Quiz Performance Analysis for Week 4 EAQ: Key Insights

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 1/17 Exit Performance Week 4 EAQ #3 Due Feb 6, 2024 by 8:30 am Final Score 60% 9 out of 15 questions answered correctly Completed on Feb 1, 2024 12:37 pm Incorrect (6) Report content error Using the paced breathing method, which step would the nurse coach the client to do at the beginning and end of each contraction? Exhale a deep breath.

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 2/17 Rationale The client must remember that all breathing patterns begin with a deep, relaxing, cleansing breath at the beginning of each contraction. The client would then exhale a deep breath. The client would take six to eight breaths per minute when performing slow-paced breathing. As contractions increase in frequency and intensity, the client would take shallow, fast breaths, about 32 to 40 per minute. STUDY TIP: Identify your problem areas that need attention. Do not waste time on restudying information you know. p. 335 Report content error Which statement relates to internal fetal monitoring? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Take a deep relaxing breath. Take 32 breaths per minute. Take five breaths per minute. Requires secure attachment to the fetal presenting part Can be used during the antepartum period Uses a pressure-sensing device Effectiveness is dependent on suﬃcient cervical dilation Can be used with intact membranes

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 3/17 Rationale A spiral electrode is a method of internally monitoring the fetal heart rate. In this method, an electrode attaches to the fetal presenting part and the attachment must be secure for a good signal. The intrauterine pressure catheter technique as well as the spiral electrode require suﬃcient cervical dilation for effective monitoring. Internal fetal monitoring is only used during the intrapartum period. A pressure-sensing device is used with the tocotransducer technique, which monitors uterine activity and not the fetal heart rate. Internal fetal monitoring requires membranes to have ruptured. p. 360 Report content error Which condition often occurs in a nulliparous client in contrast with a multiparous client during labor? Rationale A nulliparous client may experience a longer labor and therefore more fatigue compared with a multiparous client. This is because her reproductive tract structures are less ﬂexible. The firmer tissues in nulliparous clients, as compared with the ﬂexible tissues in multiparous clients, result in a gradual fetal descent. A nulliparous client has a longer An increase in the speed of fetal descent Less fatigue and pain because of a short labor Greater sensory labor pain during early labor Greater fatigue and pain because of a long labor

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2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 4/17 labor and therefore experiences greater fatigue. A rapid fetal descent in the second stage of labor occurs in multiparous clients and causes greater sensory pain. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, “I will study for the examination.” Specify how many hours, what day and time, and what material you will cover. pp. 331, 332 Report content error Which assessment finding is obtained while performing Leopold maneuvers in a client who is in the first stage of labor? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Rationale Leopold maneuvers , or abdominal palpation, during the first stage of labor help determine the fetal part present in the fundus, which indicates the fetal lie. The presenting part of the fetus would help determine if the Fetal heart rate Fetal part in the fundus Tone of the uterus Presenting part of the fetus Location of fetal back

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 5/17 client would undergo vaginal birth or require a cesarean delivery. The position and location of the fetal back help determine the best location to listen to the fetal heart rate using an ultrasound transducer. The fetal heart rate can only be auscultated using Doppler ultrasonography. However, using abdominal palpation, the point of maximum intensity of the fetal heart rate can be determined. The nurse may not assess the tone of the fundus during the first stage of labor; this is done after the delivery of the infant to determine the risk of postpartum hemorrhage. Test-Taking Tip: Pace yourself during the testing period, and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously. p. 384 Report content error When assessing the fetal heart rate (FHR) of a client in labor, which finding would the nurse identify as normal? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Absent variability Minimal variability Moderate variability Marked variability Sinusoidal

