HESI - OB, Shoulder Dystocia

After a delivery that involves shoulder dystocia, the nurse should assess the newborn for which complication? A. Brachial plexus injury B. Hip dislocation C. Subdural hematoma D. Subconjunctival hemorrhage

A. Brachial plexus injury Rationale: Shoulder dystocia increases the risk of brachial plexus injury to the newborn. Hip dislocation may occur at delivery for a number of reasons; however, shoulder dystocia has not been linked to hip dislocation. Subdural hematoma and subconjunctival hemorrhage are not considered complications of shoulder dystocia, and the nurse should assess the newborn for these conditions after any delivery.

During the delivery by a multipara at 41 weeks' gestation, shoulder dystocia occurs, and the practitioner instructs the nurse to apply pressure above the pubic bone over the fetal anterior shoulder using a downward and lateral motion on the posterior aspect of the fetal shoulder. Which maneuver is the practitioner describing? A. Suprapubic pressure B. Woods maneuver C. Zavanelli maneuver D. McRoberts maneuver

A. Suprapubic pressure Rationale: With suprapubic pressure, the fist or palm of a hand is placed suprapubically over the fetal anterior shoulder, and pressure is applied using a downward and lateral motion on the posterior aspect of the fetal shoulder. This intervention causes flexion of the fetal shoulder toward the fetal chest, which reduces the bisacromial diameter (distance between the outermost aspects of the fetal shoulders). Woods maneuver involves having the practitioner rotate the fetus by placing pressure on the anterior clavicular surface of the posterior shoulder to turn the fetus until the anterior shoulder comes out from behind the maternal symphysis pubis. The Zavanelli maneuver involves pushing the delivered fetal head back into the birth canal and holding it in place until a cesarean section can be performed. McRoberts maneuver involves having the patient flex her hips while pulling her thighs straight up to her abdomen, thus helping to rotate the symphysis pubis anteriorly to dislodge the fetus's anterior shoulder.

What is the usual cause of shoulder dystocia at delivery? A. The anterior shoulder becomes lodged behind the maternal symphysis pubis after delivery of the head. B. The posterior shoulder becomes lodged behind the maternal symphysis pubis after delivery of the head. C. The anterior shoulder becomes lodged in front of the maternal symphysis pubis after delivery of the head. D. The anterior shoulder becomes dislodged behind the maternal symphysis pubis after delivery of the head.

A. The anterior shoulder becomes lodged behind the maternal symphysis pubis after delivery of the head. Rationale: Shoulder dystocia occurs when the anterior fetal shoulder becomes lodged behind the maternal symphysis pubis after delivery of the fetal head. The posterior shoulder at times can become lodged behind the maternal symphysis pubis, but it is not the usual reason for shoulder dystocia. The anterior shoulder becomes lodged (not dislodged) behind (not in front of) the symphysis pubis.

The nurse is caring for a multigravida at 41 weeks' gestation with a history of gestational diabetes. Her cervix is fully dilated, and she is delivering. As the head is delivered, the nurse notices that it immediately retracts against the perineum. What is this condition? A. Turtle sign B. McRoberts maneuver C. Caput succedaneum D. Shoulder dystocia

A. Turtle sign Rationale: Retraction of the fetal head against the perineum is known as the turtle sign and may be an indicator of shoulder dystocia. The McRoberts maneuver is performed to relieve shoulder dystocia. Caput succedaneum may occur during labor when the uterus or vaginal walls apply pressure to the fetal vertex during vaginal delivery, especially after the maternal membranes have ruptured.

After delivery of an infant with shoulder dystocia, the patient has a postpartum hemorrhage. The nurse notes that the bleeding spurts and clots. What could be the cause of this patient's bleeding? A. Uterine atony B. Superficial lacerations C. Deep lacerations D. Disseminated intravascular coagulation

A. Uterine atony Rationale: Patients who experience shoulder dystocia have a significantly increased risk of postpartum hemorrhage. Uterine atony generally results in bleeding that spurts and clots. Dark red bleeding may be the result of superficial lacerations, and bright red bleeding may be the result of deep lacerations (i.e., cervical lacerations). If the blood does not clot, the patient may have a coagulation disorder, such as disseminated intravascular coagulation.

