Chapter 18 PrepU

A woman has been in labor for the past 8 hours, and she has progressed to the second stage of labor. However, after 2 hours with no further descent, the provider diagnoses "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question?

"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next?

Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis

A woman presents at Labor and Delivery very upset. She reports that she has not felt her baby moving for the last 6 hours. The nurse listens for a fetal heart rate and cannot find a heartbeat. An ultrasound confirms fetal death and labor induction is started. What intervention by the nurse would be appropriate for this mother at this time?

Offer to take pictures and footprints of the infant once it is delivered.

A client with a pendulous abdomen and uterine fibroids (uterine myomas) has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman?

transverse lie

A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation?

ultrasound

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. The nurse should immediately check the client for:

umbilical cord prolapse.

A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect?

uterine rupture

The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems?

"Continue to monitor fetal movements daily."

The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth?

Abnormal position of the fetal head

While the placenta is being delivered after labor, a client experiences an amniotic fluid embolism. What should the nurse do first to help this client?

Administer oxygen by nasal cannula.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client?

Assess fetal heart sounds.

A pregnant client receiving intravenous oxytocin for 1 hour has contractions lasting 85 seconds. What should the nurse do first for this client?

Discontinue the oxytocin infusion.

Tocolytic therapy will help to prevent preterm birth.

False

A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priority fetal assessment the health care provider should focus on at this time?

Look for late decelerations on monitor, which is associated with fetal anoxia.

The nurse is caring for a client in labor whose fetus is in an occiput posterior position. Which intervention should the nurse use to reduce this client's discomfort?

Massage the lower back.

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth?

McRoberts maneuver

A 26-year-old primigravida has brought her doula to the birthing center for support during her labor and birth. 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 client 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?

Occiput posterior position

A circulating nurse is preparing for a breech birth. The critical instrument needed for this type of delivery that the nurse must include when preparing the operating table is:

Piper forceps.

The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding?

erratic.

Preterm prelabor rupture of membranes (PPROM) can be a serious complication of labor. What is the most common cause of preterm PROM?

infection

A nurse in a hospital is caring for a 22-year-old G2P1 client who is at 32 weeks' gestation in active labor. The client calls out, "I think my water broke." The nurse at the bedside pulled back the sheet and found clear fluid with an umbilical cord in the client's vagina.

insert a hand to hold up the cord follow the hospital's cord prolapse protocol delegate tasks to other nurses contact the health care provider

What terminology would the nurse use to document a newborn who weighs 4,000 grams (8.8 lb) or more at birth?

macrosomia

The nursing student doing a clinical obstetrics rotation correctly picks which term to label a pregnancy that continues past the end of the 42nd week of gestation?

post-term pregnancy

A pregnant client presents to the emergency department reporting back-to-back contractions. Within 2 hours, the client is completely effaced and 9 cm dilated, and the fetal head is showing. Within minutes the client gives birth with only the nurse in attendance. This is an example of which occurrence?

precipitate labor

A pregnant client at 24 weeks' gestation comes to the clinic for an evaluation. The client called the clinic earlier in the day stating that she had not felt the fetus moving since yesterday evening. Further assessment reveals absent fetal heart tones. Intrauterine fetal demise is suspected. The nurse would expect to prepare the client for which testing to confirm the suspicion?

ultrasound

A client who has been in prolonged labor reports extreme back pain. She asks why her back hurts so much. What would be the best response by the nurse?

"Different fetal positions can cause prolonged labor and back pain."

The nursing student demonstrates an understanding of dystocia with which statement?

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

A pregnant woman gives birth to 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?

"Hold your baby as long as you like. Please let me know what I can do to help you."

A pregnant patient at 32 weeks' gestation calls the clinic and informs the nurse that she thinks her membranes are leaking. She states that some clear fluid has run down her leg. What is the best response by the nurse?

"It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid."

A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply.

