NUR 410 MATERNITY PREPU
A client who has been in prolonged labor reports extreme back pain. She asks why her back hurts so much. What would be the best response by the nurse?
"Different fetal positions can cause prolonged labor and back pain."
Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant?
"I know you are hurting, but you can have another baby in the future."
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?
"No, walking actually shortens the first stage of labor."
The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambuate until the next day. What response by the nurse is most appropriate?
"Walking is the best way to prevent complications such as blood clots."
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule?
1 cm/hour for cervical dilation
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:
8 hours after birth.
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.
The labor and delivery nurse would identify that which women are more likely to experience dystocia during labor? Select all that apply.
A mother having elective induction A diabetic mother An Asian mother
While the placenta is being delivered after labor, a patient experiences an amniotic fluid embolism. What should the nurse do first to help this patient?
Administer oxygen by mask.
Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth?
Assess uterine tone to determine fundal firmness.
The nurse is evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective?
Client achieved 4 cm of dilation after 7 hours of labor.
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
Experience of additional back pain
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?
Experience of additional back pain
The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds?
High in the abdomen
In terms of planning care, why is the development of a pathologic retraction ring important?
It precedes uterine rupture.
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?
Keeping the communication lines open.
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?
Leopold maneuvers
A woman in labor is having very intense contractions with a resting uterine tone >20 mm Hg. The woman is screaming out every time she has a contraction. What is the highest priorityfetal assessment the health care provider should focus on at this time?
Look for late decelerations on monitor, which is associated with fetal anoxia.
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?
McRoberts maneuver
Shoulder dystocia is a true medical emergency that can cause fetal demise because the baby cannot be born. Stuck in the birth canal, the infant cannot take its first breath. Which maneuver is first attempted to deliver an infant with shoulder dystocia?
McRoberts maneuver
A mother having her third baby is to deliver via a repeat cesarean section. Which factors in the mother's history that place her at a higher risk for hemorrhage and the need for blood transfusions should the nurse identify? Select all that apply.
Multiple cesarean sections Placenta accreta with first delivery
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?
Occiput posterior
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?
Offer to take pictures and footprints of the infant once it is delivered.
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?
Oxytocin therapy
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?
Penicillin G
A client is admitted to the health care facility. The fetus has a gestational age of 42 weeks and is suspected to have cephalopelvic disproportion. Which should the nurse do next?
Prepare the client for a cesarean birth.
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?
Shoulder dystocia
A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply.
Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?
Sudden shortness of breath
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 angerily says no and starts crying?
Tell her that the hospital will keep the photos for her in case she changes her mind.
The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action?
The fundus is located 2 fingerbreadths above the umbilicus.
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?
The wound will be stronger.
The nurse is assisting the mother to push. The nurse suspects shoulder dystocia is present when which symptom is present?
Turtle sign
A client in the first stage of labor is diagnosed with dystocia involving the powers of labor. What would the nurse identify as the problem?
Uterine contractions are too weak or uncoordinated.
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?
Uterine contractions are weak and ineffective.
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
The nurse is caring for a mother laboring with her third baby. Suddenly the nurse notes severe fetal bradycardia and the mother becomes hypotensive. For which emergent complication should the nurse direct care to the mother?
Uterine rupture
A nurse is conducting an in-service program for a group of labor and birth unit nurses about about cesarean birth. The group demonstrates understanding of the information when they identify which conditions as appropriate indications? Select all that apply.
active genital herpes infection placenta previa previous cesarean birth fetal distress
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's firstaction would be to:
administer oxygen by mask.
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?
amniotic fluid embolism
A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth?
brachial plexus assessment
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?
cephalhematoma
A 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case?
cesarean birth
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound?
continuing to monitor maternal and fetal status
A patient is confirmed to be in labor. Upon examination she is 3 cm dilated and the fetus has started to descend. Three hours after admission, however, she appears not to be progressing. She remains only 3 cm dilated, and the fetus is in the same position. The physician correctly terms this as which of the following?
disorder of arrest
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?
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?
external cephalic version
A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration?
fourth degree
A nursing instructor is teaching students about fetal presentations during birth. The mostcommon cause for increased incidence of shoulder dystocia is:
increasing birth weight.
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?
infection
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position?
knee-chest
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?
offering mementos to the family of the newborn
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?
patent airway
A nurse is reviewing a postpartum woman's history and labor and birth record. The nurse determines the need to closely monitor this client for infection based on which factor?
placenta removed via manual extraction
A pregnant client presents to the emergency department reporting back-to-back contractions. Within 2 hours, the client is completely effaced and 9 cm dilated, and the fetal head is showing. Within minutes the client gives birth with only the nurse in attendance. This is an example of which occurrence?
precipitate labor
A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate?
providing a comfortable environment with dim lighting
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?
uterine rupture
A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?
uterine stimulants
