OB PrepU Chapter 21

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? a. Occiput posterior position b. Breech presentation c. Nongynecoid pelvis d. Fetal macrosomia

a. Occiput posterior position

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? a. Prepare the client for a cesarean birth. b. Prepare to assist the care provider with an amniotomy. c. Prepare for a precipitous vaginal birth. d. Administer an analgesic to the client.

a. Prepare the client for a cesarean birth.

The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do? a. Prepare the client for a cesarean birth. b. Place the client in a knee-chest position. c. Bolus the client with another dose of medication through the epidural. d. Turn the client on her left side.

a. Prepare the client for a cesarean birth.

Hypertonic labor is labor that is characterized by short, irregular contractions without complete relaxation of the uterine wall in between contractions. Hypertonic labor can be caused by an increased sensitivity to oxytocin. What would the nurse do for a client who is in hypertonic labor because of oxytocin augmentation? a. Turn off the oxytocin. b. Turn off the methotrexate. c. Increase the oxytocin. d. Increase the methotrexate.

a. Turn off the oxytocin.

A woman at 39 weeks' gestation is brought to the emergency department in labor following blunt trauma from an vehicle accident. The labor has been progressing well after the epidural when suddenly the woman reports severe pain in her back and shoulders. Which potential situation should the nurse suspect? a. Uterine rupture b. Fractured ribs c. Placental abruption (abruptio placentae) d. Dystocia

a. Uterine rupture

A woman who is 42 weeks' pregnant comes to the clinic. During the visit, which assessment should the nurse prioritize? a. asking her about the occurrence of contractions b. determining an accurate gestational age c. checking for spontaneous rupture of membranes d. measuring the height of the fundus

b. determining an accurate gestational age

A client at 38 weeks' gestation 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. trial labor b. external cephalic version c. vacuum extraction d. forceps birth

b. external cephalic version

A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: a. ask her to push with the next contraction so birth is rapid. b. place a hand gently on the fetal head to guide birth. c. attach a fetal monitor to determine fetal status. d. assess blood pressure and pulse to detect placental bleeding.

b. place a hand gently on the fetal head to guide birth.

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for: a. increased risk for uterine rupture. b. potential lacerations and bleeding. c. increased risk for cord entanglement. d. damage to the maternal tissues.

b. potential lacerations and bleeding.

A client with a pendulous abdomen and uterine fibroid tumors 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? a. anterior fetal position b. transverse lie c. cephalic presentation d. occipitoposterior position

b. transverse lie

A woman in active labor with a history of two previous cesarean births is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes her blood pressure is 80/50 mm Hg, pulse rate is 130 bpm and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication? a. an undiagnosed abdominal aorta aneurysm b. uterine rupture c. an amniotic embolism to the lungs d. compression on the inferior vena cava

b. uterine rupture

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? a. darkening room lights and decreasing noise and stimulation b. administration of oxytocin c. cesarean birth d. administration of morphine sulfate

c. cesarean birth

A woman in active labor has just had her membranes ruptured to speed up labor. The nurse is concerned the woman is experiencing a prolapse of the umbilical cord when the nurse notices which pattern on the fetal heart monitor? a. fetal heart rate (FHR) increase to 200 beats/min b. late deceleration with late recovery following contraction c. variable deceleration pattern d. early deceleration with each contraction

c. variable deceleration pattern

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? a. Need to have the baby manually rotated b. Necessity for vacuum extraction for birth c. Shorter dilation (dilatation) stage of labor d. Experience of additional back pain

d. Experience of additional back pain

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? a. Fetal heart tones b. Signs of shock c. Infection d. Uterine stabilization

a. Fetal heart tones

A nursing instructor is teaching students about fetal presentations during birth. 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 length of labor.

a. increasing birth weight.

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 factors? Select all that apply. a. presentation b. mother's age c. fetal development d. analgesia e. position

a. presentation c. fetal development e. position

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? a. Administer oxytocin in a 20 cc bolus of saline. b. Administer oxytocin diluted as a "piggyback" infusion. c. Administer oxytocin in two divided intramuscular sites. d. Administer oxytocin diluted in the main intravenous fluid.

b. Administer oxytocin diluted as a "piggyback" infusion.

The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? a. Need to have the baby manually rotated b. Experience of additional back pain c. Shorter dilation (dilatation) stage of labor d. Necessity for vacuum extraction for birth

b. Experience of additional back pain

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

b. McRoberts maneuver

A nursing student working with a client in preterm labor correctly identifies which medication as being used to relax the smooth muscles of the uterus and for seizure prophylaxis and treatment in clients with preeclampsia? a. nifedipine b. magnesium sulfate c. betamethasone d. indomethacin

b. magnesium sulfate

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

c. 1 cm/hour for cervical dilation

A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina? a. With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders. b. Contact the health care provider and prepare the client for an emergent vaginal birth. c. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. d. Place the client in Trendelenburg position and gently attempt to reinsert the cord.

c. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord.

