Complications Occurring During Labor and Delivery

Second degree laceration

Damage to the fascia and muscles of the perineum; no damage to the anal sphincter

Performed in the second stage of labor, an episiotomy is considered to be routine practice.

FALSE

Placenta increta is defined as the "penetration of the placenta into the myometrium". T/F

T

Trendelenburg position

lying on back with body tilted so that the head is lower than the feet

It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: 1 empty the mother's bladder. 2 provide pain medication. 3 have anesthesia provider present. 4 call the neonatologist.

1 Forceps delivery may be outlet, low, or midforceps depending on the station of the fetus and the rotation of the fetal head. Client consent must be obtained and the maternal bladder must be emptied to reduce the chance of bladder injury and to increase the room for the fetus. NOT 3.4. The anesthesia provider and neonatologist would only be necessary if there was suspicion of complications to the mother and the fetus.

Fourth degree laceration

As with a third-degree laceration, but additionally including damage to the rectal mucosa and the internal anal sphincter

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

C. In evaluating the progress in active labor, the nurse uses the simple rule of 1 cm/hour for cervical dilation

_______________ disproportion occurs when the fetal head is larger than the size of the maternal pelvis.

Cephalopelvic

A prolonged latent phase of labor is one that lasts more than 14 hours for a nulliparous woman.

FALSE > 20 hours in a nulliparous woman > 14 hours in a multiparous woman

A transverse incision during a cesarean section is associated with less maternal blood loss and better surgical repair. T/F

True

First degree laceration

No injury to the muscle; injury only to the skin and subcutaneous tissue of the perineum and vagina

An umbilical cord prolapse can often present in the fetal heart rate pattern as severe fetal ________________.

bradycardia

Placenta percreta

growth of the chorionic villi through the myometrium to the uterine serosa

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? 1 Shorter dilation (dilatation) stage of labor 2 Experience of additional back pain 3 Need to have the baby manually rotated 4 Necessity for vacuum extraction for birth

2 Most women whose fetus is in a posterior position experience back pain while in labor. Pressure against the back by a support person often reduces this type of pain. NOT 1 An occiput posterior position does not make for a shorter (dilation) dilatation stage of labor. 3.4. OP position does not indicate the need to have the baby manually rotated, nor does it indicate a necessity for a vacuum extraction birth

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? 1 "I will make handprints and footprints of the baby for you to keep." 2 "I know you are hurting, but you can have another baby in the future." 3 "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" 4 "Have you named your baby yet? I would like to know your baby's name."

2 Parents who have experienced a stillborn need support from the nursing staff. Statements by the nurses need to be therapeutic for the grieving parents. Statements that offer false hope or diminish the value of the stillborn child cause the parents pain. Telling them that they can have another child is both thoughtless and hurtful

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding? 1 well coordinated. 2 poor in quality. 3 brief. 4 erratic.

4 Hypertonic contractions occur when the uterus never fully relaxes between contractions, making the contractions erratic and poorly coordinated because more than one uterine pacemaker is sending signals for contraction. Hypotonic uterine contractions are poor in quality, brief, and lack sufficient intensity to dilate and efface the cervix

Group B streptococcus infection typically appears in the newborn as ________________, pneumonia, or meningitis

Sepsis

Placenta accreta

Improper implantation of placenta into the myometrium with little or no intervening decidua (thick layer of modified mucous membrane which lines the uterus during pregnancy and is shed with the afterbirth)

The nurse would prepare a client for amnioinfusion when which action occurs? 1 Severe variable decelerations occur and are due to cord compression. 2 Fetal presenting part fails to rotate fully and descend in the pelvis. 3 The fetus shows abnormal fetal heart rate patterns. 4 Maternal pushing is compromised due to anesthesia

1 Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. NOT 2.3.4. Failure of the fetal presenting part to rotate fully; descent in the pelvis; abnormal fetal heart rate patterns or acute pulmonary edema; and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amnioinfusion

The nurse is teaching an antepartum class to first-time mothers. A mother asks the nurse if she should stay in bed when her contractions start. How should the nurse respond? 1 "No, walking actually shortens the first stage of labor." 2 "No, but you need to only walk for 15-minute intervals." 3 "Yes, you don't want to risk having your water break while you are walking." 4 "Yes, it is important so monitoring can be done for you and the baby."

