OB PrepU: Chapter 21

The experienced labor and delivery nurse knows to evaluate progress in active labor by using which simple rule? a) 1 cm/hour for cervical dilation b) 1/4 cm/hour for cervical dilation c) 1/2 cm/hour for cervical dilation d) 2 cm/hour for cervical dilation

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

A nurse preceptor asks a student to list commonly used diagnostic tests for preterm labor risk assessment. Which of the following tests should the student include? (Select all that apply.) a) thyroid level b) U/A c) CBC d) arterial blood gases e) amniotic fluid analysis

b) U/A c) CBC e) amniotic fluid analysis Rationale: Commonly used diagnostic testing for preterm labor risk assessment includes a complete blood count, urinalysis, and an amniotic fluid analysis.

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? a) Laminaria b) Prostaglandin c) Amniotomy d) Breast stimulation

c) Amniotomy Rationale: Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.

A woman is admitted to the labor suite with contractions every five minutes lasting one minute. She is post-term and has oligohydramnios. What does this increase the risk of during delivery? a) Shoulder dystocia b) Macrosomia c) Cord compression d) Fetal hydrocephalus

c) Cord compression Rationale: Oligohydramnios and meconium staining of the amniotic fluid are common complications of post-term pregnancy. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor.

A physician orders oral tocolytic therapy for a woman with preterm labor. Which agent would the nurse be least likely to administer? a) Nifedipine b) Terbutaline c) Magnesium sulfate d) Indomethacin

c) Magnesium sulfate Rationale: Magnesium sulfate is only given intravenously for preterm labor. Nifedipine and indomethacin are given orally for preterm labor. Terbutaline is given intravenously during the initial period and then switched to the oral route for maintenance.

A nursing instructor highlights risk factors associated with preterm labor that include which of the following? (Select all that apply.) a) weight of pregnant mother b) current multiple gestation pregnancy c) history of previous preterm birth d) weight of fetus e) uterine or cervical abnormalities

b) current multiple gestation pregnancy c) history of previous preterm birth e) uterine or cervical abnormalities Rationale: The top risk factors for preterm labor include history of previous preterm birth, current multiple gestation pregnancy, and uterine or cervical abnormalities. The weight of the fetus or mother does not cause preterm labor.

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? a) Aspiration b) Placental separation c) Amniotic fluid embolism d) Congestive heart failure

c) Amniotic fluid embolism Rationale: 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 nursing instructor identifies which of the following as increasing the chances of infection when coupled with prolonged labor? a) age of mother b) number of previous pregnancies c) multiple births d) ruptured membranes

d) ruptured membranes Rationale: The risk for infection increases during prolonged labor particularly in association with ruptured membranes. The other options do not increase the risk of infection during labor.

A gravida 7, para 6 woman is in the hospital only 15 minutes when she begins to deliver precipitously. The fetal head begins to deliver as you walk into the labor room. Your best action would be to a) attach a fetal monitor to determine fetal status. b) ask her to push with the next contraction so delivery is rapid. c) assess blood pressure and pulse to detect placental bleeding. d) place a hand gently on the fetal head to guide delivery.

d) place a hand gently on the fetal head to guide delivery. Rationale: If a head is controlled as it delivers, trauma to internal vessels or to the maternal cervix is less apt to occur.

A nursing instructor is teaching students about fetal presentations during delivery. The most common cause for increased incidence of shoulder dystocia is: a) increasing birth weight b) increased number of overall pregnancies c) poor quality of prenatal care d) longer lengths of labor

a) increasing birth weight Rationale: Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in up to 2% of vaginal births.

A nurse is preparing to teach a class to pregnant women about the signs of preterm labor and what to do if these occur. Which of the following should the nurse include in the presentation? (Select all that apply.) a) leaking of fluid from the vagina b) uterine contractions, cramping, low back pain c) feeling of pelvic pressure or fullness d) feelings of stress e) nausea, vomiting, and diarrhea f) increase in vaginal discharge

a) leaking of fluid from the vagina b) uterine contractions, cramping, low back pain c) feeling of pelvic pressure or fullness e) nausea, vomiting, and diarrhea f) increase in vaginal discharge Rationale: Signs and symptoms of preterm labor include uterine contractions, cramping, or low back pain; feeling of pelvic pressure or fullness; increased vaginal discharge; nausea, vomiting, and diarrhea; and leaking of fluid from the vagina.

A woman experiences an amniotic fluid embolism as the placenta is delivered. Your first action would be to a) increase her intravenous fluid infusion rate. b) administer oxygen by mask. c) put firm pressure on the fundus of her uterus. d) tell the woman to take short, catchy breaths.

b) administer oxygen by mask. Rationale: An amniotic embolism quickly becomes a pulmonary embolism. The woman needs oxygen to compensate for the sudden blockage of blood flow through her lungs.

A nursing student correctly identifies the most desirable position to promote an easy delivery as which of the following? a) breech b) occiput anterior c) face and brow d) shoulder dystocia

b) occiput anterior Rationale: Any presentation other than occiput anterior or a slight variation of the fetal position or size increases the probability of dystocia.

