Labor and delivery order questions
The nurse is caring for a client in labor whose fetus is in the breech presentation. Which complication should the nurse monitor the client for? 1Hemorrhagic shock 2Increased blood pressure 3Compression of the cord 4Meconium in the amniotic fluid
Compression of the cord The cord may prolapse after the membranes rupture, and pressure of the presenting part on the cord could compress the cord, resulting in fetal hypoxia. The risk for hemorrhage or preeclampsia in a breech presentation is no greater than that in a cephalic presentation. Meconium in the amniotic fluid is expected; as the fetus's buttocks are compressed, meconium may be expelled.
A client who is having her labor induced with oxytocin has internal fetal monitoring in place. Her contractions are occurring every 2 minutes, are lasting 70 seconds, and are reaching 65 mm Hg on an intrauterine pressure catheter. The baseline fetal heart rate is 130 to 140 beats/min with variability of about 15 beats/min. The nurse notices that with the last two contractions the fetal heart rate began to drop during the peak of the contraction to 110 beats/min, where it remained for about 40 seconds before returning to baseline. What type of pattern is this? 1Bradycardia 2Late decelerations 3Early decelerations 4Variable decelerations
Late decelerations Late decelerations begin during the peak of a contraction and continue after the contraction has ended. Bradycardia is a fetal heart rate slower than 110 beats/min for 10 minutes. Early decelerations mirror the contraction, beginning at the start of the contraction and ending when the contraction is over. Variable decelerations fall and rise abruptly and do not have the uniform appearance noted with early and late decelerations.
What is the most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone? 1Misoprostol 2Mifepristone 3Dinopristone 4Methylergonovine
Misoprostol Misoprostol is the most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone because it is relatively affordable. Mifepristone is used to induce labor. Dinoprostone is used for cervical ripening but is not an off-label drug for cervical ripening. Methylergonovine is used to enhance myometrial tone but is not used to augment labor.
In which clinical situation would cervical ripening drugs be prescribed to pregnant women? 1There is a need for a termination of pregnancy. 2The cervical status indicates a Bishop score of 6. 3Uterine contractions occur after 25 weeks of gestation. 4Uterine contractions occur after 18 weeks of gestation.
The cervical status indicates a Bishop score of 6 Cervical-ripening drugs are used to soften the cervix and improve uterine muscle tone. The cervical status of a Bishop score of 6 indicates a need for cervical-ripening drugs such as dinoprostone. Contractions that occur within 25 weeks of gestation are called preterm labor. Uterine contractions that occur within 18 weeks of pregnancy are due to the presence of a nonviable fetus. Cervical ripening drugs are not issued during the termination of a pregnancy.
Epidural anesthesia was initiated 30 minutes ago for a client in labor. The nurse determines that the fetus is experiencing late decelerations. List the following nursing actions in order of priority. 1.Reposition client on her side. 2.Increase intravenous fluids. 3.Notify the healthcare provider if late decelerations persist. 4.Reassess the fetal heart rate (FHR) pattern. 5.Document interventions and related maternal/fetal responses.
1,2,4,3,5 Repositioning the client to the side increases uterine blood flow, improves cardiac output, and takes the pressure exerted by the uterus off the vena cava. Increasing the delivery of fluids augments uterine blood flow and improves cardiac output. Reassessing the FHR pattern enables the nurse to determine whether the FHR has returned to a safe level without reflex late decelerations. Persistent late decelerations are a nonreassuring fetal sign; the healthcare provider should be informed. Documentation of interventions and client responses ensures that information is included in the client's legal clinical record and communicated to other care providers.
A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed? 1Administer oxygen. 2Place the client on the left side. 3Discontinue the oxytocin infusion. 4Check the client's blood pressure
Discontinue the oxytocin infusion The infusion should be stopped because it is the likely source of fetal compromise. Administering oxygen may not be necessary if late decelerations cease with other interventions. Placing the client on the left side should be done after the oxytocin infusion is discontinued. The client's blood pressure may be checked, but this is not the priority.
A client's membranes rupture, and the nurse immediately detects the presence of a prolapsed umbilical cord. The nurse alerts another nurse, who calls the primary healthcare provider. Place the following nursing interventions in the order in which they should be performed. Place them in order. 1.Moving the presenting part off the cord 2.Placing the client in the Trendelenburg position 3.Checking the fetal heart rate 4.Administering oxygen by facemask
1,2,4,3 The priority nursing intervention is to maintain perfusion to the cord by removing the presenting part that is compressing it. The Trendelenburg position will help keep the presenting part off the cord. Oxygen should be administered to the mother to promote optimal oxygenation to the mother and fetus. Evaluating the response to the interventions includes checking the fetal heart rate.
An epidural anesthetic is planned for the adolescent who is in labor. What nursing interventions are essential before epidural anesthesia is administered? Select all that apply. 1 Performing a baseline vaginal examination 2 Telling the adolescent what to expect with each procedure 3 Identifying risk factors that contraindicate epidural anesthesia 4 Having the parents sign a consent form for the epidural anesthesia 5 Explaining the need to stay in one position while the epidural catheter is in place
1,2,3 A baseline vaginal examination is needed to determine the extent of cervical dilation and effacement. Before any procedure is implemented, the nurse should explain the procedure and answer any questions. Risk factors that contraindicate epidural anesthesia include antepartum hemorrhage, bleeding disorders, and allergy to the medication. None of these conditions is indicated in the client's history. Although a signed informed consent is legally required for this invasive procedure, the adolescent, not the parents, should sign the consent; a pregnant woman is considered an emancipated minor and is legally empowered to sign the consent. The client should change position from side to side every hour to promote distribution of the anesthetic and to maintain circulation to the uterus and placenta.
Oxytocin is prescribed for a client in labor after a period of ineffective uterine contractions. What nursing interventions are most important if strong contractions that last 90 seconds or longer occur? Select all that apply. 1 Stopping the infusion 2 Turning the client on her side 3 Notifying the primary healthcare provider 4 Verifying the duration of contractions 5 Administering magnesium sulfate
1,2,3,4 Discontinuing the oxytocin infusion decreases uterine stimulation and eases intrauterine pressure; continuing the oxytocin may lead to fetal hypoxia, placental separation, or uterine rupture. Turning the client on her side increases oxygen perfusion to the fetus. The primary healthcare provider should be notified to obtain additional prescriptions. Contractions lasting longer than 90 seconds warrant stopping the oxytocin infusion to prevent uterine rupture. Magnesium sulfate is prescribed for preterm labor to inhibit contractions; this client needs to continue with labor. The goal is to decrease the length of contractions, not to stop them.
A pregnant woman is diagnosed with intrauterine fetal death. What would be the drug of choice for labor induction? 1Oxytocin 2Clomiphene 3Dinoprostone 4Methylergonovine
Dinoprostone Dinoprostone is a uterine stimulant indicated for the uterine evacuation of fetal remains. Oxytocin is used to aid in uterine contractions during childbirth. Clomiphene is indicated for female infertility in some clients. Methylergonovine is an oxytocic ergot alkaloid used to reduce postpartum uterine hemorrhage.