1 Maternal position can affect the progress of labor. An upright instead of a horizontal position may shorten the first stage of labor as much as 90 minutes, especially if a mother has given birth before. An upright position also shortens the second stage of labor, reduces the rate of surgical vaginal deliveries, and helps reduce labor pain. An upright position includes sitting, kneeling, squatting and standing. The mother has options other than just sitting in a chair. NOT 3 Staying in bed to reduce the risk of membranes rupturing is not valid. 4 Monitoring can be done while the mother is upright.

The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus? 1 shoulder dystocia 2 umbilical cord prolapse 3 nuchal cord 4 breech position

1 The "turtle sign" is the classic sign that alerts the practitioner to the probability of shoulder dystocia. The fetal head delivers, but then retracts similar to a turtle. The fetal head may wiggle from side to side and fail to rotate

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? 1 Uterine rupture 2 Hypertonic uterus 3 Placenta previa 4 Umbilical cord compression

1 The client with any prior history of uterus surgery is at increased risk for a uterine rupture. A falling blood pressure and increasing pulse is a sign of hemorrhage, and in this client a uterine rupture needs to be a first consideration. NOT 2.3.4. The scenario does not indicate a hypertonic uterus, a placenta previa, or umbilical cord compression

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 dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case? 1 cesarean birth 2 administration of oxytocin 3 administration of morphine sulfate 4 darkening room lights and decreasing noise and stimulation

1 If the cause of the delay in dilation (dilatation) is fetal malposition or cephalopelvic disproportion (CPD), cesarean birth may be necessary. NOT 2 Oxytocin would be administered to augment labor only if CPD were ruled out. 3.4. Administration of morphine sulfate (an analgesic) and darkening room lights and decreasing noise and stimulation are used in the management of a prolonged latent phase (1st) caused by hypertonic contractions. These measures would not help in the case of CPD

The nurse is caring for a laboring mother who is making little progress with cervical dilation (dilatation). The mother is very anxious and tense. How can the nurse best help this mother? 1 Provide support. 2 Provide pain medication. 3 Reposition the mother. 4 Teach breathing techniques.

1 The client's psyche or psychological state can contribute to dystocia. Anxiety increases catecholamine levels, which have a negative impact on normal labor. Support from others, particularly continuous one-on-one support, can help allay anxiety and is generally desired by most women. NOT 2.3.4. The other option choices may be necessary but providing support is the best option

The nurse is caring for a laboring mother. The mother continues to complain of back pain. The nurse instructs the mother the pain is occurring because the fetus is in which position? 1 occiput posterior 2 occiput transverse 3 left occiput anterior 4 right occiput anterior

1 The fetal position is the position of the presenting part in relation to the maternal pelvis. Occiput posterior (OP) position causes severe maternal backache. NOT 3.4. The most common fetal positions are left occiput anterior and right occiput anterior. The most common fetal malposition is (OP). 2 There is no fetal position of occiput transverse

The nurse is teaching the mother about surgical incisions for a cesarean birth. What reason would the nurse give to the mother as to why a low transverse incision is preferable? 1 The wound will be stronger. 2 It requires less sutures. 3 It leaves a better scar. 4 There's less chance of bleeding

1 The low transverse incision ("bikini cut") is preferred generally because it results in less pain, provides greater wound strength, and provides a better aesthetic result. NOT 2.4. It does not require less sutures or alter the chance for bleeding. 3 The scar will be the same for the surgical incision. Most women prefer the "bikini cut" because it is hidden in the pubic hair

The nurse performs a vaginal exam on a mother in active labor. The cervix has dilated to 5 cm but the fetal head remains at -2 station. The nurse interprets these findings as: 1 pelvic dystocia. 2 shoulder dystocia. 3 cervical edema. 4 maternal full bladder.

