Unit 3 Maternity Exam - Greater Lowell Technical School

Explanation:

Correct Answer: (C) Reducing blood flow to the uterus.

Anxiety activates the sympathetic nervous system, triggering the fight-or-flight response which causes the release of catecholamines such as epinephrine and norepinephrine. These stress hormones cause vasoconstriction of uterine blood vessels, reducing uteroplacental blood flow. This can decrease fetal oxygenation, inhibit effective uterine contractions, and prolong labor, making anxiety a significant physiological concern during labor and delivery.

Why Other Options are Incorrect:

A. Anxiety actually increases, not decreases, pain sensitivity. The heightened sympathetic state amplifies the perception of pain, making labor contractions feel more intense and difficult to manage for anxious patients.

B. Anxiety does not enhance maternal pushing through muscle tension. Instead, excessive muscle tension from anxiety impedes effective pushing efforts, increases maternal fatigue, and interferes with the coordinated muscle relaxation needed for effective expulsive efforts.

D. Anxiety decreases rather than increases the ability to tolerate pain. The stress response lowers the pain threshold, making the same intensity of contraction feel more painful and reducing the effectiveness of coping strategies.

Explanation:

Correct Answer: (C) Stay with the woman and use the call bell to get help.

When imminent delivery is occurring, the nurse must never leave the patient alone. Leaving a patient in precipitate delivery to find help is abandonment and could result in an unattended birth with serious complications. The nurse stays at the bedside, uses the call bell to summon additional assistance and the physician, and prepares to assist with the delivery if necessary.

Why Other Options are Incorrect:

A. Leaving the patient to go find the physician is dangerous and constitutes patient abandonment. The nurse must remain with the patient who is actively delivering, as complications such as cord prolapse, shoulder dystocia, or neonatal resuscitation needs can arise instantly.

B. Attempting to slow the labor process with deep breathing is not effective or appropriate at this stage. When a patient states the baby is coming and is actively bearing down, labor cannot and should not be stopped through breathing techniques alone.

D. Sending the woman's partner to locate a registered nurse leaves the patient without professional support at the most critical moment of delivery and is not an acceptable substitute for using the nurse call system while remaining at the bedside.

Explanation:

Correct Answer: (A) Help her breathe into her cupped hands.

When a laboring woman hyperventilates, she blows off excessive carbon dioxide, leading to respiratory alkalosis, tingling, and dizziness. Having her breathe into her cupped hands allows her to rebreathe the exhaled carbon dioxide, restoring CO2 levels and correcting the respiratory alkalosis. This is the immediate, simple, and effective first-line intervention that the nurse can implement without a physician order.

Why Other Options are Incorrect:

B. Notifying the doctor is not the immediate priority for hyperventilation, which is a common and manageable occurrence in labor that the nurse can independently address with breathing techniques before escalating to the physician.

C. Placing her flat on her back is contraindicated in labor as the supine position compresses the inferior vena cava by the gravid uterus, reducing venous return and cardiac output, which can cause supine hypotensive syndrome and fetal distress.

D. Initiating oxygen at 2 liters via a mask would worsen the situation by providing more oxygen without addressing the excess CO2 loss that is causing the hyperventilation and respiratory alkalosis. Oxygen therapy is not the treatment for hyperventilation-induced respiratory alkalosis.

Explanation:

Correct Answer: (B) This is a normal response when the infusion begins.

A warm flushing sensation is a well-known, expected, and normal side effect that occurs when magnesium sulfate infusion is initiated. It results from the vasodilatory effects of magnesium and is not a sign of an adverse reaction or toxicity. Reassuring the patient that this sensation is normal reduces anxiety and demonstrates knowledgeable therapeutic communication.

Why Other Options are Incorrect:

A. Stopping the infusion and notifying the healthcare provider is not necessary for a warm sensation, which is an anticipated and benign side effect of magnesium sulfate initiation. Stopping the infusion for a normal side effect would inappropriately interrupt tocolytic therapy.

C. Asking about supplements is not relevant to the complaint of warmth during magnesium sulfate infusion. This response does not address the patient's concern and deflects from providing accurate and reassuring patient education.

D. Getting a cool cloth, while a comfort measure, does not address the patient's primary concern about why she is feeling warm. The priority is to first educate and reassure the patient that the warm sensation is normal before offering comfort measures.

Explanation:

Correct Answer: (A) Check the fundus for position and firmness.

Saturating three perineal pads within one hour postdelivery indicates excessive postpartum bleeding and possible postpartum hemorrhage. The most common cause of early postpartum hemorrhage is uterine atony, where the uterus fails to contract adequately after delivery. The immediate nursing priority is to assess the fundus for position and firmness, as a soft, boggy, or displaced fundus confirms uterine atony requiring immediate intervention such as uterine massage and oxytocin administration.

