Chapter 10 High-Risk Labor and Birth

The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug?

Synthetic oxytocin is identical to endogenous oxytocin.

The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening?

The method may be indicative of fetal demise.

A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply.

Intracranial hemorrhage Cephalohematoma Nerve injuries Skin lacerations Skull fracture

The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication?

Neonatal asphyxia related to prolonged labor

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor?

Dystocia is associated with extreme fear.

The nurse is providing care for a primip patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next?

Augmentation of labor with oxytocin per health care provider's order

A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process?

Call the health care provider to validate patient understanding.

The terminology intrauterine inflammation or infection or both or Triple I is now used instead of the term ____________________.

Chorioamnionitis

The first sign of shoulder dystocia is the ____________________ of the fetal head against the maternal perineum after delivery of the head.

retraction

The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply.

Alert the neonatal team of a possible meconium aspiration neonate. Notify the primary care provider about the presence of meconium.

A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure?

The fetal head is currently engaged in the maternal pelvis.

The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient?

Administer morphine to decrease contractions and promote uterine rest.

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC?

Cesarean due to pelvic abnormalities

The nurse is attending to a patient who just delivered a term fetus who was stillborn. Which nursing interventions will the nurse use to provide emotional support to the couple? Select all that apply.

Cut a lock of the neonate's hair and get foot and hand prints. Allow parents unlimited time to hold and touch the neonate.

A patient at 34 weeks gestation is in labor with twins. The primary care provider decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply.

Delivery is attended by two medical personnel. The placement of a large-bore IV access is ensured. A hospital with a Level II or III nursery is selected.

The nurse is providing care to a patient who is at 41 weeks gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy?

Fetus is identified as a male

When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply.

Pump up the vacuum manually to the pressure indicated on the pump. Recognize that cup detachment (pop off) is a warning sign. Understand that pressure should be released between contractions. The procedure is timed from insertion of the cup into the vagina until the birth.

During a vaginal delivery, the primary care provider notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply.

Result in airway obstruction Contribute to pulmonary hypertension Result in chemical pneumonitis Cause surfactant dysfunction

The nurse is providing care for a patient who is at 42 weeks gestation. The patient's primary care provider is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply.

Stillbirth or newborn death increases in pregnancies beyond 42 weeks. There is a greater chance of developing complications because of larger fetal size. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo.

The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met?

The "three-pull rule" has been achieved.