OB Chapter 21 & 22: Complications Occurring Before Labor and Delivery
A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which condition? a low-lying placenta fetopelvic disproportion contraction ring uterine bleeding
fetopelvic disproportion Explanation: The woman is experiencing dystocia most likely due to hypotonic uterine dysfunction and fetopelvic disproportion associated with a large fetus. A low-lying placenta, contraction ring, or uterine bleeding would not be associated with a change in labor pattern.
The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? 11 7 5 3
11
A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? hemorrhage macrosomia infection dystocia
macrosomia
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? magnesium sulfate nifedipine indomethacin betamethasone
magnesium sulphate
A pregnant client tells the nurse that she hopes the baby is not in the breech position because she has heard that this causes difficult labor. What should the nurse include when explaining the reasons for this presentation to the client? Select all that apply. multiple fetuses maternal diabetes fetal birth defects lax abdominal muscles fetal age less than 40 weeks
multiple fetuses fetal birth defects lax abdominal muscles fetal age less than 40 weeks Reasons for the breech presentation include multiple fetuses, lax abdominal muscles, fetal birth defects such as hydrocephalus, and fetal age less than 40 weeks. Maternal diabetes is not identified as a cause for a fetal breech presentation. Reference:
A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. nifedipine magnesium sulfate dinoprostone misoprostol indomethacin
nifedipine magnesium sulfate indomethacin Explanation: Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), indomethacin (a prostaglandin synthetase inhibitor), and nifedipine (a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.
After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? supine side-lying sitting knee-chest
knee-chest Explanation: Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.
The nurse documents for a pregnant client experiencing acute abdominal pain (above). For which health concern will the nurse plan care for this client?
disseminated intravascular coagulation (DIC)
A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth? extensive lacerations monitor for a cardiac anomaly assess for cleft palate brachial plexus assessment
brachial plexus assessment Explanation: 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, which should be assessed and treated. Cleft palate and cardiac anomalies are not related to shoulder dystocia.
Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? macrosomia gestational hypertension gestational diabetes low parity
estational hypertension
The postpartum mother who delivered via cesarean birth is preparing for discharge from the hospital. As part of the discharge teaching, the nurse instructs the mother to make an appointment with her physician to have the staples removed in: 3 days. 6 days. 11 days. 14 days.
6 days. Explanation: Staples placed for surgical closure need to be removed anywhere from 4 to 10 days depending on wound healing and physician preference. Women who are at higher risk for wound complications, such as those with diabetes or those who are obese, typically have their staples left in place longer.
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5. 6. 7. 9.
5 Explanation: A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.
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? The fetus is macrosomic. The mother is fighting the contractions. The mother has a small pelvic opening. Uterine contractions are weak and ineffective.
Uterine contractions are weak and ineffective. Explanation: Labor dystocia indicates that the labor is progressing too slowly. Reasons for this are described as due to the "four P's", which are passageway, passenger, power and psyche. A power problem involves either ineffective contractions in either quality or quantity or the mother is too tired to push when needed.
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? breast stimulation amniotomy laminaria prostaglandin
amniotomy Explanation: Amniotomy is considered a surgical method of cervical ripening. Breast stimulation is considered a nonpharmacologic method for ripening the cervix. Laminaria is a hygroscopic dilator that mechanically causes cervical ripening. Prostaglandins are pharmacologic methods for cervical ripening.
A nurse is preparing an in-service program about labor and the hormones involved with the initiation of labor. Which information would the nurse include as believing to play a role in the onset of labor? suppression of prostaglandin release withdrawal of progesterone decrease in fetal cortisol levels suppression of oxytocin
withdrawal of progesterone Explanation: The onset of labor is believed to be due to a number of factors involving hormones. The uterine muscle stretches from the increasing size of the fetus, which results in release of prostaglandins. The fetus presses on the cervix, which stimulates the release of oxytocin from the posterior pituitary. Oxytocin stimulation works together with prostaglandins to initiate contractions. Changes in the ratio of estrogen to progesterone occurs, increasing estrogen in relation to progesterone, which is interpreted as progesterone withdrawal.
