Intrapartum-L&D

A G4P3 patient in the transition phase of labor asks the nurse, "How much longer will it be before I have my baby?" What would be the best estimate that the nurse could provide?

One hour is a reasonable estimate of time until delivery for a multipara woman in transition. Three hours or less would be a more appropriate answer for a nullipara woman.

The fetal monitor has shown several late decelerations over the past 10 minutes. What does this pattern indicate?

A pattern of late decelerations indicates fetal hypoxia, caused primarily by uteroplacental insufficiency. Variable decelerations are caused by umbilical cord compression. Early decelerations are caused by head compression. Maternal fever may contribute to fetal tachycardia.

A client who is gravida 1, para 0 is admitted in labor. Her cervix is 100% effaced, and she is dilated to 3 cm. Her fetus is at +1 station. The nurse is aware that the fetus' head is:

A station of +1 indicates that the fetal head is 1 cm below the ischial spines.

After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:

As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears.

Irregular intermittent contractions occurring throughout the pregnancy are __________ contractions (two words).

Braxton Hicks

A laboring client is in the first stage of labor and has progressed from 4 to 7 cm in cervical dilation. In which of the following phases of the first stage does cervical dilation occur most rapidly?

Cervical dilation occurs more rapidly during the active phase than any of the previous phases. The active phase is characterized by cervical dilation that progresses from 4 to 7 cm. The preparatory, or latent, phase begins with the onset of regular uterine contractions and ends when rapid cervical dilation begins. Transition is defined as cervical dilation beginning at 8 cm and lasting until 10 cm or complete dilation.

When a non-reassuring fetal heart pattern is detected, what remedial nursing intervention is carried out?

Change position, preferably on the left side; give IV fluids; administer oxygen by tight-fitting mask; discontinue oxytocics; and notify the physician.

The landmark for a vertex presentation is the __________.

Occiput

Softening of the cervix toward the end of pregnancy is known as __________.

Ripening

The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?

Variable decelerations occur if the umbilical cord becomes compressed, thus reducing blood flow between the placenta and the fetus. Early decelerations result from pressure on the fetal head during a contraction. Late decelerations are an ominous pattern in labor because it suggests uteroplacental insufficiency during a contraction. Short-term variability refers to the beat-to-beat range in the fetal heart rate.

During the period of induction of labor, a client should be observed carefully for signs of:

Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise.

What findings meets the criteria of a Reassuring FHR pattern?

Variability indicates a well oxygenated fetus with a functioning autonomic nervous system. FHR should accelerate with fetal movement. Baseline range for the FHR is 120 to 160 beats per minute. Late deceleration patterns are never reassuring, though early and mild variable decelerations are expected, reassuring findings.

18. A nurse is monitoring a client in labor who is receiving Pitocin and notes that the client is experiencing hypertonic uterine contractions. List in order of priority the actions that the nurse takes. 1)Stop of Pitocin infusion. 2)Perform a vaginal examination. 3)Reposition the client. $)Check the client's blood pressure and heart rate. 5)Administer oxygen by face mask at 8 to 10 L/min

1, 4, 2. 5, 3. If uterine hypertonicity occurs, the nurse immediately would intervene to reduce uterine activity and increase fetal oxygenation. The nurse would stop the Pitocin infusion and increase the rate of the nonadditive solution, check maternal BP for hyper or hypotension, position the woman in a side-lying position, and administer oxygen by snug face mask at 8-10 L/min. The nurse then would attempt to determine the cause of the uterine hypertonicity and perform a vaginal exam to check for prolapsed cord.

An assessment is performed, and the nurse notes that the client's hemoglobin and hematocrit levels are low, indicating anemia. The nurse determines that the client is at risk for which of the following?

Anemic women have a greater likelihood of cardiac decompensation during labor, postpartum infection, and poor wound healing. Anemia does not specifically present a risk for hemorrhage. Having a loud mouth is only related to the person typing up this test.

A client arrives at the hospital in the second stage of labor. The fetus' head is crowning, the client is bearing down, and the birth appears imminent. The nurse should:

Gentle pressure is applied to the baby's head as it emerges so it is not born too rapidly. The head is never held back, and it should be supported as it emerges so there will be no vaginal lacerations. It is impossible to push and pant at the same time.

A nurse is reviewing the factors important in the process of labor. Which two pelvic types are favorable for labor and vaginal delivery?

