HESI - OB, Precipitous Delivery
The labor and delivery charge nurse learns that a multipara at term has just arrived feeling rectal pressure and is starting to crown. The labor and delivery charge nurse recruits another labor and delivery nurse to accompany the patient to the emergency room and the nursery is notified. Another health care team member is notifying the patient's practitioner. What should be the nurse's next action? A. Bring the precipitous delivery tray, including newborn resuscitation equipment, to the emergency room. B. Have the emergency room team members bring the patient to the labor and delivery unit on a stretcher to deliver. C. Start an IV on the patient before delivery and draw laboratory work. D. Take the patient's vital signs before the patient delivers.
A. Bring the precipitous delivery tray, including newborn resuscitation equipment, to the emergency room. Rationale: The nurse should bring the precipitous delivery tray with newborn resuscitation equipment to the emergency room to make sure the proper instruments and newborn resuscitation equipment (if needed), are available at delivery. It would not be appropriate to have the emergency room team members bring the patient to the labor and delivery unit on a stretcher because a multipara who is feeling pressure and starting to crown could deliver during the transfer, which could put the newborn and mother at risk. Trying to start an IV or taking vital signs while the mother is delivering is not the priority action.
A pregnant patient who arrived at the health care organization via private car sat down in the lobby because the fetal head was crowning. The nurse is assisting in this precipitous delivery. What should the nurse check for as soon as the head is delivered? A. Nuchal cord B. Placenta previa C. FHR D. Meconium
A. Nuchal cord Rationale: As the head is delivered, the nurse should check for a nuchal cord immediately and should intervene, if possible, to avoid excessive traction on the cord and to prevent injury to the fetus. Placenta previa presents as excessive vaginal bleeding at this stage and would be a life-threatening emergency. After the head is delivered, the priority is to complete the delivery versus checking FHR. Meconium is important to note if visible; however, when the head is being delivered, the nurse should first support it and check for a nuchal cord.
The nurse is explaining to a new nurse the factors that contribute to precipitous labor. Which factors are included? A. Prematurity, young maternal age, and cocaine abuse B. Diabetes, hypertensive disorders, and IUGR C. Premature rupture of membranes, hypertensive disorders, and low birth weight D. Meconium-stained amniotic fluid, young maternal age, and opioid abuse
A. Prematurity, young maternal age, and cocaine abuse Rationale: Some factors contributing to precipitous labor and potential precipitous delivery in nulliparas include prematurity and young maternal age, and cocaine abuse. In multiparas, precipitous labor and delivery is associated with hypertensive disorders. Cocaine abuse is linked to precipitous labor and delivery. Neither diabetes, IUGR, premature rupture of membranes, low birth weight, meconium-stained amniotic fluid, nor opioid abuse are factors that contribute to precipitous labor.
The nurse is caring for a multipara at 41 weeks' gestation who has a history of gestational diabetes. The patient calls the nurse into the room to report that the newborn is coming. The nurse finds that the fetal head is crowning and knows that the practitioner is 20 minutes away. The nurse assists in the precipitous delivery and notices the turtle sign when the head is being delivered. For which condition should the nurse prepare? A. Shoulder dystocia B. Postpartum hemorrhage C. Perineal laceration D. Cesarean delivery
A. Shoulder dystocia Rationale: Shoulder dystocia is suspected if the head, when it appears on the perineum (crowning), retracts instead of protrudes with each contraction. This is referred to as the turtle sign. The turtle sign does not specifically indicate a risk for postpartum hemorrhage, a perineal laceration, or the need for a cesarean delivery.
A multipara at term is delivering precipitously and the practitioner is still 20 minutes away. The nurse realizes that the newborn will need to be delivered now. To help guide and control the delivery of the fetal head to prevent trauma to the mother and fetus, what is an appropriate action by the nurse? A. Apply gentle upward pressure to maintain the fetal head in a flexed position while supporting the mother's perineum with the other hand. B. Apply gentle downward pressure to maintain the fetal head in a flexed position while supporting the mother's perineum with the other hand. C. Apply forceful downward pressure to maintain the fetal head in a flexed position while supporting the mother's perineum with the other hand. D. Apply gentle downward pressure to maintain the fetal head in a flexed position while supporting the mother's labia with the other hand.
B. Apply gentle downward pressure to maintain the fetal head in a flexed position while supporting the mother's perineum with the other hand. Rationale: Applying gentle downward pressure while supporting the mother's perineum with the other hand helps to maintain the fetal head in a flexed position, which uses the space in the birth canal more effectively. Applying gentle upward pressure on the fetal head is incorrect because this would not help to keep the fetal head in the flexed position. The goal is to guide and control the delivery of the fetal head to prevent trauma to the mother and fetus that may result from a rapid and uncontrolled delivery. It would not be appropriate to apply forceful downward pressure because this could cause trauma to the mother and fetus. It is important to support the mother's perineum, not the labia.
