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List 3 premonitory signs of labor
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What determines if a pt is in true labor?
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Intrapartal
Jeopardy & NCLEX ?'s
| Question | Answer |
|---|---|
| List 3 premonitory signs of labor | Lightening Braxton Hicks Ctx Inc vag mucous secretions Bloody show Sudden burst of energy Weight loss |
| What determines if a pt is in true labor? | Contractions cause Progressive Cervical changes |
| What is the landmark when fetus is at 0 station? | Ischial spines |
| Describe the position if fetus is in LOP position | |
| What are 5 mechanisms of labor? | Descent, Engagement, Flexion, Internal rotation Extension, External rotation Expulsion |
| List the 3 phases of labor. What are the cervical dilations for each phase? | Latent 0-3 cm Active 4-7 cm Transition 8-10 cm |
| Describe the 2nd stage of labor. (including avg length) | Complete dilation to del of infant Avg length few min to 3 hours |
| Phase of labor when ctx are q2-5mins, mod-strong intensity, may need pain med | Active phase |
| Phase of labor when pt needs total concentration to get thru ctx & may bear down during ctx | Transition phase |
| Stage of labor lasts 1-4hrs & may physiological & psychological adjustments occur | 4th Stage of Labor |
| How is frequency & duration of ctx determined? | Frequency- begin to begin of next ctx Duration- Begining of ctx to end of ctx |
| What are 2 methods of detemining intensity of ctx? Describe each. | Palpation MVU |
| What is effacement & how should it progress in labor? | Thinning of cervix 0 to 100% Progresses with Dilation |
| Describe station & normal progression during labor. | Descent of fetus -3 above ischial spines 0 station at spines +3 on perineum |
| The labor pt states she has ROM, what is 1st RN action? | Check FHR |
| What is normal FHR baseline? | 110 to 160 bpm |
| FHR mirrors the ctx. What is this decel & what RN interventions should be done? | Early Decel Benign, do nothing |
| What medical tx can the nurse anticipate for severe variables early in labor? | Amnioinfusion |
| The RN notices late decels. What are 4 RN interventions? | Stop pitocin Change position Inc IVF O2 Initiate cont EFM/IFM Call MD |
| RN notices FHR of 180bpm over last 30min. What is 1st RN intervention? | Take maternal temp |
| What is purpose of breathing techniques during labor? | Relaxation Reduces anxiety And fear |
| Can IV morphine be given during active labor? Why? | No Causes resp depression in fetus |
| What procedure is used during induction of general anesthesia to prevent aspiration? | Sellick’s Maneuver Pressure on the Cricoid cartilage |
| After obtaining the consent for an epidural, what are 2 RN interventions prior to inserting? | VS baseline Fluid bolus- 500-1000 mL LR |
| Your pt has just received an epidural, what are the 2 SE that are possible with the test dose? | 1. Numbness tongue & lips Tachycardia, Tinnitus 2. Sudden loss of Movement LE |
| Pt presents to L&D with PROM @ 32wks, list 1 assessment the RN will NOT do. | Vaginal Exam |
| What are S/S PTL? List 4. | Baby Balling Up Cramps Low backache Pain in vag or thighs Increased vag discharge “Just feeling bad” |
| Pt is in labor. MD states fetus is OP. What can RN expect with labor? | Prolonged labor Increased back pain Prolonged 2nd stage Inc risk of c/s or forceps del |
| RN does a vag exam & feels a gelatin like mass. What should be done next? | Hold the presenting Part off the cord |
| MD has ordered Terbutaline 2.5mg PO. Why is this med administered & what are SE? | To stop PTL Tachycardia, shakiness |
| What is the indication, dose & SE of Betamethasone? | Inc surfactant in fetus; 12mg IM x2 12-24 apart; possible infection, inc blood sugars |
| During a vaginal exam of a woman in labor the nurse identifies the buttocks as lying over the pelvic inlet. The nurse should document this presentation as: Cephalic Breech Shoulder Transverse | Breech |
| Examination reveals that the presenting part of the fetus in the cephalic presentation has passed the pelvic inlet and is at the level of the ischial spines. How does she interpret this? | The nurse interprets this to mean that the presenting part is: Engaged |
| Which method would be most effective for the nurse to use when assessing the intensity of a client’s uterine contractions? Auscultation with a Doppler ultrasound Observing the woman’s facial expression Asking the woman to rate the intensity Palpating | Palpating the uterine fundus |
| A woman is in labor. The nurse assesses the contractions to be q 2-3 minutes, 50 – 60 seconds, and MVUs 140. The nurse informs the physician which of the following? The client is in adequate labor The client is hyperstimulated The client has hypotoni | The client has hypotonic contractions |
