M/N - Week 3 - Durham/Chapman Ch. 8 Davis NCLEX Practice Q's - Exam 2 Rated A+

M/N - Week 3 - Durham/Chapman Ch. 8 Davis NCLEX Practice Q's - Exam 2 Rated A+ A nurse is caring for a patient who is in the active phase of the first stage of labor. How often should the nurse monitor fetal heart rate and contractions during this phase? 1. Every 5 to 10 minutes 2. Every 15 to 20 minutes 3. Every 30 to 40 minutes 4. Every 45 to 60 minutesAns- 2. Every 15 to 20 minutes The nurse should monitor fetal heart rate and contractions every 15 to 20 minutes in the active phase of the first stage of labor. A woman in labor is dilated 9 cm, effaced 100%, and has contractions that occur almost every minute and last 90 seconds. She is exhausted and has trouble concentrating. The nurse recognizes that this woman is in which phase of the first stage of labor? 1. Latent phase 2. Active phase 3. Transitional phase 4. Expulsive phaseAns- 2. Active phase The latent phase is the early and slower part of labor with an average length of 9 hours for primiparous and 5 hours for multiparous women. Women in this phase are talkative and able to relax with the contractions. Characteristics of this phase are cervical dilation from 0 to 3 cm with effacement from 0% to 40%, along with contractions occurring every 5 to 10 minutes, lasting 30 to 45 seconds, and being of mild intensity. Women often describe these contractions as feeling like strong menstrual cramps. The active phase is characterized by cervical dilation of 4 to 7 cm with effacement of 40% to 80%. Contractions become more intense, occurring every 2 to 5 minutes with a duration of 45 to 60 seconds. The woman tends to be more serious and fatigued in this phase and turns inward. The transition phase is characterized by cervical dilation of 8 to 10 cm with complete (100%) effacement. Contractions are intense, occur every 1 to 2 minutes, and last 60 to 90 seconds. It is the shortest but most difficult phase of the first stage of labor, and the woman is typically exhausted and has trouble concentrating. Expulsive refers to the second stage of labor, not a phase of the first. It involves the delivery of the baby. Early in labor, a patient tells the nurse that she had an awful experience with pain in her last pregnancy and would like strongest pain relief option available for a vaginal birth. Which of the following should the nurse suggest to the patient? 1. Parenteral opioids 2. Nitrous oxide 3. Epidural anesthesia 4. General anesthesiaAns- 3. Epidural anesthesia Parenteral opioids blunt but do not eliminate pain, and therefore are not the strongest form of pain relief in labor and delivery. Nitrous oxide is a combination of oxygen and nitrous oxide gas that is self-administered by the laboring woman using a mouth tube or face mask, when she determines that she needs it. As an analgesic, it relieves pain, but does not block it as effectively as an epidural. Epidural anesthesia involves placement of a very small catheter and injection of local anesthesia and/or analgesia between the fourth and fifth vertebrae into the epidural space. It has the potential of 100% blockage of pain. General anesthesia is not typically used in vaginal births. 4.Early in labor, a patient tells the nurse that she would like an unmedicated birth, in general, but would like some pain relief that is fast-acting, that she can administer hersef, and that will not interfere with the normal physiology and progress of labor. Which of the following should the nurse suggest to the patient? 1. Parenteral opioids 2. Nitrous oxide 3. Epidural anesthesia 4. General anesthesiaAns- 1. Parenteral opioids Parenteral opioids are considered a medication and can cause neonatal respiratory depression, so they do not meet the criteria of the patient. Nitrous oxide is a combination of oxygen and nitrous oxide gas that is self-administered by the laboring woman using a mouth tube or face mask, when she determines that she needs it. It can be started and stopped at any point during labor, according to the needs and preferences of the woman. It takes effect in about 50 seconds after the first breath, and the effect is transient. It is has no adverse effects on the normal physiology and progress of labor. Epidural anesthesia involves placement of a very small catheter and injection of local anesthesia and or analgesia between the fourth and fifth vertebrae into the epidural space. It involves the administration of a medication and is rather involved to set up, so it does not meet the criteria of the patient. General anesthesia is not typically used in vaginal births. 5.A nurse is monitoring a woman's progress during active labor. The nurse observes that the woman's cervix has thinned and shortened dramatically in the past 15 minutes. The nurse recognizes that this phenomenon is known as which of the following? 1. Dilation 2. Effacement 3. Bearing down 4. LighteningAns- 2. Effacement Dilation is the enlargement or opening of the cervical os. The cervix dilates from closed to 10 cm in diameter. Effacement is the shortening and thinning of the cervix. Before the onset of labor, the cervix is 2 to 3 cm long and approximately 1 cm thick. The degree of effacement is measured in percentage and goes from 0% to 100%. Bearing-down powers occur once the cervix is fully dilated (10 cm), and the woman feels the urge to push; she will involuntarily bear down. Lightening refers to the descent of the fetus into the true pelvis that occurs approximately 2 weeks before term in first-time pregnancies. A nurse is assisting a patient who has finished delivering her baby vaginally and is now delivering the placenta. The nurse recognizes that the woman is in which stage of labor? 1. First 2. Second 3. Third 4. FourthAns- 3. Third The first stage begins with the onset of