Maternity and Pediatrics - Ch 9: Nursing Care During Labor and Childbirth

Which action would the LPN/LVN perform to enable monitoring of a fetus during labor and delivery? (SATA)

1.Placement of an external monitor device

2.Initiation of internal fetal monitoring

3.Insertion of intrauterine pressure catheters (IUPCs)

4.Attachment of fetal scalp electrodes (FSEs) to the fetal scalp

5.Performance of intermittent external monitoring

1.Placement of an external monitor device

2.Initiation of internal fetal monitoring

The nurse is careful to don gloves before handling a neonate in the delivery room. For which reason would the nurse wear gloves?

1.The neonate is wet and slippery.

2.The neonate is susceptible to infections.

3.The neonate was immersed in body fluids.

4.The neonate's umbilicus is open and bleeding.

3.The neonate was immersed in body fluids.

The LPN/LVN in a prenatal clinic is aware of multiple theories about factors that cause the onset of labor. Which factors would the LPN/LVN correctly identify? (SATA)

1.Increased levels of oxytocin

2.Increased prostaglandin production

3.Uterus size

4.Increased chemical secretion from placenta

5.Decreased progesterone levels

1.Increased levels of oxytocin

2.Increased prostaglandin production

3.Uterus size

5.Decreased progesterone levels

After examining a patient who is at 36 weeks' gestation, the health care provider reports the fetus is in transverse lie. Which additional information would the health care provider likely discuss with the patient?

1.The need to walk to promote fetal repositioning

2.The possibility that labor will begin soon

3.The possibility of a cesarean birth

4.The likelihood that labor will be long and difficult

3.The possibility of a cesarean birth

A patient at 38 weeks' gestation is being monitored in the birthing unit to determine whether true labor is occurring. Which finding best supports the conclusion of true labor?

1.Contractions are irregular and intermittent.

2.Contractions stop after a warm shower and some rest.

3.Effacement and dilation have occurred.

4.Discomfort increases with contractions.

3.Effacement and dilation have occurred.

The LPN/LVN is reviewing the patient's understanding for the reasons the neonate received a vitamin K injection. Which statement made by the patient indicates effective teaching?

1."Oral vitamin K is given every day for the first month."

2."The baby does not have enough vitamin to form clots."

3."If I eat a diet high in vitamin K, it will pass through breast milk."

4."After 6 weeks, the baby is no longer at risk for hemorrhage."

2."The baby does not have enough vitamin to form clots."

The LPN/LVN is assisting in the care of an adolescent patient who is in active labor. The patient's support person is also an adolescent who is sleeping at the bedside. The LPN/LVN notices the patient is grimacing and crying during contractions. Which action would the LPN/LVN take?

1.Wake the support person and describe how to help the patient.

2.Stay with the patient and coach her through contractions.

3.Call the patient's guardian and request the help with supportive care.

4.Distract the patient with questions about her expectations for her baby.

2.Stay with the patient and coach her through contractions.

The LPN/LVN is assisting with the care of a patient in active labor who is receiving an epidural. Which effect would the LPN/LVN expect the epidural to have on the patient's genitourinary system?

1.The patient will feel the need to urinate more often.

2.The fetal position will place increased pressure on the bladder.

3.The position of the bladder will be shifted.

4.The patient's bladder will be kept empty with a catheter.

4.The patient's bladder will be kept empty with a catheter.

The nurse in a birthing unit receives the health care provider's prescription for a patient who is in active labor at 37 weeks' gestation. One prescription is for continuous fetal monitoring. Which indication would the nurse recognize as validation for this prescription? (SATA)

1.Chronic maternal hypertension

2.Preterm labor

3.Induced labor

4.Patient history of type 2 diabetes mellitus

5.Patient history of cesarean delivery

1.Chronic maternal hypertension

4.Patient history of type 2 diabetes mellitus

5.Patient history of cesarean delivery

The LPN/LVN is assisting in the care of a patient who is in active labor. The LPN/LVN notices the patient squatting in the bed. The patient notes that this is the labor position of choice in her country of origin. Which action would the LPN/LVN take next ?

