Nursing Management of Labor and Birth at Risk OB
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? A. McRoberts maneuver B. McGeorge maneuver C. McDonald maneuver D. McRonald maneuver
A. McRoberts maneuver
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? A. Prepare the client for a cesarean birth. B. Place the client in lithotomy position for birth. C. Administer oxytocin intravenously at 4 mU/minute. D. Perform artificial rupture of membranes.
A. Prepare the client for a cesarean birth.
The nurse is admitting a client in labor. The nurse determines that the fetus is in a transverse lie by performing Leopold maneuvers. What intervention should the nurse provide for the client? A. Prepare the client for a cesarean birth. B. Administer an analgesic to the client. C. Prepare for a precipitous vaginal birth. D. Prepare to assist the care provider with an amniotomy.
A. Prepare the client for a cesarean birth.
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? A. Sudden shortness of breath B. Bradycardia C. Bradypnea D. Unrelieved pain
A. Sudden shortness of breath
The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging? A. Use McRoberts maneuver. B. Use Zavanelli maneuver. C. Apply pressure to the fundus. D. Attempt to push in one of the fetus's shoulders.
A. Use McRoberts maneuver.
A nurse assesses a client in labor and suspects dysfunctional labor (hypotonic uterine dysfunction). The woman's membranes have ruptured and fetopelvic disproportion is ruled out. Which intervention would the nurse expect to include in the plan of care for this client? A. administering oxytocin B. encouraging the woman to assume a hands-and-knees position C. preparing the woman for an amniotomy D. providing a comfortable environment with dim lighting
A. administering oxytocin
A nurse is caring for a client who is experiencing acute onset of dyspnea and hypotension. The health care provider 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. A. cyanosis B. hyperglycemia C. arrhythmia D. hematuria E. pulmonary edema
A. cyanosis E. pulmonary edema
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? A. identical B. neither type results from a split ovum C. both types can result from the split ovum D. fraternal
A. identical
A client at 33 weeks' gestation is calling the office with various reports and is very concerned. The nurse recognizes which report(s) as indicating the client is potentially going into preterm labor? Select all that apply. A. low, dull backache B. irregular contractions C. GI upset (nausea, vomiting, diarrhea) D. general sense of discomfort E. achiness in the thighs
A. low, dull backache C. GI upset (nausea, vomiting, diarrhea) D. general sense of discomfort E. achiness in the thighs
A graduate nurse (GN) is caring for a woman being induced via oxytocin infusion. The client is currently reporting a headache and is vomiting. The graduate nurse thinks that the client is getting near the end of labor. However, the GNs preceptor intervenes by performing which interventions immediately after hearing this report? Select all that apply. A. notifying the health care provider immediately B. administering IV ondansetron for the nausea/vomiting C. increasing IV fluid rate D. calling respiratory therapy to obtain ABGs on this client E. discontinuing the oxytocin infusion
A. notifying the health care provider immediately E. discontinuing the oxytocin infusion
A nursing student correctly identifies the most desirable position to promote an easy birth as which position? A. occiput anterior B. shoulder dystocia C. face and brow D. breech
A. occiput anterior
A pregnant client at 28 weeks' gestation in preterm labor has received a dose of betamethasone IM today at 1400. The client is scheduled to receive a second dose. At which time would the nurse expect to administer that dose? A. tomorrow at 1400 B. tomorrow at 0800 C. tomorrow at 1800 D. today at 2200 E. tomorrow at 1200
A. tomorrow at 1400
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? A. "This is just a normal part of labor." B. "Different fetal positions can cause prolonged labor and back pain." C. "Let me help you out of bed to try walking it off." D. "Perhaps you have been in one position for too long."
B. "Different fetal positions can cause prolonged labor and back pain."
A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? A. Administer oxytocin in two divided intramuscular sites. B. Administer oxytocin diluted as a "piggyback" infusion. C. Administer oxytocin diluted in the main intravenous fluid. D. Administer oxytocin in a 20 cc bolus of saline.
B. Administer oxytocin diluted as a "piggyback" infusion.
Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? A. Make sure the epidural medication is turned down. B. Check for a full bladder. C. Make sure the client is lying on her left side. D. Assess vital signs every 30 minutes.
