Ch 21: Nursing Manage of Labor and Birth at Risk

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? A) 1 cm/hour for cervical dilation B) 2 cm/hour for cervical dilation C) 1/4 cm/hour for cervical dilation D) 1/2 cm/hour for cervical dilation

A) 1 cm/hour for cervical dilation In evaluating the progress in active labor, the nurse uses the simple rule of 1 cm/hour for cervical dilation.

The second-year nursing student taking an obstetrics course correctly attributes which descriptions to the term dystocia? Select all that apply. A) Labor is slow. B) Labor is fast. C) Labor progresses normally. D) Progress of labor deviates from normal.

A) Labor is slow. D) Progress of labor deviates from normal. Dystocia is said to exist when the progress of labor deviates from normal and is slow.

The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention? A) a forceps and vacuum-assisted birth B) a cesarean birth C) a precipitous birth D) artificial rupture of membranes

A) a forceps and vacuum-assisted birth A forceps-and-vacuum-assisted birth is required for the client having a prolonged second stage of labor. The client may require a cesarean birth if the fetus cannot be delivered with assistance. A precipitous birth occurs when the entire labor and birth process occurs very quickly. Artificial rupture of membranes is done during the first stage of labor.

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia? A) diabetes B) pendulous abdomen C) nullipara D) preterm birth

A) diabetes Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. A pendulous abdomen is associated with the transverse lie fetal position not with shoulder dystocia.

The nurse would prepare a client for amnioinfusion when which action occurs? A) Maternal pushing is compromised due to anesthesia. B) The fetus shows abnormal fetal heart rate patterns. C) Severe variable decelerations occur and are due to cord compression. D) Fetal presenting part fails to rotate fully and descend into the pelvis.

C) Severe variable decelerations occur and are due to cord compression. Indications for amnioinfusion include severe variable decelerations resulting from cord compression, oligohydramnios (decreased amniotic fluid), postmaturity, preterm labor with rupture of the membranes, and thick meconium fluid. Failure of the fetal presenting part to rotate fully, descend in the pelvis, abnormal fetal heart rate patterns or acute pulmonary edema, and compromised maternal pushing sensations from anesthesia are indications for forceps-assisted birth, and not for amniofusion.

A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth? A) monitor for a cardiac anomaly B) assess for cleft palate C) brachial plexus assessment D) extensive lacerations

C) brachial plexus assessment The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia. Other fetal risks include asphyxia, clavicle fracture, central nervous system injury or dysfunction, and death. Extensive lacerations is a poor maternal outcome due to the occurrence of shoulder dystocia. Cleft palate and cardiac anomalies are not related to shoulder dystocia.

A client has been in labor for 10 hours, with contractions occurring consistently about 5 minutes apart. The resting tone of the uterus remains at about 9 mm Hg, and the strength of the contractions averages 21 mm Hg. The nurse recognizes which condition in this client? A) hypertonic contractions B) Braxton Hicks contractions C) hypotonic contractions D) uncoordinated contractions

C) hypotonic contractions With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.

The nursing student demonstrates an understanding of dystocia with which statement? A) "Dystocia is not diagnosed until after birth." B) "Dystocia is diagnosed after labor has progressed for a time." C) "Dystocia is diagnosed at the start of labor." D) "Dystocia cannot be diagnosed until just before birth."

B) "Dystocia is diagnosed after labor has progressed for a time." Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the client and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.

A client who is in labor presents with shoulder dystocia of the fetus. Which is an important nursing intervention? A) Assess for prolonged second stage of labor with arrest of descent. B) Assess for reports of intense back pain in first stage of labor. C) Anticipate possible use of forceps to rotate to anterior position at birth. D) Assist with positioning the woman in squatting position.

D) Assist with position the woman in squatting position. The nurse caring for the client in labor with shoulder dystocia of the fetus should assist with positioning the client in squatting position. The client can also be helped into the hands and knees position or lateral recumbent position for birth, to free the shoulders. Assessing for complaints of intense back pain in first stage of labor, anticipating possible use of forceps to rotate to anterior position at birth, and assessing for prolonged second stage of labor with arrest of descent are important interventions when caring for a client with persistent occiput posterior position of fetus.

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? A) infection B) dystocia C) hemorrhage D) macrosomia

D) macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks of gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia are risk to the mother not the fetus.