1 The mother may be experiencing pelvic dystocia. This can be due to a maternal pelvis that is smaller or contracted. This problem can occur at the pelvic inlet, the mid-pelvis, or the pelvic outlet. Pelvic dystocia is a large reason for surgical deliveries. Cervical edema and a full bladder or symptoms of soft tissue dystocia

When a woman in labor has reached 8 cm dilation, the nurse notices the fetal heat rate suddenly slows. On perineal inspection, the nurse observes the fetal cord has prolapsed. The nurse's first action would be to: 1 turn her to her left side. 2 place her in a knee-chest position. 3 replace the cord with gentle pressure. 4 cover the exposed cord with a dry, sterile wrap.

2 Keeping the pressure of the fetus off the cord improves fetal circulation. Placing the woman in a knee-chest position accomplishes this. Replacing the cord could knot it; allowing it to dry would constrict cord blood vessels.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? 1 Bradypnea 2 Sudden shortness of breath 3 Bradycardia 4 Unrelieved pain

2 Sudden SOB can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema.

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? 1 Monitor heart rate for tachycardia. 2 Monitor fetal movements to ensure they are neurologically intact. 3 Look for late decelerations on monitor, which is associated with fetal anoxia. 4 Monitor fetal blood pressure for signs of shock (low BP, high FHR).

3 A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this can lead to fetal anoxia early in the latent phase of labor. NOT 1.2.4. Applying a uterine and a fetal external monitor will help identify that the resting phase between contractions is adequate and that the FHR is not showing late deceleration

Review of a woman's labor and birth record reveals a laceration that extends through the anal sphincter muscle. The nurse identifies this laceration as which type? 1 first-degree laceration 2 second-degree laceration 3 third-degree laceration 4 fourth-degree laceration

3 A third-degree laceration extends through the anal sphincter muscle. NOT A1 first-degree laceration involves only skin and superficial structures above the muscle. 2 A second-degree laceration extends through the perineal muscles. 4 A fourth-degree laceration continues through the anterior rectal wall

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? 1 Apologize and tell her that the photos will be destroyed immediately. 2 Console her with the fact that she has other children. 3 Tell her that the hospital will keep the photos for her in case she changes her mind. 4 Tell her that once she gets over her shock and grief, she will probably be happy to have the photos.

3 Emotional care of the woman is complex, especially one who has suffered the loss of a child. The woman will need time to move through the stages of grief and the responses of grief vary from person to person. The mother may request the items later and they should be stored or kept for a year after the birth. NOT 1 There is no need to apologize to the client. 2 It would be inappropriate to console her with the fact that she has other children. It negates her feelings and is not supportive of the woman at this time

A woman in labor is experiencing dysfunctional labor (hypotonic uterine dysfunction). Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? 1 sedatives 2 tocolytics 3 uterine stimulants 4 corticosteroids

3 For dysfunctional labor (hypotonic uterine dysfunction), a uterine stimulant such as oxytocin may be prescribed once fetopelvic disproportion is ruled out. NOT 1 Sedatives might be helpful for the woman with hypertonic uterine contractions to promote rest and relaxation. 2 Tocolytics would be ordered to control preterm labor. 4 Corticosteroids may be given to enhance fetal lung maturity for women experiencing preterm labor

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? 1 labor less than 3 hours 2 hemoglobin of 11.5 mg/dl (115 g/L) 3 placenta removed via manual extraction 4 multiparity

3 Manual removal of the placenta places a woman at risk for postpartum infection NOT 2 as does a hemoglobin level less than 10.5 mg/d (105 g/L). 1.4. Precipitous labor of less than 3 hours and multiparty of more than three births closely spaced place a woman at risk for postpartum hemorrhage