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? a) Severe lower back pain, leg cramps, sweating b) Pain in the abdomen, shoulder, or back c) Respiratory depression, hypotension, absent tendon reflexes d) Low potassium or elevated glucose, tachycardia, chest pain

c) Respiratory depression, hypotension, absent tendon reflexes Rationale: Magnesium sulfate is a smooth muscle relaxant and can cause vaso-dilation and results in respiratory depression and severe hypotension at toxic levels. Options A, C, and D are incorrect indications of magnesium sulfate toxicity.

While in labor a woman with a prior history of cesarean birth complains of light-headedness and dizziness. The nurse assesses the patient and notes an increase in pulse and decrease in blood pressure from the vital signs 15 minutes prior. What might the nurse consider as a possible cause for the symptoms? a) Placentea previa b) Hypertonic uterus c) Uterine rupture d) Umbilical cord compression

c) Uterine rupture Rationale: The patient 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 patient a uterine rupture needs to be a first consideration. The scenario does not indicate a hypertonic uterus, a placenta previa, nor umbilical cord compression.

While in labor a woman with a prior history of cesarean birth complains of light-headedness and dizziness. The nurse assesses the patient and notes an increase in pulse and decrease in blood pressure from the vital signs 15 minutes prior. What might the nurse consider as a possible cause for the symptoms? a) Umbilical cord compression b) Hypertonic uterus c) Uterine rupture d) Placentea previa

c) Uterine rupture Rationale: The patient 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 patient a uterine rupture needs to be a first consideration. The scenario does not indicate a hypertonic uterus, a placenta previa, nor umbilical cord compression.

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? a) fraternal b) both types can result from the split ovum c) identical d) neither type results from a split ovum

c) identical Rationale: The incidence of twins is about 1 in 30 conceptions, with about 2/3 being from the fertilization of two ova (fraternal) and about 1/3 from the splitting of one fertilized ovum (identical).

The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which of the following? (Check all that apply.) a) mother's age b) analgesia c) position d) fetal development e) presentation

c) position d) fetal development e) presentation Rationale: Dystocia can result from problems or abnormalities involving the expulsive forces (known as the "powers"): presentation, position, and fetal development. The others are not included in the "powers."

The nursing student doing a clinical rotation in labor and delivery has noticed numerous women expressing various emotions during labor. The student's preceptor informs the student that these emotions can lead to psychological stress, which in turn can cause which of the following complications? a) deep vein thrombosis b) pulmonary emboli c) premature labor d) dystocia

d) dystocia Rationale: Many women experience an array of emotions during labor, which may include fear, anxiety, helplessness, desire to be alone, and weariness. These emotions can lead to psychological stress, which indirectly can cause dystocia.

A placenta succenturiate is a placenta in which the cord is inserted marginally rather than centrally. a) False b) True

a) False Rationale: In a battledore placenta, the cord is inserted marginally rather than centrally. A placenta succenturiata is a placenta that has one or more accessory lobes connected to the main placenta by blood vessels.

The client is 35 weeks of gestation and is being admitted for vaginal bleeding. The patient is stable at the time of admission. The priority nursing assessment for the client is for: a) Fetal heart tones. b) Signs of shock. c) Infection. d) Uterine stabilization

a) Fetal heart tones. Rationale: When a patient is admitted for vaginal bleeding and is stable, the next priority assessment is to determine if the fetus is viable. Options C and D are not a higher priority than fetal heart tones.

The second-year nursing student taking an obstetrics course correctly attributes which of the following to the term dystocia? (Check all that apply.) a) Progress of labor deviates from normal. b) Labor is slow. c) Labor progresses normally. d) Labor is fast.

a) Progress of labor deviates from normal. b) Labor is slow. Rationale: Dystocia is said to exist when the progress of labor deviates from normal and is slow.

A client in the first stage of labor is diagnosed with dystocia involving the powers of labor. Which of the following would the nurse identify as the problem? a) Uterine contractions are too weak or uncoordinated b) Contractions are insufficient to cause fetus descent c) Fetus is in a different position or presentation d) Pelvis is either android type or platypelloid type

a) Uterine contractions are too weak or uncoordinated Rationale: When there are problems with the powers causing dystocia during the first stage of labor, the uterine contractions are too weak or uncoordinated to cause adequate cervical effacement and dilatation. Contractions are insufficient to cause fetal descent; the fetus being in a different position or presentation, and pelvis being either android type or platypelloid type are not the results of dystocia. During the second stage of labor, the nurse should observe if the contractions and the pushing are insufficient to cause descent of the fetus. A fetus that is in a different position or presentation is a problem with the passenger. A pelvis that is either android type or platypelloid type is a problem with the passageway and is not related to dystocia.

After an hour of oxytocin therapy, a woman in labor states she feels dizzy and nauseated. Your best action would be to a) assess the rate of flow of the oxytocin infusion. b) assess her vaginally for full dilation. c) administer oral orange juice for added potassium. d) instruct her to breathe in and out rapidly.

a) assess the rate of flow of the oxytocin infusion. Rationale: A toxic effect of oxytocin therapy is water intoxication. Symptoms include dizziness and nausea. Assessing and slowing the infusion rate will relieve symptoms.