Gynecoid and anthropoid pelvis types are favorable for labor or delivery, whereas android and platypelloid pelvis types are not favorable

A pregnant patient asks the nurse, "How will I know when I am close to starting labor?" The nurse correctly states that one possible sign of impending labor is:

Impending labor may be indicated by a weight loss of 2.2-6.6 kg (1-3 pounds) resulting from fluid loss and electrolyte shifts produced by changes in estrogen and progesterone levels. Diarrhea, indigestion, or nausea and vomiting usually occur just prior to the onset of labor. Some women report a sudden burst of energy approximately 24-48 hours before labor. Abdominal discomfort can be a sign of false labor.

What are indications for continuous fetal monitoring in labor?

Indications include previous history of a stillbirth at 38 or more weeks' gestation, presence of a complication of pregnancy, induction of labor, preterm birth, decreased fetal movement, non-reassuring fetal status, meconium-stained amniotic fluid, and trial of labor following a previous cesarean birth.

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order?

Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.

What fetal heart rate assessment will best ensure fetal well-being during the period Cindy is ambulating?

Perform intermittent auscultation every 15 minutes with an ultrasound or a fetoscope. Listen to the fetal heart during a contraction and 30 seconds after the contraction to identify non-reassuring heart pattern.

A laboring patient is lying supine with a blood pressure of 88/60. What should be the initial nursing action?

Position patient to a lateral (side-lying) position to correct the supine hypotension (88/60) due to aortocaval compression. Administration of oxygen, notifying the physician or nurse-midwife, or increasing the intravenous drip rate are not initial actions, because they will not correct aortocaval compression.

Which observation would indicate that the placenta has separated from the uterine wall and is ready for delivery?

Signs of placental separation include lengthening of the umbilical cord, a sudden gush of dark blood from the introitus (vagina), a firmly contracted uterus, and the uterus changing from a discoid (like a disk) to a globular (like a globe) shape. The client may experience vaginal fullness, but not severe uterine cramping. I am going to look more into this answer. According to our book on page 584, this is not one of our options.

A nurse is receiving a report on four patients in the birthing center. Which patient should the nurse anticipate giving birth first?

The patient who is G5P4, 5 cm dilated, and 40% effaced probably would be the first to deliver. Multiparas usually progress faster than nulliparas. A gravida 6 with only one prior delivery probably would not progress as rapidly as the woman who is gravida 5 para 4.

A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician's orders and would expect to note what prescribed treatments for this condition?

Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows.

A laboring patient complains of nausea, vomiting, and increasing rectal pressure. She states, "I can't take this anymore." The nurse correctly assesses that this patient is in which phase of labor?

Transition is the phase of labor where patients usually complain of nausea, vomiting, and increasing rectal pressure, and state, "I can't take any more." A laboring patient usually is able to cope in the latent and active phases of labor. Nausea, vomiting, and rectal pressure decrease during the second stage with the birth of the baby.

Ann asks how she will know if she is getting contractions. How would you answer her?

Uterine contractions are felt in the lower abdominal wall and in the area over the lower lumbar and upper sacrum region. They can start in the front and radiate to the back, or start in the back and radiate to the front. In the latent stage, they can feel like cramping.

A nurse is caring for a patient admitted to the birthing unit with rupture of membranes for two hours. A pelvic exam reveals a dilatation of 4 cm, and the presenting part is not engaged. Which possible complication should the nurse anticipate?

When a pelvic exam reveals a dilatation of 4 cm and the presenting part is not engaged, the nurse should anticipate a prolapsed cord. With placenta previa, the placenta is implanted in the lower uterine segment rather than the upper portion of the uterus, and it is not a complication of ruptured membranes or cervical dilatation. Amniotic infection is a potential complication after the membranes have been ruptured for >12 hours, especially if uterine contractions are present. Abruptio placentae is the premature separation of a normally implanted placenta from the uterine wall, and is not a complication of ruptured or cervical dilatation.

The nurse is caring for a patient at 37 weeks gestation who has pregnancy-induced hypertension and is in the active phase of labor. How frequently should the nurse assess the fetal heart rate?

Assessing the fetal heart rate every 15 minutes is appropriate for a high-risk patient in active labor. Assessing the fetal heart rate every five minutes is appropriate for high-risk patients in the second stage of labor; every 30 minutes is appropriate in the latent phase for high-risk patients; and every hour is appropriate in the latent phase for low-risk patients.

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for:

The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.

The nurse assesses a laboring patient whose contractions occur every five to seven minutes and last for 30 seconds. Which phase of labor is this patient in?