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia? 1 McDonald maneuver 2 McGeorge maneuver 3 McRoberts maneuver 4 McRonald maneuver

3 McRoberts maneuver is an intervention that is frequently successful in cases of shoulder dystocia (difficult birth), and it is often tried first. McRoberts requires the assistance of two individuals. Two nurses are ideal; however, a support person or a technician can serve as the second assistant. With the woman in lithotomy position, each nurse holds one leg and sharply flexes the leg toward the woman's shoulders. This opens the pelvis to its widest diameters and allows the anterior shoulder to deliver in almost half of the cases

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? 1 Lie flat on her back. 2 Stay in high Fowler position. 3 Lie in a semi-recumbent position. 4 Use pillows and wedges to stay in a fully recumbent position.

3 Semi-recumbent position is the best position for circulation of the mother and fetus. NOT 1.4. Lying flat on the back can induce supine hypotensive syndrome and fully recumbent impedes other circulation. 2 The high Fowler position would not be comfortable for sleeping, as well as possibly impede the blood flow through the hips and lower abdomen

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: 1 longer length of labor. 2 increased number of overall pregnancies. 3 increasing birth weight. 4 poor quality of prenatal care.

3 Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has emerged. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in as many as 2% of vaginal births

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? 1 If the woman has a full bladder, labor may be uncomfortable for her. 2 If the woman's bladder is distended, it may rupture. 3 A full bladder or rectum can impede fetal descent. 4 A full rectum can cause diarrhea

3 Throughout labor the nurse needs to assess the woman's fluid balance status as well as check skin turgor and mucous membranes. In addition she needs to monitor the bladder and bowel status. A full bladder or rectum can impede fetal descent

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? 1 genetic abnormality 2 premature rupture of membranes 3 preeclampsia 4 placental abruption

4 The most common cause of fetal death after a trauma is placental abruption (abruptio placentae), where the placenta separates from the uterus, and the fetus is not able to survive. NOT 1 Genetic abnormalities typically cause spontaneous abortion (miscarriage) in the first trimester. 3.2. Trauma does not cause preeclampsia (which is related to various issues in the mother) nor does trauma usually cause PROM

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? 1 first degree 2 second degree 3 third degree 4 fourth degree

4 The nurse should classify the laceration as fourth degree because it continues through the anterior rectal wall. NOT 1 First-degree laceration involves only skin and superficial structures above muscle; 2 second-degree laceration extends through perineal muscles; 3 and third-degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall.

A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? 1 extensive lacerations 2 monitor for a cardiac anomaly 3 assess for cleft palate 4 brachial plexus assessment

4 The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia. Other fetal risks include asphyxia, clavicle fracture, central nervous system injury or dysfunction, and death. NOT 1 Extensive lacerations is a poor maternal outcome due to the occurrence of shoulder dystocia, which should be assessed and treated. 3.2. Cleft palate and cardiac anomalies are not related to shoulder dystocia.

The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client? 1 Administer an analgesic to the client. 2 Prepare the client for a cesarean birth. 3 Prepare for a precipitous vaginal birth. 4 Prepare to assist the care provider with an amniotomy.

2 If a transverse lie persists, the fetus cannot be born vaginally. Thus, the nurse will prepare the client for a caesarean birth. NOT 3 There is no indication the client will have precipitous labor. 4 Amniotomy (artificial rupture of the membranes) is not indicated when preparing from a caesarean birth. 1 The nurse would not administer analgesic before surgery unless prescribed by the health care provider

Amnioinfusion (AI)

Procedure used to infuse a sterile fluid (such as normal saline) through an intrauterine catheter into the uterus in an attempt to increase the fluid around the umbilical cord to decrease or prevent cord compression during labor contractions; also used to dilute thick meconium-stained amniotic fluid.

