Question 1

The perinatal nurse observes a woman entering the transition phase of labor while she uses a patterned breathing method to cope with the increasing strength of contractions.She complains of light-headedness and tingling in her fingers.The most appropriate intervention by the nurse is to assist the patient in doing which of the following?

Accepted Answer

The symptoms of respiratory alkalosis are light-headedness,dizziness,tingling of the fingers,or circumoral numbness.Strategies to eliminate respiratory alkalosis focus on replacement of the bicarbonate ion by rebreathing carbon dioxide.This can be accomplished by instructing the woman to breathe into a paper bag held tightly around the mouth and nose or,if no bag is available,instructing her to breathe into her cupped hands.

Question 2

A woman is preparing for whirlpool bath hydrotherapy.To ensure patient safety,what action by the nurse is best?

Accepted Answer

For safety,water temperature should remain between 96.8 and 100.4°F (36-38°C).The other actions are not necessary.

Question 3

A nursing instructor is explaining the differences between the somatic and visceral pain felt by women in labor to a class of nursing students.Which statement about these two types of pain is inconsistent with thorough knowledge of these two types of pain?

Accepted Answer

Somatic pain is sharp,intense,well-localized,burning,or prickling pain felt during the second stage of labor.It is caused by stretching of the perineal body,distention and traction,and soft tissue lacerations.Visceral pain is predominant during the first stage of labor.This deep,dull and aching,poorly localized pain is usually felt only during contractions.

Question 4

The woman in labor is complaining of severe back pain.What action should the nurse suggest to the birth partner?

Accepted Answer

Counterpressure is performed when the support person uses the fist or heel of the hand to apply steady pressure to the sacral area.This can be especially helpful when the woman is having back pain due to the pressure of the occiput against spinal nerves while the fetus is in a posterior position.Massage has demonstrated some usefulness,but more studies are needed.Effleurage is a gentle stroking technique performed in rhythm with contractions.Therapeutic touch is provided by trained personnel.

Question 5

A patient in labor complains of a pain rating of 7 on a 1-to-10 scale.On assessing the patient further,the nurse finds her vital signs to be within normal limits,the patient is calm and cooperative,and she voided 400 mL 30 minutes ago.What action by the nurse is best?

Accepted Answer

Quite simply,pain is what the patient says it is,and the nurse should treat this patient according to the treatment plan.Although there are objective signs that can be assessed with pain (changes in vital signs,emotional changes,and decreased urinary output),their absence does not invalidate the woman's complaints.

Question 6

The perinatal nurse prepares the laboring woman for an epidural anesthesia insertion.What action is best to help prevent maternal hypotension?

Accepted Answer

Complications that may occur with spinal anesthesia block include maternal hypotension,decreased placental perfusion,and an ineffective breathing pattern.Prior to administration,the patient's fluid balance is assessed,and IV fluids are administered to reduce the potential for sympathetic blockade (decreased cardiac output that results from vasodilation with pooling of blood in the lower extremities).Following administration of the anesthetic,the patient's blood pressure,pulse and respirations,and fetal heart rate must be taken and documented every 5 to 10 minutes; however,assessing vital signs will not prevent hypotension from occurring.The woman is helped to a sitting position on the side of the bed.Deep cleansing breaths may be helpful for relaxation,but will not help prevent hypotension.

Question 7

The perinatal nurse explains to the new graduate nurse that fear and anxiety have physiological consequences in labor.The nurse is referring to what physiological process?

Accepted Answer

As muscle tension increases due to fear or anxiety,the effectiveness of uterine contractions decreases.Maternal pain is intensified.This leads to decreased labor progress.

Question 8

The perinatal nurse suggests that a laboring woman may wish to use the birth ball.The patient questions the rationale for this suggestion.The best answer by the nurse is that use of the birth ball will facilitate what action?

Accepted Answer

Assuming a sitting position on the birth ball facilitates a supported squatting position that opens the pelvis to allow fetal descent in preparation for birth.

Question 9

The perinatal nurse is caring for a woman in early labor with a fetus in the occiput posterior position.What action should the nurse perform to increase the woman's comfort?

Accepted Answer

Assuming a hands-and-knees position will help relieve the pressure on the woman's back when the fetus is in a posterior position.This also helps the fetus rotate to a more favorable position.The other interventions will not be as helpful.

Question 10

The perinatal nurse is caring for a Native American woman in labor with her first baby.The patient asks about the possibility of burning sweet grass,a part of her cultural tradition,during labor.Which of the following is the best response by the nurse?

Accepted Answer

When providing care,nurses must recognize that culture strongly influences how one perceives and copes with pain.Assessment of cultural beliefs and practices,questions to identify specific needs,and encouragement and support to use safe interventions is key in providing culturally sensitive care that empowers the patient to maintain her sense of control over her labor and childbirth experience.The nurse should make every attempt to accommodate this woman's request as long as safety is not compromised.If the ritual is not permitted,the nurse can work with the patient to find an acceptable alternative.Using open-ended questions is preferable to yes-no questions for gathering information.

