?
What is Calcium Gluconate?
Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. The nurse should stop the magnesium infusion, notify the provider, support respiratory function, and prepare to administer the antidote as ordered.
A stitch placed around the cervix to help keep it closed and prevent premature cervical dilation.
What is a Cerclage?
Rationale: It is commonly used for patients with cervical insufficiency, who may experience painless cervical shortening or dilation during pregnancy, increasing the risk of pregnancy loss or preterm birth.