A nurse is assigned to document the time of each procedure during a delivery in which a shoulder dystocia has occurred. After the delivery of the fetal head, how often should this nurse call out the time elapsed? A. Every 10 seconds B. Every 30 seconds C. Every 60 seconds D. Every 90 seconds

B. Every 30 seconds Rationale: The nurse should call out each 30-second interval after the delivery of the fetal head, so the practitioner knows how much time has elapsed. An interval of 10 seconds is too short, and an interval of 60 or 90 seconds is too long.

A nurse caring for a patient in labor calls a colleague for assistance because of shoulder dystocia. The assisting nurse arriving in the room knows that the best chance for successful resolution of shoulder dystocia includes the combination of which two interventions? A. McRoberts maneuver and fundal pressure B. McRoberts maneuver and suprapubic pressure C. Hands-and-knees position and suprapubic pressure D. Vacuum extraction and suprapubic pressure

B. McRoberts maneuver and suprapubic pressure Rationale: The McRoberts maneuver and suprapubic pressure relieve as many as 50% of shoulder dystocia cases. Fundal pressure is contraindicated for shoulder dystocia because it may result in uterine rupture or push the fetal shoulders farther against the symphysis pubis and further delay delivery. The hands-and-knees position may be used if the McRoberts maneuver and suprapubic pressure are not successful. Vacuum extraction is not an intervention for shoulder dystocia.

A multigravida is in active labor after the initiation of induction 12 hours ago. Which event should alert the nurse to an increased risk of shoulder dystocia? A. The fetus is in an occiput posterior position. B. The cervix is swollen on vaginal examination. C. The mother experienced shoulder dystocia with her previous delivery. D. The fetal presenting part is at +2.

C. The mother experienced shoulder dystocia with her previous delivery. Rationale: A multigravida who experienced shoulder dystocia with her previous delivery is at risk for shoulder dystocia with subsequent deliveries. Cervical swelling, occiput posterior presentation, and fetal station are not indicators of an increased risk of shoulder dystocia.

The nurse is preparing for a vaginal delivery by a multipara who has a history of shoulder dystocia. The nurse explains to the student nurse that one of the maneuvers used for shoulder dystocia involves having the patient flex her hips while pulling her thighs straight up to her abdomen to help rotate the symphysis pubis anteriorly and dislodge the fetus's anterior shoulder. What is the name of this maneuver? A. Suprapubic pressure B. Rubin's maneuver C. Zavanelli maneuver D. McRoberts maneuver

D. McRoberts maneuver Rationale: The McRoberts maneuver involves having the patient flex her hips while pulling her thighs straight up to her abdomen, thus helping to rotate the symphysis pubis anteriorly and dislodge the fetus's anterior shoulder. For suprapubic pressure, the fist or palm of a hand is placed suprapubically over the fetal anterior shoulder and pressure is applied using a downward and lateral motion on the posterior aspect of the fetal shoulder. This intervention causes flexion of the fetal shoulder toward the fetal chest, which reduces the bisacromial diameter (distance between the outermost aspects of the fetal shoulders). Rubin's maneuver involves rotating the anterior shoulder under the symphysis pubis. The Zavanelli maneuver involves pushing the delivered fetal head back into the birth canal and holding it in place until a cesarean section can be performed.

A patient who experienced shoulder dystocia has delivered. During the immediate postpartum phase, the nurse should assess the patient for which complication? A. Hypotension B. Perineal swelling C. Hypertension D. Postpartum hemorrhage

D. Postpartum hemorrhage Rationale: Patients experiencing shoulder dystocia have an increased risk of postpartum hemorrhage because of uterine atony and trauma. Perineal swelling may occur after any vaginal delivery. Hypertension and hypotension are not complications of shoulder dystocia, although hypotension may be a secondary sign of postpartum hemorrhage.