Immediately after giving birth to a full-term infant, a client 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 client? a. congestive heart failure b. placental separation c. amniotic fluid embolism d. aspiration

c. amniotic fluid embolism

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? a. Avoid early ambulation to prevent respiratory problems. b. Delay breastfeeding the newborn for a day. c. Ensure that the client does not cough or breathe deeply. d. Assess uterine tone to determine fundal firmness.

d. Assess uterine tone to determine fundal firmness.

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

d. identical

A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate? a. encouraging the women to change positions frequently b. preparing the woman for an amniotomy c. administering oxytocin d. providing a comfortable environment with dim lighting

d. providing a comfortable environment with dim lighting

After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition? a. contractions most forceful in the middle of uterus rather than the fundus b. fetal buttocks as the presenting part c. lack of cervical dilation past 2 cm d. reports of severe back pain

d. reports of severe back pain

A woman in labor with a history of drug and alcohol addiction and no prenatal care has arrived in the emergency department in active labor with cervix 5 cm dilated. An ultrasound shows the fetus in a breech presentation. As a nurse prepares to care for this woman, which assessments indicate the fetus is in distress and needs immediate help to survive? Select all that apply. a. fetal heart rate decreasing into the 80s b. premature rupture of membranes with yellow-green color fluid that smells foul c. meconium staining noted on fluid seeping from vagina d. minimal movement as the fetus descends into the pelvic opening e. variable deceleration FHR pattern noted on monitor

a. fetal heart rate decreasing into the 80s e. variable deceleration FHR pattern noted on monitor

A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client? a. encouraging the woman to assume a hands-and-knees position b. administering oxytocin c. preparing the woman for an amniotomy d. providing a comfortable environment with dim lighting

b. administering oxytocin

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 an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question? a. "Maybe your uterus is just tired and needs a rest." b. "It is likely that your body has not secreted enough hormones to soften the ligaments so your pelvic bones can shift to allow birth of the baby." c. "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." d. "Maybe your baby has developed hydrocephaly and the head is too swollen."

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

The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule? a. Cervix dilates 2 cm per hour. b. Fetus descends 1 cm per hour. c. Cervix dilates 1 cm per hour. d. Fetus descends 2 cm per hour.

c. Cervix dilates 1 cm per hour.

At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with? a. Bed rest and hydration at home b. An emergency cesarean birth c. Hospitalization, tocolytic, and corticosteroids d. Careful monitoring of fetal kick counts

c. Hospitalization, tocolytic, and corticosteroids

A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement? a. The parents just cannot believe their perfect infant died. b. The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn. c. The parents are beginning to demonstrate positive grieving behaviors. d. The parents continue to mourn the loss of their infant.

c. The parents are beginning to demonstrate positive grieving behaviors.

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? a. Explain to her that there was probably something wrong with the infant and that is why it died. b. Call the hospital chaplain to talk to the parents. c. Recommend that she not hold the infant after it is delivered so as to not upset her more. d. Offer to take pictures and footprints of the infant once it is delivered.

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

After only 45 minutes of labor, the client feels the urge to push. She pushes once and the baby's head is visible. With the next push, the head emerges. What is the immediate risk when the head is delivered too fast? a. Bladder incontinence b. Pelvic floor relaxation c. Vaginal stretching d. Perineal tearing

d. Perineal tearing

The nurse is admitting a client at 23 weeks' gestation in preparation for induction and delivery after it was determined the fetus had died secondary to trauma. When asked by the client to explain what went wrong, the nurse can point out which potential cause for this loss? a. Preeclampsia b. Genetic abnormality c. Premature rupture of membranes d. Placental abruption

d. Placental abruption

A G2P1 woman is in labor attempting a VBAC, when she suddenly complains of light-headedness and dizziness. An increase in pulse and decrease in blood pressure is noted as a change from the vital signs obtained 15 minutes prior. The nurse should investigate further for additional signs or symptoms of which complication? a. Placenta previa b. Umbilical cord compression c. Hypertonic uterus d. Uterine rupture

d. Uterine rupture

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

d. administer oxygen by mask.

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? a. prostaglandin b. breast stimulation c. laminaria d. amniotomy

d. amniotomy

A nurse is reading a journal article about cervical ripening agents, based on the understanding that certain pharmaceuticals can be used to attain cervical ripening in women who need assistance in this area. They have also often continued into labor without further agents to stimulate uterine contractions. Which agent would the nurse anticipate reading about as an FDA-approved agent for cervical ripening? a. misoprostol b. oxytocin c. magnesium sulfate d. dinoprostone

d. dinoprostone

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? a. poor in quality. b. well coordinated. c. brief. d. erratic.

d. erratic.