1.Inform the RN about the patient's statement and behavior.

2.Explain that it is safer for the patient to lay down to labor.

3.Put up the side rails and make sure the bed is in the lowest position.

4.Ask the patient to move to the floor where she will be safer.

3.Put up the side rails and make sure the bed is in the lowest position.

The LPN/LVN is reinforcing teaching by the RN to a patient who is at 35 weeks' gestation. Which statement made by the patient would indicate that the LPN/LVN should reinforce teaching? (SATA)

1."I will call my health care provider when I arrive at the hospital."

2."I will call my health care provider if labor does not start within 4 hours after my water breaks."

3."I will go to the hospital if vaginal bleeding occurs, with or without pain."

4."I will go to the hospital if my contractions are 5 minutes apart for 1 hour."

5."I go to the hospital if my contractions do not increase in length and intensity."

1."I will call my health care provider when I arrive at the hospital."

2."I will call my health care provider if labor does not start within 4 hours after my water breaks."

5."I go to the hospital if my contractions do not increase in length and intensity."

Which factor would be the primary reason for fetal monitoring during labor?

1.Determine projected delivery time

2.Guide pain management

3.Monitor fetal oxygenation

4.Visualize contraction progression

3.Monitor fetal oxygenation

The LPN/LVN is assisting in caring for a patient and her newborn child. Which action would the nurse take to maintain the infant's airway?

1.Place the infant skin-to-skin with the patient.

2.Gently suction secretions with bulb syringe.

3.Administer erythromycin.

4.Administer vitamin K.

2.Gently suction secretions with bulb syringe.

The LPN/LVN is caring for a patient in active labor. Which intervention can the LPN/LVN implement to promote relaxation?

1.Assist the patient with breathing techniques.

2.Introduce bright lighting and soft music.

3.Apply a warm washcloth to the forehead.

4.Encourage patient to focus on contractions.

1.Assist the patient with breathing techniques.

The LPN/LVN is assisting in caring for a patient who is in active labor. The health care provider determines that forceps will be needed for delivery. Which anesthetic would the LPN/LVN prepare to administer quickly?

1.Pudendal block

2.Epidural anesthesia

3.Spinal anesthesia

4.General anesthesia

1.Pudendal block

A primipara patient expresses concern about her baby's head being too big for a vaginal delivery. Which information from the RN would the LPN/LVN reinforce? (SATA)

1.The frontal, parietal, and occipital bones are fused in the fetus.

2.The bones of the fetal head are pliable.

3.Uterine contractions cause an overlapping of bones in the fetus's head.

4.The fetus's head will appear elongated during and after birth.

5.The fetus will likely be in position to present the smallest fetal head dimension.

2.The bones of the fetal head are pliable.

3.Uterine contractions cause an overlapping of bones in the fetus's head.

4.The fetus's head will appear elongated during and after birth.

5.The fetus will likely be in position to present the smallest fetal head dimension.

A patient who is in the early second trimester of pregnancy mentions to the LPN/LVN that she is considering delivery at a birthing center. The patient has a history of chronic hypertension, has a body mass index of 32, and is 36 years old. Which statement made by the LPN/LVN would be accurate?

1."Your medical history may not fit with the birthing center's screening criteria."

2."Birthing centers allow you to give birth in any position you choose."

3."If there are any emergencies during labor and delivery, you can quickly be transported to a hospital."

4."You would be discharged soon after giving birth."

1."Your medical history may not fit with the birthing center's screening criteria."

A patient who is at 36 weeks' gestation for her first pregnancy arrives at the childbirth unit. The patient reports mild contractions and the loss of a mucous plug. Upon examination, which additional finding would warrant the patient being admitted?

1.Membranes have ruptured.

