Nokea
Which patient will most likely have increased anxiety and tension during labor?
- A. Gravida 2 who refused any medication
- B. Gravida 2 who delivered a stillborn baby last year
- C. Gravida 1 who did not attend prepared childbirth classes
- D. Gravida 3 who has two children younger than 3 years
Correct Answer: B
Rationale: The correct answer is B. A patient who delivered a stillborn baby last year is more likely to experience increased anxiety and tension during labor due to previous traumatic experience. This can trigger fear and worry about the current pregnancy outcome, leading to heightened emotional distress.
Incorrect Choices:
A: Refusing medication does not necessarily correlate with increased anxiety during labor.
C: Not attending childbirth classes may result in lack of knowledge but does not directly relate to increased anxiety during labor.
D: Having two children younger than 3 years may cause stress but does not specifically indicate increased anxiety during labor.
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Induction of labor is considered an acceptable obstetric procedure if it is a safe time to deliver the fetus. The charge nurse on the labor and birth unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction, including which of the following? (Select all that apply.)
- A. Fetal death
- B. Postterm pregnancy
- C. Rupture of membranes at or near term
- D. Convenience of the patient or her health care provider
Correct Answer: B
Rationale: The correct answer is B: Postterm pregnancy. Induction of labor is considered appropriate for postterm pregnancies to prevent potential complications for the mother and fetus. Postterm pregnancy is defined as a pregnancy that extends beyond 42 weeks gestation, increasing the risk of stillbirth and other adverse outcomes. Therefore, inducing labor in postterm pregnancies can help to ensure the well-being of both the mother and fetus.
Rationale for Incorrect Choices:
A: Fetal death - Induction of labor is not appropriate in cases of fetal death as there is no live fetus to deliver.
C: Rupture of membranes at or near term - Rupture of membranes alone does not always necessitate induction of labor unless there are other medical indications.
D: Convenience of the patient or her health care provider - Induction of labor should not be performed for convenience but rather for medical reasons to ensure the safety of the mother and fetus.
During labor, a patient using hydrotherapy reports feeling faint. What is the nurse's priority intervention?
- A. Remove the patient from the water.
- B. Increase the room temperature.
- C. Provide additional fluids orally.
- D. Notify the physician immediately.
Correct Answer: A
Rationale: The correct answer is A: Remove the patient from the water. This is the priority intervention because the patient's safety is at risk due to feeling faint. Removing the patient from the water helps prevent potential drowning or injury. Increasing room temperature (choice B) may worsen the patient's condition by increasing heat stress. Providing additional fluids orally (choice C) may not address the immediate risk of fainting. Notifying the physician immediately (choice D) is important, but ensuring the patient's safety by removing them from the water takes precedence.
The process of labor places significant metabolic demands on the obstetric patient. Which physiologic findings would be expected?
- A. Decreased maternal blood pressure as a result of stimulation of alpha receptors
- B. Uterine vasoconstriction as a result of stimulation of beta receptors
- C. Increased maternal demand for oxygen
- D. Increased blood flow to placenta because of catecholamine release
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct:
1. Labor is a physically demanding process that requires increased energy expenditure.
2. Increased uterine activity during labor leads to higher oxygen consumption by the mother.
3. Maternal demand for oxygen increases to meet the metabolic needs of both the mother and the fetus.
4. Adequate oxygen supply is crucial to support the increased workload during labor.
Summary:
A: Incorrect. Labor typically leads to increased blood pressure due to sympathetic activation, not decreased.
B: Incorrect. Uterine vasoconstriction is not expected during labor as it needs adequate blood supply for contractions.
D: Incorrect. Catecholamine release during labor can lead to vasoconstriction, not increased blood flow to the placenta.
A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation strategy for pain management. The nurse would
- A. assist her into the shower.
- B. apply a heat pack to lower back.
- C. help her to create a relaxing mental scen
- D. encourage cleansing breaths and slow-paced breathing.
Correct Answer: B
Rationale: The correct answer is B because applying a heat pack to the lower back can help alleviate labor pain through cutaneous stimulation. Heat therapy can increase blood flow, relax muscles, and reduce pain perception. Choice A is not specific to cutaneous stimulation and may not provide effective pain relief. Choice C focuses on mental imagery, not cutaneous stimulation. Choice D, while helpful for pain management, does not involve cutaneous stimulation.
A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5 minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment. When is the best time to ask questions or perform procedures?
- A. After the contraction is over
- B. When it is all right with the coach
- C. During the increment of the next contraction
- D. After administration of analgesic-anesthetic
Correct Answer: C
Rationale: The correct answer is C: During the increment of the next contraction. This is the best time for assessment as the patient is likely to be more focused and cooperative during this phase. Asking questions or performing procedures during the contraction or immediately after may be distracting or uncomfortable for the patient. Waiting until the contraction is over (choice A) may delay necessary assessment. Waiting for the coach's approval (choice B) may not always align with the patient's needs. Waiting until after administration of analgesic-anesthetic (choice D) may not be timely for necessary assessment and may also impact the patient's ability to provide accurate information.