Chapter 21: Nursing Management of Labor and Birth at Risk

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

"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 woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5. 6. 7. 9.

5. A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.

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 Early decelerations Variable decelerations Mild decelerations

Late decelerations When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.

A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? complications of a post-term pregnancy complications of preterm labor complications of placenta previa placental abruption (abruptio placentae)

complications of a post-term pregnancy A post-term pregnancy carries risks for increased perinatal mortality, particularly during labor. Oligohydramnios and meconium staining of the amniotic fluid are common complications. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor. Thick, meconium-stained fluid increases the risk for meconium aspiration syndrome.

A client with full-term pregnancy who is not in active labor has been prescribed oxytocin intravenously. The nurse would notify the health care provider if which finding is noted? dysfunctional labor pattern postterm status prolonged ruptured membranes overdistended uterus

overdistended uterus Overdistended uterus is a contraindication for oxytocin administration. Postterm status, dysfunctional labor pattern, and prolonged ruptured membranes are indications for administration of oxytocin.

A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication? reduced oxygen to the fetus ruptured uterus cephalopelvic disproportion precipitate labor

reduced oxygen to the fetus Hypertonic uterine dysfunction occurs when the uterus never fully relaxes between contractions. Placental perfusion becomes compromised, thereby reducing oxygen to the fetus. This occurs in early labor and affects nulliparous women more than multiparous women. A ruptured uterus is a potential complication; however, hypoxia to the fetus would occur first. Cephalopelvic disproportion is usually associated with hypotonic uterine dysfunction. Precipitate labor is one that is completed in less than 3 hours from the start of contractions to birth.

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? Uterine rupture Hypertonic uterus Placenta previa Umbilical cord compression

Uterine rupture The client with any prior history of uterus surgery is at increased risk for a uterine rupture. A falling blood pressure and increasing pulse is a sign of hemorrhage, and in this client a uterine rupture needs to be a first consideration. The scenario does not indicate a hypertonic uterus, a placenta previa, or umbilical cord compression.