Ch 21 Mgmt of labor and birth risks
A nurse is caring for a client who is a 22-year-old gravida 1 para 0 in labor. The client has been in labor for 10 hours. The nurse assesses the fetal monitor, and the client has contractions every 3 to 5 minutes, lasting 40 to 45 seconds, and are palpated moderately. The vaginal examination is completed, and the client is only 3 cm, at 60% effacement, and at -3 station. The client states that the pain level is 7 out of 10.
dystocia; cervical dilation at 3 cm
A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse to initiate?
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?
"Continue to monitor fetal movements daily."
The nursing student demonstrates an understanding of dystocia with which statement?
"Dystocia is diagnosed after labor has progressed for a time."
A pregnant client in labor experiences a problem with the passenger related to shoulder dystocia. The health care provider is planning to relieve it with McRoberts maneuver. The client asks the nurse, "What is going to happen when they try this?" Which response by the nurse would be appropriate?
"Your thighs will be flexed and moved away from the center of your body to open things up."
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
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is:
5
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?
Experience of additional back pain
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?
Keeping the communication lines open.
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?
Late decelerations
The fetus of a client in labor is determined to be in a persistent occiput posterior position. Which intervention would the nurse prioritize?
Pain relief measures
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?
Prepare the client for a cesarean birth.
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?
Uterine rupture
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?
administering oxytocin
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
The nurse is assessing a woman who had a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?
caput succedaneum
The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule?
cervix dilates 1 cm per hour
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
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction?
contractions most forceful in the middle of uterus rather than the fundus
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
At 31 weeks' gestation, a 37-year-old client 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?
hospitalization, tocolytic, and corticosteroids
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?
less than 3 hours
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?
placental abruption
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?
tomorrow at 1400
A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment?
uterine hypertonicity
A client in active labor with a history of two previous cesarean births is being monitored frequently as they try to have a vaginal birth. Suddenly, the client grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes the client's blood pressure is 80/50 mm Hg, pulse rate is 130 bpm and weak, the skin is cool and clammy, and the fetal monitor shows bradycardia. The nurse activates the code team because the nurse suspects the client may be experiencing which complication?
uterine rupture
The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider?
45 ml urine output in 2 hours
Why is it important for the nurse to thoroughly assess maternal bladder and bowel status during labor?
A full bladder or rectum can impede fetal descent.
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?
Abnormal position of the fetal head
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?
Administer oxytocin diluted as a "piggyback" infusion.
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?
Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis
A woman receives magnesium sulfate as treatment for preterm labor. The nurse assess and maintains the infusion at the prescribed rate based on which finding?
Respiratory rate of 16 breaths/minute
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's first action would be to:
administer oxygen by mask.
A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth?
cord compression
A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize?
depressed deep tendon reflexes
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize?
fetal heart tones
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer?
magnesium sulfate
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
A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply.
* Discontinue the oxytocin infusion. * Administer an IV bolus of fluids. * Apply oxygen to the woman via mask at 8 to 10 L/min.
A nurse in a hospital is caring for a 22-year-old G2P1 client who is at 32 weeks' gestation in active labor. The client calls out, "I think my water broke." The nurse at the bedside pulled back the sheet and found clear fluid with an umbilical cord in the client's vagina.
1. Delegate tasks to other nurses 2. Contact the healthcare provider 3. Follow the hospital's cord prolapse protocols 4. Insert a hand to hold up the cord
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:
4,000 g to 4500 g
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?
McRoberts maneuver McRoberts maneuver is an intervention that is frequently successful in cases of shoulder dystocia, and it is often tried first. McRoberts requires the assistance of two individuals. Two nurses are ideal; however, a support person or a technician can serve as the second assistant. With the woman in lithotomy position, each nurse holds one leg and sharply flexes the leg toward the woman's shoulders. This opens the pelvis to its widest diameters and allows the anterior shoulder to deliver in almost half of the cases.
The nurse is examining a client at 37 weeks' gestation who came to labor and delivery with severe cramps and vaginal spotting. While listening to the fetal heart rate the nurse observes a reddened area of the side of the client's abdomen. When the nurse asks about the area, the client says "I got hit with a broom." The nurse asks who hit her, but the client does not respond. A vaginal examination reveals the cervix is 50% effaced and dilated 1 cm, membranes are intact, no bleeding and the presenting part is floating. Based on the nurse's assessment, the client is admitted to the observation unit to be monitored for which obstetrical condition?
Placental abruption (abruptio placentae)
The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in the abdomen and shoulder. What should the nurse prepare to do?
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?
Sudden shortness of breath
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.
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?
diabetes
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?
applying counterpressure to the back
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule?
1 cm/hr for dilation
The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply.
* It significantly increases the risk of cesarean birth. * It significantly increases instrumented birth. * It significantly increases the use of epidural analgesia. * It significantly increases the admissions to the neonatal ICU.
The nurse is assessing a multipara client 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?
Prepare to assist with external version.
A fetus is experiencing shoulder dystocia during birth. The nurse would place priority on performing which fetal assessment postbirth?
brachial plexus assessment
A nurse is teaching a nulliparous woman at 42 weeks' gestation about labor induction, which is being recommended by her health care provider. The nurse determines that the woman needs additional teaching when she identifies which assessment as being done before induction?
maneuvers for fetal positioning