A primigravida arrives in the labor and delivery unit reporting the need to push. The nurse performs the initial assessment and determines that delivery is imminent. The nurse notifies other health care team members to notify the practitioner. The FHR is Category I with early decelerations. After preparing the patient for delivery, which action should the nurse take? A. Instruct the patient to push to the count of 10 with contractions. B. Encourage the patient to use the feather blow or panting breathing technique. C. Encourage the patient to push whenever the urge is present. D. Instruct the patient not to push under any circumstances.
B. Encourage the patient to use the feather blow or panting breathing technique. Rationale: The nurse should encourage the patient to use the feather blow or panting breathing technique. The distraction of controlled breathing may help the patient resist the urge to push or bear down, thereby allowing time for the practitioner to arrive for delivery, which is appropriate since the FHR is Category I. The nurse should not instruct the patient to push because with a precipitous delivery, a slower, more controlled delivery is desired to prevent cervical, vaginal, or perineal trauma. During precipitous delivery, the patient should be encouraged to blow through contractions; however, in some circumstances, the patient may need to push gently (or more strongly in the case of shoulder dystocia) to assist with delivery.
A student nurse is caring for a multipara at 40 weeks' gestation who delivered upon arrival. The patient reported contractions starting 2 hours before delivery. The student nurse asks the nurse what length of time is considered a precipitous labor. How does the nurse respond? A. "A precipitous labor lasts 2 hours or less." B. "A precipitous labor lasts 4 hours or less." C. "A precipitous labor lasts 3 hours or less." D. "A precipitous labor lasts 5 hours or less."
C. "A precipitous labor lasts 3 hours or less." Rationale: Precipitous labor refers to labor that lasts for 3 hours or less from the onset of contractions until the birth of the newborn. In some cases, the contractions may begin suddenly and may be intense.
A patient is undergoing induction of labor with oxytocin infusion. The patient has an epidural for analgesia but continues to report feeling intense rectal pressure. To rule out imminent delivery, the nurse should assess the patient for which finding or findings? A. Spontaneous rupture of membranes with meconium-stained fluid B. Moderate to heavy vaginal bleeding C. Increased bloody show, labial separation, and crowning D. The patient's expression of urgency
C. Increased bloody show, labial separation, and crowning Rationale: Increased bloody show, labial separation, and crowning along with the patient's reported urge to push or bear down, are likely to occur in cases of precipitous delivery. Moderate to heavy vaginal bleeding may be the result of cervical trauma or a more serious complication; a sterile vaginal examination should be avoided with vaginal bleeding, and the practitioner should be notified. Spontaneous rupture of membranes with meconium-stained fluid may occur with precipitous delivery, but this alone does not necessarily indicate delivery is imminent. The patient's behavior may not be a reliable indicator for progression of labor because many factors are involved, including culture, pain and anxiety tolerance, and age.
The nurse is caring for a multigravida at 39 weeks' gestation whose cervix was 4 cm dilated 15 minutes ago. Now the patient calls the nurse to the room stating that the baby is coming. What is the most important action by the nurse? A. Ensure that delivery supplies are readily available. B. Position the patient for delivery. C. Ensure that maternal and newborn resuscitation supplies are readily available. D. Call for help and do not leave the patient unattended.
D. Call for help and do not leave the patient unattended. Rationale: Although it is important to make sure the delivery supplies and maternal and newborn resuscitation equipment are readily available, it is most important to call for help and not leave the patient unattended. If the patient is left unattended, the patient could deliver without any health care team member in the room, which could put the patient and the newborn at risk for delivery complications. Positioning the patient for delivery is not the most important action by the nurse.
A nurse assisted in the precipitous delivery of a healthy newborn at 38 weeks' gestation after the patient's 90-minute precipitous labor. After spontaneous delivery of the placenta, the patient begins to have excessive vaginal bleeding. What is the priority intervention for this patient? A. IV fluid bolus administration B. Oxytocin administration C. Labial and perineal inspection for lacerations D. Firm fundal massage
D. Firm fundal massage Rationale: Uterine atony is the most common cause of postpartum hemorrhage, and firm massage of the fundus following the delivery of the placenta is the first step to improve uterine tone. Oxytocin administration is an important intervention following the delivery of the placenta. However, fundal massage should be performed immediately; oxytocin should not be administered without a practitioner's order. Although the labia and perineum should be inspected for lacerations if bleeding continues, these assessments are not the priority interventions. An IV fluid bolus may be necessary if bleeding continues; however, the most urgent intervention is fundal massage.