Latent phase of labor is when contractions occur every five to seven minutes and last for 30 seconds. In the active phase, contractions should occur every two to three minutes. In the transition phase, contractions should occur every one-and-a-half to two minutes. There is no second phase.

A nurse is reviewing the record of a client in the labor room and notes that the nurse midwife has documented that the fetus is at -1 station. The nurse determines that the fetal presenting part is:

Station is the relationship of the presenting part to an imaginary line drawn between the ischial spines, is measured in centimeters, and is noted as a negative number above the line and a positive number below the line. At -1 station, the fetal presenting part is 1 cm above the ischial spines.

A nurse is auscultating the heart rate of a fetus in a cephalic presentation. In which location would the nurse hear the heart rate most clearly?

The lower quadrant of the maternal abdomen is where the nurse should hear the fetal heart rate (FHR) in a cephalic presentation. Hearing the FHR at the level of the maternal umbilicus is expected of the fetus in a transverse presentation. Hearing the FHR in the upper quadrant of the maternal abdomen is appropriate for a breech presentation. FHR is heard most clearly along the back of the fetus, not at the apex of the fetal heart.

How should you most accurately determine the fetal heart sounds when auscultating with a doppler?

The nurse simultaneously should palpate the maternal radial or carotid pulse and auscultate the fetal heart rate to differentiate the two. If the fetal and maternal heart rates are similar, the nurse may mistake the maternal heart rate for the fetal heart rate. Leopold's maneuvers may help the examiner locate the position of the fetus but will not ensure a distinction between the two rates.

A nurse is caring for a patient during the fourth stage of labor. What are the expected assessment findings at this time?

Decreased blood pressure and increased pulse are the expected assessment findings during the fourth stage of labor.

Discuss the difference between mild, moderate, and strong contractions.

During the peak of the contraction, the uterine fundus is palpated to estimate the intensity of the contraction. During mild contraction, the uterine wall can be indented easily; during a strong contraction, the uterine wall cannot be indented. A contraction of moderate intensity falls between mild and strong.

A laboring client complains of low back pain. The nurse replies that this pain occurs most when the position of the fetus is:

A persistent occiput-posterior position causes intense back pain because of fetal compression of the sacral nerves. Occiput anterior is the most common fetal position and does not cause back pain.

A client arrives at a birthing center in active labor. Her membranes are still intact, and the nurse-midwife prepares to perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client that after this procedure, she will most likely have:

Amniotomy can be used to induce labor when the condition of the cervix is favorable (ripe) or to augment labor if the process begins to slow. Rupturing of membranes allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.

Drawing up of the internal os and the cervical canal into the uterine side wall is known as __________.

Effacement

What is Effleurage?

Effleurage is a specific type of cutaneous stimulation involving light stroking of the abdomen and is used before transition to promote relaxation and relieve mild to moderate pain. Effleurage provides tactile stimulation to the fetus.

Cindy would like her daughter to be present for the baby's birth. What would you discuss with her about the impact of having a young sibling present during labor and birth?

It is important that a young child have her own support person whose sole responsibility is tending to the child's needs. This person must be prepared to interpret what is happening for the child and to intervene when necessary. Being present at the birth seems to increase siblings' acceptance of the new baby.

A patient at 39 weeks gestation calls the clinic nurse with complaints of pelvic pressure, diarrhea, and vaginal secretions. The nurse would correctly interpret these as signs and symptoms of a(n):

Pelvic pressure, diarrhea, and vaginal secretions are symptoms of impending labor. Vaginal infection may be recognized by an odor to the vaginal secretions, along with back or abdominal pain and fever. Urinary tract infection will present with a strong odor to the urine, along with pain and/or burning upon urination with possible fever. Although rupture of membranes precedes labor in 12% of cases, it likely would be accompanied by the expulsion of large amounts of amniotic fluid.

Ann asks you why cervical ripening and induction of labor are recommended for her and her baby. How would you best respond to her?

Postdate pregnancy is associated with perinatal morbidity and mortality such as neonatal jaundice, neonatal low blood sugar, temperature instability, respiratory distress, meconium aspiration syndrome, birth trauma secondary to macrosomia, and neonatal asphyxia.

Fetal presentation refers to what descriptions?

Presentation is the fetal body part that enters the pelvis first; it's classified by the presenting part; the three main presentations are cephalic/occipital, breech, and shoulder. The relationship of the presenting fetal part to the maternal pelvis refers to fetal position. The relationship of the long axis to the fetus to the long axis of the mother refers to fetal lie; the three possible lies are longitudinal, transverse, and oblique.

