OB - Chapter 21 Nursing Management of Labor and Birth at Risk
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."
"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."
A client is admitted to the health care facility with a gestational age of 42 weeks. The client is to undergo a cesarean section. Which of the following would be the fetal risk associated with postterm pregnancy? a) Cephalopelvic disproportion b) Intraventricular hemorrhage c) Underdeveloped suck reflex d) Congenital heart defects
Cephalopelvic disproportion
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) Fetus in a breech presentation. b) Cervical dilation of 5 cm. c) Strong, regular contractions. d) A spontaneous abortion in an earlier pregnancy.
Cervical dilation of 5 cm.
A full-term pregnant client is being assessed for induction of labor. Her Bishop score is less than 6. Which of the following does it indicate? a) A cesarean birth may be required. b) Labor will occur spontaneously. c) Vaginal birth will be successful. d) Cervical ripening method should be used.
Cervical ripening method should be used.
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 dilatation is cephalopelvic disproportion. Which of the following interventions should the nurse most expect in this case? a) Administration of morphine sulfate b) Cesarean birth c) Administration of oxytocin d) Darkening room lights and decreasing noise and stimulation
Cesarean birth
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) Make sure the patient is lying on their left side. b) Make sure the epidural medication is turned down. c) Assess vital signs every 30 minutes. d) Check for a full bladder.
Check for a full bladder.
A nurse is caring for obstetric clients. The nurse should be aware of which of the following as an indication for labor induction? a) Chorioamnionitis b) Abruptio placenta c) Complete placenta previa d) Transverse fetal lie
Chorioamnionitis
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) Contractions most forceful in the middle of uterus rather than the fundus c) Fetal buttocks as the presenting part d) Complaints of severe back pain
Complaints of severe back pain
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) Placental abruption c) Complications of placenta previa d) Complications of a post-term pregnancy
Complications of a post-term pregnancy
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? a) "It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid." b) "You may have just passed some urine. If it were amniotic fluid, there would be much more than that." c) "There's nothing to worry about if you passed only a little bit. The membranes will seal back over." d) "Go to the hospital now, because this could be very dangerous for the baby."
"It is best for you to visit a hospital immediately. They can use a nitrazine strip to determine if it is amniotic fluid."
When assessing the following women, which would the nurse identify as being at the greatest risk for preterm labor? a. Woman who had twins in a previous pregnancy b. Client living in a large city c. Woman working full time as a computer programmer d. Client with a history of a previous preterm birth
Client with a history of a previous preterm birth
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
Potential lacerations and bleeding
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) Fourth stage of labor c) Third stage of labor d) First stage of labor
Second stage of labor
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 insufficient to dilate the cervix. b) The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix. c) The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. d) The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix.
The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix.
A woman is to undergo labor induction. The nurse determines that the woman most likely requires cervical ripening if her Bishop score is: a) 6 b) 9 c) 7 d) 5
5
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) < 3 hours b) < 5 hours c) < 8 hours d) < 4 hours
< 3 hours
A nurse is assigned to care for a client who has to undergo a forceps and vacuum-assisted birth. The nurse understands that which of the following factors has contributed to a forceps and vacuum-assisted birth? a) Rupture of uterus b) Preterm labor with premature rupture of membranes c) Oligohydramnios due to placental insufficiency d) A prolonged second stage of labor
A prolonged second stage of labor
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 two divided intramuscular sites. b) Administer oxytocin diluted as a "piggyback" infusion. c) Administer Pitocin in a 20 cc bolus of saline. d) Administer oxytocin diluted in the main intravenous fluid.
Administer oxytocin diluted as a "piggyback" infusion.
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) Applying counter pressure to the back b) Applying a heating pad to the back c) Performing acupuncture on the back d) Applying ice to the back
Applying counter pressure to the back
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) Place the woman in Trendelenburg position b) Administer oxygen at 10 L/min by face mask c) Administer amnioinfusion d) Assess fetal heart sounds
Assess fetal heart sounds
Which of the following postoperative interventions should a nurse perform when caring for a client who has undergone a cesarean birth? a) Ensure that the client does not cough or breathe deeply. b) Avoid early ambulation to prevent respiratory problems. c) Delay breastfeeding the newborn for a day. d) Assess uterine tone to determine fundal firmness.
Assess uterine tone to determine fundal firmness.
A client who is in labor presents with shoulder dystocia of the fetus. Which of the following is an important nursing intervention? a) Assess for prolonged second stage of labor with arrest of descent. b) Anticipate possible use of forceps to rotate to anterior position at birth. c) Assist with positioning the woman in squatting position. d) Assess for complaints of intense back pain in first stage of labor.
Assist with positioning the woman in squatting position.