B. Check for a full bladder.
A full-term pregnant client is being assessed for induction of labor. Her Bishop score is less than 6. Which prescription would the nurse anticipate? A. Prepare the client for a cesarean birth. B. Insert a Foley catheter into the endocervical canal. C. Rupture membranes. D. Administer oxytocin intravenously at 10 mU/minute.
B. Insert a Foley catheter into the endocervical canal.
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? A. Recommend that she not hold the infant after it is delivered so as to not upset her more. B. Offer to take pictures and footprints of the infant once it is delivered. C. Call the hospital chaplain to talk to the parents. D. Explain to her that there was probably something wrong with the infant and that is why it died.
B. Offer to take pictures and footprints of the infant once it is delivered.
The nurse cared for a client who gave birth. The duration of labor from the onset of contractions until the birth of the baby was 2 hours. How will the nurse document the client's labor in the health record? A. Prolonged labor B. Precipitous labor C. False Labor D. Prodromal labor
B. Precipitous labor
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 angrily says no and starts crying? A. Tell her that once she gets over her shock and grief, she will probably be happy to have the photos. B. Tell her that the hospital will keep the photos for her in case she changes her mind. C. Console her with the fact that she has other children. D. Apologize and tell her that the photos will be destroyed immediately.
B. Tell her that the hospital will keep the photos for her in case she changes her mind.
A woman in active labor suddenly experiences a sharp, excruciating low abdominal pain, which the nurse suspects may be a uterine rupture since the shape of the abdomen has changed. The nurse calls a code, and a cesarean birth is performed stat, but the infant does not survive the trauma. A few hours later, after the woman has stabilized, she asks to hold and touch her infant, and the nurse arranges this. Later, the nurse's documentation should include which outcome statement? A. The parents just cannot believe their perfect infant died. B. The parents are beginning to demonstrate positive grieving behaviors. C. The parents continue to mourn the loss of their infant. D. The parents are exhibiting dysfunctional coping mechanisms related to the death of their newborn.
B. The parents are beginning to demonstrate positive grieving behaviors.
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? A. noting the space at the maternal umbilicus B. continuing to monitor maternal and fetal status C. applying suprapubic pressure against the fetal back D. auscultating the fetal heart rate at the level of the umbilicus
B. continuing to monitor maternal and fetal status
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? A. brief. B. erratic. C. well coordinated. D. poor in quality.
B. erratic.
A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: A. poor quality of prenatal care. B. increasing birth weight. C. longer length of labor. D. increased number of overall pregnancies.
B. increasing birth weight.
When caring for a client requiring a forceps-assisted birth, the nurse would be alert for: A. increased risk for uterine rupture. B. potential lacerations and bleeding. C. increased risk for cord entanglement. D. damage to the maternal tissues.
B. potential lacerations and bleeding.
The nurse is caring for a client in the transition stage of labor. In which scenario would the nurse predict the use of forceps may be used to assist with the birth? A. Reduce risk of complications B. To lessen the mother's pain C. Abnormal position of the fetal head D. The fetus is descending too slowly
C. Abnormal position of the fetal head
A client's membranes rupture. The nurse observes the fetal heart rate drop from 156 to 110. The nurse inspects the client's perineum and sees a loop of umbilical cord. What is the nurse's priority concern in this situation? A. Decreased strength of uterine contractions B. Increased risk for placental abruption C. Decreased fetal oxygenation D. Increased risk for infection
C. Decreased fetal oxygenation
The nurse assesses that a fetus is in an occiput posterior position. The nurse predicts the client will experience which situation related to this assessment? A. Necessity for vacuum extraction for birth B. Need to have the baby manually rotated C. Experience of additional back pain D. Shorter dilation (dilatation) stage of labor
C. Experience of additional back pain
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? A. Mild decelerations B. Variable decelerations C. Late decelerations D. Early decelerations
C. Late decelerations
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 priority fetal assessment the health care provider should focus on at this time? A. Monitor heart rate for tachycardia. B. Monitor fetal blood pressure for signs of shock (low BP, high FHR). C. Look for late decelerations on monitor, which is associated with fetal anoxia. D. Monitor fetal movements to ensure they are neurologically intact.
C. Look for late decelerations on monitor, which is associated with fetal anoxia.
The nurse is assessing a multipara woman who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and primary care provider, which action should the LPN prioritize? A. Apply pressure to the woman's lower back with a fisted hand. B. Assist with nitrazine and fern tests. C. Prepare to assist with external version. D. Include a set of piper forceps when the table is prepped.
