Unit 2: High-risk Intrapartum 80%

A woman is delivering a macrosomic baby. The midwife is performing a mediolateral episiotomy. Draw a line where the episiotomy is being performed.

Drawn episiotomy that is about 45 degrees from the midline. The direction in which the episiotomy is performed is usually dependent upon whether the practitioner is left-handed or right-handed.

A 40-week-gestation client has an admitting platelet count of 90,000 cells/mm 3 and a hematocrit of 29%. Her laboratory values 1 week earlier were platelet count 200,000 cells/mm 3 and hematocrit 37%. Which additional abnormal laboratory value would the nurse expect to see?

Elevated alanine transaminase (ALT)

The nurse is caring for two post-cesarean section clients in the postanesthesia suite. One of the clients had her surgery under spinal anesthesia, while the other client had her surgery under epidural anesthesia. Which of the following is an important difference between the two types of anesthesia that the nurse should be aware of?

Epidurals do not fully sedate motor nerves

A baby is entering the pelvis in the vertex presentation and in the extended attitude. The nurse determines that which of the following positions is consistent with this situation?

Left mentum anterior (LMA)

A physician has notified the labor and delivery suite that four clients will be admitted to the unit. The client with which of the following clinical fi ndings would be a candidate for an external version?

Left sacral posterior position

A woman, 32 weeks' gestation, contracting every 3 min × 60 sec, is receiving magnesium sulfate. For which of the following maternal assessments is it critical for the nurse to monitor the client?

Low urinary output

In which of the following clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion?

Meconium-stained fluid

A client with an internal fetal monitor catheter in place has just received IV butorphanol (Stadol) for pain relief. Which of the following monitor tracing changes should the nurse anticipate?

Diminished short- and long-term variability

The doctor writes the following order for a 31-week-gravid client with symptomatic placenta previa: Weigh all vaginal pads and estimate blood loss. The nurse weighs one of the client's saturated pads at 24 grams and a dry pad at 4 grams. How many milliliters (mL) of blood can the nurse estimate the client has bled? Calculate to the nearest whole number.

20 mL

A client is scheduled for an external version. The nurse would expect to prepare which of the following medications to be administered prior to the procedure?

Terbutaline (Brethine)

A client, G3 P2002, is immediately postexternal version. The nurse monitors this client carefully for which of the following?

Variable fetal heart decelerations

To reduce possible side effects from a cesarean section under general anesthesia, clients are routinely given which type of medication?

Antacids

The nurse is admitting four full-term primigravid clients to the labor and delivery unit. The nurse requests pre-cesarean section orders from the healthcare practitioner for which of the clients? The client who has: Select all that apply.

Cervical cerclage Active herpes simplex 2

A nurse administers magnesium sulfate via infusion pump to an eclamptic woman in labor. Which of the following outcomes indicates that the medication is effective?

Client has no grand mal seizures

A client with a complete placenta previa is on the antepartum clinical unit in preparation for delivery. Which of the following should the nurse include in a teaching session for this client?

Coughing and deep breathing

The nurse is caring for four women who are in labor. The nurse is aware that he or she will likely prepare which of the women for cesarean delivery? Select all that apply.

Fetus is in the left sacral posterior position Fetus has been diagnosed with meningomyelocele

A client had an epidural inserted 2 hours ago. It is functioning well, the client is hemodynamically stable, and the client's labor is progressing as expected. Which of the following assessments is highest priority at this time?

Palpate bladder

A 29-week-gravid client is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and abruptio placentae, the nurse should assess which of the following?

Presence of abdominal pain

The nurse is caring for an eclamptic client. Which of the following is an important action for the nurse to perform?

Pad the client's bed rail and headboard

Which of the following physical findings would lead the nurse to suspect that a client with severe pre-eclampsia has developed HELLP syndrome? Select all that apply.

Petechiae Jaundice

A labor nurse is caring for a client, 30 weeks' gestation, who is symptomatic from a complete placenta previa. Which of the following physician orders should the nurse question?

Assess cervical dilation

A woman has been in the second stage of labor for 2½ hours. The fetal head is at +4 station and the fetal heart is showing mild late decelerations. The obstetrician advises the woman that the baby will be delivered with forceps. Which of the following actions should the nurse take at this time?

Assess the fetal heart rate after each contraction

A client is in labor and delivery with a diagnosis of HELLP syndrome. The nurse notes the following blood values: Prothrombin time (PT) 99 sec (normal 60 to 85 sec) Partial thromboplastin time (PTT) 30 sec (normal 11 to 15 sec) For which of the following signs/symptoms would the nurse monitor the client?

Pink-tinged urine

A woman is scheduled to have an external version for a breech presentation. The nurse carefully assesses the client's chart knowing that which of the following is a contraindication to this procedure?

