Chapter 11: Perinatal Education My Nursing Test Banks

Chapter 11: Perinatal Education

MULTIPLE CHOICE

1. The birth educator is discussing the advantages and disadvantages of birthing options. Which disadvantage is common with epidural anesthesia?

a.

Effective pushing is optimized.

b.

The risk of catheterization is decreased.

c.

The length of labor and birth may be decreased.

d.

The use of forceps and oxytocin administration is increased.

ANS: D

Administration of oxytocic drugs and the use of forceps are more likely with epidural anesthesia. Epidural anesthesia can cause less effective pushing because the woman cannot feel the contractions. Catheterizing the patient is common because the woman does not have the urge to empty her bladder. Epidural anesthesia usually removes most pain but may increase the length of labor.

PTS: 1 DIF: Cognitive Level: Application REF: 186

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

2. What is covered by early pregnancy classes offered in the first and second trimesters?

a.

Methods of pain relief

b.

The phases and stages of labor

c.

Coping with common discomforts of pregnancy

d.

Prebirth and postbirth care of a client having a cesarean birth

ANS: C

Early pregnancy classes focus on the first two trimesters and cover information on adapting to pregnancy, dealing with early discomforts, and understanding what to expect in the months ahead. Methods of pain relief are discussed in a childbirth preparation class. The phases and stages of labor are usually covered in a childbirth preparation class. Cesarean birth preparation classes discuss prebirth and postbirth of a client having a cesarean birth.

PTS: 1 DIF: Cognitive Level: Understanding REF: 185

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

3. Which client is most likely to experience pain during labor?

a.

Gravida 1 whose fetus is in a breech presentation

b.

Gravida 3 who is using Lamaze breathing techniques

c.

Gravida 2 who is anxious because her last labor was difficult

d.

Gravida 2 who has not attended childbirth preparation classes

ANS: C

Anxiety affects a womans perception of pain. Tension during labor causes tightening of abdominal muscles, impeding contractions and increasing pain by stimulation of nerve endings. A breech presentation does not mean that the woman will experience a painful labor. Lamaze breathing techniques use the mind to prevent pain; they involve concentration and conditioning to help the woman respond to contractions with relaxation to decrease pain. Childbirth preparation classes can help a woman prepare for the pain but will not prevent the woman from experiencing pain during labor.

PTS: 1 DIF: Cognitive Level: Analysis REF: 188

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

4. When reading a new clients birth plan, the nurse notices that the client will be bringing a doula to the hospital during labor. What does the nurse think that this means?

a.

The client will have her grandmother as a support person.

b.

The client will bring a paid, trained labor support person with her during labor.

c.

The client will have a special video she will play during labor to assist with relaxation.

d.

The client will have a bag that contains all the approved equipment that may help with the labor process.

ANS: B

A doula is a trained labor support person who is employed by the mother to provide labor support. She gives physical support such as massage, helps with relaxation, and provides emotional support and advocacy throughout labor. A doula is usually not a relative of the woman. A doula is a trained labor support person.

PTS: 1 DIF: Cognitive Level: Understanding REF: 184

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

5. Which is the method of childbirth that helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor?

a.

Bradley

b.

Lamaze

c.

Leboyer

d.

Dick-Read

ANS: D

The Dick-Read method helps prevent the fear-tension-pain cycle by using slow abdominal breathing in early labor and rapid chest breathing in advanced labor. The Lamaze method involves concentration and conditioning to help the woman respond to contractions with relaxation to decrease pain. Viewing childbirth as a traumatic experience, the Leboyer method uses decreased light and noise to help the newborn adapt to extrauterine life more easily. The Bradley method teaches women to use abdominal muscles to increase relaxation and breath control; it emphasizes avoidance of all medications and interventions.

PTS: 1 DIF: Cognitive Level: Understanding REF: 188, 189

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. Which type of cutaneous stimulation involves massage of the abdomen?

a.

Imagery

b.

Effleurage

c.

Mental stimulation

d.

Thermal stimulation

ANS: B

Effleurage is massage usually performed on the abdomen during contractions. Imagery exercises enhance relaxation by teaching the woman to imagine herself in a relaxing setting. Mental stimulation is a group of methods to decrease pain by increasing mental stimulation. Thermal stimulation decreases pain by using applications of heat and cold.

PTS: 1 DIF: Cognitive Level: Understanding REF: 190

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

7. What does a birth plan help the parents accomplish?

a.

