Mental Health OB Lesson Questions

Question 1 of 8 Occiput posterior refers to which component of the birth process? • o • Powers The powers of labor are uterine contractions and maternal pushing efforts. Correct o Passenger Occiput posterior refers to the fetal presentation within the female pelvis. The occiput anterior position is the most favorable for vaginal birth. • o Passage Passage refers to the shape and size of the maternal pelvis. There are four pelvic types: gynecoid, android, anthropoid, and platypelloid. • o Psyche Maladaptive stress responses decrease a woman’s ability to cope during labor. Adaptive responses to stress augment the natural birth process. Question 2 of 8 Which passenger position would interfere with a safe vaginal birth? • Correct o Transverse fetal lie The fetal lie is the relationship of the long axis of the baby to the long axis of the mother. With a transverse fetal lie, there is a significant risk for fetal distress, trauma, and maternal trauma if vaginal delivery occurs. • o Flexed fetal head The fetal attitude refers to the fetal body parts in relationship to one another. A normal fetal attitude and one that favors uncomplicated vaginal delivery is flexion of the head. Extension of the head can result in difficult labor, complicated or surgical birth, and trauma to the baby as a result of a complicated birth. • o Cephalic presentation The cephalic, or head-down, position favors vaginal birth. • o Longitudinal fetal lie The fetal lie is the relationship of the long axis of the baby to the long axis of the mother. Up to 99% of pregnancies have a longitudinal lie. This is the safest lie for the fetus. Question 3 of 8 A woman is visibly anxious, refuses position changes in labor, and verbalizes, “I’m afraid I’m going to die.” The nurse knows it is important to help the woman relax through effective coaching because of which responses to stress experienced in labor? • Correct o Fetal intolerance to labor Stress results in the release of catecholamines, which decrease blood flow to the placenta and fetus and can lead to fetal intolerance to labor. • o Bradycardia related to a vagal response Most patients experience tachycardia when under stress, because of the fight-or-flight response. • Correct o Release of catecholamines in the mother’s body Stress in labor results in the release of catecholamines. • Correct o Inhibited uterine contractions because of decreased blood flow to the placenta Decreased blood flow to the uterus can lead to inhibited uterine contractions. • o Umbilical cord prolapse This is when the umbilical cord comes through the cervical canal before the baby. Question 4 of 8 Which action taken by the patient will reduce discomfort during Leopold maneuvers and make fetal presenting parts easier to feel? • o Standing Standing while performing Leopold maneuvers makes it impossible to adequately assess the fetal lie, position, and presenting part and is extremely uncomfortable for the patient. A different position should be used. • o • Lying prone The woman lies supine with her knees flexed slightly or head slightly elevated to help her relax her abdominal muscles. Correct o Emptying the bladder Emptying the bladder reduces discomfort during palpation and makes fetal parts easier to feel. • o Pushing or bearing down with contractions Urging the woman to push or bear down with contractions is done after the fetus’s position is determined and the birth process begins. Question 5 of 8 A woman with an epidural is 10 cm dilated and the baby is at 0 station. There is a reassuring fetal heart pattern, although the woman does not feel the urge to push. Which are appropriate actions by the nurse? • Correct o Encourage the patient to wait to push until she feels the urge. Even with an epidural, a patient usually feels the urge to push as the fetal head descends. This is known as the Ferguson reflex. She should be encouraged to “labor down.” • o Perform another vaginal examination to check for dilation. A vaginal examination is not indicated at this time. • o Encourage the patient to push so that the baby can be born. Pushing before the Ferguson reflex can prolong pushing time, increases the risk for maternal exhaustion, and is not necessary. As long as there is a reassuring fetal heart tracing, laboring down is acceptable and encouraged. • Correct o Encourage frequent position changes while remaining in the bed. Frequent position changes help the fetus to descend in the pelvis. This will help trigger the Ferguson reflex. It also promotes uteroplacental perfusion. • o Turn off the epidural so the patient can feel the urge to push. Even in the presence of an epidural, when dosed appropriately most patients will still experience the Ferguson reflex. Question 6 of 8 What would the nurse expect when caring for a fullterm primigravida who presents for a routine office visit and is not in labor? • o • Correct A fundal height that measures 30 cm This would be a very low fundal height for a full-term patient and would suggest fetal growth problems. o A fetus that is engaged in the maternal pelvis Fetal engagement often occurs before the beginning of labor in primigravidas, where with multigravidas the fetus often does not engage until labor begins. • o A cervix that is already 3 cm dilated It is not typical of a primigravida to be 3 cm dilated before the start of labor. • o Fetal station of −3 Fetal engagement begins at 0 station. The fetus often engages before the start of labor in primigravidas. Question 7 of 8 A pregnant woman arrives at the emergency department, and after completing a vaginal examination the nurse midwife states that the patient is 5 cm dilated and 75% effaced and the fetus is at −3 station. Which statement is accurate regarding this assessment? • o The patient may initiate pushing efforts. A patient should not begin pushing until 10 cm dilated. • o The cervix is fully dilated. Complete cervical dilation is 10 cm. • o The cervix is fully effaced. A cervix is fully effaced at 100%. • Correct o The fetus is not engaged within the maternal pelvis. Fetal engagement begins at 0 station. Question 8 of 8 How is effacement measured? • Correct o Through digital palpation by a trained professional Digital palpation and transvaginal ultrasound can estimate cervical effacement. • Correct o Using transvaginal ultrasound Digital palpation and transvaginal ultrasound can estimate cervical effacement. • o By estimating the stage of labor Stage of labor does not measure cervical effacement. • o Though palpation of cervical dilation A patient’s dilation does not measure cervical effacement. • o Through Leopold maneuvers Leopold maneuvers estimate fetal position and size.