Chapter 21
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) Rupture membranes. b) Prepare the client for a cesarean birth. c) Administer oxytocin intravenously at 10 mU/minute. d). Insert a Foley catheter into the endocervical canal.
Insert a Foley catheter into the endocervical canal. A Bishop score of less than 6 indicates that a cervical ripening method should be used before inducing labor. A low Bishop score is not an indication for cesarean birth; there are several other factors that need to be considered for a cesarean birth. A Bishop score of less than 6 indicates that vaginal birth will be unsuccessful and prolonged because the duration of labor is inversely correlated with the Bishop score.
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? a). amniotic fluid studies b). Bishop scoring c). fetal dating d). maneuvers for fetal positioning
maneuvers for fetal positioning Before labor induction is started, fetal maturity (dating, ultrasound, amniotic fluid studies) and cervical readiness (vaginal examination, Bishop scoring) must be assessed. Both need to be favorable for a successful induction. Maneuvers to determine fetal position (Leopold maneuver) is a technique done as the fetus moves through the labor process.
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? a). 2 to 7 days b). 1 to 5 days c). 4 to 8 days d). 6 to 10 days
2 to 7 days 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.
A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: a). 5. b). 9. c). 7. d). 6.
5. A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.
The nurse is caring for a group of clients in labor and delivery. Which client is at greatest risk for placental abruption (abruptio placentae)? a). 42 y.o G7P6 at 42 weeks' gestation who had limited prenatal care and has a BMI of 24 b). 28 y.o G1 at 30 weeks' gestation with a blood pressure of 150/94 and history of cigarette smoking c). 30 y.o G2 at 32 weeks' gestation and a history of infertility. Her first pregnancy resulted in a stillbirth at 38 weeks d). 25 y.o. G4P3 at 38 weeks' gestation with a sedentary life style, BMI of 34, and a placenta previa
28 y.o G1 at 30 weeks' gestation with a blood pressure of 150/94 and history of cigarette smoking Hypertension and smoking are risk factors for placental abruption (abruptio placentae). Limited prenatal care, history of infertility or stillbirth, high BMI, and placenta previa are risk factors during a pregnancy, but they do not increase the risk of placental abruption.
A nurse preceptor asks a student to list commonly used diagnostic tests for preterm labor risk assessment. Which tests should the student include? Select all that apply -arterial blood gases -amniotic fluid analysis -U/A -thyroid level -CBC
CBC U/A amniotic fluid analysis Commonly used diagnostic testing for preterm labor risk assessment includes a complete blood count, urinalysis, and an amniotic fluid analysis.
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). Check for a full bladder. b). Assess vital signs every 30 minutes. c). Make sure the client is lying on her left side. d). Make sure the epidural medication is turned down.
Check for a full bladder. A full bladder can interfere with the progress of labor, so the nurse must be sure that the client has emptied her bladder.
The perinatal educator is instructing on various emotions commonly experienced during labor. Which complication of anxiety is most important to stress? a). Fetal tachycardia b). Dystocia c). Shortness of breath d). Gestational hypertension
Dystocia 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.
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 admissions to the neonatal ICU. -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 weight of the newborn.
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. Evidence is compelling that elective induction of labor significantly increases the risk of cesarean birth, instrumented birth, use of epidural analgesia, and neonatal ICU admissions. Increased birth weight is not a factor.
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). Prepare to assist with external version. b). Include a set of piper forceps when the table is prepped. c). Assist with nitrazine and fern tests. d). Apply pressure to the woman's lower back with a fisted hand.
Prepare to assist with external version. Transverse lie is a fetal malposition and is a cause for labor dystocia. The fetus would need to be turned to the occipital position or be born via cesarean birth. Piper forceps are used in the birth of a fetus that is in the breech position. Nitrazine and fern tests are done to assess if amniotic fluid is leaking from the sac into the vagina. Counterpressure applied to the lower back with a fisted hand sometimes helps the woman to cope with the "back labor" that is characteristic of occiput posterior (OP) positioning.
The nurse is caring for a client experiencing a prolonged second stage of labor. The nurse would place priority on preparing the client for which intervention? a). a forceps and vacuum-assisted birth b). a precipitous birth c). artificial rupture of membranes d). a cesarean birth
a forceps and vacuum-assisted birth A forceps-and-vacuum-assisted birth is required for the client having a prolonged second stage of labor. The client may require a cesarean birth if the fetus cannot be delivered with assistance. A precipitous birth occurs when the entire labor and birth process occurs very quickly. Artificial rupture of membranes is done during the first stage of labor.
A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: a) birth is likely within the next 2 weeks. b). no infection is present. c). infection is present. d). birth is unlikely within the 2 next weeks.
birth is unlikely within the 2 next weeks. Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that birth is unlikely within 2 weeks following the test. It does not diagnose infection.
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? a). corticosteroids b). magnesium sulfate c). indomethacin d). nifedipine
corticosteroids Corticosteroids are given to help reduce or prevent the frequency and severity of respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation. Medications most commonly used for tocolysis include magnesium sulfate, indomethacin, and nifedipine.
