Chapter 22: PrepU - Complications Occurring During Labor and Delivery

The nurse is assisting the mother to push. The nurse suspects shoulder dystocia is present when which symptom is present? 1- Turtle sign 2- Continuous "0 station" 3- Battle sign 4- Continuous back pain

1

The nurse is caring for a laboring mother. The mother continues to complain of back pain. The nurse instructs the mother the pain is occurring because the fetus is in which position? 1- Occiput posterior 2- Occiput transverse 3- Left occiput anterior 4- Right occiput anterior

1

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? 1- If the woman has a full bladder, labor may be uncomfortable for her. 2- If the woman's bladder is distended, it may rupture. 3- A full bladder or rectum can impede fetal descent. 4- A full rectum can cause diarrhea.

3

A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? 1- The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. 2- The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. 3- The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. 4- The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix.

1

The nurse is assisting with a vaginal birth. The patient 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? 1- Shoulder dystocia 2- Umbilical cord prolapse 3- Nuchal cord 4- Breech position

1

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? 1- "No, walking actually shortens the first stage of labor." 2- "No, but you need to only walk for 15 minute intervals." 3- "Yes, you don't want to risk having your water break while you are walking." 4- "Yes, it is important so monitoring can be done for you and the baby."

1

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. 1- Preterm labor clients receive prophylactic antibiotics. 2- Antibiotics must be started 4 hours prior to labor to be effective. 3- Mothers with previous GBS will be treated with prophylactic antibiotics. 4- Erythromycin is the primary antibiotic to treat GBS. 5- Women are screened for GBS in the 32nd week of gestation.

1,2, 3

The nurse is teaching a birthing class to pregnant mothers. What information does the nurse teach the mothers about having an upright position during the first stage of labor? Select all that apply. 1- It will shorten the length of the first stage of labor. 2- It reduces the rate of surgical vaginal deliveries. 3- It improves uteroplacental profusion. 4- It decreases the rate of higher lacerations. 5- It reduces labor pain.

1,2,3,5

A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth? 1- positioning the woman prone 2- McRoberts maneuver 3- fundal pressure 4- Lamaze position

2

A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth? 1- extensive lacerations 2- monitor for a cardiac anomaly 3- assess for cleft palate 4- brachial plexus assessment

4

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? 1- The fetus is macrosomic. 2- The mother is fighting the contractions. 3- The mother has a small pelvic opening. 4- Uterine contractions are weak and ineffective.

4

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? 1- Genetic abnormality 2- Premature rupture of membranes 3- Preeclampsia 4- Placental abruption

4

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? 1- well coordinated. 2- poor in quality. 3- brief. 4- erratic.

4

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfuction? 1- lack of cervical dilation past 2 cm 2- fetal buttocks as the presenting part 3- reports of severe back pain 4- contractions most forceful in the middle of uterus rather than the fundus

4

The pregnant mother who has had no prenatal care comes to the labor and delivery department with ruptured membranes. The history of group B streptococcus (GBS) is unknown. The mother states she has no known drug allergies. The nurse will prepare to administer which drug to this mother? 1- Penicillin G 2- Vancomycin 3- Cefdinir 4- Doxycycline

1

The nurse is caring for a mother who has delivered a stillborn. The mother has expressed a desire to hold the baby but when the nurse enters the room with the baby the mother cries and becomes hysterical. What is the nurse's most important action in this situation? 1- Provide reassurance to the mother without the baby in the room. 2- Tell the mother you will return with the baby when she is ready. 3- Provide information to the family about counseling for the mother. 4- Leave the baby in the room until the mother is ready.

1

The nurse is teaching the mother about surgical incisions for a cesarean birth. What reason would the nurse give to the mother as to why a low transverse incision is preferable? 1- The wound will be stronger. 2- It requires less sutures. 3- It leaves a better scar. 4- There's less chance of bleeding.

1

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? 1- Uterine rupture 2- Hypertonic uterus 3- Placenta previa 4- Umbilical cord compression

1

A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal? 1- 9 2- 7 3- 5 4- 3

1

During delivery, shoulder dystocia occurs. The nurse assists with the McRoberts maneuver and suprapubic pressure. Place in order the steps in which the nurse would accomplish these procedures. Use all options.

Have the mother lie on her back. Sharply flex the mother's hips. Pull the mother's knees to the chest. Push downward above the level of the pubic bone.

A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: 1- longer lengths of labor. 2- increased number of overall pregnancies. 3- increasing birth weight. 4- poor quality of prenatal care.

3

A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? 1- asphyxia 2- clavicular fracture 3- cephalhematoma 4- central nervous system injury

3

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? 1- placental separation 2- aspiration 3- amniotic fluid embolism 4- congestive heart failure

3

Labor dystocia is an abnormal progression of labor. It is the most common cause of primary cesarean birth. When is it most common for labor dystocia to occur? 1- Fourth stage of labor 2- Third stage of labor 3- Second stage of labor 4- First stage of labor

3

The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? 1- 2 cm/hour for cervical dilation 2- 1/2 cm/hour for cervical dilation 3- 1 cm/hour for cervical dilation 4- 1/4 cm/hour for cervical dilation

3

The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds? 1- Low in the abdomen 2- Left lateral abdomen 3- High in the abdomen 4- Right lateral abdomen

3

The nursing student demonstrates an understanding of dystocia with which statement? 1- "Dystocia is diagnosed at the start of labor." 2- "Dystocia is not diagnosed until after the birth." 3- "Dystocia is diagnosed after labor has progressed for a time." 4- "Dystocia cannot be diagnosed until just before birth."