2.Contractions remain mild.

3.The cervix is 50% effaced.

4.Cervical dilation is at 2 cm.

1.Membranes have ruptured.

A patient delivered a healthy neonate 15 minutes ago. The patient asks the nurse, "Why am I beginning to have contractions again?" Which statement would be correct?

1."The uterus is trying to relax after the stress of labor contractions."

2."These contractions help prevent excessive bleeding."

3."If they become too uncomfortable, we can give you pain medication."

4."The uterus is preparing for the delivery of the placenta."

4."The uterus is preparing for the delivery of the placenta."

The LPN/LVN is reinforcing the procedure used for timing labor contractions with a patient who is in the third trimester of pregnancy. Which explanation would the LPN/LVN use?

1.Duration is the actual time the contraction lasts.

2.Acme indicates the strongest part of the contraction.

3.Increment indicates the start and building of a contraction.

4.Decrement is the time involved with the subsiding of the contraction.

1.Duration is the actual time the contraction lasts.

The nurse performs an Apgar test on a neonate 1 minute after birth. The score is 6. Which action would be appropriate?

1.Place the neonate skin-to-skin with the mother.

2.Provide interventions to improve cardiorespiratory status.

3.Check the Apgar in 1 minute for changes.

4.Tell the patient the neonate is adjusting well to extrauterine life.

2.Provide interventions to improve cardiorespiratory status.

The LPN/LVN is assisting with the care of a patient in active labor. Which finding on the patient's admission history would cause the LPN/LVN to extend additional nonpharmacological pain management interventions?

1.The patient has a large fetus.

2.The patient's previous labors were of short duration.

3.The patient has a support person at the bedside.

4.The patient was unable to attend childbirth classes.

4.The patient was unable to attend childbirth classes.

The nurse is caring for a patient in active labor and notices the membranes have ruptured spontaneously. Which action would the nurse take if the fluid is clear and accompanied by thick blood-streaked mucus?

1.Call the health care provider immediately if there is a notable increase in contractions.

2.Prepare the patient for rapid dilation and quick delivery.

3.Document the finding and follow the health care provider's protocol.

4.Place the patient on a sterile under pad to prevent possible infection.

3.Document the finding and follow the health care provider's protocol.

The LPN/LVN is reviewing a patient's hematopoietic stability following a vaginal delivery. Which information would the LPN/LVN recognize as cause for concern?

1.Estimated blood loss is 500 mL

2.Lab level of hemoglobin is 11 g/dL

3.The blood hematocrit level is 33%

4.Leukocyte count is 20,000 mm3

4.Leukocyte count is 20,000 mm3

A patient who is at 39 weeks' gestation tells the nurse, "I think I am experiencing urinary incontinence. I keep dribbling yellow-colored fluid that stains my underwear." Which finding would cause the nurse to call the health care provider immediately?

1.The patient's blood type is A-.

2.The patient experiences lightening.

3.The fluid produces a slightly acidic result on a Nitrazine paper.

4.The patient is experiences anxiety.

1.The patient's blood type is A-.

A patient who is at 40 weeks' gestation awakens during the night experiencing contractions. Which actions by the patient would help determine whether labor is actually beginning? Place the options in the correct order. All options are to be used.

1.Note the exact time the next contraction begins

2.Note the exact time the contraction starts

3.Call the health care provider as instructed

4.Walk around or take a warm shower

5.Note the exact time the contraction stops

4, 2, 5, 1, 3

A patient is in active labor with contractions every 2 to 3 minutes. Each contraction lasts for 60 to 90 seconds. The patient's blood pressure is 100/68 mm Hg. The fetal heart rate monitor exhibits late decelerations. Which risk associated with these findings would be considered the greatest?

1.Maternal hypoxia

2.Possible uterus rupture

3.Placenta previa

4.Decrease in fetal oxygen

4.Decrease in fetal oxygen

After learning she is pregnant, a patient states, "I will have this baby at home just like my mother did." Which additional comment by the patient would require the LPN/LVN to reinforce the patient's understanding of home births?