A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 1 to 5 days 6 to 10 days 4 to 8 days
2 to 7 days Explanation: Tocolytic drugs may prolong the pregnancy for 2 to 7 days. During this time, steroids can be given to improve fetal lung maturity, and the woman can be transported to a tertiary care center.
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? Make sure the epidural medication is turned down. Check for a full bladder. Make sure the client is lying on her left side. Assess vital signs every 30 minutes.
Check for a full bladder.
The perinatal educator is instructing on various emotions commonly experienced during labor. Which complication of anxiety is most important to stress? Shortness of breath Dystocia Gestational hypertension Fetal tachycardia
Dystocia Explanation: Many women experience an array of emotions during labor, which may include fear, anxiety, helplessness, desire to be alone, and weariness. These emotions can lead to psychological stress, which indirectly can cause dystocia. Dystocia is a prolonged labor as the tense woman is fighting against the labor process. Shortness of breath may occur with a panic attack. Gestational hypertension occurs during pregnancy. Fetal tachycardia is not commonly associated with maternal anxiety.
A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? "I'll make sure to limit the amount of long distance traveling I do." "Stress isn't a problem that is related to preterm labor." "Separating pregnancies by about a year should be helpful." "I'll need extra iron in my diet so that I have some extra for the baby."
I'll make sure to limit the amount of long distance traveling I do." Explanation: Appropriate measures to reduce the risk for preterm labor include avoiding travel for long distances in cars, trains, planes, or buses; achieving adequate iron store through balanced nutrition (excess iron is not necessary); waiting for at least 18 months between pregnancies; and using stress management techniques for stress.
Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client? placental separation aspiration amniotic fluid embolism congestive heart failure
amniotic fluid embolism Explanation: With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension
A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? severe uterine pain board-like abdomen appearance of petechiae inversion of the uterus
appearance of petechia
A client in the active phase of labor is diagnosed as having a protracted labor pattern. Which pattern would the nurse assess as indicative of a protracted labor pattern? arrest of the descent of the fetal head prolonged deceleration phase secondary arrest of cervical dilation (dilatation) delayed descent of the fetal head
delayed descent of the fetal head
A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? firm, rigid uterus on palpation gradual onset of symptoms fetal heart rate within normal range absence of pain
firm, rigid uterus on palpation Explanation: The uterus is firm-to-rigid to the touch with abruptio placentae. It is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. A gradual onset of symptoms is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.
The nurse is caring for a laboring mother who is experiencing a protracted active phase of labor. The nurse prepares for which two interventions to assist the mother through this phase of labor? oxytocin and amniotomy amniotomy and epidural anesthesia oxytocin and epidural anesthesia amniotomy and internal monitoring
oxytocin and amniotomy Explanation: A protracted active phase is often treated with oxytocin and amniotomy. There are much better outcomes when both interventions are utilized together. Amniotomy without the use of oxytocin does not appear to improve outcomes. Internal monitoring will have no effect on contractions. An epidural provides pain relief and does not affect the quality of contractions.
A nurse is teaching a pregnant woman with preterm premature rupture of membranes (PPROM) about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? I need to keep a close eye on how active my baby is each day." "I need to call my doctor if my temperature increases." "It's okay for my husband and I to have sexual intercourse." "I can shower, but I shouldn't take a tub bath."
"It's okay for my husband and I to have sexual intercourse."
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? "Maybe your uterus is just tired and needs a rest." "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." "Maybe your baby has developed hydrocephaly and the head is too swollen." "More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."
"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal." Explanation: Arrest of labor results when no descent has occurred for 2 hours in a nullipara or 1 hour in a multipara. The most likely cause for arrest of descent during the second stage is CPD. Rest should allow the uterine contractions to be more efficient. The hormones secreted during pregnancy allow ligaments to soften so bones can shift to allow birth. Ultrasound would have previously been diagnosed prior to the onset of labor.
The diabetic mother has been in active labor for 9 hours and has only reached 3 cm dilation (dilatation). It has been determined by ultrasound the fetus is very large. The decision has been made to deliver the fetus via cesarean. How much time does the nurse have to prepare the client before the surgery begins? 15 minutes 30 minutes 45 minutes 60 minutes
30 minutes Explanation: A cesarean birth that occurs after the onset of labor is referred to as an emergency cesarean and, as dictated by national standards, must begin within 30 minutes of the decision to operate. The nurse would need to prepare the mother for surgery within this time frame.