C. Prepare to assist with external version.
The nurse would prepare a client for amnioinfusion when which action occurs? A. Fetal presenting part fails to rotate fully and descend in the pelvis. B. Maternal pushing is compromised due to anesthesia. C. Severe variable decelerations occur and are due to cord compression. D. The fetus shows abnormal fetal heart rate patterns.
C. Severe variable decelerations occur and are due to cord compression.
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? A. Umbilical cord compression B. Placenta previa C. Uterine rupture D. Hypertonic uterus
C. Uterine rupture
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to: A. increase her intravenous fluid infusion rate. B. put firm pressure on the fundus of her uterus. C. administer oxygen by mask. D. tell the woman to take short, catchy breaths.
C. administer oxygen by mask.
After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? A. prostaglandin B. laminaria C. amniotomy D. breast stimulation
C. amniotomy
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? A. less than 8 hours B. less than 5 hours C. less than 3 hours D. less than 4 hours
C. less than 3 hours
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? A. nifedipine B. betamethasone C. magnesium sulfate D. indomethacin
C. magnesium sulfate
The nursing student demonstrates an understanding of dystocia with which statement? A. "Dystocia cannot be diagnosed until just before birth." B. "Dystocia is diagnosed at the start of labor." C. "Dystocia is not diagnosed until after the birth." D. "Dystocia is diagnosed after labor has progressed for a time."
D. "Dystocia is diagnosed after labor has progressed for a time."
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 "arrest of labor." The woman asks, "Why is this happening?" Which response is the best answer to this question? A. "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." B. "Maybe your uterus is just tired and needs a rest." C. "Maybe your baby has developed hydrocephaly and the head is too swollen." D. "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."
D. "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."
A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? A. Administer amnioinfusion. B. Place the woman in Trendelenburg position. C. Administer oxygen at 10 L/min by face mask. D. Assess fetal heart sounds.
D. Assess fetal heart sounds.
Which postoperative intervention should a nurse perform when caring for a client who has undergone a cesarean birth? A. Avoid early ambulation to prevent respiratory problems. B. Ensure that the client does not cough or breathe deeply. C. Delay breastfeeding the newborn for a day. D. Assess uterine tone to determine fundal firmness.
D. Assess uterine tone to determine fundal firmness.
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? A. Assist the family in making arrangements for their stillborn infant. B. Give the parents a lock of the infant's hair. C. Allow the couple to spend as much time as they want with their stillborn infant. D. Avoid any discussion of the situation with the couple.
D. Avoid any discussion of the situation with the couple.
A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? A. Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder B. Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder C. Push the fetal head back into the uterus and prepare the client for cesarean birth D. Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis
D. Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis
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? A. Leaving the parents alone. B. Contacting a grief counselor. C. Removing the infant quickly. D. Keeping the communication lines open.
D. Keeping the communication lines open.
A G3P2 woman at 39 weeks' gestation presents highly agitated, reporting something "came out" when her membranes just ruptured. Which action should the nurse prioritize after noting the umbilical cord is hanging out of the vagina? A. Place the client in Trendelenburg position and gently attempt to reinsert the cord. B. Contact the health care provider and prepare the client for an emergent vaginal birth. C. With the client in lithotomy position, hold her legs and sharply flex them toward her shoulders. D. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord.
D. Put the client in bed immediately, call for help, and lift the presenting part of the fetus off the cord.
A client has been admitted to the birthing suite in labor. She has been in labor for 12 hours and is dilated to 4 cm. The primary care provider notes that the client is in hypotonic labor. What does this mean? A. The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. B. The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix. C. The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. D. The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.
D. The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix.
A woman whose fetus is in the occiput posterior position is experiencing increased back pain. Which is the best way for the nurse to help alleviate this back pain? A. performing acupuncture on the back B. applying ice to the back C. applying a heating pad to the back D. applying counterpressure to the back
D. applying counterpressure to the back
A pregnant client's labor has been progressing slower than normal. The client is visibly anxious and tense, telling the nurse, "I am so worried about what is going to happen. And I am so tired and feel so helpless." Other underlying issues that may be contributing to the client's slow labor progress have been ruled out. Which response(s) by the nurse would be appropriate? Select all that apply. A. "Things are moving along but sometimes it can take a little longer." B. "I will keep you updated often on how you and your baby are doing." C. "Let me leave you alone for a little while so you can get some rest." D. "Maybe dimming the lights or some soft music will help you relax a bit." E. "I will have to stop giving you pain medicine because it is slowing your labor."