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? a) Apply ice packs to her lower back. b) Massage her lower back. c) Place her in a Trendelenburg position. d) Urge her to maintain a prone position.

b) Massage her lower back. Rationale: Counterpressure against the woman's back by a support person can be helpful in reducing this type of pain.

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

b) True Rationale: none

A woman's nurse-midwife tells her that the woman has developed dystocia. You would explain that this term means a) Muscle weakness related to prolonged labor. b) High blood pressure related to difficult labor. c) Difficult or abnormal labor. d) Potential for placental detachment.

c) Difficult or abnormal labor. Rationale: Dystocia is a general term used to describe difficult or abnormal labor. Dystocia does not indicate high blood pressure related to difficult labor, a potential for placental detachment, nor muscle weakness related to prolonged labor.

A woman is to undergo labor induction. The nurse determines that the woman most likely requires cervical ripening if her Bishop score is: a) 9 b) 7 c) 6 d) 5

d) 5 Rationale: A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.

The nurse providing care for a woman with preterm labor on terbutaline (Brethine) would include which of the following assessments for safe administration of the drug? a) Deep tendon reflexes. b) Breath sounds. c) For elevated blood glucose d) For tachycardia

d) For tachycardia Rationale: Tachycardia and palpitations are commons side effects of the drug terbutaline. Elevated blood glucose is a fetal side effect but not noted to assess with the mother. Deep tendon reflexes and breath sounds are not assessments needed for the safe administration of Brethine.

Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be delivered. Stuck in the birth canal, the infant cannot take its first breath. What is the first maneuver tried to deliver an infant with shoulder dystocia? a) McGeorge maneuver b) McDonald maneuver c) McRonald Maneuver d) McRoberts maneuver

d) McRoberts maneuver Rationale: McRoberts maneuver is an intervention that is frequently successful in cases of shoulder dystocia, and 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 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? a) Have the physician administer a pudendal block. b) Place the patient supine with the head of bed elevated 30 degrees. c) Apply a warm washcloth to the lower back. d) Use a fist to apply counter pressure to the lower back.

d) Use a fist to apply counter pressure to the lower back. Rationale: Counter pressure applied to the lower back with a fisted hand sometimes helps the woman to cope with the "back labor" characteristic of the occiput posterior position.

Before calling the physician to notify him or her of a slow progression or an arrest of labor several assessments need to be made. What other maternal assessment do you need to make prior to calling the physician? a) Check for a full bladder. b) Make sure the epidural medication is turned down. c) Make sure the patient is lying on their left side. d) Assess vital signs every 30 minutes.

a) Check for a full bladder. Rationale: Remember that a full bladder can interfere with the progress of labor. So be sure that the patient has emptied her bladder.

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? a) Experience of additional back pain. b) Necessity for vacuum extraction for delivery. c) Need to have the baby manually rotated. d) Shorter dilatational stage of labor.

a) Experience of additional back pain. Rationale: 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. An occiput posterior position does not make for a shorter dilatational stage of labor, it does not indicate the need to have the baby manually rotated, and it does not indicate a necessity for a vacuum extraction delivery.

Tocolytic therapy will help to prevent preterm birth. a) False b) True

a) False Rationale: Tocolytic therapy does not typically prevent preterm birth, but instead it may delay it.

A nurse is caring for a pregnant client whose fetus has been diagnosed with macrosomia. When reviewing the client's history, which of the following would the nurse expect to find? a) Gestational diabetes b) Maternal rickets c) Small body size of mother d) Pre-term pregnancy

a) Gestational diabetes Rationale: Macrosomia usually results from uncontrolled gestational diabetes, genetic problems, multiparity, or post-term pregnancy. Pre-term pregnancy, small body size of mother, and maternal rickets are not associated with macrosomia. Small body size and maternal rickets are associated with pelvic contraction at the inlet.

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? a) Prepare the patient for a cesarean section. b) Place the patient in a knee-chest position. c) Bolus the patient with another dose of medication through the epidural. d) Turn the patient on her left side.

a) Prepare the patient for a cesarean section. Rationale: The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous good pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean delivery.

Which intervention would be most appropriate for the woman experiencing dystocia related to problems involving the psyche? a) Providing a comfortable environment with dim lighting b) Preparing the woman for an amniotomy c) Administering oxytocin d) Encouraging the woman to assume a hands-and-knees position

a) Providing a comfortable environment with dim lighting Rationale: Comfort measures minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor. Oxytocin would be appropriate for the woman experiencing hypotonic uterine dysfunction (problem with the powers). An amniotomy may be used with hypertonic uterine dysfunction to augment labor. A hands-and-knees position helps to promote fetal head rotation with a persistent occiput posterior position.

Labor dystocia is an abnormally progression of labor. It is the most common cause of primary caesarian delivery. When is it most common for labor dystocia to occur? a) Second stage of labor b) Third stage of labor c) Fourth stage of labor d) First stage of labor

a) Second stage of labor Rationale: Labor dystocia can occur in any stage of labor, although it occurs most commonly once the woman is in active labor or when she reaches the second stage of labor.