Why Other Options are Incorrect:

B. Timing how long it takes to soak one pad is not an evidence-based or clinically meaningful assessment in the setting of suspected postpartum hemorrhage. Rapid assessment and intervention are required rather than passive observation of bleeding rate.

C. Reporting to the doctor immediately is important but should not occur before the nurse first assesses the fundus, as the nurse needs clinical data about the cause of the bleeding to provide a meaningful report and may be able to initiate immediate treatment such as fundal massage before the physician arrives.

D. Simply changing the pads and charting the time does not address the underlying cause of the excessive bleeding and represents a dangerous delay in assessing and treating what could be a life-threatening postpartum hemorrhage.

Explanation:

Correct Answer: (A) The woman with oligohydramnios.

Amnioinfusion is the instillation of normal saline or lactated Ringer's solution into the amniotic cavity through an intrauterine pressure catheter. It is primarily indicated for oligohydramnios, a condition where there is insufficient amniotic fluid, which can cause umbilical cord compression leading to variable decelerations. Amnioinfusion restores adequate fluid volume to cushion the umbilical cord and relieve the compression causing fetal heart rate decelerations.

Why Other Options are Incorrect:

B. Post-term pregnancy alone is not an indication for amnioinfusion. While post-term pregnancies may develop oligohydramnios, simply being post-term without documented low fluid or cord compression does not qualify a patient for amnioinfusion.

C. Multiple gestations are not an indication for amnioinfusion. The complexity of multiple gestations presents different management challenges, and amnioinfusion is not a standard intervention for this condition.

D. Uterine prolapse is a contraindication rather than an indication for amnioinfusion. Instilling fluid into the uterus in the setting of prolapse could worsen the condition and is not an appropriate or safe intervention.

Explanation:

Correct Answer: (D) Amniotic fluid is watery and pale green.

Pale green amniotic fluid indicates the presence of meconium, which occurs when the fetus passes stool in utero, typically as a response to fetal hypoxia or distress. Meconium-stained amniotic fluid requires immediate reporting because of the risk of meconium aspiration syndrome, which can cause severe neonatal respiratory compromise. The NICU team must be notified and prepared for delivery.

Why Other Options are Incorrect:

A. A maternal temperature of 37.8°C is only slightly elevated and while it warrants monitoring and continued assessment, it does not require immediate reporting as it has not yet reached the threshold of 38.0°C that would indicate developing chorioamnionitis.

B. A fetal heart rate of 154 beats per minute that is regular is within the normal range of 110-160 beats per minute and is a reassuring finding that does not require immediate reporting.

C. Clear amniotic fluid with flecks of vernix is a completely normal and expected finding following amniotomy. Vernix caseosa is the white, waxy coating on the fetal skin and its presence in the fluid is normal and not concerning.

Explanation:

Correct Answer: (A) Labor has progressed to the transition phase.

Transition is the final and most intense part of the first stage of labor, occurring between approximately 8-10 cm dilation. However, at 7 cm with contractions every 3 minutes, the patient is entering the transition phase. This phase is characterized by the most intense contractions, shortest rest intervals, and the greatest psychological and emotional distress, including irritability, loss of coping ability, cursing, crying, and feelings of being overwhelmed. This behavior is a normal and expected manifestation of transition labor.

Why Other Options are Incorrect:

B. Contractions increasing from mild to moderate intensity occurs earlier in labor during the active phase. At 7 cm with contractions 3 minutes apart, contractions are already severe in intensity, making this explanation insufficient to account for the dramatic behavioral change observed.

C. Attributing the behavioral change to inadequate preparation is judgmental and incorrect. Even women who are very well prepared for childbirth commonly exhibit irritability, emotional distress, and loss of coping during transition labor due to the extreme physiological intensity of this phase.

D. While pain management should always be considered and offered, attributing the behavioral change solely to a need for different analgesia ignores the normal physiological explanation of transition labor and does not represent the most accurate clinical assessment of the situation.

Explanation:

Correct Answer: (B) Above the ischial spines.

Station refers to the relationship of the fetal presenting part to the ischial spines of the maternal pelvis, which serve as the zero reference point. A station of -1 means the presenting part is 1 centimeter above the ischial spines, indicating the fetus has not yet fully descended into the pelvis. Negative numbers indicate the presenting part is above the ischial spines, while positive numbers indicate it is below.

Why Other Options are Incorrect:

A. Visible at the perineum describes a station of +4 or +5, which is crowning and indicates imminent delivery. This is the complete opposite of a -1 station where the presenting part is still above the ischial spines.

C. Below the ischial spines describes positive stations such as +1, +2, or +3, indicating the fetus has descended past the ischial spines. This is incorrect for a -1 station, which places the presenting part above the spines.

D. Engaged in the mother's pelvis describes a station of 0, meaning the widest diameter of the presenting part has passed through the pelvic inlet and is level with the ischial spines. At -1 station, engagement has not yet occurred as the presenting part remains above the spines.