Question 11

A woman is using a birth ball to promote comfort and fetal descent.The nurse observes the woman rocking back and forth while sitting on the ball.What action by the nurse is most appropriate?

Accepted Answer

The birth ball helps with comfort and fetal descent during labor.The patient is using it correctly; the two methods are moving it in a circle and rocking back and forth.The nurse should assess her response to this modality and document it.There is no time restriction on using a birth ball.

Question 12

A nurse is coaching a woman in labor in patterned breathing.To use the slow-paced breathing method,which instruction is best?

Accepted Answer

With the slow-paced breathing pattern,the woman first takes a deep cleansing breath,then breathes slowly in and out of her mouth at about half her normal respiratory rate.Her coach counts slowly to 4 during inhalation and again during exhalation.Blowing out the candle is an instruction given during transition with the pattern-paced method.The woman should begin and end each contraction with a deep cleansing breath.Telling the woman that her respiratory rate will be half of the normal rate does not provide any specific instruction for her to follow.

Question 13

The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily for which of the following?

Accepted Answer

Combining an opioid with a local anesthetic agent reduces the total amount of anesthetic required and helps to preserve a greater amount of maternal motor function.

Question 14

A woman has just given birth to an infant weighing 9 lb,15 oz (4,350 g)with the assistance of forceps and an episiotomy.The patient received a pudendal block 12 minutes before the birth.The perinatal nurse would expect which of the following responses to the block?

Accepted Answer

A pudendal nerve block provides pain relief in the lower vagina,vulva,and perineum.It should be administered 10 to 20 minutes before perineal anesthesia is needed and may be used late in the second stage of labor if an episiotomy is to be performed or if forceps or vacuum extraction will be used to facilitate birth.

Question 15

A patient in labor has internal fetal monitoring and normal vital signs.All fetal signs are reassuring.She wishes to try whirlpool bath hydrotherapy as a comfort measure.Which action by the nurse is best?

Accepted Answer

Hydrotherapy can provide excellent comfort for many women in labor; however,the presence of internal fetal monitoring electrodes is a contraindication to the use of whirlpool tubs or jet hydrotherapy.The nurse should inform her of this and explore other comfort measures.The other options are not appropriate.

Question 16

A woman is being prepared for an elective cesarean birth.The perinatal nurse assists the anesthesiologist with the spinal block and then positions the patient in a supine position.The patient's blood pressure drops to 90/52 mm Hg and there is a decrease in the fetal heart rate to 110 beats/minute.Which response by the nurse is best?

Accepted Answer

In the event of severe maternal hypotension,the nurse should place the patient in a lateral position or use a wedge under the hip to displace the uterus,elevate the legs,maintain or increase the IV infusion rate,and administer oxygen by face mask at 10 to 12 L/min,or according to institution protocol.Narcan is used to reverse the effects of opioids.Ephedrine would be the drug of choice for refractory hypotension if other measures don't work.The IV would not be discontinued.

Question 17

The perinatal nurse is aware that a 25-year-old woman with gestational hypertension in labor would benefit most from which pharmacological pain relief medication?

Accepted Answer

Epidural blocks are advantageous for patients with diabetes,heart disease,pulmonary disease,and,in some cases,gestational hypertension,because they essentially eliminate the pain associated with labor and thus reduce the maternal stress associated with labor discomfort.

Question 18

The perinatal nurse prepares to assess the labor of a patient who is in the triage area with her partner.She is contracting every 5 to 7 minutes and is very fearful about going home due to extreme fatigue and the distance to her house.The perinatal nurse determines that the patient is a fingertip dilated and50% effaced,and the cervix is anterior.The nurse might anticipate an order for what medication?

Accepted Answer

Secobarbital is the most commonly used barbiturate in labor.It is a fast-acting oral agent that produces mild sedation within 15 minutes following administration,and its effects last for 3 to 4 hours.For this woman,who is not yet ready for admission and exhausted,prescribed rest would be of benefit.

Question 19

A laboring woman has the nursing diagnosis of fear related to incomplete childbirth education.What assessment would best indicate that actions to decrease fear have been successful?

Accepted Answer

Anxiety and fear stimulate the release of catecholamines and heighten the sensation of pain.Decreased fear leads to relaxation and less pain.The other options do not show decreased fear.

Question 20

The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort?

Accepted Answer

Labor induction and augmentation,amniotomy,and vaginal examinations may be associated with intensifying labor discomfort.Amniotomy,which is the artificial rupture of the fetal membranes,may be performed using a plastic amnihook or surgical clamp.The occiput anterior position is the optimal position for the fetus.Proper breathing exercises and positional changes during labor facilitate comfort for the laboring woman.

Quiz 13: Promoting Patient Comfort During Labor and Birth