ch. 22 maternity prep u

A patient is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient? Oxytocin therapy Pain management Fluid replacement Increasing activity

Oxytocin therapy

osing a newborn is perhaps one of the most difficult situations for a family. Which action by the nurse would be the most appropriate if a newborn dies? offering mementos to the family of the newborn avoiding contact with the family strictly adhering to facility policies for handling the body keeping the time that parents spend with the infant to short periods

offering mementos to the family of the newborn

A 37-year-old client experienced a perinatal loss 3 days ago. Which client characteristic would be communicated to the health care provider? denial of the death blaming herself frequent crying spells lack of appetite

denial of death

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? Need to have the baby manually rotated Experience of additional back pain Necessity for vacuum extraction for birth Shorter dilation (dilatation) stage of labor

Need to have the baby manually rotated

The nurse instructs the pregnant mother that it will necessary to collect swabs for group B streptococcus at which prenatal visit? 36 weeks' gestation 34 weeks' gestation 38 weeks' gestation 32 weeks' gestation

36 weeks' gestation

When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action? Leaving the parents alone. Contacting a grief counselor. Removing the infant quickly. Keeping the communication lines open.

Keeping the communication lines open.

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? Early decelerations Mild decelerations Variable decelerations Late decelerations

Late decelerations

A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position? Lie flat on her back. Stay in high Fowler position. Lie in a semi-recumbent position. Use pillows and wedges to stay in a fully recumbent position.

Lie in a semi-recumbent position.

A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? amniotic fluid embolism umbilical cord prolapse shoulder dystocia uterine rupture

uterine rupture

The nurse would prepare a client for amnioinfusion when which action occurs? Severe variable decelerations occur and are due to cord compression. The fetus shows abnormal fetal heart rate patterns. Fetal presenting part fails to rotate fully and descend in the pelvis. Maternal pushing is compromised due to anesthesia.

Severe variable decelerations occur and are due to cord compression.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? Sudden shortness of breath Bradypnea Unrelieved pain Bradycardia

Sudden shortness of breath

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? Attempt to push in one of the fetus's shoulders. Use Zavanelli maneuver. Use McRoberts maneuver. Apply pressure to the fundus.

Use McRoberts maneuver.

Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client? placental separation aspiration congestive heart failure amniotic fluid embolism

amniotic fluid embolism

A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth? extensive lacerations brachial plexus assessment assess for cleft palate monitor for a cardiac anomaly

brachial plexus assessment

A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factors? Select all that apply. short maternal stature plan for pudendal block anesthetic use breech fetal presentation Body mass index 30.2 multiparity

breech fetal presentation Body mass index 30.2 short maternal stature

A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? forceps birth vacuum extraction trial labor external cephalic version

external cephalic version

During a difficult labor of an infant in the face presentation, the nurse notes the infant has a large amount of facial edema with bruising and ecchymosis. Which assessment would be the priority for this infant? ability to swallow fluids patent airway palpation of the anterior fontanels (fontanelles) ability to arch the eyebrows

patent airway

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time? Recommend that she not hold the infant after it is delivered so as to not upset her more. Offer to take pictures and footprints of the infant once it is delivered. Call the hospital chaplain to talk to the parents. Explain to her that there was probably something wrong with the infant and that is why it died.

Offer to take pictures and footprints of the infant once it is delivered.

A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication? precipitate labor reduced oxygen to the fetus ruptured uterus cephalopelvic disproportion

reduced oxygen to the fetus

he nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is not diagnosed until after the birth." "Dystocia is diagnosed after labor has progressed for a time." "Dystocia cannot be diagnosed until just before birth." "Dystocia is diagnosed at the start of labor."

"Dystocia is diagnosed after labor has progressed for a time."

he laboring mother is becoming very tired because she is experiencing tachysystole. The nurse can use which interventions to assist this mother? Select all that apply. Warm bath Sleeping medication Ambulation Opioid medication

Warm bath Opioid medication Sleeping medication

A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? oxytocin relaxin prostaglandins catecholamines

catecholamines

A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing? depression pulmonary emboli hemorrhage infection

infection

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor? hemoglobin of 11.5 mg/dl (115 g/L) multiparity placenta removed via manual extraction labor less than 3 hours

placenta removed via manual extraction

The postpartum mother who was delivered via cesarean section is preparing for discharge from the hospital. As part of the discharge teaching the nurse instructs the mother to make an appointment with her physician to have the staples removed in: 11 days. 14 days. 3 days. 6 days.