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? 1 placental separation 2 aspiration 3 amniotic fluid embolism 4 congestive heart failure

With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension

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: 1 place a hand gently on the fetal head to guide birth. 2 ask her to push with the next contraction so birth is rapid. 3 assess blood pressure and pulse to detect placental bleeding. 4 attach a fetal monitor to determine fetal status.

1 If a head is controlled as it emerges, trauma to internal vessels or to the maternal cervix is less apt to occur.

The health care provider has chosen to utilize a vacuum device to assist in the birth of an infant. During this procedure the nurse can best help the mother by: 1 teaching the most effective pushing techniques. 2 explaining how the device works. 3 providing reassurance to reduce fear. 4 emptying the bladder prior to use of the device

1 A vacuum-assisted birth occurs when the obstetric provider applies a suction cup to the fetal head. During a contraction and maternal pushing, traction is applied to the fetal head to assist with descent. The nurse can best assist the mother by teaching her the most effective pushing techniques during this procedure. NOT 2.3.4. Explaining how the vacuum device works, providing reassurance, and emptying the bladder are all correct, but they are not as effective as helping with maternal pushing

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: 1 administer oxygen by mask. 2 increase her intravenous fluid infusion rate. 3 put firm pressure on the fundus of her uterus. 4 tell the woman to take short, catchy breaths.

1 An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to compensate for the sudden blockage of blood flow through her lungs

Four hours after giving birth 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? 1 nonrebreather mask 2 Venturi mask 3 face mask 4 nasal cannula

1 An amniotic fluid embolism occurs when amniotic fluid enters the maternal circulation. It is always an emergency. Providing oxygenation is crucial to prevent respiratory failure. The goal is to keep the PaO2 level above 65 mm Hg. This can be accomplished with a nonrebreather mask at a rate of 8-10L/min or by a resuscitation bag delivering 100% oxygen. NOT 2.3.4. The other options are incorrect because they will not provide enough flow rate or FiO2.

A mother who had a cesarean delivery with her second child wishes to deliver her third baby vaginally. The nurse prepares the mother for an induction of labor. Because of the previous cesarean birth the nurse knows which classification of drugs will not be used in the induction process? 1 prostaglandins 2 oxytocin 3 ergot alkaloids 4 laminaria

1 Any labor induction contributes to the risk of uterine rupture in women with a history of cesarean birth. Because of the increased risk of rupture with prostaglandins their use is contraindicated in women with a previous cesarean birth. NOT 2 There is also a risk with oxytocin but it is not contraindicated. 3 Ergot alkaloids (methergine) are more useful postpartum to keep the uterus contracted to prevent bleeding. 4 Laminaria (seaweed) is useful to help soften the cervix prior to induction but does not stimulate contractions

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse to initiate? 1 providing a comfortable environment with dim lighting 2 administering oxytocin 3 preparing the woman for an amniotomy 4 encouraging the women to change positions frequently

1 Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor. This action is consistent with assisting a woman experiencing problems with the psyche. NOT 2 Oxytocin would be appropriate for the woman experiencing hypotonic uterine dysfunction (problem with the powers). 3 An amniotomy may be used with hypertonic uterine dysfunction to augment labor. 4 Frequent position changes would be appropriate for a woman with persistent occiput posterior position (problem with the passenger).

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? 1 external cephalic version 2 trial labor 3 forceps birth 4 vacuum extraction

1 External cephalic version is the turning of a fetus from a breech to a cephalic position before birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of pregnancy. NOT 2 A trial birth is performed when a woman has a borderline (just adequate) inlet measurement and the fetal lie and position are good and involves allowing labor to take its normal course as long as descent of the presenting part and dilation (dilatation) of the cervix continue to occur. 3.4. Forceps, which are not commonly used anymore, and vacuum extraction are used to facilitate birth when other complications are present, but they would be less likely to be used with a fetus in breech position.

A client who is in labor presents with shoulder dystocia of the fetus. Which is an important nursing intervention? 1 Assist with positioning the woman in squatting position. 2 Assess for reports of intense back pain in first stage of labor. 3 Anticipate possible use of forceps to rotate the fetus to anterior position at birth. 4 Assess for prolonged second stage of labor with arrest of labor.

