Question 1

A woman from out of state is visiting her relatives for the holidays.She presents at your facility in labor but does not have a copy of her prenatal records.The nurse would like to contact the woman's health care provider to obtain these records.Because the woman is in active labor it is not necessary for the nurse to obtain written consent for the transfer of these records.Is this statement true or false?

Accepted Answer

According to the Health Insurance Portability and Accountability Act (HIPAA)the woman must give permission for other persons to be involved in the exchange of information regarding her care.

Question 2

Which collection of risk factors will most likely result in damaging lacerations (including episiotomies)?

Accepted Answer

Reddish-haired women have tissue that is less distensible than darker-skinned women and so may have less efficient healing.First-time mothers are also more at risk,especially with breech births,long second-stage labors,or rapid labors in which there is insufficient time for the perineum to stretch.The rate of episiotomies is higher when obstetricians rather than midwives attend births.This woman is at low risk for either damaging lacerations or an episiotomy.The client is multiparous,has dark skin,and is being attended by a midwife (who is less likely to perform an episiotomy).Reddish-haired women have tissue that is less distensible than that of darker-skinned women.This puts the client at increased risk for lacerations;however,she has had two previous deliveries,which result in a lower likelihood of an episiotomy.The fact that this woman is experiencing a prolonged labor might increase her risk for lacerations.Fortunately she is dark skinned,which indicates that her tissue is more distensible than that of fair-skinned women and therefore less susceptible to injury.

Question 3

Concerning the third stage of labor,nurses should be aware that:

Accepted Answer

Active management facilitates placental separation and expulsion,reducing the risk of complications.The placenta cannot detach itself from a flaccid (relaxed)uterus.Which surface of the placenta comes out first is not clinically important.The major risk for women during the third stage of labor is postpartum hemorrhage.

Question 4

A ____________-degree perineal laceration continues through the anal sphincter muscle.

Accepted Answer

The answer of A ____________-degree perineal laceration continues through the...

Question 5

The Valsalva maneuver can be described as the process of making a forceful bearing-down attempt while holding one's breath with a closed glottis and tightening the abdominal muscles.During the second stage of labor,when the woman is ready to push,this is considered the optimal method to enhance movement of the fetus down the birth canal.Is this statement true or false?

Accepted Answer

This process stimulates the parasympathetic division of the autonomic nervous system and produces a vagal response (decrease in heart rate and blood pressure).An alternative method includes instructing the client to perform open-mouth and open-glottis breathing and pushing.

Question 6

Women who have participated in childbirth education classes often bring a birth plan with them to the hospital.This document includes the couple's preference related to (choose all that apply):

Accepted Answer

The presence of companions,clothing to be worn,care and handling of the newborn,medical interventions,and environmental modifications all might be included in the couple's birth plan.Other items include the presence of nonessential medical personnel (students),labor activities such as the tub or ambulation,preferred comfort and relaxation methods,and any cultural or religious requirements.Couples can visit www.childbirth.org for an interactive birth plan to assist them in preparing for their birth.

Question 7

A means of controlling the birth of the fetal head with a vertex presentation is:

Accepted Answer

The Ritgen maneuver extends the head during the actual birth and protects the perineum.Gentle,steady pressure against the fundus of the uterus facilitates vaginal birth.The lithotomy position has been commonly used in Western cultures,partly because it is convenient for the health care provider.The De Lee apparatus is used to suction fluid from the infant's mouth.

Question 8

In the recovery room,if a woman is asked either to raise her legs (knees extended)off the bed or to flex her knees,place her feet flat on the bed,and raise her buttocks well off the bed,most likely she is being tested to see whether she:

Accepted Answer

If the numb or prickly sensations are gone from her legs after these movements,she likely has recovered from the epidural or spinal anesthesia.It is always important to assess the client for bleeding beneath her buttocks prior to discharge from the recovery room;however,she should be rolled to her side for this assessment.The nurse is not required to assess the woman for flexibility.This assessment is performed in order to evaluate if the client has recovered from spinal anesthesia,not to determine if she is a candidate for early discharge.

Question 9

The progress of labor can be verified effectively through use of a chart that plots cervical dilation and station.This chart is called a(n)____________________.

Accepted Answer

The answer of The progress of labor can be verified...

Question 10

Emergency conditions during labor that require immediate nursing intervention can arise with startling speed.Examples of such emergencies include (choose all that apply):

Accepted Answer

A nonreassuring or abnormal FHR pattern,inadequate uterine relaxation,vaginal bleeding,infection,and cord prolapse all constitute an emergency during labor that requires immediate nursing intervention.

