POEP Module 5: Process of Labor and Birth (Abnormal) Questions With Correct Answers.

Maternal and fetal indications exist for the induction of labor. Identify all indications that are maternal. - Chorioamnionitis Preeclampsia Postterm pregnancy Jamie, a new RN on the labor and delivery unit, asks you why your patient is being induced at 39 1/7 weeks gestation when there is no medical or obstetric indication. What is your BEST response? - The ARRIVE study demonstrated the potential benefit of non-medically indicated induction of labor. Offering induction of labor after 39 0/7 weeks gestation is acceptable and may be associated with decreased maternal and perinatal risks. Kelly, a G2P1 at 39 4/7 weeks gestation presents to the OB triage with complaints of contractions. Her cervical examination revealed 2 cm dilatated, 50 % effaced, a ballotable fetal presenting part. The cervical consistency is medium and in a mid position. Based on these findings, what is Kelly's Bishop score? - 4 You are assisting Dr. Torres with placing a cervical ripening balloon catheter for Amy, G1P0 at 40 1/7 weeks gestation. Amy asks you how long the catheter has to remain in place. What is your BEST response? - The catheter will be in place no longer than 24 hours Brianna G1P0 at 39 6/7 weeks gestation presents to the OB triage with complaints of vaginal bleeding. You noted small amount of pink tinged discharge on the pad that Brianna was wearing. Brianna reported that she was in the doctors office earlier in that day and she did a "very rough" vaginal examination. Brianna stated "the doctor told me I may go into labor because of the examination". Given the information Brianna gave you, what may be the best explanation for the vaginal bleeding? - Dr. Torres probably stripped Brianna's membranes Louis is a new RN working in labor and delivery. He is curious what happens if a woman has too many contractions and no oxytocin is infusing. What is your best response? - After a fluid bolus, if the woman is still having more than five contractions in 10 minutes, we will notify the provider and request terbutaline 0.25 mg SQ.Kira, G2P1, at 39 0/7 weeks gestation is being induced for gestational diabetes. Dr. Albertson ordered Dinoprostone vaginal insert (Cervidil) for cervical ripening prior to starting oxytocin. You have just received training and demonstrated competence in insertion. Given what you learned in your training, what are the key components to care. (Select all that apply.) - Oxytocin admin may be started 30- 60 min after removal of the insert The insert is usually removed after 12 hours or when active labor begins The insert should be removed in the presence of an abnormal FHR pattern, with or without tachysystole Women should remain recumbent for two hours after insertion Effective cervical ripening agents include (Select all that apply) - Cervidil Misoprostol Prepidil You are caring for Jenny, G2P1 at 39 4/7 weeks who is having an elective induction. Dr. Biglin ordered oxytocin to be started at 2 milliunits/minute and to increase by 1 milliunit/minute every 30 minutes until Jenny is in a good labor pattern. The pharmacy has prepared 30 units oxytocin in a 500 mL bag of IV solution. To administer 2 milliunits/minute, what rate should be set on the IV pump? - 2mL/hour When administering oxytocin, nursing responsibilities include (Select all that apply.) - decreasing the dose rate or discontinuing the oxytocin when contractions are too frequent. decreasing the dosage rate or discontinuing the oxytocin if an indeterminate or abnormal FHR patterns occur. increasing the dosage rate when uterine activity and labor progress are inadequate. notifying the provider of tachysystole, abnormal FHR patterns, or suspected uterine rupture. You are reviewing intrauterine resuscitation measures with Amanda, a new RN on the labor and delivery unit. You ask her what interventions she would perform to promote fetal oxygenation. Amanda's best response would include - Position the woman laterally, give an IV fluid bolus, and stop pushing or push with every other contractionYou are caring for Iesha, G3P2 at 39 2/7 weeks gestation who was admitted for an elective induction of labor. Currently the oxytocin rate is 10 milliunits/minute. You note the following FHR tracing. What is your next course of action? - Although the fetus has moderate variability and accelerations, Iesha is having too many contractions. The oxytocin should be reduced. Kendall, a G1P0 at 40 weeks gestation has been pushing for 30 minutes. You notice that Kendall is getting tired and is not pushing adequately. What nursing interventions can you perform to assist Kendall during the second stage? (Select all that apply.) - Assist Kendall to breathe and rest between contractions Assist Kendall to change positions Encourage Kendall to push when she has the urge and to use open glottis pushing Casie, G1P0, at 40 6/7 weeks gestation has been pushing for 45 minutes. You note retraction of the fetal head against the maternal pelvis. What is your best response? - The provider asked you to perform suprapubic pressure. Which image reflects the correct method. - Justine, G1P0 at 39 5/7 weeks gestation is has been pushing for 50 minutes. Dr. Linton has requested to use the vacuum device. Prior to application of the vacuum, what should you suggest? - Empty Justine's bladder You are caring for Liesa, G2P1 at 39 weeks gestation. Liesa is attempting a TOLAC. You note the following FHR tracing. This tracing may reflect - A prolonged deceleration that may be associated with uterine rupture In caring for a woman who is in labor with an attempt at a vaginal birth after cesarean (VBAC), it is important to provide labor support, perform ongoing assessment of maternal and fetal status, and observe for signs of abnormal labor progress. Which intervention is usually indicated as a precaution throughout labor in TOLAC patients? - Maintaining patent IV accessYour patient, Kayla, calls a nurse to her bedside describing spontaneous rupture of membranes. As the sheets are pulled back, a loop of umbilical cord is noted protruding from her vagina. All of the following are appropriate interventions for umbilical cord prolapse. (Select all that apply.) - Covering the cord with a moistened gauze Calling for immediate assistance Placing the patient in Trendelenburg position to relieve compression on the cord Jessica, a new RN on the labor and delivery unit, asks you when she should complete a hemorrhage risk assessment. What is your BEST response? - Upon admission to labor, during the pre-birth period, during the post-birth period, and once per shift for the first 24 hours after birth