1 The nurse caring for the client in labor with shoulder dystocia of the fetus should assist with positioning the client in squatting position. The client can also be helped into the hands and knees position or lateral recumbent position for birth, to free the shoulders. NOT 2.3.4. Assessing for report of intense back pain in first stage of labor, anticipating possible use of forceps to rotate to anterior position at birth, and assessing for prolonged second stage of labor with arrest of labor are important interventions when caring for a client with persistent occiput posterior position of fetus

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? 1 Assess uterine tone to determine fundal firmness. 2 Delay breastfeeding the newborn for a day. 3 Ensure that the client does not cough or breathe deeply. 4 Avoid early ambulation to prevent respiratory problems.

1 When caring for a client who has undergone a cesarean birth, the nurse should assess the client's uterine tone to determine fundal firmness. NOT 2 The nurse should assist with breastfeeding initiation and offer continued support. The nurse can also suggest alternate positioning techniques to reduce incisional discomfort while breastfeeding. Delaying breastfeeding may not be required. 3 The nurse should encourage the client to cough, perform deep-breathing exercises, and use the incentive spirometer every 2 hours. 4 The nurse should assist the client with early ambulation to prevent respiratory and cardiovascular problems

A client is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this client? 1 oxytocin therapy 2 fluid replacement 3 pain management 4 increasing activity

1 With a prolonged descent, intravenous oxytocin may be used to induce the uterus to contract effectively. NOT 2.3.4. Fluid replacement, pain management, and activity will not cause the fetus to descend quicker

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? 1 nonstress test (NST) 2 contraction stress test 3 vaginal ultrasound 4 doppler ultrasound

1 Women with a Hx of previous stillbirth begin antepartum fetal testing 1 to 2 weeks prior to the gestational age at which the intrauterine demise occurred, or no later than 32 to 34 weeks' gestation. One method to assess the well-being of the fetus is the biophysical profile. Included in this is the nonstress test. Other regular screening methods are having the mother keep a record of kicks (fetal movement counts/kick counts) and monitoring for hypertensive disorders and diabetes. NOT 3 An abdominal ultrasound could screen for fetal growth restriction. 4 A Doppler ultrasound measures the blood flow of the fetus but it is not part of the regular screening unless fetal problems have been identified

The mother who delivered 60 minutes ago still has not expelled the placenta and the cervix is closing. Nitroglycerin is ordered by the obstetric provider. What nursing care should the nurse provide when administering this drug? Select all that apply. 1 Provide oxygen. 2 Blood pressure assessment every 5 minutes. 3 Continuous pulse oximetry. 4 Increase IV flow rate. 5 Continuous HR monitoring.

1.2.3.5. If the placenta is entrapped behind a closing cervix, nitroglycerin may be administered to help the cervix relax. Nitroglycerin can cause hypotension, tachycardia, hypoxia, and a headache because it causes both arterial and venous dilation (dilatation). Monitoring for all these situations is important to prevent further complications for the mother. NOT 4 The IV rate would only need to be increased if the mother begins to bleed

The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate? 1 "If you do not get up to walk you will not recover." 2 "Walking is the best way to prevent complications such as blood clots." 3 "As long as you walk more tomorrow to make up for the delay in walking today you should be fine." 4 "Maybe you will feel better after you take pain medication."

2 The development of blood clots is a potential complication of a cesarean birth. Early ambulation is key in the prevention of the complication. The client needs to be advised of this complication and the best means of clot prevention. NOT 1 Telling the client that failing to walk will prevent her recovery is threatening and does not provide her the needed information. 3 A delay in walking by even one day can be detrimental to her recovery. 4 Recommending pain medication may help the client in her ability and willingness to ambulate, but it does not provide the needed client education

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? 1 hemorrhage 2 infection 3 depression 4 pulmonary emboli

2 There are many risk factors for developing a postpartum infection: operative procedures (e.g., forceps, cesarean section, vacuum extraction), history of diabetes, prolonged labor (longer than 24 hours), use of Foley catheter, anemia, multiple vaginal examinations during labor, prolonged rupture of membranes, manual extraction of placenta, and HIV.

