Chapter 21: Nursing Management of Labor and Birth at Risk

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

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

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? Apply pressure to the fundus. Use Zavanelli maneuver. Attempt to push in one of the fetus's shoulders. Use McRoberts maneuver.

Use McRoberts maneuver.

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

providing a comfortable environment with dim lighting

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

"Dystocia is diagnosed after labor has progressed for a time."

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: 3,000 g to 3500 g 4,000 g to 4500 g 2500 to 3000 g 3,500 g to 4000 g

4,000 g to 4500 g

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? Administer oxytocin diluted in the main intravenous fluid. Administer oxytocin in two divided intramuscular sites. Administer oxytocin diluted as a "piggyback" infusion. Administer oxytocin in a 20 cc bolus of saline.

Administer oxytocin diluted as a "piggyback" infusion.

A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would be least effective in assisting a couple at this time? Give the parents a lock of the infant's hair. Avoid any discussion of the situation with the couple. Assist the family in making arrangements for their stillborn infant. Allow the couple to spend as much time as they want with their stillborn infant.

Avoid any discussion of the situation with the couple.

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? Shorter dilation (dilatation) stage of labor Necessity for vacuum extraction for birth Need to have the baby manually rotated Experience of additional back pain

Experience of additional back pain

The nurse cared for a client who gave birth. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record? Prolonged labor False Labor Prodromal labor Precipitous labor

Precipitous labor

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

Prepare the client for a cesarean 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? Umbilical cord compression Uterine rupture Hypertonic uterus Placenta previa

Uterine rupture

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

brachial plexus assessment

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? fetal heart tones signs of shock infection uterine stabilization

fetal heart tones

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 preeclampsia premature rupture of membranes genetic abnormality

placental abruption

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

potential lacerations and bleeding.

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? precipitate labor preterm labor normal labor dystocia

preterm labor

A multipara client in labor is having contractions which are 2 minutes apart but rarely over 50 mm Hg in strength; the resting uterine tone is high, 20 to 25 mm Hg. The client asks what she can do to make contractions more effective. The nurse's best response is: be patient as contractions will strengthen by themselves. rest between contractions. ambulate to make the contractions regular. request oxytocin to strengthen the contractions.

rest between contractions.

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? "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." "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." "Maybe your baby has developed hydrocephaly and the head is too swollen." "Maybe your uterus is just tired and needs a rest."

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

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Assess fetal heart sounds. Administer oxygen at 10 L/min by face mask. Place the woman in Trendelenburg position. Administer amnioinfusion.

Assess fetal heart sounds.

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? A full bladder or rectum can impede fetal descent. If the woman has a full bladder, labor may be uncomfortable for her. A full rectum can cause diarrhea. If the woman's bladder is distended, it may rupture.

A full bladder or rectum can impede fetal descent.

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

Assess uterine tone to determine fundal firmness.

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? Nongynecoid pelvis Fetal macrosomia Occiput posterior position Breech presentation

Occiput posterior position

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? With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord. Place the client in Trendelenburg position and gently attempt to reinsert the cord. Contact the health care provider and prepare the client for an emergent vaginal birth.

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

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

Severe variable decelerations occur and are due to cord compression.

A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying? Tell her that once she gets over her shock and grief, she will probably be happy to have the photos. Apologize and tell her that the photos will be destroyed immediately. Console her with the fact that she has other children. Tell her that the hospital will keep the photos for her in case she changes her mind.

Tell her that the hospital will keep the photos for her in case she changes her mind.

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? The parents just cannot believe their perfect infant died. The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn. The parents are beginning to demonstrate positive grieving behaviors. The parents continue to mourn the loss of their infant.

The parents are beginning to demonstrate positive grieving behaviors.

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? congestive heart failure amniotic fluid embolism placental separation aspiration

amniotic fluid embolism

A woman whose fetus is in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain? performing acupuncture on the back applying a heating pad to the back applying ice to the back applying counterpressure to the back

applying counterpressure to the back

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? noting the space at the maternal umbilicus auscultating the fetal heart rate at the level of the umbilicus continuing to monitor maternal and fetal status applying suprapubic pressure against the fetal back

continuing to monitor maternal and fetal status

A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? bradycardia depressed deep tendon reflexes tachypnea elevated blood glucose

depressed deep tendon reflexes

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? brief. poor in quality. well coordinated. erratic.

erratic.

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? trial labor external cephalic version forceps birth vacuum extraction

external cephalic version

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? less than 4 hours less than 8 hours less than 5 hours less than 3 hours

less than 3 hours

What terminology would the nurse use to document a newborn who weighs 4,000 grams (8.8 lb) or more at birth? microsomia macrosomia meconium hydrocephalus

macrosomia

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? contractions most forceful in the middle of uterus rather than the fundus fetal buttocks as the presenting part lack of cervical dilation (dilatation) past 2 cm reports of severe back pain

reports of severe back pain

A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed? bronchodilators anti-anxiety therapy muscle relaxants tocolytic therapy

tocolytic therapy

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? occipitoposterior position anterior fetal position transverse lie cephalic presentation

transverse lie