Intrapartum 1
Which type of Contractions are Coordinated, Involuntary and Intermittent
A. True
B. False
C. Braxton Hicks
D. Regular
True Contractions are Coordinated: Contracts and relaxes similar to other smooth muscles.
Involuntary: Inability to start and stop however actions may increase and decrease contractions such as walking. Anxiety/Stress can cause the contractions to lessen (due to adrenalin)
Intermittent: Allows for relaxation of the muscle and blood flow to resume
Braxton Hicks or false:
Contractions are considered regular when the duration and frequency are stable over a period of time.
A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition?
A. Medication that will provide sedation
B. Increased hydration
C.Oxytocin (Pitocin) infusion
D.Administration of a tocolytic medication
C. Pitocin
Dropping in pregnancy is also known as _________
Lightening: At the end of the third trimester, the baby settles, or drops lower, into the mother's pelvis.
The primary reason for evaluating alpha-fetoprotein (AFP) levels in maternal serum is to determine whether the fetus has which condition?
a. Hemophilia
b. Sickle cell anemia
c. A neural tube defect
d. Abnormal lecithin-to-sphingomyelin (LS) ratio
ANS: C
An open neural tube allows a high level of AFP to seep into the amniotic fluid and enter the maternal serum.
Hemophilia-genetic defect, is best detected with chromosomal studies, such as chorionic villus sampling or amniocentesis.
Sickle cell anemia is a genetic defect and is best detected with chromosomal studies such as chorionic villus sampling or amniocentesis.
L/S ratios are determined with an amniocentesis and are usually performed in the third trimester.
At one minute the nurse checks the APGAR and finds that the neonates HR is greater than 100, RR shows good effort with breathing, color acrocyanosis, some flexion of extremities with a strong cry. The nurse scores the APGAR as:
a. 8 with deductions for color and flexion
b. 8 with a deduction for color
c. 9 with a deduction for HR and color
d. 8 with a deduction for HR, color and flexion
a. Color acrocyanotic with muscle tone slightly slow.
The beginning of one contraction to the beginning of the next is known as:
A. Frequency
B. Duration
C. Intensity
D. Recurrence
Correct: Frequency
Duration: Beginning of one contraction to the end of that contraction.
Intensity: Strength of the contraction
Recurrence: Another word for Frequency but not correct
A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted?
A.The client begins to expel clear vaginal fluid
B.The contractions are regular
C.The membranes have ruptured
D.The cervix is dilated completely
B. The contractions are regular
A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding would indicate a need to contact the physician?
A. Fetal heart rate of 180 beats per minute
B. White blood cell count of 10,000.
C. Maternal pulse rate of 92 beats per minute
D. Hemoglobin of 11.0 g/dL
A. Fetal HR of 180 may indicate fetal distress
When is the earliest interval that chorionic villus sampling (CVS) can be performed during pregnancy?
a. 4 weeks
b. 8 weeks
c. 10 weeks
d. 14 weeks
CVS is normally performed between 10 and 13 weeks' gestation.
(not earlier or later than 14 w).
1. The nurse is caring for a newborn immediately after delivery. Which first action by the nurse shows an understanding of the newborn’s thermoregulatory ability?
a. Immediately place the newborn skin to skin.
b. Immediately wipe the newborn with dry towels.
c. Immediately place the newborn under a radiant warmer with a hat.
d. Obtains an Apgar score during the first one and five minutes to assess for acrocyanosis.
B. The first action is to wipe the infant down with dry towels then skin to skin. Hats are not placed on an infant in the warmer.
A client arrives at a birthing center in active labor. Her membranes are still intact. and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure. she will most likely have:
A. Less pressure on her cervix
B. Increased efficiency of contractions
C. Decreased number of contractions
D. The need for increased maternal blood pressure monitoring
Increased efficiency of contractions
What is the most common presentation?
A. Head first
B. Facing rearward
C. Face and body angled toward the left
D. Transverse lie
E. Chin tucked in
A. Head first AKA Cephalic
Sunny side up is actually known as which presentation?
The occiput posterior presentation (also called sunny-side up), the fetus is head-first but is facing up (toward the mother's abdomen). It is the most common abnormal position or presentation.