Previous cesarean section

The fetal monitor tracing of a laboring woman who is 9 cm dilated shows recurring late decelerations to 100 bpm. The nurse notes a moderate amount of greenish-colored amniotic fl uid gush from the vagina after a practitioner performs an amniotomy. Which of the following nursing diagnoses is appropriate at this time?

Risk for fetal injury related to possible intrauterine hypoxia

A pregnant woman, G3 P2002, had her two other children by cesarean section. Which of the following situations would mandate that this delivery also be by cesarean?

The previous uterine incisions were vertical

An anesthesiologist informs the nurse that a woman scheduled for cesarean section will have the procedure under general anesthesia with postoperative patientcontrolled analgesia rather than under continuous epidural infusion. Which of the following would warrant this decision?

The woman has had surgery for scoliosis

During the delivery of a macrosomic baby, the woman develops a fourth-degree laceration. How should the nurse document the extent of the laceration in the woman's medical record?

Through the rectal sphincter

A physician has given a nurse a verbal order to apply cricoid pressure. Which of the following is the likely indication for the action?

Endotracheal tube insertion

Which of the following situations should the nurse conclude is a vaginal delivery emergency?

Shoulder dystocia

During a nurse's shift, the fetal heartbeat patterns on fi ve fully dilated clients showed minimal variability and late decelerations. The primary healthcare practitioners all requested forceps to speed the deliveries. In which of the situations should the nurse have refused to provide the delivery forceps? Select all that apply.

Transverse fetal lie Mentum presentation and -1 station

A nurse is monitoring a client who is receiving an amnioinfusion. Which of the following assessments is critical for the nurse to make to prevent a serious complication related to the procedure?

Uterine resting tone

A woman with severe pre-eclampsia, 38 weeks' gestation, is being induced with IV oxytocin (Pitocin). Which of the following would warrant the nurse to stop the infusion?

Duration of contractions of 130 seconds

A doctor orders a narcotic analgesic for a laboring client. The nurse notes that there are late decelerations on the electronic fetal monitor tracing. Which of the following situations would lead a nurse to hold the medication?

Fetal monitor tracing shows late decelerations

During a vaginal delivery, the obstetrician declares that a shoulder dystocia has occurred. Which of the following actions by the nurse is appropriate at this time?

Flex the woman's thighs sharply toward her abdomen

An obstetrician declares at the conclusion of the third stage of labor that a woman is diagnosed with placenta accreta. The nurse would expect to see which of the following signs/symptoms?

Hemorrhage

A labor nurse is caring for a client, 38 weeks' gestation, who has been diagnosed with symptomatic placenta previa. Which of the following orders by the primary healthcare provider should the nurse question?

Begin oxytocin drip rate at 0.5 milliunit/min

A client who has been diagnosed with severe pre-eclampsia is being administered magnesium sulfate via IV pump. Which of the following medications must the nurse have immediately available in the client's room?

Calcium gluconate

The nurse identifies the following nursing diagnosis for a client undergoing an emergency cesarean section: Risk for ineffective individual coping related to emergency procedure. Which of the following nursing interventions would be appropriate in relation to this diagnosis?

Explain all procedures slowly and carefully

A woman in active labor received Nubain (nalbuphine hydrochloride) 14 mg IV for pain relief. One-half hour later her respirations are 8 rpm. The nurse reports the respiratory rate to the physician. Which of the following medications would be appropriate for the physician to order at this time?

Narcan (naloxone)

Which of the following laboratory values should the nurse report to the physician as being consistent with the diagnosis of HELLP syndrome?

Platelets 75,000

The nurse is assisting in the delivery of a baby via vacuum extraction. Which of the following nursing diagnoses for the gravida is appropriate at this time?

Risk for impaired skin integrity

A client is on magnesium sulfate for severe pre-eclampsia. The nurse must notify the attending physician regarding which of the following findings?

Serum magnesium level of 9 g/dL

After a multiparous woman has been in active labor for 15 hours, an ultrasound is done. The results state that the obstetric conjugate is 10 cm and the suboccipitobregmatic diameter is 10.5 cm. Which of the following labor findings is related to these results?

Station of -3

The nurse is monitoring a woman, G2 P1001, 41 weeks' gestation, in labor. A 12 p.m. assessment revealed: cervix, 4 cm; 80% effaced; -3 station; and FH 124 with moderate variability. A 5 p.m. assessment: cervix, 6 cm; 90% effaced; −3 station; and FH 120 with moderate variability. A 10 p.m. assessment: cervix, 8 cm; 100% effaced; −3 station; and FH 124 with moderate variability. Based on the assessments, which of the following should the nurse conclude?

The woman is likely carrying a macrosomic fetus