Avoidance of an episiotomy

b.

Determining the outcome of the birth

c.

Assuming complete control of the situation

d.

Taking an active part in planning the birth experience

ANS: D

The birth plan helps the woman and her partner look at the available options and plan the birth experience to meet their personal needs. A birth plan cannot dictate the need for or avoidance of an episiotomy. The outcome of the birth is not an absolute determinant. A birth plan does not assume complete control of the situation; it allows for expanding communication.

PTS: 1 DIF: Cognitive Level: Understanding REF: 192

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. Which client could safely be cared for by a certified nurse-midwife?

a.

Gravida 3, para 2, with no complications

b.

Gravida 1, para 0, with mild hypertension

c.

Gravida 2, para 1, with insulin-dependent diabetes

d.

Gravida 1, para 0, with borderline pelvic measurements

ANS: A

A certified nurse-midwife (CNM) cares for women who are at low risk for complications. The CNM would not care for a woman with hypertension. The CNM would not care for a woman with insulin-dependent diabetes. The CNM would not care for a woman with borderline pelvic measurements.

PTS: 1 DIF: Cognitive Level: Analysis REF: 184

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

9. Martha is a gravida 3, para 2, whose last child was born 5 years ago. She attended childbirth preparation classes with her first pregnancy. Which class would be most appropriate for her?

a.

Refresher course

b.

Infant care classes

c.

Postpartum classes

d.

Early pregnancy classes

ANS: A

When 2 or more years elapse between a prepared childbirth class and a subsequent pregnancy, a refresher course is recommended to provide couples with an update on new developments and to review techniques. Infant care classes cover the basics of infant care, with which she is familiar. She has experienced the postpartum period so this class would not be as beneficial as a refresher class. Early pregnancy classes cover information on adapting to pregnancy, dealing with discomforts such as morning sickness and fatigue, and understanding what to expect in the months ahead.

PTS: 1 DIF: Cognitive Level: Analysis REF: 186

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

10. A client asks, What can I do to help decrease the amount of pain with labor? What should be the nurses best response?

a.

Nothing. That is the way God intended it to be.

b.

We can give you medications to help with the pain.

c.

You should not worry about the pain; leave that concern up to the staff.

d.

By trying to relax, the contractions will be more efficient and the pain may be less.

ANS: D

Anxiety and tension will make the uterine contractions less effective and increase the length of labor. Relaxation will help the contractions to be more effective and the labor will be less painful. Stating nothing is demeaning and does not answer the womans questions. The woman may not want medications but instead is looking for alternatives. You should not worry about the pain; leave that concern up to the staff does not answer the womans questions and would not alleviate her concern about pain control.

PTS: 1 DIF: Cognitive Level: Application REF: 188

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

11. Which phrase best describes neuromuscular dissociation?

a.

Loosening taut muscles when touched by another person

b.

Contracting and consciously releasing different muscle groups

c.

Relaxing while someone is applying pressure against a tendon or large muscle

d.

Relaxing the rest of the body while one group of muscles is strongly contracted

ANS: D

Neuromuscular dissociation helps the woman learn to relax her body, even when one group of muscles is strongly contracted. Loosening taut muscles when touched by another person describes touch relaxation. Contracting and consciously releasing different muscle groups refers to progressive relaxation. Relaxing while someone is applying pressure against a tendon or large muscle describes sacral pressure.

PTS: 1 DIF: Cognitive Level: Understanding REF: 189

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

12. A primipara client asks about possible support options for her during the labor process. She is apprehensive that her family members will not be prepared to assist her during this time. Which option would be most effective for this client?

a.

Reassure the client that the labor and birth staff consists of highly trained nurses who are well educated to take care of laboring clients, so that should be sufficient.

b.

Encourage the client to take prepared childbirth classes with her husband because that should provide the best support by a family member.

c.

Provide information to the client about obtaining a doula during the labor process.

d.

Tell the client that this is a normal feeling based on fear of the unknown and that it will subside once she starts the labor process.

ANS: C

Providing information about a doula addresses the clients concern because the doulas designated role is to provide support during labor. Although it is true that labor and birth nurses are trained in their specialty, the client is voicing concern for support so her feelings should not be minimized. Encouraging the client to take prepared childbirth classes is also important but does not address the clients concern for support. Because this client is a primipara, it is normal to have some anxiety over the unknown process of the labor experience but, again, this response minimizes the clients concern.