While the placenta is being delivered after labor, a client experiences an amniotic fluid embolism. What should the nurse do first to help this client? Administer oxygen by nasal cannula. Increase intravenous fluid infusion rate. Put firm pressure on the fundus of the uterus. Tell the client to take short, shallow breaths.
Administer oxygen by nasal cannula. Explanation: The clinical picture of an amniotic fluid embolism is dramatic. The client suddenly experiences sharp chest pain and is unable to breathe as pulmonary artery constriction occurs. The immediate management is oxygen administration by face mask or cannula. Intravenous fluids; pressure on the fundus; or taking short, shallow breaths is not going to help the manifestations of an amniotic fluid embolism.
amniotic fluid embolism Explanation: With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension
Late decelerations Explanation: When the fetus is being deprived of oxygen the fetus will demonstrate late decelerations on the fetal monitoring strip. This is an indication the mother is in need of further assessment. Early decelerations are a normal finding. Variable decelerations usually coincide with cord compression.
After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placental abruption results in painless, bright red vaginal bleeding during labor. Placental abruption requires "watchful waiting" during labor and birth.
Placenta previa is an abnormally implanted placenta that is too close to the cervix. Explanation: Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. Immediate intervention is required for placental abruption.
The mother who delivered 60 minutes ago still has not expelled the placenta and the cervix is closing. Nitroglycerin is ordered by the obstetric provider. What nursing care should the nurse provide when administering this drug? Select all that apply. Provide oxygen. Blood pressure assessment every 5 minutes. Continuous pulse oximetry. Increase IV flow rate. Continuous HR monitoring.
Provide oxygen. Blood pressure assessment every 5 minutes. Continuous pulse oximetry. Continuous HR monitoring. If the placenta is entrapped behind a closing cervix, nitroglycerin may be administered to help the cervix relax. Nitroglycerin can cause hypotension, tachycardia, hypoxia, and a headache because it causes both arterial and venous dilation (dilatation). Monitoring for all these situations is important to prevent further complications for the mother. The IV rate would only need to be increased if the mother begins to bleed.
When preparing a mother for a trial of labor after cesarean (TOLAC), what information should the nurse include in the teaching plan? There may be a longer active phase of first stage of labor. There may be a shorter active phase of first stage of labor. There may be a longer latent phase of labor. There may be a shorter latent phase of labor.
There may be a longer active phase of first stage of labor. Explanation: During a TOLAC, nurses should be aware that women who have delivered by cesarean previously but have not delivered vaginally are likely to have a longer active phase of the first stage of labor than a woman who has never given birth previously. Women who have previously delivered by cesarean and given birth vaginally can anticipate an active phase similar to that of other women who have previously given birth vaginally.
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? superficial structures above the muscle through the perineal muscles through the anal sphincter muscle through the anterior rectal wall
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? superficial structures above the muscle through the perineal muscles through the anal sphincter muscle through the anterior rectal wall
As part of a review class for perinatal nurses, the nurse is explaining the laboratory and diagnostic tests that can be conducted to evaluate a woman's risk for preterm labor. The nurse determines that additional teaching is needed when the group identifies which test as being used? blood chemistry levels fetal fibronectin testing salivary estriol levels transvaginal ultrasound
blood chemistry levels Explanation: Commonly used diagnostic testing for preterm labor risk assessment includes a complete blood count, urinalysis, amniotic fluid analysis, fetal fibronectin testing, cervical length evaluation by transvaginal ultrasound, salivary estriol, and home monitoring of uterine activity to recognize preterm contractions. Blood chemistry levels will inform the primary care provider as to the condition of the mother but would not be definitive in determining preterm labor risks.
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound? applying suprapubic pressure against the fetal back continuing to monitor maternal and fetal status noting the space at the maternal umbilicus auscultating the fetal heart rate at the level of the umbilicus TAKE ANOTHER QUIZ
continuing to monitor maternal and fetal status Explanation: Once a breech presentation is confirmed by ultrasound, the nurse should continue to monitor the maternal and fetal status when the team makes decisions about the method of birth. The nurse usually plays an important role in communicating information during this time. Applying suprapubic pressure against the fetal back is the nursing intervention for shoulder dystocia and may not be required for breech presentation. Noting the space or dip at the maternal umbilicus and auscultating the fetal heart rate at the umbilicus level are assessments related to occipitoposterior positioning of the fetus.
