Chapter 17 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Chapter 17 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 17_LO01_Q01

The nurse is caring for laboring clients. Which women are experiencing problems related to a critical factor of labor? Select all that apply.

1. Primip at 7 cm, fetus in military attitude
2. Multip at 3 cm, fetus in longitudinal lie
3. Primip at 4 cm, fetus with macrocephaly due to hydrocephalus
4. Multip at 6 cm, fetus at −2 station, mild contractions
5. Primip at 5 cm, fetal presenting part is right shoulder.

Correct Answers: 1, 3, 4, 5

Rationale:

1. Attitude refers to the relationship of the fetal parts to one another. Military attitude is an unflexed neck; normal fetal attitude is flexion of the neck. Military attitude creates a larger diameter of the head fitting through the pelvis. This client is experiencing a problem between the maternal pelvis and the presenting part.
2. Lie refers to the relationship between the cephalocaudal axis of the mother to the cephalocaudal axis of the fetal body; longitudinal lie is normal.
3. Hydrocephalus can lead to macrocephaly, or an abnormally large head. Macrocephalic babies might not fit through the bony pelvis, and could require birth by cesarean. This client is experiencing a problem between the maternal pelvis and the presenting part.
4. Station refers to how low in the pelvis the baby’s presenting part is; −2 station is high in the pelvis. Contractions should be strong to cause fetal descent and cervical dilation. Mild contractions will not move the baby down or open the cervix. This client is experiencing a problem between the maternal pelvis and the presenting part.
5. The presenting part is the fetal part coming through the cervix. The occiput or back of the baby’s head is the most common and most effective presenting part. A shoulder presentation cannot deliver vaginally, and will require a cesarean birth. This client is experiencing a problem between the maternal pelvis and the presenting part.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 17.1 Describe the five critical factors that influence labor in the assessment of an expectant woman and fetus’s progress in labor and birth.

Chapter 17_LO02 _Q02

The charge nurse has received shift change report. Which patient requires immediate intervention?

1. Multip at 6 cm undergoing induction of labor, strong contractions every three minutes
2. Primip at 4 cm whose fetus is in a longitudinal lie with an cephalic presentation
3. Multip at 10 cm and fetus at +2 station experiencing a strong expulsion urge
4. Primip at 3 cm screaming in fear because her mother died during childbirth

Correct Answer: 4

Rationale:

1. Strong contractions every three minutes are an adequate labor pattern during induction of labor. This client is experiencing no complications.
2. Longitudinal lie with cephalic presentation is a head-down position. This is expected.
3. 10 cm is fully dilated; a +2 station is low in the pelvis. A strong expulsion urge is the urge to push, which will facilitate the birth of the child. These are expected.
4. This client is most likely fearful that she will die during labor if her mother died during childbirth. It is very rare to die during childbirth in developing countries. The extreme fear this client is experiencing could stimulate the fight-or-flight mechanism and hormone cascade, which can significantly slow the progress of her labor; screaming and muscle tension increase the body’s oxygen consumption, and in extreme cases can lead to fetal hypoxia. This client requires education and a great deal of support, and is therefore the top priority.

Cognitive level: Assessment

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Analysis

Learning Outcome: 17.2 Summarize the implications of abnormalities present in each of the five critical factors on the outcome of labor and the health of the expectant woman and the fetus.

Chapter 17_LO03 _Q03

The primiparous client has asked the nurse why her cervix has only changed from 1 to 2 cm in three hours of contractions occurring every five minutes. The best response by the nurse is:

1. “Your cervix has also effaced, or thinned out, and that change in the cervix is also labor progress.”
2. “When your perineal body thins out, your cervix will begin to dilate much faster than it is now.”
3. “What did you expect? You’ve only had contractions for a few hours. Labor takes time.”
4. “The hormones that cause labor to begin are just getting to be at levels that will change your cervix.”

Correct Answer: 1

Rationale:

1. Cervical effacement must be nearly complete before cervical dilation takes place in primips. This is why the labor and birth of a first baby usually take much less time than for subsequent labor and births.
2. The perineal body thinning primarily occurs during the second stage of labor; it is not expected now.
3. This reply is not therapeutic. Although it is true that this client has only been in early labor for a short time, and it is true that labor for a primip averages 12–24 hours, the nurse must always be therapeutic in all communication.
4. The hormones that cause labor contractions do not directly cause cervical change; the contractions cause the cervix to change.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 17.3 Examine an expectant woman’s and fetus’s response to labor based on the physiological processes that occur during labor.