6 days

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? Avoid early ambulation to prevent respiratory problems. Ensure that the client does not cough or breathe deeply. Assess uterine tone to determine fundal firmness. Delay breastfeeding the newborn for a day.

Assess uterine tone to determine fundal firmness.

The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds? High in the abdomen Right lateral abdomen Left lateral abdomen Low in the abdomen

High in the abdomen

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which area? superficial structures above the muscle through the anal sphincter muscle through the anterior rectal wall through the perineal muscles

through the anal sphincter muscle

The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation. It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins? 30 minutes 45 minutes 60 minutes 15 minutes

30 mins

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? Placental abruption Brachial plexus injury Cord prolapse Uterine atony

Cord prolapse

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 1/2 cm/hour for cervical dilation 1/4 cm/hour for cervical dilation 1 cm/hour for cervical dilation 2 cm/hour for cervical dilation

1 cm/hr

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration? fourth degree first degree second degree third degree

fourth degree

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? "I know you are hurting, but you can have another baby in the future." "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" "Have you named your baby yet? I would like to know your baby's name." "I will make handprints and footprints of the baby for you to keep."

"I know you are hurting, but you can have another baby in the future."

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your baby has developed hydrocephaly and the head is too swollen." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." "Maybe your uterus is just tired and needs a rest." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

The nurse instructs the pregnant mother that it will necessary to collect swabs for group B streptococcus at which prenatal visit? 38 weeks' gestation 32 weeks' gestation 36 weeks' gestation 34 weeks' gestation

36 weeks' gestation

he nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? To lessen the mother's pain Abnormal position of the fetal head Reduce risk of complications The fetus is descending too slowly

Abnormal position of the fetal head

in terms of planning care, why is the development of a pathologic retraction ring important? It precedes uterine rupture. It denotes a multiple pregnancy is present. It suggests cesarean birth is no longer possible. It identifies that the pelvic division of labor is beginning.

It precedes uterine rupture.

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priority fetal assessment the health care provider should focus on at this time? Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor heart rate for tachycardia. Monitor fetal movements to ensure they are neurologically intact. Monitor fetal blood pressure for signs of shock (low BP, high FHR).

Look for late decelerations on monitor, which is associated with fetal anoxia.

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth? positioning the woman prone Lamaze position fundal pressure McRoberts maneuver

McRoberts maneuver

Four hours after delivery a mother suddenly complains of not being able to breathe and is gasping for breath. The nurse administers oxygen and calls for help. Which type of oxygen delivery device would be most appropriate for the nurse to utilize? Nasal cannula Nonrebreather mask Venturi mask Face mask

Nonrebreather mask

The nurse is caring for a laboring mother experiencing a precipitous delivery. The nurse would assess the mother for symptoms of which complication? Prolapsed cord Placental abruption Fetal hypoglycemia Poor Apgar scores

Placental abruption

Group B streptococcus (GBS) infection presents a large risk to the neonate. Which factor should the nurse consider when developing a plan of care related to GBS? Select all that apply. Antibiotics must be started 4 hours prior to labor to be effective. Women are screened for GBS in the 32nd week of gestation. Erythromycin is the primary antibiotic to treat GBS. Mothers with previous GBS will be treated with prophylactic antibiotics. Preterm labor clients receive prophylactic antibiotics.

Preterm labor clients receive prophylactic antibiotics. Antibiotics must be started 4 hours prior to labor to be effective. Mothers with previous GBS will be treated with prophylactic antibiotics.

A woman at 37 weeks' gestation is admitted to the labor and delivery suite to have an external cephalic version (ECV) due to the breech position of the fetus. Which nursing interventions are needed for this procedure? Select all that apply. Insert a peripheral IV. Provide client education. Perform a nonstress test (NST). Administer a tocolytic. Insert a Foley catheter

Provide client education. Insert a peripheral IV. Perform a nonstress test (NST). Administer a tocolytic.

he nurse would prepare a client for amnioinfusion when which action occurs? Severe variable decelerations occur and are due to cord compression. Fetal presenting part fails to rotate fully and descend in the pelvis. The fetus shows abnormal fetal heart rate patterns. Maternal pushing is compromised due to anesthesi

Severe variable decelerations occur and are due to cord compression.