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? lack of cervical dilation past 2 cm fetal buttocks as the presenting part reports of severe back pain contractions most forceful in the middle of uterus rather than the fundus
contractions most forceful in the middle of uterus rather than the fundus Explanation: Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest hypertonic uterine dysfunction. Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx. Cervical dilation (dilatation) that has not progressed past 2 cm is associated with dysfunctional labor. A breech position is one in which the fetal presenting part is the buttocks or feet.
A mother in labor with ruptured membranes comes to the labor and delivery unit. It is determined that the fetus is in a single footling breech presentation. The nurse assesses the mother for which complication associated with this fetal position? cord prolapse uterine atony placental abruption (abruptio placentae) brachial plexus injury
cord prolapse Explanation: All infants born breech are at greater risk for asphyxia and trauma at the time of birth. Infants born footling breech are at a higher risk for cord prolapse. Breech presentation does not affect the tone of the uterus nor does it increase the risk for placental abruption. A brachial plexus injury can occur with any fetal position during delivery. It is not specific to breech presentation.
A client at 30 weeks' gestation comes to the clinic and tells the nurse "I am afraid that my water has broken. My underwear always feels wet." Which action will the nurse take? Perform a digital vaginal examination. Assess the fluid for the presence of meconium. Prepare the client for labor induction. Assist with a sterile speculum examination.
Assist with a sterile speculum examination. Explanation: The nurse assists with (or if protocol allows, perform) a sterile speculum examination to assess for pooling of amniotic fluid, which would confirm rupture of membranes. The nurse should not perform a digital vaginal examination because it presents a risk for infection in the presence of ruptured membranes. Once preterm premature rupture of membranes (PPROM) is confirmed, the nurse can assess the fluid for the presence of meconium. The nurse would not prepare the client for labor induction at 30 weeks' gestation without confirming PPROM or unless there is fetal compromise, client or fetal infection, or evidence of placental abruption. In the absence of these complications, labor is usually not induced until 34 weeks' gestation.
The nursing student demonstrates an understanding of dystocia with which statement? "Dystocia is diagnosed at the start of labor." "Dystocia is not diagnosed until after the birth." "Dystocia is diagnosed after labor has progressed for a time." "Dystocia cannot be diagnosed until just before birth.
Dystocia is diagnosed after labor has progressed for a time." Explanation: Nursing management of the woman with dystocia, regardless of etiology, requires patience. The nurse needs to provide physical and emotional support to the client and family. Dystocia is diagnosed not at the start of labor, but rather after it has progressed for a time.
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? Monitor heart rate for tachycardia. Monitor fetal movements to ensure they are neurologically intact. Look for late decelerations on monitor, which is associated with fetal anoxia. Monitor fetal blood pressure for signs of shock (low BP, high FHR).
Look for late decelerations on monitor, which is associated with fetal anoxia. Explanation: A danger of hypertonic contractions is that the lack of relaxation between contractions may not allow optimal uterine artery filling; this can lead to fetal anoxia early in the latent phase of labor. Applying a uterine and a fetal external monitor will help identify that the resting phase between contractions is adequate and that the FHR is not showing late deceleration.
During active labor, the nurse notes a decrease in the baby's fetal heart rate and consults with the health care provider. The provider concurs and prescribes application of oxygen via mask, increase in IV fluids, and repositioning. The nurse should communicate which piece of information to the woman when she protests about being "tied down" in bed with IVs? "An IV line will assist the staff if your baby shows signs of distress." "Increasing your oxygen level will also increase the infant's oxygen level." "Changing your position to side lying can prevent hypotension from inferior vena cava compression." "Remember, the goal is to increase the FHR so a healthy infant can be born."
Remember, the goal is to increase the FHR so a healthy infant can be born." Explanation: If a woman develops a complication of labor or birth, actions to increase the fetal heart rate (FHR) or to strengthen uterine contractions are a priority and possibly an emergency. Interventions must be planned and performed efficiently and effectively, based on the individual circumstances. Focusing on IV lines, rationale for oxygen placement, or educating about changing position does not put the focus on the priority—a healthy baby.
