Chapter 22 The Family in Childbirth: Needs and Care

Chapter 22   The Family in Childbirth: Needs and Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The laboring client is at 7 cm, with the vertex at a +1 station. Her birth plan indicates that she and her partner took Lamaze prenatal classes, and they have planned on a natural, unmedicated birth. Her contractions are every 3 minutes and last 60 seconds. She has used relaxation and breathing techniques very successfully in her labor until the last 15 minutes. Now, during contractions, she is writhing on the bed and screaming. Her labor partner is rubbing the client’s back and speaking to her quietly. Which nursing diagnosis should the nurse incorporate into the plan of care for this client?

1. Fear/Anxiety related to discomfort of labor and unknown labor outcome
2. Pain, Acute, related to uterine contractions, cervical dilatation, and fetal descent
3. Coping: Family, Compromised, related to labor process
4. Knowledge, Deficient, related to lack of information about normal labor process and comfort measures

Answer:  2

Explanation:  2. The client is exhibiting signs of acute pain, which is both common and expected in the transitional phase of labor.

Page Ref: 509

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: I. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | NLN Competencies: Relationship-Centered Care: Promote and accept the patient’s emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome:  1 Identify nursing diagnoses specific to the first, second, third, and fourth stages of labor.

MNL LO:  3.2.1 Apply appropriate nursing care for the child-bearing family during the 1st stage of labor.

 

2) A client is admitted to the labor and delivery unit with contractions that are regular, are 2 minutes apart, and last 60 seconds. She reports that her labor began about 6 hours ago, and she had bloody show earlier that morning. A vaginal exam reveals a vertex presenting, with the cervix 100% effaced and 8 cm dilated. The client asks what part of labor she is in. The nurse should inform the client that she is in what phase of labor?

1. Latent phase
2. Active phase
3. Transition phase
4. Fourth stage

Answer:  3

Explanation:  3. The transition phase begins with 8 cm of dilatation, and is characterized by contractions that are closer and more intense.

Page Ref: 516

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  2 Describe factors that are assessed in the laboring woman during the admission process.

MNL LO:  3.2.1 Apply appropriate nursing care for the child-bearing family during the 1st stage of labor.

 

3) Usually, the family is advised to arrive at the birth setting at the beginning of the active phase of labor or when which of the following occur?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Rupture of membranes (ROM)
2. Increased fetal movement
3. Decreased fetal movement
4. Any vaginal bleeding
5. Regular, frequent uterine contractions (UCs)

Answer:  1, 3, 4, 5

Explanation:  1. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when the membranes rupture.

3. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is decreased fetal movement.
4. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there is any vaginal bleeding.
5. The family is advised to arrive at the birth setting at the beginning of the active phase of labor or when there are regular, frequent uterine contractions.

Page Ref: 509

Cognitive Level:  Understanding

Client Need/Sub:  Safe and Effective Care Environment: Management of Care

Standards:  QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  2 Describe factors that are assessed in the laboring woman during the admission process.

MNL LO:  3.2.1 Apply appropriate nursing care for the child-bearing family during the 1st stage of labor.

 

 

4) The client presents to the labor and delivery unit stating that her water broke 2 hours ago. Barring any abnormalities, how often would the nurse expect to take the client’s temperature?

1. Every hour
2. Every 2 hours
3. Every 4 hours
4. Every shift

Answer:  3

Explanation:  3. Maternal temperature is taken every 4 hours unless it is above 37.5°C. If elevated, it is taken every hour.

Page Ref: 515

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  2 Describe factors that are assessed in the laboring woman during the admission process.

MNL LO:  3.2.1 Apply appropriate nursing care for the child-bearing family during the 1st stage of labor.

 

5) The nurse is orienting a new graduate nurse to the labor and birth unit. Which statement indicates that teaching has been effective?

1. “When a client arrives in labor, a urine specimen is obtained by catheter to check for protein and ketones.”
2. “When a client arrives in labor, she will be positioned supine to facilitate a normal blood pressure.”
3. “When a client arrives in labor, her prenatal record is reviewed for indications of domestic abuse.”
4. “When a client arrives in labor, a vaginal exam is performed unless birth appears to be imminent.”

Answer:  4

Explanation:  4. Unless delivery seems imminent because the client is bearing down or contractions are very close and strong, the vaginal exam is performed after the vital signs are obtained.

Page Ref: 515

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  2 Describe factors that are assessed in the laboring woman during the admission process.

MNL LO:  3.2.1 Apply appropriate nursing care for the child-bearing family during the 1st stage of labor.