A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying? Apologize and tell her that the photos will be destroyed immediately. Tell her that once she gets over her shock and grief, she will probably be happy to have the photos. Tell her that the hospital will keep the photos for her in case she changes her mind. Console her with the fact that she has other children.

Tell her that the hospital will keep the photos for her in case she changes her mind.

A mother pregnant with her second baby is admitted to L&D for a vaginal birth after cesarean (VBAC). While obtaining an admission assessment, what important information is necessary for the labor and delivery nurse to obtain? Select all that apply. The type of uterine incision The presenting part of the fetus The fetal heart rate The mother's vital signs Reason for the cesarean birth

The presenting part of the fetus The type of uterine incision Reason for the cesarean birth The fetal heart rate The mother's vital signs

A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem? The mother has a small pelvic opening. The mother is fighting the contractions. The fetus is macrosomic. Uterine contractions are weak and ineffective.

Uterine contractions are weak and ineffective.

The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability? Variability is minimal. Variability is normal. Variability is absent. Variability is marked.

Variability is normal.

Which clients should the nurse monitor for fetal demise? Select all that apply. client with hydramnios client with hypertension client with multifetal gestation client who has a prolonged pregnancy client whose fetus is displaying malpresentation

client who has a prolonged pregnancy client with hypertension

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? applying suprapubic pressure against the fetal back noting the space at the maternal umbilicus continuing to monitor maternal and fetal status auscultating the fetal heart rate at the level of the umbilicus

continuing to monitor maternal and fetal status

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? lack of cervical dilation past 2 cm contractions most forceful in the middle of uterus rather than the fundus reports of severe back pain fetal buttocks as the presenting part

contractions most forceful in the middle of uterus rather than the fundus

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? reports of severe back pain fetal buttocks as the presenting part lack of cervical dilation past 2 cm contractions most forceful in the middle of uterus rather than the fundus

contractions most forceful in the middle of uterus rather than the fundus

he nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action? The client is afebrile. The fundus is located 2 fingerbreadths above the umbilicus. The client requires assistance to ambulate in the hallway. The client is having a moderate amount of rubra lochia. Bowel sounds are active.

he fundus is located 2 fingerbreadths above the umbilicus.

It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: have anesthesia provider present. provide pain medication. empty the mother's bladder. call the neonatologist.

empty the bladder

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? uterine bleeding a low-lying placenta fetopelvic disproportion contraction ring

fetopelvic disproportion

primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? fetopelvic disproportion contraction ring uterine bleeding a low-lying placenta

fetopelvic disproportion

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? uncoordinated contractions hypertonic contractions Braxton Hicks contractions hypotonic contractions

hypotonic contractions

The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? Nonstress test (NST) Contraction stress test Doppler ultrasound Vaginal ultrasound

nst

A nurse is preparing an in-service education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common? breech presentation multifetal pregnancy persistent occiput posterior position macrosomia

persistent occiput posterior position

A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: place a hand gently on the fetal head to guide birth. attach a fetal monitor to determine fetal status. ask her to push with the next contraction so birth is rapid. assess blood pressure and pulse to detect placental bleeding.

place a hand gently on the fetal head to guide birth

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? genetic abnormality placental abruption premature rupture of membranes preeclampsia

placental abruption

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? premature rupture of membranes genetic abnormality placental abruption preeclampsia

placental abruption

G3P2 woman arrives at the birthing center stating that she has been in labor for the past 18 hours. The nurse suspects a protracted labor pattern disorder based on which finding? slower than usual cervical dilation (dilatation) fetal face presentation incomplete relaxation of the uterus between contractions poor contraction quality and intensity

slower than usual cervical dilation (dilatation)

A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix. The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix

the uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.

A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication? Placenta previa Umbilical cord compression Uterine rupture Hypertonic uterus

uterine rupture

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? "Maybe your baby has developed hydrocephaly and the head is too swollen." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "Maybe your uterus is just tired and needs a rest." "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby."

you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."