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? The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. The uterine contractions are irregular, but the quantity or quality or strength is insufficient to dilate the cervix. The uterine contractions are regular, but the quantity or quality or strength is insufficient to dilate the cervix. The uterine contractions may or may not be regular, but the quantity or quality or strength is sufficient to dilate the cervix.
The uterine contractions may or may not be regular, but the quantity or quality or strength is insufficient to dilate the cervix. Explanation: There are two types of uterine dysfunction: hypotonic and hypertonic. The most common is hypotonic dysfunction. 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.
Immediately after giving birth to a full-term infant, a client develops dyspnea and cyanosis. Her blood pressure decreases to 60/40 mm Hg, and she becomes unresponsive. What does the nurse suspect is happening with this client? placental separation aspiration amniotic fluid embolism congestive heart failure TAKE ANOTHER QUIZ
amniotic fluid embolism Explanation: With amniotic fluid embolism, symptoms may occur suddenly during or immediately after labor. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension.
A nurse is describing the risks associated with post-term pregnancies as part of an in-service presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems concerning the fetus? aging of the placenta increased amniotic fluid volume meconium aspiration cord compression
increased amniotic fluid volume
A client in labor is agitated and nervous about the birth of her child. The nurse explains to the client that fear and anxiety cause the release of certain compounds that can prolong labor. The nurse is referring to which compounds? prostaglandins catecholamines oxytocin relaxin
catecholamines Explanation: Fear and anxiety cause the release of catecholamines, such as norepinephrine and epinephrine, which stimulate the adrenergic receptors of the myometrium. This in turn interferes with effective uterine contractions and results in prolonged labor. Estrogen promotes the release of prostaglandins and oxytocin. Relaxin is a hormone that is involved in producing backache by acting on the pelvic joints. Prostaglandins, oxytocin, and relaxin are not produced due to fear or anxiety in clients during labor.
When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment? fetal heart rate cervical ripening vaginal discharge fundal height
cervical ripening Explanation: The nurse should assess for cervical ripening before inducing labor with exogenous oxytocin. Oxytocin administration produces uterine contractions when the cervix is ripe. Cervical ripening indicates the presence of many oxytocin receptors. Exogenous oxytocin administration is ineffective when the cervix is unripe. Assessment of fetal heart rate is always important, but it is not a criteria for induction. Additionally, assessments of vaginal discharge and fundal height are not necessary prior to induction of labor with oxytocin.
A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? complications of a post-term pregnancy complications of preterm labor complications of placenta previa placental abruption (abruptio placentae)
complications of a post-term pregnancy Explanation: A post-term pregnancy carries risks for increased perinatal mortality, particularly during labor. Oligohydramnios and meconium staining of the amniotic fluid are common complications. Oligohydramnios increases the incidence of cord compression, which can lead to fetal distress during labor. Thick, meconium-stained fluid increases the risk for meconium aspiration syndrome.
A 37-year-old client experienced a perinatal loss 3 days ago. Which client characteristic would be communicated to the health care provider? lack of appetite denial of the death blaming herself frequent crying spells
denial of the death Explanation: Denial of the perinatal loss is dysfunctional grieving in the client. Lack of appetite, blaming oneself, and frequent crying spells are part of a normal grieving process.
The nurse documents for a pregnant client experiencing acute abdominal pain (above). For which health concern will the nurse plan care for this client? vasa previa placenta previa spontaneous abortion (miscarriage) disseminated intravascular coagulation (DIC)
disseminated intravascular coagulation (DIC) Explanation: Disseminated intravascular coagulation (DIC) is a disruption of hemostasis caused by a pathologic activation of the clotting cascade that results simultaneously in blood clots and platelet and clotting factor depletion leading to bleeding. DIC is always a complication of another condition. In pregnancy, common antecedent conditions include placental abruption, which presents with severe acute abdominal pain and evidence of bleeding such as a blood clot behind the placenta as seen on ultrasound. Laboratory values that support nursing care for DIC include a low platelet count, prolonged prothrombin time, and low fibrinogen level. Bleeding from a venipuncture site is another indication of DIC. The signs and symptoms that the client experienced are not associated with vasa previa or placenta previa.
