The nurse is preparing to assess a laboring primiparous patient ...

[Chelseaamend]

The nurse is preparing to assess a laboring primiparous patient who has just arrived in the labor and birth unit. Which statement by the patient indicates that additional education is needed?
 
  1. You are going to do a vaginal exam to see how dilated my cervix is.
  2. The reason for a pelvic exam is to determine how low in the pelvis my baby is.
  3. When you check my cervix, you will find out how thinned out it is.
  4. After you assess my pelvis, you will be able to tell when I will deliver.

Question 2

The nurse is working with a new mother who delivered yesterday. The mother has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the patient understands breastfeeding?
 
  1. She puts the infant to breast when he is asleep to help wake him up.
  2. She takes off her gown to achieve skin-to-skin contact.
  3. She holds the infant so that he turns his head to access the nipple.
  4. The infant is crying when he is brought to the breast.

[britb2u]

Answer to Question 1

4
Rationale 1: Cervical dilation is one aspect of the pelvic exam assessment.
Rationale 2: Determining the station of the presenting part is one aspect of the pelvic exam assessment.
Rationale 3: Cervical effacement, or the thinning of the cervix, is one aspect of the pelvic exam assessment.
Rationale 4: An experienced labor and birth nurse can estimate the time of delivery based on the cervix, fetal position, station, and contraction pattern. However, during a pelvic exam, no information is obtained about contractions. The nurse will not have enough information following the cervical exam to estimate time of birth.

Answer to Question 2

2
Rationale 1: Breastfeeding is more successful if the infant is in the alert-awake state when put to breast. Putting a newborn to breast is not likely to wake him up to feed.
Rationale 2: Skin-to-skin contact creates tactile sensations that increase the sucking of newborns.
Rationale 3: The infant should be held in a tummy-to-tummy position so that the head does not have to turn to find the nipple and access the breast.
Rationale 4: Crying is a late cue of hunger. Newborns should be put to breast when they begin rooting, lip-smacking, or tongue-thrusting behaviors.