The nurse would prepare a client for amnioinfusion when which of the following occurs? a) Severe variable decelerations are due to cord compression b) Maternal pushing is compromised due to anesthesia c) The fetus shows non-reassuring fetal heart rate patterns d) Fetal presenting part fails to rotate fully and descend in the pelvis

a) Severe variable decelerations are due to cord compression Rationale: 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. Failure of the fetal presenting part to rotate fully, descend in the pelvis, non-reassuring fetal heart rate patterns or acute pulmonary edema, and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion.

Which of the following would be appropriate for the use of low forceps? a) The leading point of fetal skull is at or above station +2, not on the pelvic floor b) The fetal head is engaged but the leading point of the skull is less than +2 c) The fetal skull has reached the pelvic floor, with the fetal head at the perineum d) The fetal scalp is visible at the introitus without spreading the labia

a) The leading point of fetal skull is at or above station +2, not on the pelvic floor Rationale: Low forceps are applied when the leading point of the fetal skull is at or above station +2 and not on the pelvic floor. Outlet forceps, and not low forceps, are applied when the fetal skull has reached the pelvic floor, with the fetal head at the perineum and the fetal scalp visible at the introitus without spreading the labia. Mid forceps, and not low forceps, are applied when the fetal head is engaged but the leading point of the skull is less than +2.

The nursing student correctly identifies which of the following as risk factors for developing dystocia? (Check all that apply.) a) excessive analgesia b) maternal exhaustion c) maternal diabetes d) high fetal station at complete cervical dilation e) multiple gestation f) epidurals g) shoulder dystocia

a) excessive analgesia b) maternal exhaustion d) high fetal station at complete cervical dilation e) multiple gestation f) epidurals g) shoulder dystocia Rationale: Early identification and prompt interventions for dystocia are essential to minimize risk to the woman and fetus. Factors associated with increased risk for dystocia include epidurals, excessive analgesia, multiple gestations, maternal exhaustion, ineffetive pushing technique, longer first stage of labor, fetal birth weight, maternal age of >35, ineffective uterine contractions, and high fetal station at complete cervical dilation.

A nursing instructor teaching about risk factors associated with preterm labor includes which of the following demographic and lifestyle issues? (Select all that apply.) a) smoking b) infection c) hypertension d) low socioeconomic status e) high level of stress f) alcohol use

a) smoking d) low socioeconomic status e) high level of stress f) alcohol use Rationale: Demographic and lifestyle risk factors associated with preterm labor are extremes of maternal age (younger than 17 years or older than 35 years), low socioeconoomic status, smoking, alcohol or drug use, high levels of stress, and long working hours. Infection and hypertension are medical risk factors and not demographic or lifestyle factors.

A pregnant woman delivers a term fetus who has died in utero. She requests time after the birth to hold her baby. What is the best response by the nurse? a) "This was nature's way of taking care of a defective baby." b) "Hold your baby as long as you like. Please let me know what I can do to help you." c) "You can hold your baby for a few minutes, but then I must take it to the nursery to do the paperwork." d) "You don't want to see your baby like this. I will take the baby away for you."

b) "Hold your baby as long as you like. Please let me know what I can do to help you." Rationale: A woman who has just received a diagnosis of fetal demise is experiencing a terrific loss. The nurse should be available to her without intruding and answer her questions honestly. He or she should encourage the woman to hold and name her baby, if she is able.

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? a) < 5 hours b) < 3 hours c) < 8 hours d) < 4 hours

b) < 3 hours Rationale: Precipitous labor is completed in less than 3 hours.

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? a) < 8 hours b) < 3 hours c) < 4 hours d) < 5 hours

b) < 3 hours Rationale: Precipitous labor is completed in less than 3 hours.

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

b) A full bladder or rectum can impede fetal descent. Rationale: 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.

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in a persistent occiput posterior position? a) Lack of cervical dilation past 2 cm b) Complaints of severe back pain c) Fetal buttocks as the presenting part d) Contractions most forceful in the middle of uterus rather than the fundus

b) Complaints of severe back pain Rationale: Complaints of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet. Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction.

A pregnant woman comes to the birthing center, stating she is in labor and doesn't know far along her pregnancy is because she has not had prenatal care. A physician performs an ultrasound that indicates oligohydramnios. When the patient's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this patient? a) Complications of preterm labor b) Complications of a post-term pregnancy c) Complications of placenta previa d) Placental abruption

b) Complications of a post-term pregnancy Rationale: A post-term pregnancy carries risks for increased perinatal mortality, particularly during labor. Oligohydramnios and meconium staining of the amniotic fluid are common complications. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor. Thick, meconium-stained fluid increases the risk for meconium aspiration syndrome.

Which of the following interventions would be most important when caring for the client with breech presentation confirmed by ultrasound? a) Noting the space at the maternal umbilicus b) Continuing to monitor maternal and fetal status c) Applying suprapubic pressure against the fetal back d) Auscultating the fetal heart rate at the level of the umbilicus

b) Continuing to monitor maternal and fetal status Rationale: Once a breech presentation is confirmed by ultrasound, the nurse should continue to monitor the maternal and fetal status when the team makes decisions about the method of birth. The nurse usually plays an important role in communicating information during this time. Applying suprapubic pressure against the fetal back is the nursing intervention for shoulder dystocia and may not be required for breech presentation. Noting the space or dip at the maternal umbilicus and auscultating the fetal heart rate at the umbilicus level are assessments related to occipitoposterior positioning of the fetus.