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 6/17 Rationale Moderate variability is highly predictive of a normal fetal acid-base balance. It indicates that FHR regulation is not significantly affected by fetal sleep cycles, tachycardia, prematurity, congenital anomalies, preexisting neurologic injury, or central nervous system (CNS) depressant medications. The significance of marked variability is unclear but likely represents a normal variant. Absent or minimal variability is classified as either abnormal or indeterminate. It can result from fetal hypoxemia and metabolic acidemia. A sinusoidal pattern is considered abnormal. pp. 357, 363-364 Report content error Which condition might be a possible cause of a fetal heart rate (FHR) of 100 beats/min? Rationale An FHR of less than 110 beats/min for 10 minutes or more is referred to as bradycardia . Maternal hypoglycemia is a common cause of bradycardia in the fetus. Chorioamnionitis is an infection that causes fetal tachycardia, in which the heart rate is more than 160 beats/min. Hypoxemia (low fetal oxygen supply) and anemia (decreased hemoglobin) of the fetus also cause fetal tachycardia. Maternal hypoglycemia Chorioamnionitis Low fetal oxygen supply Decreased fetal hemoglobin levels

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2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 7/17 p. 364 Correct (9) Report content error The nurse would document a uterine contraction using which characteristic? Select all that apply. One, some, or all responses may be correct. Rationale Uterine contractions are documented in terms of frequency (how often they occur), intensity (the strength of the contraction at its peak), resting tone (the tension in the uterine muscle between contractions), and duration. Appearance and attitude are not characteristics of a uterine contraction. STUDY TIP: Determine whether you are a "lark" or an "owl." Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary Frequency Intensity Resting tone Appearance Attitude

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 8/17 schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. p. 372 Report content error Which detail would be included in a birth plan for an expectant mother? Select all that apply. One, some, or all responses may be correct. Rationale The birth plan would include the client’s or couple’s preferences regarding the presence of birth companions, such as the partner, preferred position for labor and birth, and medical interventions. The birth plan would not include tracking the onset of progressive, regular contractions or discussing any fears about labor. p. 380 Method for tracking the of the onset of progressive, regular contractions The presence of birth companions such as the partner Preferred position for labor and for birth Preferred medical interventions Discussion of any fears about labor

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2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 10/17 Which intervention would promote safety when assisting a client in labor with showering? Select all that apply. One, some, or all responses may be correct. Rationale A warm shower may help relieve discomfort in a client who is in labor. Before the client showers, the nurse would first assess her progress in labor to determine if she is close to delivery. The nurse would supervise the client during the shower to prevent a fall and to monitor for the acceleration of labor. Pouring warm water over the client’s vulva or placing her hand in warm water during a shower may not promote safety; these interventions may help the client urinate. Assisting the client in oral hygiene may promote oral health but may not be helpful in promoting safety. Test-Taking Tip: Make educated guesses when necessary. p. 390 Report content error Assess for progress in labor. Pour warm water over the client’s vulva. Place the client’s hand in warm water. Supervise showers during true labor. Help the client with oral hygiene.

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 11/17 How would the nurse record the baseline fetal heart rate (FHR) that varies between 120 and 130 beats/min over a 10- minute period? Record your answer using a whole number. beats/min Rationale After 10 minutes of tracing is observed, the approximate mean rate is rounded to the closest 5 beats/min interval, which is 125 beats/min. p. 362 Report content error Which reason explains why the nurse says, "You are doing so well; do it again" to a client during the second stage of labor? Rationale 125 To promote comfort and minimize distractions To promote bearing-down efforts in the client To encourage the client to feel confident To promote adequate oxygen levels in the fetus

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 12/17 During the second stage of labor, the client experiences severe pain, fear, anxiety, and confusion. The client might scream during the active pushing stage. Therefore, the nurse would encourage the client to feel confident in her body. The nurse would dim the lights during labor and speak quietly to comfort the client and minimize distractions. Once the client gains confidence, the bearing-down effort improves. Adequate oxygen levels in the maternal blood can be maintained by asking the client to take full breaths throughout the second stage. p. 398 Report content error Arrange the steps in the appropriate order for conducting a nitrazine pH test. 1. 2. 3. 4. 5. Inform the client and partner about the procedure. Soak the cotton-tipped applicator in nitrazine dye. Insert the cotton-tipped applicator deep into the vagina. Perform perineal care for the client as required. Document the test result in the client record.