PTS: 1 DIF: Cognitive Level: Analysis REF: 191

OBJ: Nursing Process Step: Planning MSC: Client Needs: Psychologic Integrity

13. Which statement is incorrect regarding prepared childbirth education?

a.

No use of anesthetics or drugs is to be administered to clients so they can have a natural childbirth experience.

b.

Clients can take refresher courses if they have delivered within the last 2 years.

c.

Prepared childbirth classes may differ slightly based on the available resources of health care facilities.

d.

Prepared childbirth classes are aimed at increasing awareness of the childbirth experience for parents and significant others to promote better control of pain and decrease anxiety.

ANS: A

Medications and anesthesia information are provided during childbirth education. It is up to the client to decide if she wants to use these treatment options during the course of labor. Refresher courses are available up to 3 years postbirth for clients. Different information may be provided based on the availability of resources in health care facilities that provide obstetric care to clients. Goals of childbirth classes are to increase knowledge of the birth experience, foster control of the situation to decrease anxiety, and minimize the pain experience.

PTS: 1 DIF: Cognitive Level: Analysis REF: 188, 189

OBJ: Nursing Process Step: Evaluation

MSC: Client Needs: Psychosocial Integrity: Therapeutic Communication

14. A relaxation technique that can be used during the childbirth experience to decrease maternal pain perception is:

a.

using increased environmental stimulation as a method of distraction.

b.

restricting family and friends from visiting during the labor period to keep the client focused on breathing techniques.

c.

medicating the client frequently to reduce pain perception.

d.

assisting the client in breathing methods aimed at taking control of pain perception based on the contraction pattern.

ANS: D

Relaxation techniques are aimed at incorporating mind and body activities to maintain control over pain. Additional environmental stimuli may have the opposite effect and increase client anxiety, which will affect pain perception. Restricting visitors may have the opposite effect, leading to increased anxiety because of isolation. Medicating a client may not decrease pain perception but may place the client at risk for adverse reactions and/or complications of pregnancy related to medications.

PTS: 1 DIF: Cognitive Level: Analysis REF: 189

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity: Therapeutic Communication

15. During the course of labor, a client has been having her labor coach rub her lower back to relieve pain. After 30 minutes, the client complains that this method is no longer working and becomes increasingly frustrated with the labor coach. The vaginal exam is 2 to 3 cm, 80% effaced, and 1 station, membranes intact. Which option would you recommend to decrease the clients perceived pain?

a.

Have the labor coach change the touch location and begin gently massaging another area on the back.

b.

Perform a vaginal exam to determine progress.

c.

Have the labor coach step outside the room (LDR) and take a break because it is best to try and defuse the confrontation.

d.

Suggest to the client that perhaps the use of a narcotic opioid will relieve her pain and facilitate the labor process.

ANS: A

It would appear that habituation has occurred and a change of location may lead to improved pain control relief through touch. A vaginal exam does not address the clients concern of pain, and there is no evidence to support the use of this option at this time. Current data from the vaginal exam indicate that the client is in early labor. The client and labor coach have a bond so to remove the labor coach from the room would further isolate the client and potentially raise the perceived pain level. The nurse should encourage the client and labor coach to work together during the labor process. It is too early in the labor process to recommend the use of narcotics because this might further delay labor. Alternate treatment options involve the use of nonpharmacologic methods such as touch and positioning.

PTS: 1 DIF: Cognitive Level: Analysis REF: 189, 190

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity: Therapeutic Communication

16. Which technique would provide the best pain relief for a pregnant woman with an occiput posterior position?

a.

Neuromuscular disassociation

b.

Effleurage

c.

Psychoprophylaxis

d.

Sacral pressure

ANS: D

The use of sacral pressure may provide relief for clients who are experiencing back labor. The presentation of the fetus in a posterior position indicates this. Neuromuscular dissociation is used as a conditioned response to affect pain relief based on the mother tensing one group of muscles and focusing on releasing tension in the rest of her body. Effleurage is the process of using circular massage to effect pain relief. Psychoprophylaxis is another name for the Lamaze method of prepared childbirth.

PTS: 1 DIF: Cognitive Level: Analysis REF: 190

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity: Sensory Perceptual Alterations

17. The support person for your labor client has been applying gentle massage to the clients upper back frequently over the past hour. Now, the labor client states that it just isnt helping anymore. Both the support person and labor client are becoming frustrated with each others inability to make things less stressful during the labor process. What would be the best nursing response at this time?

a.