1."I will be more comfortable in my own home."

2."Caregivers won't be coming in and out at odd hours."

3."Medication for pain will be available if needed."

4."I will not be separated from my baby after birth."

3."Medication for pain will be available if needed."

The LPN/LVN is caring for a patient in active labor who is experiencing a contraction. Which cardiovascular finding would be expected during this time period? (SATA)

1.An increase in maternal blood pressure

2.A decrease in fetal blood volume

3.An increase in maternal blood volume

4.A decrease in maternal pulse rate

5.An increase in fetal oxygen demands

1.An increase in maternal blood pressure

3.An increase in maternal blood volume

4.A decrease in maternal pulse rate

The LPN/LVN is aware that the significant factors of labor are referred to as the seven "Ps". Which of the "Ps" would the LPN/LVN assist the patient in achieving? (SATA)

1.Passage

2.Position

3.Psyche

4.Pain management

5.Patience

2.Position

3.Psyche

4.Pain management

5.Patience

The nurse is closely watching the monitor strip from an internal scalp electrode. The tracings show minimal variability and absent accelerations. Which fetal condition would the nurse report to the health care provider?

1.Metabolic acidosis

2.Hypoxemia

3.Tissue hypoxia

4.Neurological injury

1.Metabolic acidosis

The LPN/LVN in a hospital birth unit assists with supporting a patient during labor. Which interventions would the LPN/LVN implement to facilitate a shorter labor? (SATA)

1.Encourage the patient to change positions and/or to take walks.

2.Instruct the patient to report nausea and/or vomiting.

3.Keep the patient informed about the physical progression of labor.

4.Remind the patient to urinate every 2 hours.

5.Perform pant-blow breathing with the patient.

1.Encourage the patient to change positions and/or to take walks.

4.Remind the patient to urinate every 2 hours.

5.Perform pant-blow breathing with the patient.

The LPN/LVN is assisting in the care of a patient in active labor. For which finding would the LPN/LVN expect the RN to contact the health care provider immediately? (SATA)

1.Bright red vaginal bleeding

2.Blood pressure of 136/88 mm Hg

3.Maternal heart rate of 100 beats per minute

4.Abnormal fetal heart rate pattern

5.Contractions are 2 minutes apart lasting 90 seconds

1.Bright red vaginal bleeding

4.Abnormal fetal heart rate pattern

The LPN/LVN is caring for a patient in active labor who requests medication for pain management. After pain medication is administered, the nurse closely monitors fetal heart rate for which complication?

1.Fetal heart rate of 110 beats per minute

2.Fetal heart rate of 155 beats per minute

3.Undetectable fetal heart rate variability

4.Moderately variable fetal heart rate

3.Undetectable fetal heart rate variability

The LPN/LVN is monitoring the fetal heart rate of a patient during labor. Which finding would the LPN/LVN recognize as a normal fetal heart rate specific to active labor?

1.Acceleration with fetal movement

2.Deceleration during head compression

3.Deceleration with intrauterine fetal activity

4.Remains steady with little change during compression

2.Deceleration during head compression

A primipara patient arrives at the birthing unit and reports ruptured membranes and contractions that last 30 seconds every 10 minutes. Which data would the nurse obtain from this patient first?

1.Baseline information

2.Immediate cervical examination

3.Fetal heart variability

4.Fetal heart rate.

1.Baseline information

The LPN/LVN on a birthing unit is attending to patients in various stages and phases of labor. Which manifestations indicate a patient is likely approaching the second stage of labor?

1.Contractions are 2 to 3 minutes apart and last 60 seconds.

2.Contractions occur at irregular intervals and are increasingly more intense.

3.Contractions are 2 to 3 minutes apart and last 60 to 90 seconds.

