Chapter 18 The Family in Childbirth: Needs and Care

Chapter 18   The Family in Childbirth: Needs and Care

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is orienting a new graduate nurse to the labor and birth unit. Which statement indicates that teaching has been effective? “When a patient arrives in labor:

1. “A urine specimen is obtained by catheter to check for protein and ketones.”
2. “She will be positioned supine to facilitate a normal blood pressure.”
3. “Her prenatal record is reviewed for indications of domestic abuse.”
4. “A vaginal exam is performed if delivery appears to be imminent.”

Answer:  4

Explanation:  1. A midstream clean-catch specimen is obtained to assess for proteinuria and ketonuria.

2. Supine position predisposes the patient to supine hypotension syndrome; side-lying is preferred.
3. Domestic abuse is not the sole reason the prenatal record is examined; any complications of pregnancy are noted.
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: 364

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Education

Learning Outcome:  LO 18.1-Identify admission data for a woman admitted to the birthing area.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

 

 

2) The client presents to labor and delivery stating that her water broke 2 hours ago. Indicators of normal labor include (select all that apply):

1. Fetal heart rate of 130 with average variability.
2. Blood pressure of 130/80.
3. Maternal pulse of 160.
4. Protein of +1 in urine.
5. Odorless, clear fluid on underwear.

Answer:  1, 2, 5

Explanation:  1. FHR 120 to 160 with variability is a normal indication.

2. Maternal vital sign of blood pressure below 140/70 is a normal indication.
3. A pulse of 60 to 100 is a normal indication.
4. Proteinuria of +1 or more could be a sign of pre-eclampsia.
5. Fluid clear and without odor is a normal indication.

Page Ref: 364-365

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 18.1-Identify admission data for a woman admitted to the birthing area.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

3) The laboring client and her partner have arrived at the birthing unit. Which step of the admission process should be undertaken first?

1. The sterile vaginal exam
2. Welcoming the couple
3. Auscultation of the fetal heart rate
4. Checking for ruptured membranes

Answer:  2

Explanation:  1. The sterile vaginal exam should be performed after rapport has been established and maternal vital signs have been assessed.

2. Establishing rapport will decrease anxiety of the couple and facilitate a more pleasant birth experience.
3. Welcoming the couple is more important upon arrival.
4. Although assessing for intact or ruptured membranes is a part of the admission assessment, welcoming the couple is more important upon arrival.

Page Ref: 364

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 18.2-Describe the nursing care of a woman and her partner/family upon admission to the birthing area.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

 

4) An expectant father has been at the bedside of his laboring partner for more than 12 hours. An appropriate nursing intervention would be to:

1. Insist that he leave the room for at least the next hour.
2. Tell him he is not being as effective as he was and that he needs to let someone else take over.
3. Offer to remain with his partner while he takes a break.
4. Suggest that the client’s mother might be of more help.

Answer:  3

Explanation:  1. Insisting that the father leave does not reassure him about the care the woman will receive in his absence.

2. Telling him that he is ineffective does not reassure him about the care the woman will receive in his absence.
3. Support persons frequently are reluctant to leave the laboring woman to take care of their own needs. Offering to stay with the woman so that he can take a break reassures the support person that the woman will be well cared for in his absence.
4. Suggesting that the client’s mother take his place does not reassure him about the care the woman will receive in his absence.

Page Ref: 365

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 18.2-Describe the nursing care of a woman and her partner/family upon admission to the birthing area.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.

 

5) The laboring client has been found to be having moderately strong contractions lasting 60 seconds every 3 minutes. The fetal head is presenting at a −2 station. The cervix is 6 cm and 100 percent effaced. The membranes spontaneously ruptured prior to admission, and clear fluid is leaking. Fetal heart tones are in the 140s with accelerations to 150. Which nursing action has the highest priority?

1. Encourage the husband to remain in the room.
2. Keep the client on bed rest at this time.
3. Apply an internal fetal scalp electrode.
4. Obtain a clean-catch urine specimen.

Answer:  2

Explanation:  1. It is unknown from the given information whether it is culturally appropriate for the client’s husband to remain in the room for the labor and birth.

2. Because the membranes are ruptured and the head is high in the pelvis at a −2 station, the client should be maintained on bed rest to prevent cord prolapse.
3. An internal fetal scalp electrode is placed when there are signs of fetal intolerance of labor. This client has normal fetal heart tones and clear amniotic fluid; no signs of fetal intolerance of labor are present.
4. A clean-catch urine specimen is usually obtained upon admission, but amniotic fluid contamination might falsely increase the protein present. Preventing cord prolapse, which is life-threatening to the fetus, is a higher priority.

Page Ref: 368

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 18.3-Use assessment data to determine the nursing interventions to meet the psychologic, social, physiologic, and spiritual needs of the woman and her partner/family during each stage of labor.

MNL LO:  Apply appropriate nursing care for the childbearing family during the first stage of labor.