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A laboring patient is 10 cm dilated; however, she does not feel the urge to push. The nurse understands that according to laboring down, the advantages of waiting until an urge to push are which of the following? (Select all that apply.)
- A. Less maternal fatigue
- B. Less birth canal injuries
- C. Decreased pushing time
- D. Faster descent of the fetus
Correct Answer: A
Rationale: The correct answer is A: Less maternal fatigue. Waiting for the urge to push during laboring down helps conserve the mother's energy and prevents exhaustion. Pushing without the urge can lead to ineffective pushing efforts, increasing maternal fatigue.
Incorrect choices:
B: Less birth canal injuries - Pushing without the urge may increase the risk of birth canal injuries due to ineffective pushing efforts.
C: Decreased pushing time - Pushing without the urge may actually prolong pushing time as the efforts may be less effective.
D: Faster descent of the fetus - Pushing without the urge may not necessarily result in faster descent of the fetus and can lead to prolonged labor.
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A patient in labor reports a feeling of burning pain during the second stage of labor. This type of pain is associated with
- A. visceral pain.
- B. tissue ischemi
- C. cervical dilation.
- D. somatic pain.
Correct Answer: D
Rationale: The correct answer is D: somatic pain. Somatic pain is caused by the activation of pain receptors in the skin, muscles, or bones. In the second stage of labor, the baby's head passes through the birth canal, stretching the pelvic floor muscles and causing pressure and stretching of the perineum. This results in somatic pain due to the activation of pain receptors in these structures. Visceral pain (choice A) is deep, dull pain from internal organs, not applicable here. Tissue ischemia (choice B) refers to inadequate blood supply causing tissue damage, not pain. Cervical dilation (choice C) is not typically associated with burning pain.
A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely apprehensive because this is her first childbirth experience and asks for an epidural to be administered now. What is the priority nursing response based on this patient assessment?
- A. Use contact anesthesia for an epidural and prepare the patient per protocol.
- B. Tell the patient that she will not need any pain medication because the birth will be over in a matter of minutes and the pain will stop.
- C. Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth.
- D. Call the physician for admitting orders.
Correct Answer: C
Rationale: The correct answer is C. In this scenario, the patient is fully dilated and at +2 station, indicating imminent birth. The priority nursing response should focus on assisting the patient with nonpharmacologic pain distraction methods as the birth is likely to occur soon. Nonpharmacologic pain management techniques such as breathing exercises, positioning changes, massage, and emotional support can help alleviate the patient's anxiety and provide comfort during this intense stage of labor. Administering an epidural at this late stage may not be feasible or effective due to the advanced stage of labor and imminent birth. Options A and D are not appropriate as they do not address the immediate needs of the patient in active labor. Option B is incorrect as it dismisses the patient's request for pain relief and fails to address her emotional and physical needs during labor.
The nurse is reviewing the cardinal maneuvers of labor and birth with a group of nursing students. Which maneuver will immediately follow the birth of the baby's head?
- A. Expulsion
- B. Restitution
- C. Internal rotation
- D. External rotation
Correct Answer: A
Rationale: After the baby's head is born, the immediate next step is the expulsion of the baby's body. This is because the expulsion maneuver refers to the delivery of the rest of the baby's body following the birth of the head. Restitution, internal rotation, and external rotation occur before the birth of the baby's head and are part of the cardinal movements of labor and birth. Restitution involves the realignment of the baby's head with their body after the head is born. Internal rotation refers to the baby's head turning to navigate through the birth canal. External rotation involves the baby's head turning back to its original position after delivery. So, the correct answer is A (Expulsion), as it directly follows the birth of the baby's head.
The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)
- A. local.
- B. epidural.
- C. pudendal.
- D. spinal block.
Correct Answer: C
Rationale: The correct answer is C: pudendal. Pudendal nerve block is specifically used to provide anesthesia to the lower vagina and perineum during labor. This block targets the pudendal nerve, which innervates these areas, providing effective pain relief for childbirth.
A local anesthetic is more general and may not specifically target the lower vagina and perineum. Epidural anesthesia is typically used to provide pain relief during labor but does not specifically target the lower vagina and perineum. A spinal block provides anesthesia for a larger area including the lower abdomen and legs, not specifically the lower vagina and perineum.
While assisting with a vacuum extraction birth, which alteration should the nurse immediately report to the obstetric provider?
- A. Maternal pulse rate of 100 bpm
- B. Maternal blood pressure of 120/70 mm Hg
- C. Persistent fetal bradycardia below 100 bpm
- D. Decreased intensity of uterine contractions
Correct Answer: C
Rationale: The correct answer is C: Persistent fetal bradycardia below 100 bpm. This is crucial because it indicates fetal distress and requires immediate intervention to prevent potential harm to the baby. Bradycardia below 100 bpm may indicate inadequate oxygen supply to the fetus, necessitating urgent action. Maternal vital signs in choices A and B are within normal ranges. Choice D, decreased intensity of uterine contractions, while important, is not as critical as fetal bradycardia in this scenario.