A. "Things are moving along but sometimes it can take a little longer." B. "I will keep you updated often on how you and your baby are doing." D. "Maybe dimming the lights or some soft music will help you relax a bit."
The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh: A. 4,000 g to 4500 g B. 2500 to 3000 g C. 3,500 g to 4000 g D. 3,000 g to 3500 g
A. 4,000 g to 4500 g
A nurse is caring for a client at 38 weeks' gestation who is diagnosed with chorioamnionitis. On which intervention should the nurse place priority? A. Administer oxytocin. B. Monitor WBC count. C. Assess temperature. D. Assess amniotic fluid.
A. Administer oxytocin.
A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? A. Brachial plexus assessment B. assess for cleft palate C. monitor for a cardiac anomaly D. extensive lacerations
A. Brachial plexus assessment
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? A. placental abruption B. preeclampsia C. genetic abnormality D. premature rupture of membranes
A. placental abruption
A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse to initiate? A. providing a comfortable environment with dim lighting B. encouraging the women to change positions frequently C. preparing the woman for an amniotomy D. administering oxytocin
A. providing a comfortable environment with dim lighting
The nurse provides education to a postterm pregnant client. What information will the nurse include to assist in early identification of potential problems? A. "Be sure to measure 24-hour urine output daily." B. "Continue to monitor fetal movements daily." C. "Increase your fluid intake to prevent dehydration." D. "Monitor your bowel movements for constipation."
B. "Continue to monitor fetal movements daily."
After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition? A. lack of cervical dilation (dilatation) past 2 cm B. reports of severe back pain C. fetal buttocks as the presenting part D. contractions most forceful in the middle of uterus rather than the fundus
B. reports of severe back pain
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule? A. 2 cm/hour for cervical dilation B. 1/4 cm/hour for cervical dilation C. 1 cm/hour for cervical dilation D. 1/2 cm/hour for cervical dilation
C. 1 cm/hour for cervical dilation
A client with a pendulous abdomen and uterine fibroids (uterine myomas) has just begun labor and arrived at the hospital. After examining the client, the primary care provider informs the nurse that the fetus appears to be malpositioned in the uterus. Which fetal position or presentation should the nurse most expect in this woman? A. occipitoposterior position B. cephalic presentation C. transverse lie D. anterior fetal position
C. transverse lie
After an hour of oxytocin therapy, a woman in labor states she feels dizzy and nauseated. The nurse's best action would be to: A. instruct her to breathe in and out rapidly. B. assess her vaginally for full dilation (dilatation). C. administer oral orange juice for added potassium. D. assess the rate of flow of the oxytocin infusion.
D. assess the rate of flow of the oxytocin infusion.
A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? A. elevated blood glucose B. tachypnea C. bradycardia D. depressed deep tendon reflexes
D. depressed deep tendon reflexes
A nurse is caring for a pregnant client whose fetus has been diagnosed with macrosomia. When reviewing the client's history, which information would the nurse expect to find? A. preterm pregnancy B. small body size of mother C. maternal rickets D. gestational diabetes
D. gestational diabetes
At 31 weeks' gestation, a 37-year-old woman with a history of preterm birth reports cramps, vaginal pain, and low, dull backache accompanied by vaginal discharge and bleeding. Assessment reveals cervix 2.1 cm long; fetal fibronectin in cervical secretions, and cervix dilated 3 to 4 cm. Which interactions should the nurse prepare to assist with? A. an emergency cesarean birth B. bed rest and hydration at home C. careful monitoring of fetal movement (kick) counts D. hospitalization, tocolytic, and corticosteroids
D. hospitalization, tocolytic, and corticosteroids
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? A. hypertonic contractions B. uncoordinated contractions C. Braxton Hicks contractions D. hypotonic contractions
D. hypotonic contractions
A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? A. precipitate labor B. dystocia C. normal labor D. preterm labor
D. preterm labor
