OB 22

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

administer oxygen by mask.

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

high in the abdomen

The nurse is caring for a mother laboring with her third baby. Suddenly the nurse notes severe fetal bradycardia and the mother becomes hypotensive. For which emergent complication should the nurse direct care to the mother?

uterine rupture

The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation (dilatation). It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins?

30 minutes

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 mother in the active phase of labor has been contracting for 4 hours. The contractions are occurring infrequently and not lasting very long. When the nurse palpates the uterus during a contraction it feels soft. The nurse should anticipate receiving which prescription from the obstetric provider?

Administer oxytocin.

The perinatal educator is instructing on various emotions commonly experienced during labor. Which complication of anxiety is most important to stress?

Dystocia

The nurse is caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true?

Late decelerations

The mother comes to her prenatal appointment. She tells the nurse that it feels like the baby is kicking on her bladder and it is harder to breathe. The nurse suspects the fetus is in breech position. Which procedure would the nurse implement to determine the position of the baby?

Leopold maneuvers

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.

A client at 38 weeks' gestation is admitted to the labor and delivery unit in early labor and with the membranes intact. The nurse completes an assessment and determines by the Leopold maneuver that the fetus is in a malposition. What action(s) will the nurse take? Select all that apply.

Notify the health care provider. Connect the external fetal heart monitor. Bring the ultrasound machine to the bedside.

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.

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.

Group B streptococcus (GBS) infection presents a large risk to the neonate. Which factor should the nurse consider when developing a plan of care related to GBS? Select all that apply.

Preterm labor clients receive prophylactic antibiotics. Antibiotics must be started 4 hours prior to labor to be effective. Mothers with previous GBS will be treated with prophylactic antibiotics.

A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply.

Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia

When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan?

There may be a longer active phase of first stage of labor.

The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging?

Use McRoberts maneuver.

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.

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

A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position?

cord prolapse

It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should:

empty the mother's bladder

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

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration?

fourth degree

The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test?

nonstress test (NST)

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 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

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?

Experience of additional back pain

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."

An infant was born after a face presentation. When selecting a nursing diagnosis for the newborn, which body system does the nurse identify as a priority?

respiratory

A multipara woman is experiencing a prolonged descent while trying to rest and increase her fluid intake. The nurse suggests that she change position. Which position(s) will be effective for pushing to speed up the descent? Select all that apply.

semi-Fowler position squatting position

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

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant?

"I know you are hurting, but you can have another baby in the future."

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."

The nurse is teaching an antepartum class to first-time mothers. A mother asks the nurse if she should stay in bed when her contractions start. How should the nurse respond?

"No, walking actually shortens the first stage of labor."

The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate?

"Walking is the best way to prevent complications such as blood clots."

When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action?

Keeping the communication lines open

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?

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

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 fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth?

brachial plexus assessment

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?

knee-chest

A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor?

placenta removed via manual extraction

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?

placental abruption

The nurse is caring for a laboring mother experiencing a precipitous delivery. The nurse would assess the mother for symptoms of which complication?

placental abruption (abruptio placentae)