Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 25 Birth-Related Procedures

1. The client is undergoing an emergency cesarean birth for fetal bradycardia. The client's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Allow the partner to wheel the baby's crib to the newborn nursery.
2. Allow the partner to be near the operating room where the newborn's first cry can be heard.
3. Have the partner wait in the client's postpartum room.
4. Encourage the partner to be in the nursery for the initial assessment.
5. Teach the partner how to take the client's blood pressure.

Page Ref: 633

Cognitive Level: Applying

Client Need/Sub: Psychosocial Integrity: Coping Mechanisms

Standards: Q S E N Competencies: Ⅰ. C. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Relationship-Centered Care: Promote and accept the patient's emotions; accept and respond to distress in patient and self; facilitate hope, trust, and faith. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure?
2. A version
3. An amniotomy
4. Leopold maneuvers
5. A ballottement

Page Ref: 609

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered?
2. To provide analgesia
3. To relax the uterus
4. To induce labor
5. To prevent hemorrhage

Page Ref: 611

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is scheduling a client for an external cephalic version (E C V). Which finding in the client's chart requires immediate intervention?
2. Previous birth by cesarean
3. Frank breech ballotable
4. 37 weeks, complete breech
5. Failed E C V last week

Page Ref: 611

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Contrast the methods of external cephalic version and internal version and the related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed?
2. Maternal temperature, B P, and pulse
3. Estimation of fetal birth weight
4. Fetal presentation, position, station, and heart rate
5. Biparietal diameter

Page Ref: 621

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. Amniotomy as a method of labor induction has which of the following advantages?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. The danger of a prolapsed cord is decreased.
2. There is usually no risk of hypertonus or rupture of the uterus.
3. The intervention can cause a decrease in pain.
4. The color and composition of amniotic fluid can be evaluated.
5. The contractions elicited are similar to those of spontaneous labor.

Page Ref: 621

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. A laboring client's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, "What are the advantages of doing this?" What should the nurse cite in response?
2. Contractions elicited are similar to those of spontaneous labor.
3. Amniotomy decreases the chances of a prolapsed cord.
4. Amniotomy reduces the pain of labor and makes it easier to manage.
5. The client will not need an episiotomy.

Page Ref: 621

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Discuss the use of amniotomy in current maternal-newborn care.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. After inserting prostaglandin gel for cervical ripening, what should the nurse do?
2. Apply an internal fetal monitor.
3. Insert an indwelling catheter.
4. Withhold oral intake and start intravenous fluids.
5. Place the client in a supine position with a right hip wedge.

Page Ref: 614

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. Under which circumstances would the nurse remove prostaglandin from the client's cervix?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Contractions every 5 minutes
2. Nausea and vomiting
3. Uterine tachysystole
4. Cardiac tachysystole
5. Baseline fetal heart rate of 140-148

Page Ref: 615

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse knows that the Bishop scoring system for cervical readiness includes which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fetal station
2. Fetal lie
3. Fetal presenting part
4. Cervical effacement
5. Cervical softness

Page Ref: 616

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse knows that a contraindication to the induction of labor is which of the following?
2. Placenta previa
3. Isoimmunization
4. Diabetes mellitus
5. Premature rupture of membranes

Page Ref: 614

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important?
2. Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours.
3. Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour.
4. Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec).
5. Prepare to induce labor after administering a tap water enema.

Page Ref: 612

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client?
2. Apply an internal fetal monitor.
3. Monitor the client using electronic fetal monitoring.
4. Withhold oral intake and start intravenous fluids.
5. Place the client in an upright, sitting position.

