NM 704 EXAM 3 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Know the recommended frequency for the assessment of maternal vital signs in
the first stage of labor
BP, pulse, respirations: q 1 hour
Temp: q 2 to 4 hours when normal and membranes intact
OR 1 to 2 hours in the temp is abnormal and membranes have ruptured
Review the recommendations for frequency of fetal heart rate assessment during
labor
Continuous: No comp - q 15 min; comp - q 5 min
Intermittent: Acog - q 5 min; ACNM - Q 15 min before pushing, q 5 min during pushing;
AWHONN - Q 5 - 15 min
Review recommendation for the appropriate use of vaginal exams during the first
stage of labor
Consider why and when: will it change your management in any way?
Be familiar with the HISTORY of the policy of withholding foods and oral fluids
during labor
1918 - DeLee warned that food must be encouraged throughout labor to avoid general
weakness, delayed labor, and serious postpartum hemorrhage
1946 - Mendelson identified aspiration of stomach contents as the cause of post-
aspiration pneumonia and subsequent maternal mortality d/t delay in gastric emptying
,and increased gastric acidity
**the practice of feeding women in labor was deemed clinically unsound and NPO
policies were introduced
Know the CURRENT evidence regarding encouraging or withholding food or oral
fluids during labor
ASA currently recommends oral intake of modest clear liquids for uncomplicated pts
and case-by-case determination for high risk
Prolonged fasting can lead to ketosis, however no association has been shown between
ketosis and poor outcomes and the relationship is unclear
Prolonged fasting in labor has shown no increased risk for aspiration
Aspiration is more related to general anesthesia rather than regional which is more
commonly used today
List indications for IV access and/or IV fluids
Should be based on actual or potential risk factors for each individual
Need for increased hydration
Potential oxytocin administration, abx administration
For pre-epidural fluids or in case of med administration for emergency
, Understand the significance of ketonuria to the laboring woman
Occurs as a result of fat catabolism when glycogen scores are used up
May have deleterious effects on uterine function
No differences in duration of labor, augmentation of labor, cesarean sections, or Apgar
scores
Understand the potential hazards of dextrose containing intravenous hydration to
the fetus and newborn
In large doses can cause fetal lactic acidosis and newborn jaundice and hypoglycemia
Know the disadvantages of a supine maternal position in labor
Supine hypotension
May lead to an illusion of cephalopelvic disproportion d/t reduced pelvic diameter
Impedes rotation from OP or OT to OA
Requires pushing against gravity
Places fetus in unfavorable drive angle in relation to pelvis
Causes contractions to become more frequent, more painful, and less effective
Know the impact of squatting and "hands on knees" positions on pelvic
dimensions
The sagittal outlet and interspinous diameter are significantly greater than when supine;
women who are taller, younger, and parous had greater increases
List different positions and movements for labor and indicate their proposed
benefit
COMPLETE SOLUTIONS VERIFIED LATEST UPDATE
Know the recommended frequency for the assessment of maternal vital signs in
the first stage of labor
BP, pulse, respirations: q 1 hour
Temp: q 2 to 4 hours when normal and membranes intact
OR 1 to 2 hours in the temp is abnormal and membranes have ruptured
Review the recommendations for frequency of fetal heart rate assessment during
labor
Continuous: No comp - q 15 min; comp - q 5 min
Intermittent: Acog - q 5 min; ACNM - Q 15 min before pushing, q 5 min during pushing;
AWHONN - Q 5 - 15 min
Review recommendation for the appropriate use of vaginal exams during the first
stage of labor
Consider why and when: will it change your management in any way?
Be familiar with the HISTORY of the policy of withholding foods and oral fluids
during labor
1918 - DeLee warned that food must be encouraged throughout labor to avoid general
weakness, delayed labor, and serious postpartum hemorrhage
1946 - Mendelson identified aspiration of stomach contents as the cause of post-
aspiration pneumonia and subsequent maternal mortality d/t delay in gastric emptying
,and increased gastric acidity
**the practice of feeding women in labor was deemed clinically unsound and NPO
policies were introduced
Know the CURRENT evidence regarding encouraging or withholding food or oral
fluids during labor
ASA currently recommends oral intake of modest clear liquids for uncomplicated pts
and case-by-case determination for high risk
Prolonged fasting can lead to ketosis, however no association has been shown between
ketosis and poor outcomes and the relationship is unclear
Prolonged fasting in labor has shown no increased risk for aspiration
Aspiration is more related to general anesthesia rather than regional which is more
commonly used today
List indications for IV access and/or IV fluids
Should be based on actual or potential risk factors for each individual
Need for increased hydration
Potential oxytocin administration, abx administration
For pre-epidural fluids or in case of med administration for emergency
, Understand the significance of ketonuria to the laboring woman
Occurs as a result of fat catabolism when glycogen scores are used up
May have deleterious effects on uterine function
No differences in duration of labor, augmentation of labor, cesarean sections, or Apgar
scores
Understand the potential hazards of dextrose containing intravenous hydration to
the fetus and newborn
In large doses can cause fetal lactic acidosis and newborn jaundice and hypoglycemia
Know the disadvantages of a supine maternal position in labor
Supine hypotension
May lead to an illusion of cephalopelvic disproportion d/t reduced pelvic diameter
Impedes rotation from OP or OT to OA
Requires pushing against gravity
Places fetus in unfavorable drive angle in relation to pelvis
Causes contractions to become more frequent, more painful, and less effective
Know the impact of squatting and "hands on knees" positions on pelvic
dimensions
The sagittal outlet and interspinous diameter are significantly greater than when supine;
women who are taller, younger, and parous had greater increases
List different positions and movements for labor and indicate their proposed
benefit