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? a) Need to have the baby manually rotated. b) Experience of additional back pain. c) Shorter dilatational stage of labor. d) Necessity for vacuum extraction for delivery.

b) Experience of additional back pain. Rationale: 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. An occiput posterior position does not make for a shorter dilatational stage of labor, it does not indicate the need to have the baby manually rotated, and it does not indicate a necessity for a vacuum extraction delivery.

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.) a) Large-for-gestational age fetus b) History of previous preterm birth c) Current multiple gestation pregnancy d) Uterine or cervical abnormalities e) Previous Cesarean section

b) History of previous preterm birth c) Current multiple gestation pregnancy d) Uterine or cervical abnormalities Rationale: The top three risk factors for premature birth are history of previous preterm birth, current multiple gestation pregnancy, and uterine or cervical abnormalities.

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? a) Variable decelerations. b) Late decelerations. c) Mild decelerations. d) Early decelerations.

b) Late decelerations. Rationale: When the fetus is being deprived of oxygen the fetus will demonstrated late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.

A laboring patient has been pushing without delivering the fetal shoulders. The physician determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the delivery? a) Lamaze position b) McRobert's maneuver c) Fundal pressure d) Positioning the woman prone

b) McRobert's maneuver Rationale: The McRobert's maneuver is frequently successful and often tried first. It requires assistance from two people. Two nurses place the patient in the lithotomy position, while each holds a 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 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? a) Anterior fetal position b) Transverse lie c) Cephalic presentation d) Occipitoposterior position

b) Transverse lie Rationale: A transverse lie, in which the fetus is more horizontal than vertical, occurs in women with pendulous abdomens, with uterine fibroid tumors that obstruct the lower uterine segment, with contraction of the pelvic brim, with congenital abnormalities of the uterus, or with hydramnios. Anterior fetal position and cephalic presentation are normal conditions. Occipitoposterior position tends to occur in women with android, anthropoid, or contracted pelves.

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? a) Anterior fetal position b) Transverse lie c) Occipitoposterior position d) Cephalic presentation

b) Transverse lie Rationale: A transverse lie, in which the fetus is more horizontal than vertical, occurs in women with pendulous abdomens, with uterine fibroid tumors that obstruct the lower uterine segment, with contraction of the pelvic brim, with congenital abnormalities of the uterus, or with hydramnios. Anterior fetal position and cephalic presentation are normal conditions. Occipitoposterior position tends to occur in women with android, anthropoid, or contracted pelves.

The nurse preceptor explains that several factors are involved with the "powers" that can cause dystocia. She focuses on the dysfunction that occurs when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This is known as which of the following? a) hypertonic contractions b) precipitous labor c) hypotonic contractions d) none of the above

b) precipitous labor Rationale: When the expulsive forces of the uterus become dysfunctional, the uterus may either never fully relax (hypertonic contractions) placing the fetus in jeopardy, or relax too much (hypotonic contractions), causing ineffective contractions. Another dysfunction can occur when the uterus contracts so frequently and with such intensity that a very rapid birth will take place(precipitous labor).

A woman you are caring for during labor is having contractions 2 minutes apart but rarely over 50 mm Hg in strength; the resting tone is high, 20 to 25 mm Hg. She asks what she can do to make contractions more effective. Your best response would be that a) hypotonic contractions of this kind will strengthen by themselves. b) she needs to rest because her contractions are hypertonic. c) walking around will make her contractions more regular. d) her physician will order oxytocin to strengthen contractions.

b) she needs to rest because her contractions are hypertonic. Rationale: These contractions appear to be hypertonic because of the high resting tone. Hypertonic contractions occur because the uterus is being overstimulated or erratically stimulated. Rest is effective in helping contractions become more productive.

A patient who has been in prolonged labor reports extreme back pain. She asks why her back hurts so much. The best response by the nurse would be which of the following? a) "Let me help you out of bed to try walking it off." b) "Perhaps you have been in one position for too long." c) "Different fetal positions can cause prolonged labor and back pain." d) "This is just a normal part of labor."

c) "Different fetal positions can cause prolonged labor and back pain." Rationale: Fetal malposition can cause prolonged labor. A labor complicated by occiput posterior position is usually prolonged and characterized by maternal perception of increased intensity of back discomfort. The other answers do not address the patient's question.

A patient is 32 weeks gestation and sent home on modified bedrest for preterm labor. She is on tocolyitics and wants to know when she can have intercourse again with her husband. What is the most appropriate response by the nurse? a) "You will not be able to have intercourse again until 6 weeks after you deliver." b) "The need to keep the infant safe should be of more concern than when to have sex." c) "That is a question to ask your health care provider, at this point you are on pelvic rest to try and stop any further labor." d) "Intercourse has nothing to do with preterm labor; you can have sex with your husband."

c) "That is a question to ask your health care provider, at this point you are on pelvic rest to try and stop any further labor." Rationale: The patient needs to be on pelvic rest until the health care provider says otherwise. The intercourse can cause excitability in the uterus and encourage cervical softening and should be avoided unless the provider gives the OK. Option A is incorrect as it may be giving misinformation to the patient. Option B does not answer the patient's question so it is incorrect. Option D also gives misinformation to the patient and is incorrect.