Page Ref: 613

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Compare methods for inducing labor, explaining their advantages and disadvantages.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is caring for a client who is about to receive an amnioinfusion. For which complication(s) should the nurse monitor the client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Umbilical cord prolapse
2. Amniotic fluid embolism
3. Uterine rupture
4. Amnionitis
5. Abruptio placentae

Page Ref: 621

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss the use of transcervical intrapartum amnioinfusion.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client is having fetal heart rate decelerations. An amnioinfusion has been ordered to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is which of the following?
2. Early decelerations
3. Moderate decelerations
4. Late decelerations
5. Variable decelerations

Page Ref: 621

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss the use of transcervical intrapartum amnioinfusion.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement by the client indicates that further information is required?
2. "Because I have a midline episiotomy, I should keep my perineum clean."
3. "I can use an ice pack to relieve some the pain from the episiotomy."
4. "I can take ibuprofen (Motrin) when my perineum starts to hurt."
5. "The tear I have through my rectum is unrelated to my episiotomy."

Page Ref: 623

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 1. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. How does the nurse respond?
2. "The episiotomy goes straight back toward your rectum."
3. "The episiotomy is from your vagina toward the urethra."
4. "The episiotomy is cut diagonally away from your vagina."
5. "The episiotomy extends from your vagina into your rectum."

Page Ref: 623

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse?
2. "I'll get you one right away."
3. "You only need to use one ice pack."
4. "You need to leave it off for at least 20 minutes and then reapply."
5. "I'll bring you an extra so that you can change it when you are ready."

Page Ref: 623

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Teaching and Learning.

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. Major perineal trauma (extension to or through the anal sphincter) is more likely to occur if what type of episiotomy is performed?
2. Mediolateral
3. Episiorrhaphy
4. Midline
5. Medical

Page Ref: 622

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who will have a forceps delivery. Which action or assessment finding requires intervention?
2. Regional anesthesia is administered via pudendal block.
3. The client is instructed to push between contractions.
4. Fetal heart tones are consistently between 110 and 115.
5. The client's bladder is emptied using a straight catheter.

Page Ref: 626

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Quality and Safety: Communicate effectively with different individuals (team members, other care providers, patients, families, etc.) so as to minimize risks associated with handoffs among providers and across transitions in care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The need for forceps has been determined. The client's cervix is dilated to 10 c m, and the fetus is at +2 station. What category of forceps application would the nurse anticipate?
2. Input
3. Low
4. Mid
5. Outlet

Page Ref: 625

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. What type of forceps are designed to be used with a breech presentation?
2. Midforceps
3. Piper
4. Low
5. High

Page Ref: 625

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The physician has determined the need for forceps. The nurse should explain to the client that the use of forceps is indicated because of which of the following?
2. Her support person is exhausted
3. Premature placental separation
4. To shorten the first stage of labor
5. To prevent fetal distress

Page Ref: 625

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The physician/C N M opts to use a vacuum extractor for a delivery. What does the nurse understand?
2. There is little risk with vacuum extraction devices.
3. There should be further fetal descent with the first two "pop-offs."
4. Traction is applied between contractions.
5. The woman often feels increased discomfort during the procedure.

Page Ref: 628

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?
2. The head is delivered after eight "pop-offs" during contractions.
3. A cephalohematoma is present on the fetal scalp.
4. The location of the vacuum is apparent on the fetal scalp after birth.
5. Positive pressure is applied by the vacuum extraction during contractions.

Page Ref: 628

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?
2. "A small cup will be put onto the baby's head, and a gentle suction will be applied."
3. "I can stop pushing and just rest if the vacuum extractor is used."
4. "The baby's head might have some swelling from the vacuum cup."
5. "The vacuum will be applied for a total of ten minutes or less."