Have the client change position and tell the support person to take a break.

b.

Discuss the effects of habituation and suggest alternate measures that could be used to relieve pain.

c.

Advise the client that this may be the best time to ask for an epidural.

d.

Tell the client and support person that she must be progressing further and you will do a vaginal exam to determine progress.

ANS: B

The process of habituation occurs as nerve fibers become less responsive to massage efforts, so alternative methods should be suggested to reduce frustration and improve outcomes. Although it might be advisable to suggest a break for the support person, that will leave the client alone when she is clearly frustrated. Change of position may be advisable. There is no indication that the client wants to have anesthesia as part of the labor-birth plan. Vaginal exams are done to determine progress but the situation as stated does not indicate that the client is progressing further so this might lead to further frustration if the findings do not indicate progress.

PTS: 1 DIF: Cognitive Level: Analysis REF: 189, 190

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Psychosocial Integrity: Sensory Perceptual Alterations

18. A pregnant client is anticipating a vaginal birth without complications. During the course of her labor, complications arise and the fetus has to be delivered via cesarean section. The client is visibly upset and wants to know why this has happened to her because she did everything right during her pregnancy. Which priority nursing diagnosis would apply?

a.

Risk for injury

b.

Pain

c.

Impaired skin integrity

d.

Anxiety

ANS: D

Although risk for injury, pain, and impaired skin integrity apply as nursing diagnoses, the client situation is such that she was anticipating a vaginal birth. Thus, she is more likely to be experiencing anxiety related to the change in birth plan so the nurse should respond to that as the priority need.

PTS: 1 DIF: Cognitive Level: Analysis REF: 188

OBJ: Nursing Process Step: Diagnosis

MSC: Client Needs: Psychosocial Integrity: Sensory Perceptual Alterations

19. The nurse is reviewing the option of childbirth classes with a patient in her second trimester. Which statement indicates to the nurse that the patient has understood the teaching?

a.

My labor will likely be shorter if I go to classes.

b.

I will likely perceive less pain during labor if I go to classes.

c.

I will likely be more satisfied with my labor if I go to classes.

d.

I will likely use fewer medications during labor if I go to classes.

ANS: C

Many studies agree that couples receiving prenatal preparation for childbirth are more satisfied with their birth experiences and have greater feelings of control, even when unexpected complications occur. Studies to determine whether education for childbirth affects patient satisfaction, pain relief, length of labor, and frequency of complications have had conflicting results.

PTS: 1 DIF: Cognitive Level: Application REF: 188

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

20. The labor nurse is reviewing breathing techniques with a primipara admitted for induction of labor. When is the best time to encourage the laboring patient to use slow, deep chest breathing with contractions?

a.

During labor, when she can no longer talk through contractions

b.

During the first stage of labor, when the contractions are 3 to 4 minutes apart

c.

Between contractions, during the transitional phase of the first stage of labor

d.

Between her efforts to push to facilitate relaxation between contractions

ANS: A

Focused breathing techniques should not be used in labor until they are actually needed, which is usually when the woman can no longer walk and talk during a contraction. If breathing techniques are used too early, the woman tends to move through the different techniques too quickly, and she may stop using them. In addition, the use of the more complex breathing patterns in latent labor may increase fatigue. Women should be encouraged to adapt the techniques to their own comfort and needs. Breathing deeply between contractions or pushing can increase the possibility of carbon dioxide retention and make the patient dizzy.

PTS: 1 DIF: Cognitive Level: Application REF: 191

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

21. In a prenatal education class, the nurse is reviewing the importance of using relaxation techniques during labor. Which client statement will the nurse need to correct?

a.

We will practice relaxation techniques only in a quiet setting so I can focus.

b.

Relaxation is important during labor because it will help me conserve my energy.

c.

If I relax in between contractions, my baby will get more oxygen during labor.

d.

My partner and I will practice relaxation throughout the remainder of my pregnancy.

ANS: A

Relaxation exercises must be practiced frequently to be useful during labor. Couples begin practice sessions in a quiet, comfortable setting. Later, they practice in other places that simulate the noise and unfamiliar setting of the hospital. The ability to relax during labor is an important component of coping effectively with childbirth. Relaxation conserves energy, decreases oxygen use, and enhances other pain relief techniques. Women learn exercises to help them recognize and release tension. The labor partner assists the woman by providing feedback during exercise sessions and labor.