"Maybe dimming the lights or some soft music will help you relax a bit." "I will keep you updated often on how you and your baby are doing." "Things are moving along but sometimes it can take a little longer."

A pregnant client at 38 weeks' gestation is to undergo external cephalic version. The client asks the nurse, "What exactly will happen with this procedure?" Which response by the nurse is appropriate?

"The practitioner will gently press on your abdomen to turn your baby so the head is facing down."

Although many women envision a plan of how labor will go, sometimes complications happen, and their plan is no longer achievable. When this happens, what is the best question the nurse can ask the woman at this time?

"What do you consider your primary goal for the outcome of this pregnancy?"

The fetal heart rate patterns of a pregnant client in labor reveals variable decelerations. Which nursing action(s) is appropriate? Select all that apply.

Assist with amnioinfusion of warmed normal saline. Administer supplemental oxygen via a nonrebreather mask. Assist the client to change position at frequent intervals.

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider?

Check for a full bladder.

The nurse cared for a client who gave birth. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record?

Precipitous labor

The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client?

Prepare the client for a cesarean birth.

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

Provide ongoing communication about what is happening.

The nurse would prepare a client for amnioinfusion when which action occurs?

Severe variable decelerations occur and are due to cord compression.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?

Sudden shortness of breath

A client in labor has been prescribed an intravenous infusion of 5% dextrose in water. Following insertion of the intravenous line, what should the nurse instruct the client to do?

Try to forget the fluid line is in place.

A client in their third trimester is being seen in the clinic with new-onset fever, lethargy, and painful urination. Vital signs: temperature, 101.2°F (38.4°C); blood pressure, 110/70 mm Hg; heart rate, 98 beats/min.

UTI Painful Urination

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

Use a fist to apply counterpressure to the lower back.

A laboring client is experiencing dysfunctional labor or dystocia due to the malfunction of one or more of the "four Ps" of labor. Which scenario best illustrates a power problem?

Uterine contractions are weak and ineffective.

When preterm prelabor rupture of membranes (PPROM) occurs and labor does not commence within 24 hours, the client is usually placed on bed rest with pelvic rest. What is pelvic rest?

a situation where nothing is placed in the vagina.

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to:

administer oxygen by mask.

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

cesarean birth

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

continuing to monitor maternal and fetal status

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction?

contractions most forceful in the middle of uterus rather than the fundus

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth?

cord compression

The nurse is caring for a client in labor. The nurse realizes it is most common for labor dystocia to occur during which stage of labor?

first stage of labor

The fetus of a pregnant client is in a breech presentation. Where will the nurse auscultate fetal heart sounds?

high in the abdomen

A client in labor has been diagnosed with shoulder dystocia. Which risk factors would the nurse expect in the prenatal history? Select all that apply.

history of maternal diabetes dates indicating a post-term pregnancy measurements indicating fetal macrosomia

A client is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this client?

oxytocin therapy

A client who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the client that pelvic rest involves which of the following?

placing nothing in the vagina

A client at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This client is showing clinical signs of which of the following?

premature rupture of membranes

A nursing instructor identifies which of the following as increasing the chances of infection when coupled with prolonged labor?

ruptured membranes

The nurse is assisting with a vaginal birth. The client is fully dilated, 100% effaced, and is pushing. The nurse observes the "turtle sign" with each push and there is no progress. What does the nurse suspect may be occurring with this fetus?

shoulder dystocia

A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed?

tocolytic therapy

A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose?

tomorrow at 1400

The nurse is assessing a client in labor. On which complication of labor as identified within the 2030 National Health Goals will the nurse focus?

uterine rupture

A woman whose fetus is in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain?

applying counterpressure to the back

During a prenatal ultrasound, the client is discovered to have a succenturiate placenta. Following delivery of the fetus and placenta, which nursing assessment is most important?

assessment for hemorrhage

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

breech presentation

A woman in labor is experiencing dysfunctional labor (hypotonic uterine dysfunction). Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

uterine stimulants