Page Ref: 628

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?
2. Elation, euphoria, and talkativeness
3. A sense of failure and loss
4. Questions about whether or not to circumcise
5. Uncertainty surrounding the baby's name

Page Ref: 626

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 13. Acknowledge the tension that may exist between patient rights and the organizational responsibility for professional, ethical care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased healthcare costs in clients undergoing cesarean birth by request?
2. Increased abnormal placenta implantation in subsequent pregnancies
3. Decreased use of general anesthesia with greater use of epidural anesthesia
4. Prolonged anemia, requiring blood transfusions every few months
5. Coordination of career projects of both partners leading to increased income

Page Ref: 634

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅴ. 10. Articulate, through a nursing perspective, issues concerning healthcare delivery to decision makers within healthcare organizations and other policy arenas. | N L N Competencies: Knowledge and Science: Translate research into practice in order to promote quality and improve practices. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. After being in labor for several hours with no progress, a client is diagnosed with C P D (cephalopelvic disproportion), and must have a cesarean section. The client is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the client would receive what type of incision?
2. Transverse
3. Infraumbilical midline
4. Classic
5. Vertical

Page Ref: 630

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The client demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states which of the following?
2. "The next time I have a baby, I can try to deliver vaginally."
3. "The risk of rupturing my uterus is too high for me to have any more babies."
4. "Every time I have a baby, I will have to have a cesarean delivery."
5. "I can only have one more baby."

Page Ref: 630

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. In the operating room, a client is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the client is draped for surgery?
2. Maternal temperature
3. Maternal urine output
4. Vaginal exam
5. Fetal heart tones

Page Ref: 632

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. A client is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (V B A C) with this pregnancy. Which statement indicates that the client requires more information about V B A C?
2. "I can try a vaginal birth because my uterine incision is a low segment transverse incision."
3. "The vertical scar on my skin doesn't mean that the scar on my uterus goes in the same direction."
4. "There is about a 90% chance of giving birth vaginally after a cesarean."
5. "Because my hospital has a surgery staff on call 24 hours a day, I can try a V B A C there."

Page Ref: 634

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 10 Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth after cesarean birth (V B A C) or a trial of labor after cesarean birth (T O L A C).

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The nurse is teaching a class on vaginal birth after cesarean (V B A C). Which statement by a participant indicates that additional information is needed?
2. "Because the scar on my belly goes down from my navel, I am not a candidate for a V B A C."
3. "My first baby was in a breech position, so for this pregnancy, I can try a V B A C if the baby is head-down."
4. "Because my hospital is so small and in a rural area, they won't let me attempt a V B A C."
5. "The rate of complications from V B A C is lower than the rate of complications from a cesarean."

Page Ref: 634

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 10 Examine the risks, guidelines, and nursing care of the woman undergoing vaginal birth after cesarean birth (V B A C) or a trial of labor after cesarean birth (T O L A C).

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The healthcare provider of a laboring patient is considering a mediolateral episiotomy. On the following diagram, identify where this incision should be made.

1. A
2. B
3. C
4. D

Page Ref: 624

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. | Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 6 Describe the types of episiotomies performed, the rationale for each, and the associated nursing interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The healthcare provider asks for forceps to aid in the delivery of a fetus that is engaged, but the leading edge is at +1. Which type of forceps should be handed to the healthcare provider for this delivery?

Page Ref: 625

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. Forceps are being used to deliver the fetus of a laboring patient, as identified in the diagram. In which direction should the healthcare provider use the forceps to guide the fetus for delivery?

1. Upward and outward
2. Downward and outward
3. Midline and towards the left
4. Midline and toward the right

Page Ref: 627

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 7 Summarize the indications for forceps-assisted birth, types of forceps that may be used, complications, and related interventions.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. The spouse of a laboring patient is concerned that the baby is taking too long to be delivered and he has overhead some discussion about using a vacuum. Which diagram should the nurse show the spouse to explain the procedure being discussed?

Page Ref: 628

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 8 Discuss the use of vacuum extraction, including indications, procedure, complications, and related nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.

1. A patient is scheduled to have the following type of incision for a cesarean birth. What advantage should the nurse explain to the patient that this type of incision has?

1. Easier to repair
2. Less blood loss
3. Expedites delivery of multiple fetuses
4. Less likely to rupture with future pregnancies

Page Ref: 631

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 9 Explain the indications for cesarean birth, impact on the family unit, preparation and teaching needs, and associated nursing management.

M N L L O: Demonstrate use of the nursing process in the care of the woman and fetus during birth-related procedures.