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2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 13/17 Rationale A nitrazine dye test is performed to learn the status of the amniotic membrane in the pregnant client. Informing the client and her partner about the procedure makes the client feel comfortable. The cotton-tipped applicator specified for this procedure is soaked in nitrazine dye. Then the applicator is inserted into the vagina to get the ﬂuid on the applicator. Perineal care is then performed to ensure that there is no risk of infection. Finally, the test result is seen and documented appropriately. STUDY TIP: Determine whether you are a “lark” or an “owl.” Larks, day people, do best getting up early and studying during daylight hours. Owls, night people, are more alert after dark and can remain up late at night studying, catching up on needed sleep during daylight hours. It is better to work with natural biorhythms than to try to conform to an arbitrary schedule. You will absorb material more quickly and retain it better if you use your most alert periods of each day for study. Of course, it is necessary to work around class and clinical schedules. Owls should attempt to register in afternoon or evening lectures and clinical sections; larks do better with morning lectures and day clinical sections. p. 380 Report content error Which rationale explains the nursing intervention of placing one hand below the umbilicus and the other on the symphysis, then applying downward pressure toward the vagina? Select all that apply. One, some, or all responses may be correct. To assess laceration repair for redness

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 14/17 Rationale During the fourth stage of labor, the nurse must assess parameters such as blood pressure, temperature, and tone of the fundus. The tone of the fundus is assessed to determine if the client is at risk for postpartum hemorrhage. Massaging the fundus also helps expel retained clots from the vagina. When assessing the fundus, one hand must be placed on the fundus while the other supports the uterus at the symphysis to prevent prolapse. Redness or edema is observed while caring for lacerations; however, applying pressure toward the vagina would not aid in repairing lacerations. The nurse would help the client to void spontaneously to help the client urinate. The perineum is assessed for the presence of hemorrhoids, but applying downward pressure toward the vagina would not be helpful in assessing hemorrhoids. p. 412 Report content error The nurse caring for a laboring client is aware that maternal cardiac output can be increased by which factor? To help the client to void spontaneously To determine whether the fundus is firm To assist the client in expelling clots To assess for the presence of hemorrhoids Position change Oxytocin administration

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 15/17 Rationale Intrauterine resuscitation involves maternal position change, which increases maternal cardiac output. This will ultimately improve maternal and fetal oxygenation status. Oxytocin administration, regional anesthesia, and intravenous analgesics may reduce maternal cardiac output. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. p. 370 Report content error Which initial assessment question is appropriate for a healthy client who is at 30 weeks of gestation and reports a brownish cervical discharge? Regional anesthesia Intravenous analgesic "Are you experiencing abdominal pain?" "Are you experiencing strong uterine contractions?" "Did you have sexual intercourse in the past 2 days?" "Did you take any other medications than those prescribed?"

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2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 16/17 3 topics covered Chapter 17, Maximizing Comfort for the La… Lowdermilk: Maternity and Women's Health Care, 13th edition You Chapter 18, Fetal Assessment During Labor Lowdermilk: Maternity and Women's Health Care, 13th edition Novice You Rationale Sexual intercourse during this period of pregnancy may cause cervical trauma and result in cervical discharge. Therefore, the nurse would first ask whether the client had intercourse in the past 2 days. Abdominal pain and strong uterine contractions are indicative of labor, but the client is unlikely to go into labor at this time. Medications would not generally cause the production of brownish cervical discharge, so this is not a priority question at this time. p. 378 Quiz me on this topic Novice Intermediate Proficient Questions answered 2 Novice Intermediate Proficient Questions answered 29

2/3/24, 11:08 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/51005498 17/17 Chapter 19, Nursing Care of the Family Du… Lowdermilk: Maternity and Women's Health Care, 13th edition Intermediate You Quiz me on this topic Quiz me on this topic Novice Intermediate Proficient Questions answered 65

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