A client at 38 weeks' gestation has an ultrasound performed at a routine office visit and learns that her fetus has not moved out of a breech position. Which intervention does the nurse anticipate for this client? external cephalic version trial labor forceps birth vacuum extraction
external cephalic version Explanation: External cephalic version is the turning of a fetus from a breech to a cephalic position before birth. It may be done as early as 34 to 35 weeks, although the usual time is 37 to 38 weeks of pregnancy. A trial birth is performed when a woman has a borderline (just adequate) inlet measurement and the fetal lie and position are good and involves allowing labor to take its normal course as long as descent of the presenting part and dilation (dilatation) of the cervix continue to occur. Forceps, which are not commonly used anymore, and vacuum extraction are used to facilitate birth when other complications are present, but they would be less likely to be used with a fetus in breech position.
A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? grade 2 grade 1 grade 3 grade 4
grade 2 Explanation: The classifications for placental abruption (abruptio placentae) are: grade 1 (mild) - minimal bleeding (less than 500 ml), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 ml), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 ml), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4.
The fetus of a pregnant client is in a breech presentation. Where will the nurse auscultate fetal heart sounds? low in the abdomen left lateral abdomen high in the abdomen right lateral abdomen
high in the abdomen Explanation: With a breech presentation, fetal heart sounds usually are heard high in the abdomen. In a breech presentation, fetal heart sounds will not be heard low in the abdomen or over the left or right lateral abdominal regions
The fetus of a pregnant client is in a breech presentation. Where will the nurse auscultate fetal heart sounds? low in the abdomen left lateral abdomen high in the abdomen right lateral abdomen
high in the abdomen Explanation: With a breech presentation, fetal heart sounds usually are heard high in the abdomen. In a breech presentation, fetal heart sounds will not be heard low in the abdomen or over the left or right lateral abdominal regions.
A nursing instructor is teaching students about fetal presentations during birth. The most common cause for increased incidence of shoulder dystocia is: longer length of labor. increased number of overall pregnancies. increasing birth weight. poor quality of prenatal care.
increasing birth weight. Explanation: Shoulder dystocia is the obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has emerged. The incidence of shoulder dystocia is increasing because of increasing birth weights, with reports of it in as many as 2% of vaginal births.
A client at 30 weeks' gestation is admitted to labor and delivery with a diagnosis of a class 2 acute placental abruption. Which intervention(s) will the nurse plan to implement when providing care for the client? Select all that apply. intermittent fetal monitoring inserting large-bore intravenous (IV) access monitoring client's intake and output administering corticosteroids administering magnesium sulfate
inserting large-bore intravenous (IV) access monitoring client's intake and output administering corticosteroids The nurse plans to insert a large-bore IV, monitor client intake and output, and administer corticosteroids. An acute class 2 placental abruption presents with mild to moderate abdominal tenderness, uterine contractions, signs of hemodynamic instability, and fetal distress, which can necessitate a preterm birth. The nurse should utilize continuous, not intermittent, fetal monitoring. Tocolysis is contraindicated with a placental abruption.
A nurse is reviewing the medical record of a pregnant client. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which condition? placenta increta placenta percreta placenta accreta low-lying placenta
low-lying placenta Explanation: Placenta previa is currently classified with two terms: "placenta previa" and "low-lying placenta." If the placental edge is less than 2 cm from the internal os but does not cover it, the placenta is reported as low-lying. If the placental edge covers the internal os, it is labeled as a placenta previa. Placenta accreta spectrum includes three conditions. Accreta is the most common and is a condition in which the placenta attaches itself too deeply into the wall of the uterus but does not penetrate the uterine muscle. Placenta increta occurs when the placenta invades the myometrium, and placenta percreta occurs when it has extended through the myometrium and uterine serosa and adjacent tissue.
