chapter 26: Birth-Related Procedures
The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?
"Because the scar on my belly goes down from my navel, I am not a candidate for a VBAC."
The client demonstrates understanding of the implications for future pregnancies secondary to her classic uterine incision when she states which of the following?
"Every time I have a baby, I will have to have a cesarean delivery."
The client requires vacuum extraction assistance. To provide easier access to the fetal head, the physician cuts a mediolateral episiotomy. After delivery, the client asks the nurse to describe the episiotomy. What does the nurse respond?
"The episiotomy is cut diagonally away from your vagina."
A client is consulting a certified nurse-midwife because she is hoping for a vaginal birth after cesarean (VBAC) with this pregnancy. Which statement indicates that the client requires more information about VBAC?
"There is about a 90% chance of giving birth vaginally after a cesarean."
The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. Ten minutes after an ice pack is applied, the client asks for another. What is the best response from the nurse?
"You need to leave it off for at least 20 minutes and then reapply."
The nurse is monitoring a client who is receiving an amnioinfusion. Which assessments must the nurse perform to prevent a serious complication?
Maternal blood pressure Uterine resting tone Fluid leaking from the vagina
Major perineal trauma (extension to or through the anal sphincter) is more likely to occur if what type of episiotomy is performed?
Midline
The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client?
Monitor the client using electronic fetal monitoring.
Under which circumstances would the nurse remove prostaglandin from the client's cervix?
Nausea and vomiting Uterine tachysystole Cardiac tachysystole
What type of forceps are designed to be used with a breech presentation?
Piper
After inserting prostaglandin gel for cervical ripening, what should the nurse do?
Place the client in a supine position with a right hip wedge.
The nurse knows that a contraindication to the induction of labor is which of the following?
Placenta previa
The physician has determined the need for forceps. The nurse should explain to the client that the use of forceps is indicated because of which of the following?
Premature placental separation
The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention?
Previous birth by cesarean
The need for forceps has been determined. The client's cervix is dilated to 10 cm, and the fetus is at +2 station. What category of forceps application would the nurse anticipate?
Low
The laboring client participated in childbirth preparation classes that strongly discouraged the use of medications and intervention during labor. The client has been pushing for two hours, and is exhausted. The physician requests that a vacuum extractor be used to facilitate the birth. The client first states that she wants the birth to be normal, then allows the vacuum extraction. Following this, what should the nurse assess the client for after the birth?
A sense of failure and loss
The client tells the nurse that she has come to the hospital so that her baby's position can be changed. The nurse would begin to organize the supplies needed to perform which procedure?
A version
A woman is scheduled to have an external version for a breech presentation. The nurse carefully reviews the client's chart for contraindications to this procedure, including which of the following?
Abnormal fetal heart rate and tracing Previous cesarean section Rupture of membranes
The client is undergoing an emergency cesarean birth for fetal bradycardia. The client's partner has not been allowed into the operating room. What can the nurse do to alleviate the partner's emotional distress?
Allow the partner to wheel the baby's crib to the newborn nursery. Allow the partner to be near the operating room where the newborn's first cry can be heard. Encourage the partner to be in the nursery for the initial assessment.
A client attending a prenatal class asks why episiotomies are performed. The nurse explains that risk factors that predispose women to episiotomies include which of the following?
Large or macrosomic fetus Use of forceps Shoulder dystocia
Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important?
Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec).
A prenatal client asks the nurse about conditions that would necessitate a cesarean delivery. The nurse explains that cesarean delivery generally is performed in the presence of which of the following?
Complete placenta previa Placental abruption Umbilical cord prolapse Failure to progress
A laboring client's obstetrician has suggested amniotomy as a method for creating stronger contractions and facilitating birth. The client asks, "What are the advantages of doing this?" What should the nurse cite in response?
Contractions elicited are similar to those of spontaneous labor.
A laboring client's obstetrician has suggested amniotomy as a method for inducing labor. Which assessment(s) must be made just before the amniotomy is performed?
Fetal presentation, position, and station
The nurse is explaining induction of labor to a client. The client asks what the indications for labor induction are. Which of the following should the nurse include when answering the client?
Hypertension
The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased health care costs in clients undergoing cesarean birth by request?
Increased abnormal placenta implantation in subsequent pregnancies
During a visit to the obstetrician, a pregnant client questions the nurse about the potential need for an amniotomy. The nurse explains that an amniotomy is performed to do which of the following?
Stimulate the beginning of labor Augment labor progression Allow application of an internal fetal electrode Allow insertion of an intrauterine pressure catheter
The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who will have a forceps delivery. Which action or assessment finding requires intervention?
The client is instructed to push between contractions.
The client has been pushing for 2 hours and is exhausted. The physician is performing a vacuum extraction to assist the birth. Which finding is expected and normal?
The location of the vacuum is apparent on the fetal scalp after birth.
Amniotomy as a method of labor induction has which of the following advantages?
There is usually no risk of hypertonus or rupture of the uterus. The color and composition of amniotic fluid can be evaluated. The contractions elicited are similar to those of spontaneous labor.
The physicians/CNM opts to use a vacuum extractor for a delivery. What does the nurse understand?
There should be further fetal descent with the first two "pop-offs."
A client at 40 weeks' gestation is to undergo stripping of the membranes. The nurse provides the client with information about the procedure. Which information is accurate?
The physician/CNM will insert a gloved finger into the cervical os and rotate the finger 360 degrees. Labor should begin within 24-48 hours after the procedure. Uterine contractions, cramping, and a bloody discharge can occur after the procedure.
A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered?
To relax the uterus
After being in labor for several hours with no progress, a client is diagnosed with CPD (cephalopelvic disproportion), and must have a cesarean section. The client is worried that she will not be able to have any future children vaginally. After sharing this information with her care provider, the nurse would anticipate that the client would receive what type of incision?
Transverse
The client is having fetal heart rate decelerations. An amnioinfusion has been ordered for the client to alleviate the decelerations. The nurse understands that the type of decelerations that will be alleviated by amnioinfusion is which of the following?
Variable decelerations
In which clinical situations would it be appropriate for an obstetrician to order a labor nurse to perform amnioinfusion?
Variable decelerations Meconium-stained fluid
The nurse knows that the Bishop scoring system for cervical readiness includes which of the following?
cervical effacement Cervical softness Fetal station
In the operating room, a client is being prepped for a cesarean delivery. The doctor is present. What is the last assessment the nurse should make just before the client is draped for surgery?
fetal heart tones
The client has been pushing for two hours, and is exhausted. The fetal head is visible between contractions. The physician informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?
"I can stop pushing and just rest if the vacuum extractor is used."
The nurse is completing discharge teaching for a client who delivered 2 days ago. Which statement by the client indicates that further information is required?
"The tear I have through my rectum is unrelated to my episiotomy."