| A client is at home and thinks she is in labor. The nurse instructs the client to determine the frequency of contractions. The client will do this by timing contractions: From the beginning of one contraction to the end of the contraction From the beg | From the beginning of the contraction to the beginning of the next contraction |
| A woman is at home and thinks her water breaks. She is not having contractions. What should she do next? Walk to help contractions begin Lay down to rest Obtain knee chest position to prevent cord prolapse Go to the hospital | Go to the hospital |
| EFM reveals a baseline FHR of 144 bpm, which slows to 128 bpm as the client’s contraction peaks. The FHR then returns to baseline by the end of the contraction. The nurse interprets this finding as indicating: Compression of fetal head Uteroplacental | Compression of fetal head |
| A woman is admitted to labor and delivery and is accompanied by her partner and doula. The nurse includes the doula in the client’s plan of care based on the understanding that the doula’s primary role is to: Assist the primary care provider in the birt | Provide for client comfort and continuous support |
| A woman arrives at the labor and delivery area. Assessment reveals moderate contractions every 5 minutes and lasting approximately 45 seconds. Cervical dilation is 2 cm; effacement 50%. The nurse determines that the client is in which stage of labor? | First stage, latent phase |
| A woman is experiencing hypertonic contractions and is 1 cm, 40% effaced, -2 station. The nurse would be least likely to prepare the client for which intervention? Intravenous fluid therapy Intramuscular morphine Administration of short-acting barbitu | Intravenous oxytocin |
| A client has undergone external cephalic version successfully. Which of the following would the nurse do next? Prepare the client for an ultrasound Plan for an immediate cesarean birth Have the client undergo a nonstress test Perform McRobert’s maneu | Have the client undergo a nonstress test |
| Which finding would lead the nurse to suspect the fetus of a client in labor is in OP position? Complaints of significant back pain with contractions Auscultation of fetal heart sounds in the lower abdomen Fetal back easily palpated with Leopold’s mane | Complaints of significant back pain with contractions |
| Which of the following assessment findings would indicate the need for tocolytic therapy in a client with preterm labor? Fetus at 36 weeks’ gestation Immature fetal lung profile Fetal weight of 2700 grams Intact membranes | Immature fetal lung profile |
| A primigravida who is at 41 weeks’ gestation is being evaluated for possible labor induction. The nurse assesses the client’s cervical readiness using the Bishop scoring method. Which score would indicate that the cervix is favorable for labor induction | 6 |
| Which position would be least effective for a pregnant woman in labor who is experiencing umbilical cord prolapsed? Knee-chest Trendelenburg Semi-Fowler’s Sims lateral | Semi-Fowler’s |
| A client is to receive a continuous intravenous infusion of oxytocin. The nurse determines that the client is receiving the intended effect as evidenced by: Uterine resting tone of 35 mm Hg Contractions occurring q 2 – 3 minutes Contractions lasting a | Contractions occurring q 2 – 3 minutes |
| The nurse is describing the types of uterine incisions that may be used with a client who is to have an elective cesarean birth. Which of the following should the nurse include as characteristics of a transverse incision? Reduces the amount of blood los | Reduces the amount of blood lost during the procedure |
| The nurse should be alert for the development of malignant hyperthermia in a client who has received: Epidural anesthesia General anesthesia Pudendal anesthesia Local anesthesia | General anesthesia |
| Three hours after giving vaginal birth to a healthy newborn with the aid of epidural anesthesia, a client complains of a headache unrelieved by medication. The nurse suspects the client is possibly suffering from: Exhaustion and needs more rest in a qu | Effects of an inadvertent spinal anesthetic requiring additional intervention |
| The two most reliable sources for determining the existence of pain and severity are the client’s vital signs and Self-report of the client using the FLACC scale Subjective client observation using the Wong-Baker FACES pain scale Self report of the cl | Self report of the client using a 0 to 10 point scale rating for the level of pain |
| Following an epidural, the client’s systolic blood pressure drops from a baseline of 118 mm Hg to 75 mm Hg. The nurse’s most immediate response should be to: Administer ephedrine IV Inform the anesthesiologist Increase the IV fluid rate Administer ox | Increase the IV fluid rate |
Created by:
L.moore