A client at 32 weeks' gestation receives indomethacin as treatment for preterm labor. Which assessment finding(s) indicates to the nurse that the client is experiencing a side effect from this medication? Select all that apply. nausea vomiting headache palpitations shortness of breath
nausea vomiting
The nurse is caring for a woman at 32 weeks' gestation who expresses deep concern because her previous pregnancy ended in a stillbirth. The nurse would encourage the mother to have what screening test? nonstress test (NST) contraction stress test vaginal ultrasound doppler ultrasound
nonstress test (NST) Explanation: Women with a history of previous stillbirth begin antepartum fetal testing 1 to 2 weeks prior to the gestational age at which the intrauterine demise occurred, or no later than 32 to 34 weeks' gestation. One method to assess the well-being of the fetus is the biophysical profile. Included in this is the nonstress test. Other regular screening methods are having the mother keep a record of kicks (fetal movement counts/kick counts) and monitoring for hypertensive disorders and diabetes. An abdominal ultrasound could screen for fetal growth restriction. A Doppler ultrasound measures the blood flow of the fetus but it is not part of the regular screening unless fetal problems have been identified.
A client at 29 weeks' gestation is seen in obstetric triage with reports of heavy vaginal bleeding noted upon waking. The client denies abdominal pain or uterine contractions. Continuous fetal monitoring shows a normal fetal heart rate with no signs of fetal distress. Which is the likely cause of the client's condition? disseminated intravascular coagulation (DIC) placenta previa placental abruption vasa previa
placenta previa
A client has arrived at the labor and delivery suite for a scheduled induction of labor. Which nursing intervention will the nurse implement before starting the oxytocin infusion? assessing the client's lung sounds placing on a tocodynamometer obtaining a urine specimen completing an ultrasound
placing on a tocodynamometer
A nurse is providing care to a client being treated for preterm labor with intravenous magnesium sulfate. In the presence of this medication, which assessment should the nurse prioritize? fetal status uterine contraction pattern pregnant parent respirations pregnant parent pain
pregnant parent respirations Explanation: Because respiratory depression is a sign of magnesium sulfate toxicity, the nurse prioritizes assessment of respirations. Uterine contractions and fetal status are both important assessments for the nurse to make when caring for a client receiving magnesium sulfate. However, the priority assessment is pregnant parent respirations. Headache is a potential side effect of magnesium sulfate and should be assessed and addressed by the nurse, but the priority is respirations.
A 19-year-old nulliparous woman is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. The nurse suspects which complication? reduced oxygen to the fetus ruptured uterus cephalopelvic disproportion precipitate labor
reduced oxygen to the fetus Explanation: Hypertonic uterine dysfunction occurs when the uterus never fully relaxes between contractions. Placental perfusion becomes compromised, thereby reducing oxygen to the fetus. This occurs in early labor and affects nulliparous women more than multiparous women. A ruptured uterus is a potential complication; however, hypoxia to the fetus would occur first. Cephalopelvic disproportion is usually associated with hypotonic uterine dysfunction. Precipitate labor is one that is completed in less than 3 hours from the start of contractions to birth
The nurse is caring for a newborn whose pregnant parent was diagnosed with chorioamnionitis. For which potential condition(s) will the nurse monitor the newborn? Select all that apply. sepsis asphyxia meningitis pneumonia tetralogy of Fallot
sepsis asphyxia meningitis pneumonia Chorioamnionitis has implications for the newborn. The primary condition that can develop is sepsis; up to 40% of cases of neonatal sepsis are related to chorioamnionitis. Additional conditions that the newborn is at risk for developing include asphyxia, meningitis, and pneumonia. Tetralogy of Fallot is not a condition associated with chorioamnionitis.
A nurse is providing care to a postpartum client who had a placental abruption and has now become tachycardic with a thready pulse. The client also has moderate to heavy vaginal bleeding. Laboratory testing reveals anemia, thrombocytopenia, and altered liver function tests. The health care team suspects the client is developing disseminated intravascular coagulation (DIC). Which assessment finding is most indicative of DIC? vaginal bleeding tachycardia altered liver function thrombocytopenia
thrombocytopenia Explanation: Thrombocytopenia is most indicative of disseminated intravascular coagulation (DIC), because it reflects consumption of clotting factors. The vaginal bleeding can result from a postpartum hemorrhage associated with the placental abruption. Tachycardia along with the thready pulse are signs of hypovolemia and altered liver function tests can be a side effect of DIC, but thrombocytopenia is one of the clinical hallmarks of the clotting cascade associated with DIC.