Nursing Roles in Labor and Delivery

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Questions and Answers

A primiparous woman at 41 weeks gestation presents with a fetal heart rate tracing demonstrating repetitive late decelerations. The most appropriate initial intervention, predicated on the underlying pathophysiology, is:

Maternal repositioning to the left lateral decubitus position, supplemental oxygen administration via non-rebreather mask, and intravenous fluid bolus to address potential placental insufficiency. (correct)

Insertion of a fetal scalp electrode to obtain a more accurate fetal heart rate tracing and application of warm compresses to the maternal abdomen to promote fetal relaxation.

Immediate preparation for emergency cesarean delivery, anticipating fetal acidosis and potential need for neonatal resuscitation.

Administration of a tocolytic agent, such as terbutaline, to reduce uterine activity and improve uteroplacental perfusion.

The presence of cotyledons on the fetal side of the placenta is an indicator of placental abruption.

False (B)

During the active phase of labor, a nulliparous woman requests an epidural. Describe the anatomical layers that the epidural needle must traverse to reach the epidural space, but without puncturing the dura mater. List the layers in the correct order from superficial to deep.

Skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum.

The umbilical cord's vascular structure comprises two and one , which facilitate fetal-placental circulation.

arteries, vein Signup and view all the answers

Match the stage of labor with its cardinal movement:

First Stage, Active Phase = Progressive cervical dilation and effacement Second Stage = Descent, flexion, internal rotation, extension, external rotation, expulsion Third Stage = Placental separation and expulsion Fourth Stage = Physiologic stabilization and bonding Signup and view all the answers

A laboring patient exhibiting signs of hyperventilation, including carpopedal spasms and circumoral paresthesia, should be immediately assessed for:

Respiratory alkalosis secondary to excessive carbon dioxide exhalation. (B) Signup and view all the answers

Administration of nitrous oxide during labor is contraindicated in patients with confirmed methylenetetrahydrofolate reductase (MTHFR) deficiency due to the risk of acute neurological sequelae.

True (A) Signup and view all the answers

Differentiate between a pudendal block and local infiltration anesthesia in the context of postpartum perineal pain management, detailing their respective mechanisms of action and clinical applications.

A pudendal block targets the pudendal nerve to provide broader perineal anesthesia, often for second-stage labor or operative vaginal deliveries, while local infiltration involves direct injection of anesthetic into the perineal tissue for localized pain relief, typically for episiotomy repair. Signup and view all the answers

The primary nursing intervention for a patient experiencing hypotension following epidural placement is to administer a bolus of fluid and, if unresponsive, prepare for the administration of , a vasopressor.

intravenous, ephedrine Signup and view all the answers

Match each non-pharmacological pain management technique to its primary physiological mechanism during labor:

Hydrotherapy = Gate control theory of pain modulation via thermal stimulation Acupuncture = Release of endogenous opioids via specific nerve stimulation Breathing Techniques = Distraction and controlled respiration affecting autonomic nervous system Therapeutic Touch = Modulation of energy fields to promote relaxation and reduce anxiety Signup and view all the answers

A primiparous woman at 41 weeks gestation is admitted to the labor and delivery unit. Upon initial assessment, the fetal heart rate (FHR) tracing demonstrates repetitive late decelerations. Which of the following interventions is MOST critical to implement prior to notifying the attending physician, assuming all interventions can be initiated concurrently?

Immediately repositioning the mother to a lateral decubitus position and administering oxygen via non-rebreather mask at 10-12 L/min. (B) Signup and view all the answers

In cases of shoulder dystocia, the McRoberts maneuver involves hyperflexing the mother's legs tightly to her abdomen to straighten the sacrum, and suprapubic pressure should be applied simultaneously along the fetal anterior shoulder in the direction of the fetal spine.

False (B) Signup and view all the answers

A nulliparous woman at 39 weeks gestation presents to the triage unit reporting spontaneous rupture of membranes. What is the MOST appropriate clinical action after confirming rupture of membranes and assessing fetal heart rate?

Assess cervical dilation and effacement. Signup and view all the answers

In the context of fetal monitoring, a Category III fetal heart rate tracing is characterized by absent baseline variability and recurrent late decelerations or recurrent variable decelerations, and/or ______.

bradycardia Signup and view all the answers

Match the following descriptions of fetal positions with their corresponding abbreviations:

Left Occiput Anterior = LOA Right Sacrum Posterior = RSP Left Mentum Transverse = LMT Right Acromion Anterior = RAA Signup and view all the answers

Which of the following biophysical profile (BPP) components, when scored in isolation, is MOST indicative of chronic fetal hypoxia?

