ch 21 OB

"Hold your baby as long as you like. Please let me know what I can do to help you."

A pregnant woman delivers a term fetus who has died in utero. She requests time after the birth to hold her baby. What is the best response by the nurse?

• CBC • U/A • amniotic fluid analysis

(see full question) A nurse preceptor asks a student to list commonly used diagnostic tests for preterm labor risk assessment. Which of the following tests should the student include? (Select all that apply.)

Hypotonic contractions

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 of the following conditions in this client?

Brachial plexus assessment

A client is experiencing shoulder dystocia during delivery. The nurse would place priority on performing which assessment post delivery?

Assist with positioning the woman in squatting position

A client who is in labor presents with shoulder dystocia of the fetus. Which is an important nursing intervention?

Overdistended uterus

A client with full-term pregnancy who is not in active labor has been ordered oxytocin intravenously. The nurse would notify the health care provider if which is noted?

The 41-year-old client who conceived by in vitro fertilization

A nurse is assessing the following antenatal clients. Which client is at highest risk for having a multiple gestation?

• Cyanosis • Pulmonary edema

A nurse is caring for a client who is experiencing acute onset of dyspnea and hypotension. The physician suspects the client has amniotic fluid embolism. What other signs or symptoms would alert the nurse to the presence of this condition in the client? Select all that apply.

• uterine contractions, cramping, low back pain • feeling of pelvic pressure or fullness • increase in vaginal discharge • nausea, vomiting, and diarrhea • leaking of fluid from the vagina

A nurse is preparing to teach a class to pregnant women about the signs of preterm labor and what to do if these occur. Which of the following should the nurse include in the presentation? (Select all that apply.)

Avoid any discussion of the situation with the couple

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?

Delivery is unlikely within the 2 next weeks.

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates:

identical

A pregnant woman has just found out that she is having twin girls. She asks the nurse the difference between fraternal and identical twins. The nurse explains that with one set of twins there is fertilization of two ova, and with the other set one fertilized ovum splits. What type of twins result from the split ovum?

Uterine rupture

A pregnant woman near term is brought to the emergency room because she's been in an automobile accident. She has sustained blunt trauma to her abdomen and has gone into labor. An epidural is started and labor is going as well as can be expected under the circumstances. Suddenly the woman complains of severe pain in her back and shoulder. What do you suspect?

Applying counter pressure to the back

A woman whose fetus in in the occiput-posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain?

Caput succedaneum

The nurse is assessing the woman who has a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?

A forceps and vacuum-assisted delivery

The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention?

• Prolonged pregnancy • Hypertension

The nurse would monitor clients with which conditions for fetal demise? Select all that apply.

macrosomia

What terminology would the nurse use to document a newborn who weighs 4,000 grams (8.13 lbs) or more at birth?

Be sure to monitor fetal movements daily.

When educating the post-term pregnant patient, what should the nurse be sure to include to prevent fetal complications?

Complaints of severe back pain

Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfuction?

Hypertonic uterine contractions

are marked by an increase in resting tone to more than 15 mm Hg. occur frequently and are most commonly seen in the latent phase of labor.

Amniotomy

he deliberate rupturing of the fetal membranes to bring on labor

occiput posterior

head down but faces abdomen.

fraternal

the fertilization of two ova.

identical

the splitting of one fertilized ovum.

• history of previous preterm birth • current multiple gestation pregnancy • uterine or cervical abnormalities

(see full question) A nursing instructor highlights risk factors associated with preterm labor that include which of the following? (Select all that apply.)

Cervical dilation of 5 cm.

(see full question) A woman at 32 weeks' gestation is admitted in preterm labor. On your admission assessment, which of following findings should cause the nurse to question the administration of a tocolytic agent?

diabetes

A client is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which of the following conditions in the client is likely to increase the risk for shoulder dystocia?

increasing birth weight

A nursing instructor is teaching students about fetal presentations during delivery. The most common cause for increased incidence of shoulder dystocia is:

• low socioeconomic status • smoking • high level of stress • alcohol use

A nursing instructor teaching about risk factors associated with preterm labor includes which of the following demographic and lifestyle issues? (Select all that apply.)

• magnesium sulfate • atosiban • indomethacin • nifedipine

A nursing student doing a rotation in labor and delivery correctly identifies which of the following medications as most commonly used for tocolysis? (Select all that apply.)

less than 3 hours

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?

Magnesium sulfate

A physician orders oral tocolytic therapy for a woman with preterm labor.The nurse explains to the client about the drugs that may be used. The nurse determines that the client needs additional teaching when she states which drug might be used?

The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.

Mrs. M. has been admitted to the delivery suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The physician notes that Mrs. M. is in hypotonic labor. What does this mean?

• macrosomia • shoulder dystocia • brachial plexus injuries • cephalopelvic disproportion

The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which of the following should she include? (Check all that apply.)

Hypotonic contractions

This labor pattern manifests by uterine contractions that may or may not be regular, but the quantity or strength is insufficient to dilate the cervix.

false it will delay not prevent it.

Tocolytic therapy will help to prevent preterm birth.

Assess uterine tone to determine fundal firmness

Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth?

A full bladder or rectum can impede fetal descent.

Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor? You selected: If the woman has a full bladder, labor may be uncomfortable for her.

Experience of additional back pain.

You assess that the fetus of a woman is in an occiput posterior position. Which of the following identifies the way you would expect her labor to differ from others?