A newly admitted patient overhears the nurse telling the midwife accelerations are noted on the EFM. When asked, the nurse tells the patient (Select all that apply).
a. These are normal variations with contractions.
b. They are often referred to as 'icing' on the cake.
c. They may show that the baby's heart rate is elevated. I will place you on your right side and place a face mask on.
d. The midwife is monitoring the accelerations.
e. I will give you oxygen to help the baby's HR slow down.
Accelerations are known as the icing on the cake as they dhow increased 02 in the fetus as well as an increase in HR. This is a normal and preferred variable in labor.
Assessment of a newborn reveals an asymmetrical Moro reflex. Which action by the nurse is next?
A. Assess for increased intracranial pressure.
B. Examine for a fractured elbow.
C. Assess for talipes equinovarus.
D. Examine for a fractured clavicle.
D. Examine for a fractured clavicle.
A nurse explains the purpose of effleurage to a client in early labor. The nurse tells the client that effleurage is:
A. A form of biofeedback to enhance bearing down efforts during delivery
B. Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus
C. The application of pressure to the sacrum to relieve a backache
D. Performed to stimulate uterine activity by contracting a specific muscle group while other parts of the body rest
Light stroking of the abdomen to facilitate relaxation during labor and provide tactile stimulation to the fetus
A nurse in the labor room is caring for a client in the active phases of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. The most appropriate nursing action is to:
A. Place the mother in the supine position
B. Document the findings and continue to monitor the fetal patterns
C. Administer oxygen via face mask
D. Place the mother in a 45 degree angle E. Increase the rate of the Pitocin
C. Administer oxygen via face mask Late decelerations are due to uteroplacental insufficiency This causes hypoxemia; therefore, oxygen is necessary.
Place the mother in a supine position could put the fetus at risk
45 degrees is not indicated
Hold the Pitocin
What hormone has the strongest effect promoting smooth muscle relaxation for contractions (secreted from lower aspect of fetal membranes).
A. Oxytocin
B. Estrogen
C. Progesterone
D. Prostaglandins
Prostaglandins
Oxytocin stimulates uterine contractions
progesterone slows down contractions
Estrogen loosens the ligaments and connective tissue of the birth canal during the last stage of pregnancy.
A 32-year-old female is diagnosed with gestational diabetes. As the nurse, you know what test below is used to diagnose a patient with this condition?
A. 1-hour glucose tolerance test
B. 24-hour urine collection
C. Hemoglobin A1C
D. 3-hour glucose tolerance test
D. If a patient has a positive 1-hour glucose tolerance test (which is administered at about 24-28 weeks), a 3-hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.
The nurse prepares to administer vitamin K to a newborn. Which action by the nurse is correct?
a. Administers vitamin K in the vastus lateralis muscle.
b. Administers vitamin K using a dropper.
c. Administers vitamin K 6-12 hours after birth.
d. Administers vitamin K SQ in the vastus lateralis muscle.
A. Administers vitamin K in the vastus lateralis muscle using a 5/8"needle IM.
A nurse is caring for a client in the second stage of labor. The client is experiencing uterine contractions every 2 minutes and cries out in pain with each contraction. The nurse recognizes this behavior as:
A. Exhaustion Fear of losing control
B. Involuntary grunting
C. Valsalva’s maneuver
D. Pain
Exhaustion Fear of losing control
A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition?
A. Medication that will provide sedation
B. Increased hydration
C. Oxytocin (Pitocin) infusion
D.Administration of a tocolytic medication
C Pitocin
Tocolytics show down labor:
Why are intermittent versus sustained contractions important?
intermittent allows the fetus and mother to rest
Increases blood flow to the placents
Sustained contributes to fetal distress. Greater than 90 seconds=tetanic contraction.
Neck measurements at 11-13 weeks Performed by an ultrasound of the neck Not performed after 14 weeks May determine if the fetus is likely to be born with a congenital anomaly such as Patau or Down syndrome.
What is this scan known as?
a. Nuchal translucency scan
b. Fetal CT scan
c. Fetal ultrasound with stress test
d. Nuchal rigidity scan
Nuchal translucency scan
Treatment for an infant exposed to maternal gonorrhea is erythromycin ophthalmic ointment.
True. Ocular prophylaxis of newborns with 0.5 percent erythromycin ophthalmic ointment can prevent conjunctivitis in the neonate which can lead to blindness.