Chapter 22: Complications Occurring During Labor and Delivery

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 is giving birth when shoulder dystocia occurs in the fetus. The nurse recognizes that which condition in the client is likely to increase the risk for shoulder dystocia? 1 diabetes 2 preterm birth 3 nullipara 4 pendulous abdomen

1

A mother who had a cesarean delivery with her second child wishes to deliver her third baby vaginally. The nurse prepares the mother for an induction of labor. Because of the previous cesarean birth the nurse knows which classification of drugs will not be used in the induction process? 1 Prostaglandins 2 Oxytocin 3 Ergot alkaloids 4 Laminaria

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

Four hours after delivery a mother suddenly complains of not being able to breathe and is gasping for breath. The nurse administers oxygen and calls for help. Which type of oxygen delivery device would be most appropriate for the nurse to utilize? 1 Nonrebreather mask 2 Venturi mask 3 Face mask 4 Nasal cannula

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 caring for a client suspected to have a uterine rupture. The nurse predicts the fetal monitor will exhibit which pattern if this is true? 1 Late decelerations 2 Early decelerations 3 Variable decelerations 4 Mild decelerations

1

The nurse is caring for a mother experiencing precipitous labor. The nurse continues to assess this mother for which serious complication? 1 Placental abruption 2 Uterine rupture 3 Eclampsia 4 Cord prolapse

1

The nurse is caring for a mother laboring with her second baby. Her last vaginal exam revealed 5 cm dilated at a -2 station. The nurse notes on the monitor that the fetus is now experiencing severe bradycardia and variable decelerations. What should the nurse do first? 1 Call for help 2 Apply oxygen to the mother 3 Notify the obstetric provider 4 Lift the head off the cord

1

When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? 1 There may be a longer active phase of first stage of labor. 2 There may be a shorter active phase of first stage of labor. 3 There may be a longer latent phase of labor. 4 There may be a shorter latent phase of labor.

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 The client with any prior history of uterus surgery is at increased risk for a uterine rupture. A falling blood pressure and increasing pulse is a sign of hemorrhage, and in this client a uterine rupture needs to be a first consideration. VBAC trying to have vaginal birth after previous c section

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. 1 Have the mother lie on her back. 2 Sharply flex the mother's hips. 3 Pull the mother's knees to the chest. 4 Push downward above the level of the pubic bone

1, 2, 3, 4

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 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 First degree= 1 Second degree=2 third degree= 3 fourth degree= 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

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

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

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

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 The nurse should identify nerve damage as a risk to the fetus in cases of shoulder dystocia. Other fetal risks include asphyxia, clavicle fracture, central nervous system injury or dysfunction, and death. Extensive lacerations is a poor maternal outcome due to the occurrence of shoulder dystocia. Cleft palate and cardiac anomalies are not related to shoulder dystocia.

A patient delivered 1 hour ago and suddenly experiences cardiac arrest. What should the nurse do next? A. Call for help. B. Open airway and assess breathing. C. Initiate CPR. D. All of the above.

D An amniotic fluid embolism can occur up to 48 hours after delivery. First interventions include getting help, evaluating breathing, and initiating CPR without delay.

The nurse plans to complete a preoperative checklist for the laboring client who requires a cesarean delivery. Which actions should be completed by the nurse? Select all that apply. 1 Administer antibiotics. 2 Check hemoglobin and blood type. 3 Insert a bladder catheter. 4 Discontinue fetal monitoring. 5 Place a wedge under the mother's side.

all except 4