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? a) Administer Pitocin in a 20 cc bolus of saline. b) Administer Pitocin in two divided intramuscular sites. c) Administer oxytocin diluted as a "piggyback" infusion. d) Administer oxytocin diluted in the main intravenous fluid.

c) Administer oxytocin diluted as a "piggyback" infusion. Rationale: Pitocin is always infused in a secondary or "piggyback" infusion system so it can be halted quickly if overstimulation of the uterus occurs.

The nurse identifies a nursing diagnosis of risk for injury related to possible effects of oxytocin therapy. Which of the following would the nurse do to ensure a positive outcome for the client? a) Turn down oxytocin administration by half b) Administer hydration and sedation frequently c) Assess contractions by using external monitor d) Start administering tocolytic therapy

c) Assess contractions by using external monitor Rationale: In a client with the risk for injury, continuous assessment of contractions using external monitor and palpation to ensure the presence of a low resting tone will assist in collecting information about labor and the need for further intervention. Turning down oxytocin administration by half is required if hyperstimulation occurs, not to prevent it. Tocolytic therapy is generally employed when preterm labor has been definitively diagnosed. Administering hydration and sedation frequently, and bedrest are employed to halt preterm labor since these stop uterine activity by increasing intravascular volume and uterine blood flow.

A client's membranes have just ruptured. Her fetus is presenting breech. Which of the following should the nurse do immediately to rule out prolapse of the umbilical cord in this client? a) Administer oxygen at 10 L/min by face mask b) Administer amnioinfusion c) Assess fetal heart sounds d) Place the woman in Trendelenburg position

c) Assess fetal heart sounds Rationale: To rule out cord prolapse, always assess fetal heart sounds immediately after rupture of the membranes whether this occurs spontaneously or by amniotomy, as the fetal heart rate will be unusually slow or a variable deceleration pattern will become apparent when cord prolapse has occurred. The other answers refer to therapeutic interventions to implement once cord prolapse has been confirmed.

When educating the post-term pregnant patient, what should the nurse be sure to include to prevent fetal complications? a) Increase fluid intake to prevent dehydration. b) Be sure to measure 24-hour urine output daily. c) Be sure to monitor fetal movements daily. d) Monitor bowel movements.

c) Be sure to monitor fetal movements daily. Rationale: The nurse should be sure to teach the post-term patient to monitor fetal movements daily.

A woman at 32 weeks' gestation is admitted in preterm labor. On your admission assessment, which of following findings should cause the nurse to question the administration of a tocolytic agent? a) Strong, regular contractions. b) A spontaneous abortion in an earlier pregnancy. c) Cervical dilation of 5 cm. d) Fetus in a breech presentation.

c) Cervical dilation of 5 cm. Rationale: If cervical dilation has already progressed too far, labor cannot be halted. Tocolytics are usually not begun if cervical dilatation is over 3 to 4 cm. A breech presentation of the fetus is not cause to question the administration of a tocolytic agent, nor is it a spontaneous abortion in an earlier pregnancy.

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? a) Forceps birth b) Trial labor c) External cephalic version d) Vacuum extraction

c) External cephalic version Rationale: 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. 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 dilatation of the cervix continue to occur. Forceps, which are not commonly used anymore, and vacuum extraction are used to facilitate birth when other complications are present, but would be less likely to be used with a fetus in breech position.

A client in labor has been diagnosed with shoulder dystocia. Which of the following risk factors would the nurse expect to assess in the client? Select all that apply. a) Incompetent cervix b) Intrauterine growth restriction c) Fetal macrosomia d) Post-term pregnancy e) Maternal diabetes

c) Fetal macrosomia d) Post-term pregnancy e) Maternal diabetes Rationale: Risk factors of shoulder dystocia include maternal diabetes, maternal obesity, post-term pregnancy, fetal macrosomia, previous history of shoulder dystocia, and multiparity. Intrauterine growth restriction and incompetent cervix are not the risks associated with shoulder dystocia. Intrauterine growth restriction is one of the factors that increase the risk of a breech presentation. Incompetent cervix is a risk factor related to preterm labor.

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? a) Careful monitoring of fetal kick counts b) Bed rest and hydration at home c) Hospitalization, tocolytic therapy, and IM corticosteroids d) An emergency cesarean section

c) Hospitalization, tocolytic therapy, and IM corticosteroids Rationale: At 31 weeks gestation, the goal would be to maintain the pregnancy as long as possible if the mother and fetus are tolerating continuation of the pregnancy. Stopping the contractions and placing the patient in the hospital allow for monitoring and a safe place if the woman continues and delivers. Administration of corticosteroids may help to develop the lungs and prepare for early preterm delivery. Sending the woman home is contraindicated in the scenario described. An emergency cesarean section is not indicated at this time. Monitoring fetal kick counts is typically done with a post-term pregnancy.