Amniotic fluid volume (AFV) with a single deepest pocket of 2 cm. (C) Signup and view all the answers

During labor, the Ferguson reflex is primarily mediated by parasympathetic innervation and leads to the suppression of the urge to push through inhibition of oxytocin release; therefore, voluntary pushing should be discouraged until full cervical dilation is achieved.

False (B) Signup and view all the answers

A patient at 37 weeks undergoes an amniocentesis, and her provider is concerned about fetal lung maturity. Provide the minimum Lecithin/Sphingomyelin (L/S) ratio result that would indicate fetal lung maturity.

2:1 Signup and view all the answers

The Nadolsky Maneuver addresses ______ dystocia by rotating the posterior shoulder 180 degrees to deliver the anterior shoulder.

shoulder Signup and view all the answers

Match the following factors influencing labor with the associated descriptions:

Philosophy = Encompasses the approach to labor, including the extent of interventions. Partner = Signifies the support and assistance offered by the partner or loved ones. Patience = Emphasizes the importance of allowing the labor process to unfold naturally. Patient Preparation = Involves education and readiness for labor, enhancing coping mechanisms. Signup and view all the answers

A primiparous woman at 40 weeks gestation presents to labor and delivery. Upon initial assessment, the nurse notes the patient is anxious, reporting contractions every 7-8 minutes lasting 30 seconds. Cervical exam reveals 1 cm dilation, 50% effacement, and the presenting part is at -3 station. Based on these findings, which of the following nursing interventions demonstrates the most astute understanding of the interplay between physiological and psychological factors in early labor?

Initiating a calming presence with focused breathing techniques, while explaining the normal progression of early labor and offering comfort measures, and ensuring the partner is fully integrated into the support process. (A) Signup and view all the answers

In the context of labor physiology, the initiation of parturition is solely attributed to a unilateral surge in oxytocin levels, overriding the influence of other hormonal and mechanical factors.

False (B) Signup and view all the answers

Describe, in detail, the multifaceted role of prostaglandins in cervical ripening and the initiation of uterine contractions during the pre-labor and early labor phases. What specific prostaglandin isoforms are most implicated in these processes, and how do they exert their effects at the cellular level?

Prostaglandins, specifically PGE2 and PGF2α, play key roles in cervical ripening by promoting collagen breakdown and increasing cervical compliance. They also stimulate uterine contractions by increasing intracellular calcium concentrations in myometrial cells. PGE2 primarily induces cervical changes, while PGF2α mainly enhances uterine contractility. Signup and view all the answers

During the active phase of labor, a contraction's intensity will be influenced by administration of ______, which is a synthetic form of oxytocin.

Pitocin Signup and view all the answers

Match the 'P' of labor with its corresponding description.

Passageway = The anatomy of the mother’s bony pelvis and soft tissues of the birth canal. Passenger = Fetal size, presentation, position, and other fetal factors. Powers = The force of uterine contractions and maternal pushing efforts. Position = Maternal postures and movement during labor. Psychological Response = The mother's emotional and mental state during labor. Signup and view all the answers

Which of the following scenarios best exemplifies a nuanced understanding of 'position' as one of the 5 'Ps' of labor, going beyond the basic definition?

A multiparous woman experiencing a prolonged second stage is coached to adopt an asymmetric, upright position to leverage gravity and alter pelvic diameters to facilitate fetal descent through the birth canal. (C) Signup and view all the answers

The exclusive role of the labor and delivery nurse is confined to the continuous electronic fetal monitoring and the administration of prescribed medications, negating the need for psychosocial support.

False (B) Signup and view all the answers

Elaborate on the physiological mechanisms through which a 'bloody show' manifests as a sign of approaching labor, differentiating it from other forms of vaginal bleeding during pregnancy. What specific hormonal and mechanical changes contribute to its occurrence, and how does its appearance correlate with cervical status and labor progression?

A 'bloody show' is the expulsion of the mucus plug, resulting from disruption of cervical capillaries as the cervix softens, effaces, and begins to dilate. Hormonal changes, like increased prostaglandin levels, and mechanical pressure from the fetal presenting part contribute to this process. Its appearance suggests the onset of cervical changes and impending labor. Signup and view all the answers

The term used to describe the descent of the fetal head into the maternal pelvis, often experienced a few weeks before labor in nulliparous women, is commonly referred to as ______.