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? 1 Explain to her that there was probably something wrong with the infant and that is why it died. 2 Offer to take pictures and footprints of the infant once it is delivered. 3 Call the hospital chaplain to talk to the parents. 4 Recommend that she not hold the infant after it is delivered so as to not upset her more.

2 When parents are faced with a fetal death, they need comfort and support without being intrusive. Taking pictures, footprints and gathering other mementos are very important in helping the family deal with the death. NOT 4 The mother is encouraged to hold the infant after delivery and name it. 1 Telling the parents that the infant was probably defective is hurtful and not supportive to them. 3 Calling the hospital chaplain is something that can be offered but should not be done without the parent's approval

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? 1 amniotic fluid embolism 2 shoulder dystocia 3 uterine rupture 4 umbilical cord prolapse

3 Uterine rupture is associated with crack cocaine use disorder. Generally, the first and most reliable sign is sudden fetal distress accompanied by acute abdominal pain, vaginal bleeding, hematuria, irregular wall contour, and loss of station in the fetal presenting part. NOT 1 Amniotic fluid embolism often is manifested with a sudden onset of respiratory distress. 2 Shoulder dystocia is noted when continued fetal descent is obstructed after the fetal head is delivered. 4 Umbilical cord prolapse is noted as the protrusion of the cord alongside or ahead of the presenting part of the fetus.

The fetus of a pregnant client is in a breech presentation. Where will the nurse auscultate fetal heart sounds? 1 low in the abdomen 2 left lateral abdomen 3 high in the abdomen 4 right lateral abdomen

3 With a breech presentation, fetal heart sounds usually are heard high in the abdomen. In a breech presentation, fetal heart sounds will not be heard low in the abdomen or over the left or right lateral abdominal regions

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 "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question? 1 "Maybe your uterus is just tired and needs a rest." 2 "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." 3 "Maybe your baby has developed hydrocephaly and the head is too swollen." 4 "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

4 Arrest of labor results when no descent has occurred for 2 hours in a nullipara (never given birth) or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. NOT 1 Rest should allow the uterine contractions to be more efficient. 2 The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor

A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next? 1 Place the client in lithotomy position for birth. 2 Administer oxytocin intravenously at 4 mU/minute. 3 Perform artificial rupture of membranes. 4 Prepare the client for a cesarean birth.

4 Cephalopelvic disproportion is associated with postterm pregnancy. This client will not be able to vaginally give birth and should be prepared for a cesarean birth. NOT 1.2.3. Lithotomy position, artificial rupture of membranes, and oxytocin are interventions for a vaginal birth

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? 1 supine 2 side-lying 3 sitting 4 knee-chest

4 Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. NOT 1.2.3. Supine, side-lying, or sitting would not provide relief of cord compression

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? A 9 B 7 C 5 D 3

A. The biophysical profile is a scored test with five components, each worth 2 points if present. A total score of 10 is possible if the NST is used. Overall, a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. NOT B.C.D. A score of 6 or below is suspicious, possibly indicating a compromised fetus; further investigation of fetal well-being is needed.

Third degree laceration

As with a second-degree laceration, but additionally including damage to the external anal sphincter and possibly to the internal anal sphincter

Sims position

lying on left side with right knee drawn up and with left arm drawn behind, parallel to the back

6An external cephalic version may be attempted to manually turn a fetus in breech presentation. T/F

True

Cephalopelvic disproportion

condition preventing normal delivery through the birth canal; either the baby's head is too large or the birth canal is too small

Operative vaginal deliveries include both vacuum-assisted deliveries and ________________ -assisted deliveries

forceps