4.Contractions intensify with walking and come at regular intervals.

3.Contractions are 2 to 3 minutes apart and last 60 to 90 seconds.

The LPN/LVN is caring for the patient and her neonate in the hours after delivery. Which nursing action would be appropriate to promote thermoregulation of the neonate?

1.Administer vitamin K.

2.Administer erythromycin.

3.Keep neonate under a warmer for the first hour.

4.Place a hat on the neonate.

4.Place a hat on the neonate.

The nurse is preparing to perform a cervical examination. In which order would the nurse perform the steps of the procedure? Place the options in the correct order. All options must be used.

1.Introduce index and middle fingers of the dominant hand into the vagina

2.Inspect the labia using the nondominant hand

3.Position the patient on her back with knees flexed

4.Touch the cervix and determine effacement and dilation

5.Apply sterile gloves and place a drop of lubricant on the dominant hand

3, 5, 2, 1, 4

A patient is being monitored 30 minutes after a vaginal delivery. Which finding would require that the health care provider be notified?

1.The patient is shivering.

2.The lochia is bright red.

3.The uterus continues to contract.

4.The nurse applies a third peripad.

4.The nurse applies a third peripad.

A patient who is at 34 weeks' gestation in her first pregnancy states, "I have decided that I want to have my baby at home." Which question would initially be most important for the LPN/LVN to ask this patient?

1."Have you selected a nurse-midwife?"

2."Does your partner agree with your decision?"

3."Have you ever been admitted to a hospital before?"

4."Do you have a backup plan in case of an emergency?"

3."Have you ever been admitted to a hospital before?"

The LPN/LVN is assisting the RN in providing care to multiple patients in labor. Which patient would the LPN/LVN expect to need a higher dose of pain medication?

1.The patient with a history of drug abuse

2.The patient consistently reporting pain at a level 6

3.The patient experiencing her first labor and birth

4.The patient experiencing the transition phase of labor

1.The patient with a history of drug abuse

A multipara patient is at 38 weeks' gestation. The patient has experienced lightening and frequent Braxton Hicks contractions. The patient states, "My last labor was 12 hours. Do you think this one will be quicker?" Which statement made by the LPN/LVN would be accurate?

1."You'll likely efface slowly before you fully dilate."

2."Because you've had had a baby before, it's possible you'll have a quicker labor."

3."The strength of your contractions will determine the length of labor."

4."Primipara patients usually efface slowly before dilation occurs."

2."Because you've had had a baby before, it's possible you'll have a quicker labor."

The nurse is attending the second stage of labor with a patient who has received epidural anesthesia. When the health care provider instructs the patient to push, the patient is unable to do so. Which action would the nurse anticipate?

1.Using forceps to aid in the delivery

2.Telling the patient when a contraction occurs

3.Decreasing the amount of epidural medication

4.Allowing birth to occur by "laboring down"

3.Decreasing the amount of epidural medication

A patient arrives at the birthing unit in active labor. The patient and the patient's support person both express the desire for "a completely natural birth without medical intervention." The nurse reports a fetal heart rate with early and prolonged decelerations. Which comment made by the nurse would be most therapeutic?

1."Your health care provider is coming to perform a cesarean delivery."

2."Your baby is in distress and I have called your health care provider."

3."I am going to apply some oxygen and place you on your side."

4."I need to talk with your support person in the hallway."

3."I am going to apply some oxygen and place you on your side."

The LPN/LVN is assisting with the care of a patient in labor who just received an epidural for pain management. Which patient data would the LPN/LVN report immediately to the RN?

1.Itching

2.Tinnitus and metallic taste

3.Hypotension

4.Slowed labor

2.Tinnitus and metallic taste

Which factor would be the primary reason a pregnant patient has an increased risk for falling?

1.Increased weight.

2.Changing center of gravity.

3.Increased levels of relaxin.

4.Lightening occurs.

3.Increased levels of relaxin.

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