Lightening Signup and view all the answers

A patient at 39 weeks gestation reports experiencing an 'energy burst' and an overwhelming need to clean and organize her home. Evaluate the following interpretations of this phenomenon and select the most comprehensive explanation from an evolutionary biology perspective:

The 'nesting' instinct is an endocrinologically mediated behavior pattern that ensures a safe and provisioned environment for the neonate, thereby enhancing offspring survival. (C) Signup and view all the answers

In the context of immediate postpartum care, which of the following interventions requires the most astute and nuanced differentiation between expected physiological changes and early signs of impending maternal compromise, thus demanding the highest level of clinical judgment?

Continuous monitoring of maternal blood pressure trends, particularly focusing on pulse pressure variations, in conjunction with subjective pain assessment, to distinguish between normal adaptation and hypovolemic shock. (B) Signup and view all the answers

The primary rationale for incorporating environmental protection as a key responsibility of the labor and delivery nurse stems exclusively from the mandate to minimize iatrogenic infections within the immediate patient care environment.

False (B) Signup and view all the answers

Describe the nuanced decision-making process a labor and delivery nurse must undertake when confronted with a non-reassuring fetal heart rate tracing exhibiting prolonged decelerations, detailing at least three distinct differential diagnoses considered and the immediate intervention strategy implemented, justifying the selected approach based on potential underlying etiologies.

The nurse must differentiate between potential causes such as umbilical cord compression (relieved by repositioning), placental abruption (requiring immediate delivery), and maternal hypotension (treated with IV fluids and positioning). Immediate interventions may include administering oxygen, repositioning the mother, discontinuing oxytocin, and preparing for potential emergency delivery. The choice of intervention is based on the most likely cause and the severity of the fetal response. Signup and view all the answers

In the context of postpartum hemorrhage risk stratification, the administration of ___________ constitutes a critical intervention predicated on its capacity to stimulate potent uterine contractions, thereby effectively mitigating the potential for excessive blood loss following placental expulsion.

oxytocin Signup and view all the answers

Match each postpartum assessment parameter with its corresponding clinical significance in the immediate postpartum period:

Fundal height and consistency = Indicator of uterine involution and risk of postpartum hemorrhage Lochia color, amount, and odor = Reflects the stage of uterine healing and potential infection Bladder status = Impacts uterine contractility and risk of urinary retention/infection Perineal integrity = Indicates the presence of trauma and guides pain management strategies Signup and view all the answers

In the realm of neonatal resuscitation algorithms, what singular alteration in ventilation strategy would be most judicious when managing a preterm neonate born at 28 weeks gestation, exhibiting persistent bradycardia despite effective positive-pressure ventilation with room air?

Maintain positive-pressure ventilation while titrating the FiO2 to achieve a preductal oxygen saturation target of 85-95%, considering the potential for retinopathy of prematurity. (D) Signup and view all the answers

Documentation, as a responsibility of the labor and delivery nurse, is solely confined to the accurate recording of physiological parameters and administered interventions, thereby excluding any subjective assessments of the mother's emotional or psychological state.

False (B) Signup and view all the answers

Articulate a comprehensive, evidence-based protocol for managing shoulder dystocia during vaginal delivery, incorporating at least four distinct maneuvers (beyond McRobert's) and delineating the specific biomechanical principles underlying their efficacy in disimpacting the fetal shoulder.

Beyond McRobert's maneuver, consider suprapubic pressure (to dislodge the anterior shoulder), Rubin's maneuver (applying pressure to the posterior aspect of the anterior shoulder to rotate it), Wood's screw maneuver (rotating the fetus 180 degrees), and delivery of the posterior arm (to reduce shoulder girdle diameter). Each maneuver aims to alter the fetal position and/or maternal anatomy to facilitate delivery. Clear communication and coordinated teamwork are paramount. Signup and view all the answers

In the context of Apgar scoring, a neonate exhibiting a heart rate of 90 bpm, slow and irregular respirations, some flexion of extremities, a grimace response to stimulation, and a blue-tinged body with pink extremities would receive an aggregate score of __________.

5 Signup and view all the answers

When evaluating a postpartum patient who reports severe perineal pain despite regular administration of prescribed analgesics, what additional assessment should be prioritized to rule out a potential cause of disproportionate pain?

Carefully inspect the perineum for signs of hematoma formation and assess for any bulging or discoloration. (D) Signup and view all the answers

Flashcards

Nurse's Role in Labor

Nurses provide comfort, assessments, and education, intervening when necessary.

Factors that Initiate Labor

Labor starts due to uterine stretch, hormone changes, and pressure from the baby.