Chapter 22 Birth-Related Procedures

Chapter 22   Birth-Related Procedures

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client’s chart requires immediate intervention?

1. “Multipara, transverse lie.”
2. “Primipara, frank breech ballotable.”
3. “Multipara, 32 weeks, complete breech.”
4. “Primipara, failed ECV last week.”

Answer:  3

Explanation:  1. This client has no contraindication to ECV.

2. This client has no contraindication to ECV.
3. ECV is not attempted until 36 weeks. This client is too early in her pregnancy for ECV.
4. Although this client is less likely to have a successful ECV this week if it was unsuccessful last week, there is no contraindication to attempting the procedure.

Page Ref: 405-406

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: Implementation/Coordination of care

Learning Outcome:  LO 22.1-Explain the methods, purpose, criteria, and contraindications of external version in determining nursing care management.

MNL LO:  Describe external version, its indications, and associated nursing considerations.

 

2) The clinical nurse coordinator is meeting with a group of nursing students in post conference to teach about caring for women who undergo artificial rupture of membranes (AROM) by way of amniotomy. Which nursing student’s statement indicates that the teaching has been effective?

1. “For women who undergo artificial rupture of membranes, vaginal examinations should be limited.”
2. “In most cases, it is appropriate to assess the fetal heart rate (FHR) right after the artificial rupture of membranes is performed.”
3. “Amniotomy is contraindicated for use in labor augmentation.”
4. “Women who undergo artificial rupture of membranes should be advised that they will experience a ‘dry birth.'”

Answer:  1

Explanation:  1. Following AROM, because there is now an open pathway for organisms to ascend into the uterus, the number of vaginal exams must be kept to a minimum to reduce the chance of introducing an infection.

2. In all cases, the FHR is assessed just before and immediately after the amniotomy, and the two FHR assessments are compared.
3. Amniotomy is an accepted method of labor augmentation.
4. Women need to know that amniotic fluid is constantly produced because some women may worry that they will experience a “dry birth.”

Page Ref: 406

Cognitive Level:  Understanding

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Essential III: Scholarship for evidence-based practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Education

Learning Outcome:  LO 22.3-Describe the use of amniotomy and the nursing care management of the woman and fetus.

MNL LO:  Discuss methods of labor induction and augmentation including implications for nursing care.

 

3) Induction of labor is planned for a 31-year-old primipara due to insulin-dependent diabetes. The client is 39 weeks’ gestation. She reports that she feels as though her baby has “flipped” in her abdomen. Which nursing action is most important?

1. Evaluate fetal maturity.
2. Administer dinoprostone (Prepidil) vaginal gel.
3. Implement continuous electronic fetal monitoring (EFM).
4. Notify the client’s healthcare provider that the patient feels as though her baby has changed position.

Answer:  4

Explanation:  1. Malpresentation, such as breech, is a relative contraindication to induction of labor. Before proceeding with preparation for induction of labor, the client will require additional evaluation by her physician before proceeding.

2. Malpresentation, such as breech, is a relative contraindication to induction of labor. Before proceeding with preparation for induction of labor, the client will require additional evaluation by her physician before proceeding.
3. Malpresentation, such as breech, is a relative contraindication to induction of labor. Before proceeding with preparation for induction of labor, the client will require additional evaluation by her physician before proceeding.
4. Because malpresentation, such as breech, is a relative contraindication to induction of labor, the client will require additional evaluation by her physician before proceeding.

Page Ref: 408-410

Cognitive Level:  Understanding

Client Need&Sub:  Physiological Integrity

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

Learning Outcome:  LO 22.2-Explain the indications, contraindications, labor readiness, and methods in determining the nursing care management for women during labor induction.

MNL LO:  Discuss methods of labor induction and augmentation including implications for nursing care.

 

4) The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous client states: “I can reduce the likelihood that I’ll tear or need an episiotomy if I:

1. “Push in a semi-sitting position.”
2. “Make sure I push long and hard.”
3. “Begin regular perineal massage.”
4. “Pull back on my legs when pushing.”

Answer:  3

Explanation:  1. Semi-sitting or lithotomy position increases the likelihood of perineal lacerations.

2. Short pushes during the expulsion of the head decrease the likelihood of perineal lacerations.
3. Perineal massage has been shown to decrease the need for episiotomy in primiparous clients.
4. Pulling back on the legs while pushing tightens the perineal tissue, which in turn increases the likelihood of perineal lacerations.

Page Ref: 410

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 22.2-Explain the indications, contraindications, labor readiness, and methods in determining the nursing care management for women during labor induction.

MNL LO:  Discuss methods of labor induction and augmentation including implications for nursing care.