A nurse assesses a rise in the fundal height and a sudden gush of blood from the vagina of a postpartum patient five minutes after birth. The nurse appropriately interprets these finding as:

Separation of the placenta is characterized by a rise in fundal height and sudden gush of blood five minutes after birth. Immediate postpartum hemorrhage is not characterized by a rise in fundal height. Late postpartum hemorrhage occurs 24-48 hours or more after birth. Delivery of the placenta is characterized by a decrease in fundal height.

A nurse is caring for a PT in labor. How does the nurse know that she has entered the 2nd stage of labor?

The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate.

When examining the fetal monitor strip after rupture of the membranes in a laboring client, the nurse notes variable decelerations in the fetal heart rate. The nurse should:

Variable decelerations usually are seen as a result of cord compression; a change of position will relieve pressure on the cord.

How should a PT be positioned when being prepped for a C-section?

Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output, and blood flow to the uterus and the fetus. The best position to prevent this would be side-lying with the uterus displaced off of abdominal vessels. Positioning for abdominal surgery necessitates a supine position; however, a wedge placed under the right hip provides displacement of the uterus.

Describe the latent phase of labor.

The latent phase of labor starts with the beginning of regular uterine contractions, which are usually mild, lasting 30 seconds with a frequency of 10-20 minutes. The contractions progress to moderate ones, lasting 30-40 seconds with a frequency of 5-7 minutes. The cervix begins to efface and dilate.

While assessing a PT who is scheduled for a cesarean, what findings would be abnormal?

A normal fetal heart rate is 120-160 beats per minute. A count of 180 beats per minute could indicate fetal distress and would warrant physician notification. By full term, a normal maternal hemoglobin range is 11-13 g/dL as a result of the hemodilution caused by an increase in plasma volume during pregnancy.

A laboring client is to have a pudendal block. The nurse plans to tell the client that once the block is working she:

A pudendal block provides anesthesia to the perineum.

The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. What actions is most appropriate?

Accelerations are transient increases in the fetal heart rate that often accompany contractions or are caused by fetal movement. Episodic accelerations are thought to be a sign of fetal-well being and adequate oxygen reserve.

The middle phase of each contraction is called the __________ phase.

Acme

At 38 weeks' gestation, a client is having late decelerations. The fetal pulse oximeter shows 75% to 85%. The nurse should:

Adjusting the catheter would be indicated. Normal fetal pulse oximetry should be between 30% and 70%. 75% to 85% would indicate maternal readings.

Discuss the benefits of ambulation in labor.

Ambulation may assist in labor progression by stimulating contractions and allowing gravity to help with the descent of the fetus. Ambulating may be more comfortable for the woman and may give her a sense of independence and control.

When monitoring the fetal heart rate of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as:

An acceleration is an abrupt elevation above the baseline of 15 beats per minute for 15 seconds; if the acceleration persists for more than 10 minutes it is considered a change in baseline rate. A tachycardic FHR is above 160 beats per minute.

A laboring patient complains to the nurse about intense pain located primarily in her back. Which fetal position should the nurse expect to see written on the patient's chart?

Either occiput-posterior (LOP or ROP) position of the fetus would cause a woman to complain of intense backache, as the fetal head presents a larger diameter in the posterior position. The anterior positions and transverse positions do not place additional pressure on the sacrum and are not associated with intense backache.

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia would be:

Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure. Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic as it would be with a low spinal (saddle block) anesthetic; 2 is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication.

A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred?

Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.

After doing Leopold's maneuvers, the nurse determines that the fetus is in the ROP position. To best auscultate the fetal heart tones, the Doppler is placed:

Fetal heart tones are best auscultated through the fetal back; because the position is ROP (right occiput presenting), the back would be below the umbilicus and on the right side.

A nurse is planning to perform Leopold's maneuvers on a laboring patient. What should be the nurse's initial action?

Having the patient void before performing Leopold's maneuvers provides for improved comfort during the evaluation for the laboring patient. Positioning the patient on her back is the correct position, but this is not the initial action. The examiner's hands should be warm, but this is not the initial action. Applying sterile lubricant to the abdomen is not part of the procedure.

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?

In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding.