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? a) Attempt to push one of the fetus' shoulders in a clockwise or counterclockwise motion. b) Zavanelli's maneuver c) McRobert's maneuver d) Apply pressure to the fundus.

c) McRobert's maneuver Rationale: This intervention is used with a large baby who may have shoulder dystocia and require assistance. The legs are sharply flexed, by a support person or nurse, and the movement will help to open the pelvis to the widest diameter possible. Zavanelli maneuver is performed when the practitioner pushes the fetal head back in the birth canal and performs an emergency cesarean delivery. Fundal pressure is contraindicated with shoulder dystocia. It is out of the province of the LVN to attempt delivery of the fetus by pushing one of the fetus' shoulders in a clockwise or counterclockwise motion.

A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and delivery. The doula has been helping her through the past 16 hours of labor. The laboring woman is now 6 cm. dilated. She continues to report severe pain in her back with each contraction. The patient finds it comforting when her doula uses the ball of her hand to put counterpressure on her lower back. What is the likely cause of the woman's back pain? a) Nongynecoid pelvis b) Breech presentation c) Occiput posterior position d) Fetal macrosomia

c) Occiput posterior position Rationale: A labor complicated by occiput posterior position is usually prolonged and characterized by maternal perception of increased intensity of back discomfort. The lay term for this type of labor is "back labor."

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? a) Genetic abnormality b) Preeclampsia c) Placental abruption d) Premature rupture of membranes

c) Placental abruption Rationale: The most common cause of fetal death after a trauma is placental abruption, where the placenta separates from the uterus and the fetus is not able to survive. Genetic abnormalities typically cause spontaneous abortion in the first trimester. The scenario does not indicate that there has been a premature rupture of membranes, nor the possibility of preeclamsia.

Which action by the nurse would be least effective in assisting a couple who have experienced intrauterine fetal demise? a) Give the parents a lock of the infant's hair b) Assist the family in making arrangements for their stillborn infant c) Refrain from discussing the situation with the couple d) Allow the couple to spend as much time as they want with their stillborn infant.

c) Refrain from discussing the situation with the couple Rationale: The nurse should encourage discussion of the loss and allow the couple to vent their feelings of grief and guilt. The nurse should allow the parents to spend unlimited time with their stillborn infant so that they can validate the death. Providing the parents and family with mementos of the infant helps validate the reality of the death. Assisting the family with arrangements is helpful to reduce the stress of coping with the situation and making decisions at this difficult time.

When a woman in labor has reached 8 cm dilation, you notice the fetal heat rate suddenly slows. On perineal inspection, you observe the fetal cord has prolapsed. Your first action would be to a) replace the cord with gentle pressure. b) cover the exposed cord with a dry, sterile wrap. c) place her in a knee-chest position. d) turn her to her left side.

c) place her in a knee-chest position. Rationale: 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 nursing student demonstrates an understanding of dystocia with which of the following statements? a) "Dystocia is not diagnosed until after the delivery." b) "Dystocia cannot be diagnosed until just before delivery." c) "Dystocia is diagnosed at the start of labor." d) "Dystocia is diagnosed after labor has progressed for a time."

d) "Dystocia is diagnosed after labor has progressed for a time." Rationale: Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the patient and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.

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? a) Prostaglandin b) Laminaria c) Breast stimulation d) Amniotomy

d) Amniotomy Rationale: Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.

A woman whose fetus in in the occiput-posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain? a) Performing acupuncture on the back b) Applying a heating pad to the back c) Applying ice to the back d) Applying counter pressure to the back

d) Applying counter pressure to the back Rationale: Counter pressure applied to the lower back with a fisted hand sometimes helps the woman cope with "back labor" associated with occiput-posterior positioning. The others are not recommended or used techniques for a woman in labor with back pain.

The nurse is assessing the woman who has a forceps-assisted birth for complications. Which of the following would be least likely to occur in the mother? a) Perineal hematoma b) Cervical lacerations c) Infection of episiotomy d) Caput succedaneum

d) Caput succedaneum Rationale: Caput succedaneum is a complication that may occur in the newborn of a woman who had a forceps- assisted birth. Maternal complications include tissue trauma, such as lacerations of the cervix, vagina, and perineum, hematoma, extension of episiotomy into the anus, hemorrhage, and infection.

A nurse is working with a client who has just begun labor and who has given birth vaginally five previous times. Which of the following interventions will the nurse most likely need to implement to meet the needs of this particular client? a) Prepare the client for cesarean birth b) Prepare to administer oxytocin c) Darken the room lights d) Convert the birthing room to birth readiness before full dilatation is obtained

d) Convert the birthing room to birth readiness before full dilatation is obtained Rationale: Both grand multiparas (women who have given birth five or more times) and women with histories of precipitate labor should have the birthing room converted to birth readiness before full dilatation is obtained. Then, even if a sudden birth should occur, it can be accomplished in a controlled surrounding. As the client is likely to give birth relatively quickly, there is no need for oxytocin or to darken the room lights. There is also no indication that cesarean birth will be necessary, particularly because all of the client's previous births were vaginal.