Question 11

A 25-year-old gravida 2,para 2-0-0-2 gave birth 4 hours ago to a 9-lb,7-oz boy after augmentation of labor with oxytocin (Pitocin).She puts on her call light and asks for her nurse right away,stating "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Accepted Answer

This woman gave birth to a macrosomic infant after oxytocin augmentation.The most likely cause of bleeding 4 hours after delivery,combined with these risk factors,is uterine atony.Although retained placental fragments may cause postpartum hemorrhage,this typically is detected in the first hour after delivery of the placenta and is not the most likely cause of hemorrhage in this woman.Although unrepaired vaginal lacerations may cause bleeding,they typically occur in the period immediately after birth.Puerperal infection can cause subinvolution and subsequent bleeding;however,this typically is detected after 24 hours postpartum.

Question 12

Nurses should not use ____________________ pressure to facilitate birth,because no standard techniques are available for this maneuver,and no legal,professional,or regulatory standards exist for its use.

Accepted Answer

The answer of Nurses should not use ____________________ pressure to...

Question 13

The period encompassing the first 1 to 2 hours after birth often is referred to as the ____________________ stage of labor.

Accepted Answer

The answer of The period encompassing the first 1 to...

Question 14

A woman who has a history of sexual abuse may have a number of traumatic memories triggered during labor.She may fight the labor process and react with pain or anger.Alternately,she may become a passive player and emotionally absent herself from the process.The nurse is in a unique position of being able to assist the client to associate the sensations of labor with the process of childbirth and not the past abuse.The nurse can implement a number of care measures to help her client view the childbirth experience in a positive manner.Which intervention is key for the nurse to use while providing care?

Accepted Answer

The number of invasive procedures such as vaginal examinations,internal monitoring,and IV therapy should be limited as much as possible.The nurse should always avoid words and phrases that may result in the client's recalling the phrases of her abuser (i.e.,"Relax,this won't hurt" or "Just open your legs").The woman's sense of control should be maintained at all times.The nurse should explain procedures at the client's pace and wait for permission to proceed.Protecting the client's environment by providing privacy and limiting the number of staff who observe the client will help to make her feel safe.

Question 15

As the United States and Canada continue to become more culturally diverse,it is increasingly important for the nursing staff to recognize a wide range of varying cultural beliefs and practices.Nurses need to develop respect for these practices and learn to incorporate them into a mutually agreed-upon plan of care.Although it is common practice in the United States for the father of the baby to be present at the birth,in many societies this is not the case.When implementing care,the nurse should anticipate that a woman from which country will have the baby's father in attendance?

Accepted Answer

A woman from Mexico may be stoic about discomfort until the second stage,at which time she will request pain relief.Fathers and female relatives are usually in attendance during the second stage of labor.The father of the baby is expected to provide encouragement,support,and reassurance that all will be well.In China fathers are usually not present.The side-lying position is preferred for labor and birth because it is believed that this will reduce trauma to the infant.The client has a stoic response to pain.In Iran the father will not be present.Female support persons and female health care providers are preferred.For many,a male caregiver is unacceptable.In India the father is usually not present,but female relatives are usually present.Natural childbirth methods are preferred.

Quiz 19: Nursing Care of the Family During Labor and Birth

Which collection of risk factors will most likely result in damaging lacerations (including episiotomies) ?

Concerning the third stage of labor,nurses should be aware that:

A ____________-degree perineal laceration continues through the anal sphincter muscle.

Women who have participated in childbirth education classes often bring a birth plan with them to the hospital.This document includes the couple's preference related to (choose all that apply) :

A means of controlling the birth of the fetal head with a vertex presentation is:

In the recovery room,if a woman is asked either to raise her legs (knees extended) off the bed or to flex her knees,place her feet flat on the bed,and raise her buttocks well off the bed,most likely she is being tested to see whether she:

The progress of labor can be verified effectively through use of a chart that plots cervical dilation and station.This chart is called a(n)____________________.

Emergency conditions during labor that require immediate nursing intervention can arise with startling speed.Examples of such emergencies include (choose all that apply) :

A 25-year-old gravida 2,para 2-0-0-2 gave birth 4 hours ago to a 9-lb,7-oz boy after augmentation of labor with oxytocin (Pitocin) .She puts on her call light and asks for her nurse right away,stating "I'm bleeding a lot." The most likely cause of postpartum hemorrhage in this woman is:

Nurses should not use ____________________ pressure to facilitate birth,because no standard techniques are available for this maneuver,and no legal,professional,or regulatory standards exist for its use.

The period encompassing the first 1 to 2 hours after birth often is referred to as the ____________________ stage of labor.