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 monitor fetal movements daily. c) Monitor bowel movements. d) Be sure to measure 24-hour urine output daily.
Be sure to monitor fetal movements daily.
Which of the following interventions would be most important when caring for the client with breech presentation confirmed by ultrasound? a) Continuing to monitor maternal and fetal status b) Applying suprapubic pressure against the fetal back c) Noting the space at the maternal umbilicus d) Auscultating the fetal heart rate at the level of the umbilicus
Continuing to monitor maternal and fetal status
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) Cord compression c) Macrosomia d) Fetal hydrocephalus
Cord compression
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) Delivery is unlikely within the 2 next weeks. c) Infection is present. d) No infection is present.
Delivery is unlikely within the 2 next weeks.
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) Shorter dilatational stage of labor. b) Necessity for vacuum extraction for delivery. c) Need to have the baby manually rotated. d) Experience of additional back pain.
Experience of additional back pain.
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) External cephalic version c) Vacuum extraction d) Trial labor
External cephalic version
The nurse is assisting a physician to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the patient the procedure is called? a) External version b) Vaginal manipulation c) Internal rotation d) External rotation
External version
A placenta succenturiate is a placenta in which the cord is inserted marginally rather than centrally. a) True b) False
False
A nurse is assigned to care for a client who has been diagnosed with placental abruption. The nurse knows that which of the following could have led to placental abruption in the client? a) Gestational diabetes b) Gestational hypertension c) Cardiovascular disease (CVD) d) Obesity or excess weight gain
Gestational hypertension
The nurse would anticipate a cesarean birth for a client who has which active infection present at the onset of labor? a. Hepatitis b. Herpes simplex virus c. Toxoplasmosis d. Human papillomavirus
Herpes simplex virus
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) An emergency cesarean section d) Hospitalization, tocolytic therapy, and IM corticosteroids
Hospitalization, tocolytic therapy, and IM corticosteroids
A client who was in active labor and whose cervix had dilated to 4 cm experiences a weakening in the intensity and frequency of her contractions and exhibits no further progress in labor. The nurse interprets this as a sign of: a. Hypertonic labor b. Precipitate labor c. Hypotonic labor d. Dysfunctional labor
Hypotonic labor
A nurse is assessing the cause of multiple gestations in clients. Which of the following factors should the nurse assess as contributors to increased probability of multiple gestations? a) Advanced maternal age b) Medications c) Adolescent pregnancies d) Infertility treatment
Infertility treatment
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) Fundal pressure c) McRobert's maneuver d) Positioning the woman prone
McRobert's maneuver
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) McRonald Maneuver c) McRoberts maneuver d) McDonald maneuver
McRoberts maneuver 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 client is experiencing shoulder dystocia during delivery. Which of the following should the nurse identify as risks to the fetus in such a condition? a) Extensive lacerations b) Infection c) Nerve damage d) Bladder injury
Nerve damage
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) Occiput posterior position b) Fetal macrosomia c) Nongynecoid pelvis d) Breech presentation
Occiput posterior position
A client with full-term pregnancy who is not in active labor has been ordered oxytocin intravenously. Which of the following is a contraindication for oxytocin administration? a) Dysfunctional labor pattern b) Postterm status c) Prolonged ruptured membranes d) Overdistended uterus
Overdistended uterus
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
Placental abruption
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 to assist the physician with an amniotomy. b) Prepare for a precipitous vaginal birth. c) Administer an analgesic to the patient. d) Prepare the patient for a Cesarean section.
Prepare the patient for a Cesarean section.
A multipara presents to the hospital after 2 hours of labor. The fetus is presenting in transverse lie. You notify the physician and take what action? a) Apply pressure to the woman's lower back with a fisted hand. b) Include a set of piper forceps when you prep the table. c) Prepare to assist with external version or prep for a cesarean section delivery. d) Assist with Nitrazine and fern tests.
Prepare to assist with external version or prep for a cesarean section delivery.
Which intervention would be most appropriate for the woman experiencing dystocia related to problems involving the psyche? a) Encouraging the woman to assume a hands-and-knees position b) Preparing the woman for an amniotomy c) Administering oxytocin d) Providing a comfortable environment with dim lighting
Providing a comfortable environment with dim lighting
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) Respiratory depression, hypotension, absent tendon reflexes b) Pain in the abdomen, shoulder, or back c) Severe lower back pain, leg cramps, sweating d) Low potassium or elevated glucose, tachycardia, chest pain
Respiratory depression, hypotension, absent tendon reflexes
The rationale for using a prostaglandin gel for a client prior to the induction of labor is to: a. Stimulate uterine contractions b. Numb cervical pain receptors c. Prevent cervical lacerations d. Soften and efface the cervix
Soften and efface the cervix
A pregnant woman at her first office visit tells the nurse, "I hope I have twins. It seems like all my friends have delivered twins lately!" What should the nurse tell the patient about multiple births at this time? a) The incidence is decreasing. b) Incidence of twins is consistently approximately 1 in 100 conceptions. c) People giving birth at younger ages is resulting in more twins. d) The incidence is increasing.