A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which of the following would the nurse assess as indicative of a protracted labor pattern? a) Secondary arrest of cervical dilation b) Arrest of the descent of the fetal head c) Prolonged deceleration phase d) Delayed descent of the fetal head

d) Delayed descent of the fetal head Rationale: Protraction disorders are characterized by delayed descent of the fetal head and delayed cervical dilation. Prolonged deceleration phase, secondary arrest of cervical dilation, and arrest of the descent of the fetal head are characteristics of arrest disorder and not of protraction disorder.

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: a) Delivery is likely within the next 2 weeks. b) Infection is present. c) No infection is present. d) Delivery is unlikely within the 2 next weeks.

d) Delivery is unlikely within the 2 next weeks. Rationale: Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that delivery is unlikely within 2 weeks following the test. It does not diagnose infection.

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? a) Pendulous abdomen b) Preterm delivery c) Nullipara d) Diabetes

d) Diabetes Rationale: Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. A pendulous abdomen is associated with the transverse lie fetal position, not with shoulder dystocia.

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 of the following conditions in this client? a) Hypertonic contractions b) Braxton Hicks contractions c) Uncoordinated contractions d) Hypotonic contractions

d) Hypotonic contractions Rationale: With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for which of the following? a) Increased risk for cord entanglement b) Increased risk for uterine rupture c) Damage to the maternal tissues d) Potential lacerations and bleeding

d) Potential lacerations and bleeding Rationale: Forcible rotation of the forceps can cause potential lacerations and bleeding.. Cervical ripening increases the risk for uterine rupture in a client attempting vaginal birth after undergoing at least one previous cesarean birth. There is an increased risk for cord entanglement in multiple pregnancies. Damage to the maternal tissues happens if the cup slips off the fetal head and the suction is not released.

The nurse is admitting the patient in labor. The physician determines that the fetus is in a transverse lie and not responsive to Leopold's maneuvers. What intervention should the nurse provide for the patient? a) Prepare for a precipitous vaginal birth. b) Prepare to assist the physician with an amniotomy. c) Administer an analgesic to the patient. d) Prepare the patient for a Cesarean section.

d) Prepare the patient for a Cesarean section. Rationale: If a transverse lie persists, the fetus cannot deliver vaginally. The most common method the practitioner uses to diagnose fetal malpresentation is Leopold's maneuvers followed by ultrasound. Sometimes the practitioner notes transverse lie by looking at the contour of the abdomen, which tends to be in the shape of a football, wider side to side than top to bottom.

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? a) Prep the woman for a vaginal delivery. b) Go find assistance to confirm that the cord is in the vagina. c) With the woman in lithotomy position, hold her legs and sharply flex them toward her shoulders. d) Put her in bed immediately, call for help, and hold the presenting part of the cord.

d) Put her in bed immediately, call for help, and hold the presenting part of the cord. Rationale: Umbilical cord prolapse occurs when the umbilical cord slips down in front of the presenting part, when the presenting part compresses the cord oxygen and nutrients are cut off to the baby and the baby is at risk of death. This is an emergency. When a prolapsed cord is evident you do not put the woman in lithotomy position, and you do not leave the woman. A vaginal delivery is contraindicated in this situation.

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate? a) Notify the birth attendant. b) Slow the oxytocin infusion to the initial rate. c) Continue to monitor contractions and fetal heart rate. d) Stop the infusion immediately.

d) Stop the infusion immediately. Rationale: The woman is exhibiting signs of uterine hyperstimulation, which necessitate stopping the oxytocin infusion immediately to prevent further complications. Once the infusion is stopped, the nurse should notify the birth attendant and continue to monitor the woman's contractions and fetal heart rate.

Which of the following describes why hypertonic contractions tend to become very painful? a) More than one contraction may begin at the same time, as receptor points in the myometrium act independently of each other. b) There is an increase in the length of labor because so many contractions are needed to achieve cervical dilation. c) The number of uterine contractions is very low or infrequent. d) The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells.

d) The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. Rationale: Hypertonic contractions cause uterine cell anoxia, which is painful.

Mrs. M. has been admitted to the delivery suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The physician notes that Mrs. M. is in hypotonic labor. What does this mean? a) The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix. b) The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. c) The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. d) The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.

d) The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. Rationale: There are two types of uterine dysfunction: hypotonic and hypertonic. The most common is hypotonic dysfunction. This labor pattern manifests by uterine contractions that may or may not be regular, but the quantity or strength is insufficient to dilate the cervix.

After an hour of administering oxytocin intravenously, you assess a woman's contractions to be 80 seconds in length. Your first action would be to a) continue to monitor contraction duration every 2 hours. b) slow the infusion to under 10 gtt per minute. c) increase the flow rate of the main line infusion. d) discontinue the oxytocin infusion.

d) discontinue the oxytocin infusion. Rationale: If uterine contractions lengthen beyond 70 seconds, there is apt to be an interference with fetal circulation. Discontinuing the infusion allows contractions to shorten in length and allow fetal nourishment.