Chapter 17 Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition

Chapter 17 Contemporary Maternal Newborn Nursing Care Maternal Newborn Nursing Care Nurse, Family, 8th Edition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCMA

The nurse is caring for laboring patients. Which women are experiencing problems related to a critical factor of labor?

Standard Text: 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 Answer: 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 patient is experiencing a problem between the maternal pelvis and the presenting part.

Rationale 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.

Rationale 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 patient is experiencing a problem between the maternal pelvis and the presenting part.

Rationale 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 patient is experiencing a problem between the maternal pelvis and the presenting part.

Rationale 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 patient is experiencing a problem between the maternal pelvis and the presenting part.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO01 – Describe the five critical factors that influence labor in the assessment of an expectant woman and fetus’s progress in labor and birth.

 

Question 2

Type: MCSA

The charge nurse has received a 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 patient is experiencing no complications.

Rationale 2: Longitudinal lie with cephalic presentation is a head-down position. This is expected.

Rationale 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.

Rationale 4: This patient 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 patient 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 patient requires education and a great deal of support and is therefore the top priority.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO02 – 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.

 

Question 3

Type: MCSA

The primiparous patient 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.

Rationale 2: The perineal body thinning primarily occurs during the second stage of labor; it is not expected now.

Rationale 3: This reply is not therapeutic. Although it is true that this patient 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.

Rationale 4: The hormones that cause labor contractions do not directly cause cervical change; the contractions cause the cervix to change.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO03 – Examine an expectant woman’s and fetus’s response to labor based on the physiological processes that occur during labor.

 

Question 4

Type: MCSA

The primiparous patient at 40 weeks’ gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best?

1. “Unless you have pain with urination, we don’t need to worry about it.”
2. “These symptoms usually mean the baby’s head has descended further.”
3. “Come in for an appointment today and we’ll check everything out.”
4. “This might indicate that the baby is no longer in a head down position.”

Correct Answer: 2

Rationale 1: Increased pelvic pressure and urinary frequency are premonitory signs of labor. These are not signs of a urinary tract infection.

Rationale 2: This is the best response because it most directly addresses what the patient has reported. Increased pelvic pressure and urinary frequency are premonitory signs of labor.

Rationale 3: There is no need for an additional appointment, as increased pelvic pressure and urinary frequency are premonitory signs of labor.

Rationale 4: The patient is experiencing premonitory signs of labor; the fetus changing to a breech presentation would be experienced as fetal movement that was formerly felt in the upper abdomen but now is down in the pelvis.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Health Promotion and Maintenance

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO04 – Assess for the premonitory signs of labor when caring for an expectant woman