The incidence is increasing.
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) Occipitoposterior position c) Cephalic presentation d) Transverse lie
Transverse lie
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) Uterine rupture b) Umbilical cord compression c) Placentea previa d) Hypertonic uterus
Uterine rupture
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) increase the flow rate of the main line infusion. c) discontinue the oxytocin infusion. d) slow the infusion to under 10 gtt per minute.
discontinue the oxytocin infusion.
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) pulmonary emboli b) premature labor c) dystocia d) deep vein thrombosis
dystocia
A nursing student correctly identifies the most desirable position to promote an easy delivery as which of the following? a) occiput anterior b) breech c) shoulder dystocia d) face and brow
occiput anterior
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) cover the exposed cord with a dry, sterile wrap. b) turn her to her left side. c) replace the cord with gentle pressure. d) place her in a knee-chest position.
place her in a knee-chest position.
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
precipitous labor
A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating? a) macrosomia b) dystocia c) normal labor d) preterm labor
preterm labor
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) amniotic fluid analysis c) U/A d) CBC e) arterial blood gases
• CBC • U/A • amniotic fluid analysis
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) Current multiple gestation pregnancy b) Uterine or cervical abnormalities c) History of previous preterm birth d) Large-for-gestational age fetus e) Previous Cesarean section
• History of previous preterm birth • Current multiple gestation pregnancy • Uterine or cervical abnormalities
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) Intrauterine growth restriction b) Post-term pregnancy c) Maternal diabetes d) Incompetent cervix e) Fetal macrosomia
• Maternal diabetes • Post-term pregnancy • Fetal macrosomia
A client is 2 weeks past her due date, and her physician is considering whether to induce labor. Which of the following conditions must be present before induction can take place? (Select all that apply.) a) The fetus is in a longitudinal lie b) The cervix is ripe c) A presenting part is engaged d) Absence of eclampsia e) Cephalopelvic disproportion is present f) Normal maternal blood pressure
• The fetus is in a longitudinal lie • The cervix is ripe • A presenting part is engaged
The nursing student demonstrates an understanding of dystocia with which of the following statements? a) "Dystocia cannot be diagnosed until just before delivery." b) "Dystocia is diagnosed at the start of labor." c) "Dystocia is diagnosed after labor has progressed for a time." d) "Dystocia is not diagnosed until after the delivery."
"Dystocia is diagnosed after labor has progressed for a time."
During labor, a woman at 41 weeks gestation notes her amniotic fluid is leaking and is green in color. She is asking the nurse why the fluid is green. What is an appropriate response by the nurse? a) "Green might be a yeast infection and we need to culture the discharge." b) "You have an infection and need antibiotics." c) "This is meconium-stained fluid from the baby." d) "Amniotic fluid is normally green."
"This is meconium-stained fluid from the baby."
The experienced labor and delivery nurse knows to evaluate progress in active labor by using which simple rule? a) 1/4 cm/hour for cervical dilation b) 1 cm/hour for cervical dilation c) 1/2 cm/hour for cervical dilation d) 2 cm/hour for cervical dilation
1 cm/hour for cervical dilation
Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? a) If the woman's bladder is distended, it may rupture. 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) A full rectum can cause diarrhea.
A full bladder or rectum can impede fetal descent.
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) Congestive heart failure b) Placental separation c) Amniotic fluid embolism d) Aspiration
Amniotic fluid embolism
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) Breast stimulation c) Amniotomy d) Laminaria
Amniotomy
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) Assess contractions by using external monitor b) Start administering tocolytic therapy c) Turn down oxytocin administration by half d) Administer hydration and sedation frequently
Assess contractions by using external monitor
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) Infection of episiotomy b) Caput succedaneum c) Cervical lacerations d) Perineal hematoma
Caput succedaneum
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) Diabetes c) Nullipara d) Preterm delivery
Diabetes
A woman's nurse-midwife tells her that the woman has developed dystocia. You would explain that this term means a) High blood pressure related to difficult labor. b) Muscle weakness related to prolonged labor. c) Potential for placental detachment. d) Difficult or abnormal labor.
Difficult or abnormal labor.