3

When reviewing the medical record of a postpartum client, the nurse notes that the client has experienced a third-degree laceration. The nurse understands that the laceration extends to which area? 1- superficial structures above the muscle 2- through the perineal muscles 3- through the anal sphincter muscle 4- through the anterior rectal wall

3

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? 1- "Maybe your uterus is just tired and needs a rest." 2- "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." 3- "Maybe your baby has developed hydrocephaly and the head is too swollen." 4- "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."

4

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? 1- hypotonic contractions 2- hypertonic contractions 3- uncoordinated contractions 4- Braxton Hicks contractions

1

A client in week 38 of her pregnancy 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? 1- external cephalic version 2- trial labor 3- forceps birth 4- vacuum extraction

1

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? 1- Cord prolapse 2- Uterine atony 3- Placental abruption 4- Brachial plexus injury

1

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? 1- Administer oxytocin 2- Place in side-lying position 3- Prepare for epidural anesthesia 4- Obtain internal monitoring

1

A patient is experiencing dysfunctional labor that is prolonging the descent of the fetus. Which teaching should the nurse prepare to provide to this patient? 1- Oxytocin therapy 2- Fluid replacement 3- Pain management 4- Increasing activity

1

A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: 1- administer oxygen by mask. 2- increase her intravenous fluid infusion rate. 3- put firm pressure on the fundus of her uterus. 4- tell the woman to take short, catchy breaths.

1

A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to: 1- place a hand gently on the fetal head to guide birth. 2- ask her to push with the next contraction so birth is rapid. 3- assess blood pressure and pulse to detect placental bleeding. 4- attach a fetal monitor to determine fetal status.

1

It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should: 1- empty the mother's bladder. 2- provide pain medication. 3- have anesthesia provider present. 4- call the neonatologist.

1

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? 1- Leopold maneuvers 2- McRoberts maneuver 3- Rubin maneuver 4- Gaskin maneuver

1

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? 1- Nonstress test (NST) 2- Contraction stress test 3- Vaginal ultrasound 4- Doppler ultrasound

1

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? 1- Keep the communication lines open. 2- Leave the parents alone. 3- Remove the infant quickly. 4- Contact a grief counselor.

1

A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply. 1- problems with the uterus 2- problems with the mother's diet 3- problems with the fetus 4- problems with access to health care 5- problems with finances

1,3

A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing? 1- hemorrhage 2- infection 3- depression 4- pulmonary emboli

2

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? 1- a low-lying placenta 2- fetopelvic disproportion 3- contraction ring 4- uterine bleeding

2

During a difficult labor of an infant in the face presentation, the nurse notes the infant has a large amount of facial edema with bruising and ecchymosis. Which assessment would be the priority for this infant? 1- ability to arch the eyebrows 2- patent airway 3- ability to swallow fluids 4- palpation of the anterior fontanels

2

Losing a newborn is perhaps one of the most difficult situations for a family. Which action by the nurse would be the most appropriate if a newborn dies? 1- avoiding contact with the family 2- offering mementos to the family of the newborn 3- strictly adhering to facility policies for handling the body 4- keeping time parents spend with infant to short periods

2

The nurse assesses that the fetus of a woman is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? 1- Shorter dilatational stage of labor 2- Experience of additional back pain 3- Need to have the baby manually rotated 4- Necessity for vacuum extraction for birth

2

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called? 1- internal rotation 2- external rotation 3- vaginal manipulation 4- external version

2

The nurse is preparing a mother for a planned cesarean birth. The nurse ascertains that the mother has previously had a deep vein thrombosis. Heparin is ordered prophylactically. The nurse determines this medication will be administered: 1- 1 hour after birth. 2- 8 hours after birth. 3- 14 hours after birth. 4- 24 hours after birth.

2

The nurse preceptor explains that several factors are involved with the "powers" that can cause dystocia. She focuses on the dysfunction that occurs when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This is known as which term? 1- hypertonic contractions 2- precipitous labor 3- hypotonic contractions 4- none of the above

2

The postpartum mother who was delivered via cesarean section is preparing for discharge from the hospital. As part of the discharge teaching the nurse instructs the mother to make an appointment with her physician to have the staples removed in: 1- 3 days. 2- 6 days. 3- 11 days. 4- 14 days.

2

Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? 1- applying suprapubic pressure against the fetal back 2- continuing to monitor maternal and fetal status 3- noting the space at the maternal umbilicus 4- auscultating the fetal heart rate at the level of the umbilicus

2

Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant? 1- "I will make handprints and footprints of the baby for you to keep." 2- "I know you are hurting, but you can have another baby in the future." 3- "Many mothers who have lost an infant want pictures of the baby. Can I make some for you?" 4- "Have you named your baby yet? I would like to know your baby's name."

2

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 bestresponse if the mother angerily says no and starts crying? 1- Apologize and tell her that the photos will be destroyed immediately. 2- Console her with the fact that she has other children. 3- Tell her that the hospital will keep the photos for her in case she changes her mind. 4- Tell her that once she gets over her shock and grief, she will probably be happy to have the photos.

3

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? 1- sedatives 2- tocolytics 3- uterine stimulants 4- corticosteroids

3

A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? 1- amniotic fluid embolism 2- shoulder dystocia 3- uterine rupture 4- umbilical cord prolapse

3