Chapter 21 (Test 3)

The nursing student demonstrates an understanding of dystocia with which of the following statements?

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

A nursing student is learning about fetal presentation. The nursing instructor realizes a need for further instruction when the student makes which of the following statements?

"Transverse lie is the same as when the fetal buttocks present to the birth canal."

The experienced labor and delivery nurse knows to evaluate progress in active labor by using which simple rule?

1 cm/hour for cervical dilation

The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention?

A forceps and vacuum-assisted delivery

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor?

A full bladder or rectum can impede fetal descent.

A woman is going to have labor induced with oxytocin. Which statement below reflects the induction technique you anticipate her primary-care provider will order?

Administer oxytocin diluted as a "piggyback" infusion.

Immediately after delivering a full-term infant, a patient 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 patient?

Amniotic fluid embolism

After teaching a class about various methods for cervical ripening, the instructor determines that the teaching was successful when the class identifies which of the following as a surgical method?

Amniotomy

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth?

Assess uterine tone to determine fundal firmness

When educating the post-term pregnant patient, what should the nurse be sure to include to prevent fetal complications?

Be sure to monitor fetal movements daily.

Which of the following interventions would be most important when caring for the client with breech presentation confirmed by ultrasound?

Continuing to monitor maternal and fetal status

A client in week 38 of her pregnancy 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?

External cephalic version

At 31 weeks' gestation, a 37-year-old woman who has a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Her cervix is 2.1 cm long; she has fetal fibronectin in her cervical secretions, and her cervix is dilated 3 to 4 cm. For what do you prepare her?

Hospitalization, tocolytic therapy, and IM corticosteroids

Which of the following actions could you initiate to reduce the discomfort of a woman in labor whose fetus is in an occiput posterior position?

Massage her lower back.

You are assisting with delivery of the second child of a healthy young woman. Her pregnancy has been uneventful, and labor has been progressing well. The fetal head begins to deliver but instead of continuing to emerge, it retracts into the vagina. What should you try first?

McRobert's maneuver

A multipara presents to the hospital after 2 hours of labor. The fetus is presenting in transverse lie. You notify the physician and take what action?

Prepare to assist with external version or prep for a cesarean section delivery.

Which of the following would be most appropriate for the woman who experiences dysfunctional labor in the first stage of labor?

Provide ongoing communication about what is happening.

Which intervention would be most appropriate for the woman experiencing dystocia related to problems involving the psyche?

Providing a comfortable environment with dim lighting

A multigravida presents at 31 weeks' gestation with signs and symptoms of preterm labor. The diagnosis is confirmed and she is admitted and given magnesium sulfate. What must you report as part of her care?

Respiratory depression, hypotension, absent tendon reflexes

In vasa previa, the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.

True

A nurse is assessing a full-term patient in labor and determines the fetus is occiput posterior. The patient states that all her discomfort is in her lower back. What intervention can the nurse provide that will help alleviate this discomfort?

Use a fist to apply counter pressure to the lower back.

A nursing student correctly identifies the problem of fetal buttocks instead of the head presenting first as which of the following?

breech presentation

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum?

identical

A nursing instructor is teaching students about fetal presentations during delivery. The most common cause for increased incidence of shoulder dystocia is:

increasing birth weight

A primigravida at 28 weeks' gestation comes to the clinic for a check-up. She tells the nurse that her mother delivered both of her children prematurely, and she is afraid that the same will happen to her. What can the nurse inform her about the risk factors associated with premature births? (Select all that apply.)

• Current multiple gestation pregnancy • Uterine or cervical abnormalities • History of previous preterm birth

A client is experiencing shoulder dystocia during delivery. The nurse would place priority on performing which assessment post delivery?

Brachial plexus assessment

A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilatation is cephalopelvic disproportion. Which of the following interventions should the nurse most expect in this case?

Cesarean birth

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which of the following conditions in the client is likely to increase the risk for shoulder dystocia?

Diabetes

A woman's nurse-midwife tells her that the woman has developed dystocia. You would explain that this term means

Difficult or abnormal labor

You assess that the fetus of a woman is in an occiput posterior position. Which of the following identifies the way you would expect her labor to differ from others?

Experience of additional back pain.

At the hospital, a client is attached to the fetal monitor for uterine rupture. The nurse would assess for which pattern indicating change in the uterus impacting the fetus?

Late decelerations.

A patient is 23 weeks gestation and was admitted for induction and delivery after noting the infant was an intrauterine fetal death. The patient had fallen 3 days prior to the diagnosis and landed on her side. What is the most likely attributable cause to the fetal death?

Placental abruption

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for which of the following?

Potential lacerations and bleeding

The nurse is monitoring a patient in labor who has had a previous cesarean section and is trying a vaginal birth with epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The patient reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?

Prepare the patient for a cesarean section.

A woman near term presents to the clinic highly agitated because her membranes have just ruptured and she felt something come out when they did. You are alone with her and notice that the umbilical cord is hanging out of the vagina. What should you do next?

Put her in bed immediately, call for help, and hold the presenting part of the cord.

The nurse would prepare a client for amnioinfusion when which of the following occurs?

Severe variable decelerations are due to cord compression

A client with a pendulous abdomen and uterine fibroid tumors had just begun labor and arrived at the hospital. After examining the client, the physician informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman?

Transverse lie

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time?

less than 3 hours