When reviewing the medical record of a client, the nurse notes that the woman has a condition in which the fetus cannot physically pass through the maternal pelvis. The nurse interprets this as: a. Cervical insufficiency b. Contracted pelvis c. Maternal disproportion d. Fetopelvic disproportion
Fetopelvic disproportion
After a vaginal examination, the nurse determines that the client's fetus is in an occiput posterior position. The nurse would anticipate that the client will have: a. Intense back pain b. Frequent leg cramps c. Nausea and vomiting d. A precipitous birth
Intense back pain
A nurse is caring for a client who has been diagnosed with precipitous labor. For which of the following potential fetal complications should the nurse monitor as a result of precipitous labor? a) Cephalhematoma b) Facial nerve injury c) Facial lacerations d) Intracranial hemorrhage
Intracranial hemorrhage
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) Early decelerations. c) Late decelerations. d) Mild decelerations.
Late decelerations.
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) Apply pressure to the fundus. b) Attempt to push one of the fetus' shoulders in a clockwise or counterclockwise motion. c) Zavanelli's maneuver d) McRobert's maneuver
McRobert's maneuver
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) Turn the patient on her left side. c) Bolus the patient with another dose of medication through the epidural. d) Place the patient in a knee-chest position.
Prepare the patient for a cesarean section.
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) With the woman in lithotomy position, hold her legs and sharply flex them toward her shoulders. b) Put her in bed immediately, call for help, and hold the presenting part of the cord. c) Go find assistance to confirm that the cord is in the vagina. d) Prep the woman for a vaginal delivery.
Put her in bed immediately, call for help, and hold the presenting part of the cord.
In vasa previa, the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus. a) True b) False
True
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) tell the woman to take short, catchy breaths. c) administer oxygen by mask. d) put firm pressure on the fundus of her uterus.
administer oxygen by mask.
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) both types can result from the split ovum b) neither type results from a split ovum c) fraternal d) identical
identical
A nursing instructor is teaching students about fetal presentations during delivery. The most common cause for increased incidence of shoulder dystocia is: a) poor quality of prenatal care b) longer lengths of labor c) increasing birth weight d) increased number of overall pregnancies
increasing birth weight
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) assess blood pressure and pulse to detect placental bleeding. b) attach a fetal monitor to determine fetal status. c) ask her to push with the next contraction so delivery is rapid. d) place a hand gently on the fetal head to guide delivery.
place a hand gently on the fetal head to guide delivery.
A patient is told that she is already completely effaced and 9 cm dilated, and that the fetal head is showing. Contrary to the nurse's instructions, the patient begins to push. Before the physician can enter the room, the woman delivers the baby with only the nurse in attendance. This is an example of which of the following? a) protraction disorder b) labor dystocia c) precipitous delivery d) uterine dysfunction
precipitous delivery
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 progresses normally. c) Labor is slow. d) Labor is fast.
• Progress of labor deviates from normal. • Labor 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) Pelvis is either android type or platypelloid type b) Contractions are insufficient to cause fetus descent c) Uterine contractions are too weak or uncoordinated d) Fetus is in a different position or presentation
Uterine contractions are too weak or uncoordinated
The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which of the following should she include? (Check all that apply.) a) brachial plexus injuries b) failure to thrive c) macrosomia d) cephalopelvic disproportion e) shoulder dystocia
• macrosomia • shoulder dystocia • brachial plexus injuries • cephalopelvic disproportion
A nursing student correctly identifies the causes of labor dysfunction to include which of the following? (Select all that apply.) a) problems with access to health care b) problems with the mother's diet c) problems with the uterus d) problems with the fetus e) problems with finances
• problems with the uterus • problems with the fetus
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) Allow the couple to spend as much time as they want with their stillborn infant. d) Refrain from discussing the situation with the couple
Refrain from discussing the situation with the couple
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) Fetal presenting part fails to rotate fully and descend in the pelvis d) The fetus shows non-reassuring fetal heart rate patterns
Severe variable decelerations are due to cord compression
Which of the following would be appropriate for the use of low forceps? a) The fetal scalp is visible at the introitus without spreading the labia b) The leading point of fetal skull is at or above station +2, not on the pelvic floor c) The fetal skull has reached the pelvic floor, with the fetal head at the perineum d) The fetal head is engaged but the leading point of the skull is less than +2
The leading point of fetal skull is at or above station +2, not on the pelvic floor
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) The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells. c) The number of uterine contractions is very low or infrequent. d) There is an increase in the length of labor because so many contractions are needed to achieve cervical dilation.
The myometrium becomes sensitive from the lack of relaxation and anoxia of uterine cells.
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) Place the patient supine with the head of bed elevated 30 degrees. b) Apply a warm washcloth to the lower back. c) Have the physician administer a pudendal block. d) Use a fist to apply counter pressure to the lower back.
Use a fist to apply counter pressure to the lower back.