PTS: 1 DIF: Cognitive Level: Application REF: 189

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

22. The nurse assesses a patient in active labor and determines that the fetus is in the left occiput posterior position. The patient indicates to the nurse that she does not want an epidural. Which is the best technique for the nurse to include in the patients plan of care?

a.

Effleurage

b.

Sacral pressure

c.

Progressive relaxation

d.

Rapid, paced breathing

ANS: B

The fetus in the occiput posterior position will place pressure against the sacral area. Firm pressure against the sacral area may help relieve strain on the sacroiliac joint from a fetal occiput posterior position (often calledback labor). The partner begins to increase pressure on the sacrum as soon as the contraction begins. Effleurage is the slow massage of the abdomen; it does not focus on the sacral area. Progressive relaxation involves contracting and then consciously releasing different muscle groups. The exercise is repeated throughout the body until all voluntary muscles are relaxed. It does not focus on the sacral area. Rapid, paced breathing techniques are used during the transitional phase of labor and are not specifically focused on the sacral area.

PTS: 1 DIF: Cognitive Level: Analysis REF: 190

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

23. The prenatal nurse educator is teaching couples the technique of using sacral pressure during labor. Which should be included in the teaching session? (Select all that apply.)

a.

The technique can be combined with heat to the area.

b.

A jiggling motion should be used while applying the pressure.

c.

Tennis balls may be used to apply the pressure to the sacral area.

d.

The pressure against the sacrum should be intermittent during the contraction.

e.

The hand may be moved slowly or remain positioned directly over the sacrum.

ANS: A, C, E

Sacral pressure can be combined with thermal stimulation to increase effectiveness.

The hand may be moved slowly over the area or remain positioned directly over the sacrum, but pressure should be continuous and firm throughout the contraction. Care should be taken not to jiggle the woman, which may be irritating.

PTS: 1 DIF: Cognitive Level: Application REF: 190

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

24. A couple asks the nurse to explain the use of breathing techniques during the labor process. Which should the nurse include in the response? (Select all that apply.)

a.

Start to use the focused breathing as soon as labor begins.

b.

The use of complex breathing patterns should start during early labor.

c.

The breathing pattern chosen to use during labor should be practiced frequently.

d.

Focused or controlled breathing techniques are considered just one of many coping strategies.

e.

One helpful technique with breathing is to visualize oxygen entering on inhalation and tension leaving on exhalation.

ANS: C, D, E

If a couple plans to use specific breathing patterns, the woman and her partner should practice the techniques frequently to gain comfort with them. If the woman has not practiced, they may not be helpful during labor. Although they were once the major focus of many classes, focused or controlled breathing techniques are now considered just one of many coping strategies used to enhance the womans ability to work with her labor during birth. While practicing relaxation techniques, the woman can picture oxygen entering her body to nourish her baby as she inhales and tension leaving each time she exhales. Use of the more complex breathing patterns in latent labor may increase fatigue. Focused breathing techniques should not be used in labor until they are actually needed, which is usually when the woman can no longer walk and talk during a contraction.

PTS: 1 DIF: Cognitive Level: Application REF: 191

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

MATCHING

Match each term with the correct definition.

a.

Includes the father as a support person and a coach

b.

Psychoprophylaxis class that uses the mind to prevent pain

c.

Classes focus on breathing to prevent the fear-tension-pain cycle

25. Bradley childbirth education

26. Lamaze childbirth education

27. Dick-Read childbirth education

25. ANS: A PTS: 1 DIF: Cognitive Level: Understanding

REF: 189 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Bradley childbirth education was the first to include the father as a support person and coach. Lamaze childbirth education is based on psychoprophylaxis that uses the mind to prevent pain. Dick-Read childbirth education focuses on breathing to prevent the fear-tension-pain cycle.

26. ANS: B PTS: 1 DIF: Cognitive Level: Understanding

REF: 189 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Bradley childbirth education was the first to include the father as a support person and coach. Lamaze childbirth education is based on psychoprophylaxis that uses the mind to prevent pain. Dick-Read childbirth education focuses on breathing to prevent the fear-tension-pain cycle.

27. ANS: C PTS: 1 DIF: Cognitive Level: Understanding

REF: 188, 189 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Bradley childbirth education was the first to include the father as a support person and coach. Lamaze childbirth education is based on psychoprophylaxis that uses the mind to prevent pain. Dick-Read childbirth education focuses on breathing to prevent the fear-tension-pain cycle.

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