Late deceleration patterns are noted when assessing the monitor tracing of a woman whose labor is being induced with an infusion of Pitocin. The woman is in a side-lying position, and her vital signs are stable and fall within a normal range. Contractions are intense, last 90 seconds, and occur every 1 1/2 to 2 minutes. The nurse's immediate action would be to:

Late deceleration patterns noted are most likely related to alteration in uteroplacental perfusion associated with the strong contractions described. The immediate action would be to stop the Pitocin infusion since Pitocin is an oxytocic which stimulates the uterus to contract. The woman is already in an appropriate position for uteroplacental perfusion. Elevation of her legs would be appropriate if hypotension were present. Oxygen is appropriate but not the immediate action.

Your PT is in the active phases of labor. On the fetal patterns, you notice a late deceleration on the monitor strip. What action would you take?

Late decelerations are due to uteroplacental insufficiency as the result of decreased blood flow and oxygen to the fetus during the uterine contractions. This causes hypoxemia; therefore oxygen is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned to her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous pitocin infusion is discontinued when a late deceleration is noted.

A patient is admitted to the birthing center with possible rupture of membranes. What substance in the fluid could contribute to a false positive reading on Nitrazine test tape?

Lubricant in the fluid could contribute to a false positive reading on Nitrazine test tape. Feces, bacteria, or meconium in the fluid will not alter the test results.

A laboring client has external electronic fetal monitoring in place. Which of the following assessment data can be determined by examining the fetal heart rate strip produced by the external electronic fetal monitor?

Oxygenation of the fetus may be indirectly assessed through fetal monitoring by closely examining the fetal heart rate strip. Accelerations in the fetal heart rate strip indicate good oxygenation, while decelerations in the fetal heart rate sometimes indicate poor fetal oxygenation.

Upon completion of a vaginal examination on a laboring woman, the nurse records: 50%, 6 cm, -1. Which of the following is a correct interpretation of the data?

Station of - 1 indicates that the fetal presenting part is above the ischial spines and has not yet passed through the pelvic inlet. A station of zero would indicate that the presenting part has passed through the inlet and is at the level of the ischial spines or is engaged. Passage through the ischial spines with internal rotation would be indicated by a plus station, such as + 1. Progress of effacement is referred to by percentages with 100% indicating full effacement and dilation by centimeters (cm) with 10 cm indicating full dilation.

Labor is a series of events affected by the coordination of the five essential factors. One of these is the passenger (fetus). Which are the other four factors?

The five essential factors (5 P's) are passenger (fetus), passageway (pelvis), powers (contractions), placental position and function, and psyche (psychological response of the mother).

The physician orders internal fetal monitoring for a laboring patient. What criteria must the patient meet prior to this procedure?

The membranes must be ruptured for internal fetal monitoring to be used for a laboring patient. The fetal part must be accessible by vaginal exam but does not have to be engaged. The cervix needs to be dilated at least 2 cm. Any presentation is acceptable.

The nurse has auscultated a fetal heart rate of 80. What should the nurse's initial action be?

The nurse should check the maternal pulse, because the rate of 80 could be the maternal heart rate rather than the fetal heart rate. Positioning the patient on her left side, administering oxygen at 5 L per minute, and notifying the physician or nurse-midwife would be appropriate only if the rate of 80 (fetal bradycardia) has been confirmed to be the fetal heart rate.

The nurse is evaluating an intrapartal patient's lab results. Which laboratory finding should the nurse report to the physician or nurse-midwife?

The platelets (120,000/mm) should be reported as abnormally low, also called thrombocytopenia (normal: 250-500/000/mm). The hematocrit, leukocyte count, and white blood count are within normal limits for a laboring woman.

Discuss the action of prostaglandin gel.

The prostaglandin gel is expected to soften and efface the cervix, change the cervix from posterior to midposition, and provide cervical dilatation. If uterine activity is initiated, it is expected to improve the fetal station as well.

A client is admitted to the L & D suite at 36 weeks' gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates titanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms?

Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal bleeding and constant abdominal pain.

What position is the most favorable for birth?

Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section. Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis.

A nurse in the labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. Which of the following would be the initial nursing action?

When cord prolapse occurs, prompt actions are taken to relieve cord compression and increase fetal oxygenation. The mother should be positioned with the hips higher than the head to shift the fetal presenting part toward the diaphragm. The nurse should push the call light to summon help, and other staff members should call the physician and notify the delivery room. No attempt should be made to replace the cord. The examiner, however, may place a gloved hand into the vagina and hold the presenting part off of the umbilical cord. Oxygen at 8 to 10 L/min by face mask is delivered to the mother to increase fetal oxygenation.