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? a). pendulous abdomen b). diabetes c). preterm birth d). nullipara
diabetes Shoulder dystocia is most apt to occur in women with diabetes, in multiparas, and in postdate pregnancies. A pendulous abdomen is associated with the transverse lie fetal position not with shoulder dystocia.
A client has arrived to the birthing center in labor, requesting a VBAC. After reading the client's previous history, the nurse anticipates that the client would be a good candidate based on which finding? a). has a contracted pelvis b). had prior classic uterine incision c). had previous lower abdominal incision d). had prior transfundal uterine surgery
had previous lower abdominal incision The choice of a vaginal or repeat cesarean birth can be offered to women who have had a lower abdominal incision. Contraindications to VBAC include a prior classic uterine incision, prior transfundal uterine surgery, uterine scar other than low-transverse ("bikini cut") cesarean scar, contracted pelvis, and inadequate staff at the facility if an emergency cesarean birth is required.
When a woman in labor has reached 8 cm dilation, the nurse notices the fetal heat rate suddenly slows. On perineal inspection, the nurse observes the fetal cord has prolapsed. The nurse's first action would be to: a). place her in a knee-chest position. b). replace the cord with gentle pressure. c). cover the exposed cord with a dry, sterile wrap. d) turn her to her left side.
place her in a knee-chest position. Keeping the pressure of the fetus off the cord improves fetal circulation. Placing the woman in a knee-chest position accomplishes this. Replacing the cord could knot it; allowing it to dry would constrict cord blood vessels.
The nurse is monitoring a woman who is receiving IV oxytocin to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin? a). Continue to monitor contraction duration every 2 hours. b). Increase the flow rate of the main line infusion. c). Slow the infusion to under 10 gtts per minute. d). Discontinue the oxytocin infusion.
Discontinue the oxytocin infusion. If uterine contractions lengthen beyond 70 seconds, there is apt to be an interference with fetal circulation. Discontinuing the infusion allows contractions to shorten in length and allow fetal nourishment. The nurse would not increase the flow rate of the main line infusion or slow the infusion without the health care provider's prescription. Uterine contractions are monitored continuously.
A high-risk 43-year-old client is scheduled to receive amnioinfusion due to oligohydramnios. Which prescription by the provider should the nurse question before implementing it? a). Record woman's temperature hourly, watching for infection. b). Assist the woman to lie in a lateral recumbent position to prevent compression on the inferior vena cava. c). Warm the solution of normal saline before opening the clamp on the infusion. d) Use clean technique when handling the double-lumen catheter and IV tubing.
Use clean technique when handling the double-lumen catheter and IV tubing. Amnioinfusion is the addition of a sterile fluid into the uterus to supplement the amniotic fluid and reduce compression on the cord. This is a strict aseptic procedure. For this, a sterile double-lumen catheter is introduced through the cervix into the uterus. It is then attached to IV tubing, and a solution of warmed normal saline is rapidly infused. Throughout the procedure, the nurse should urge the woman to lie in a lateral recumbent position to prevent supine hypotension syndrome. The nurse should also record maternal temperature hourly to detect infection.
A nursing student correctly identifies the causes of labor dysfunction to include which factors? Select all that apply. -problems with finances -problems with access to health care -problems with the mother's diet -problems with the uterus -problems with the fetus
problems with the uterus problems with the fetus Labor dysfunction can occur because of problems with the uterus or fetus. Although the others might affect the type of prenatal care a woman receives, they do not directly affect her process of labor.
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? a). cephalopelvic disproportion b). reduced oxygen to the fetus c). ruptured uterus d). precipitate labor
reduced oxygen to the fetus 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.
A multipara client in labor is having contractions which are 2 minutes apart but rarely over 50 mm Hg in strength; the resting uterine tone is high, 20 to 25 mm Hg. The client asks what she can do to make contractions more effective. The nurse's best response is: a) be patient as contractions will strengthen by themselves. b). rest between contractions. c) request oxytocin to strengthen the contractions. d). ambulate to make the contractions regular.
rest between contractions. The client's contractions are hypertonic because of the high resting tone. Hypertonic contractions occur because the uterus is being overstimulated or erratically stimulated. Rest, not activity, is effective in helping contractions become more productive. Oxytocin is contraindicated. There is no guarantee that waiting will change the status of the contractions.
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? a). "Increasing your oxygen level will also increase the infant's oxygen level." b). "An IV line will assist the staff if your baby shows signs of distress." c). "Remember, the goal is to increase the FHR so a healthy infant can be born." d). "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." 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 multipara woman is fully dilated and effaced and has been pushing for over 2 hours. The student nurse observing asks the nurse, "What is causing this to last so long?" Which response by the nurse would be the most accurate? a). "The fetus probably turned to a breech position at the last minute." b). "The fetal head and shoulders are too large to get through the canal." c). "The fetal head is in an abnormal position." d) "The woman's bladder is too full, so the fetus cannot descend."
"The fetal head is in an abnormal position." A deceleration phase has become prolonged when it extends beyond 1 hour in a multipara. A prolonged deceleration phase most often results from abnormal fetal head position. Usually the size of the fetal head and shoulders have been measured via ultrasound and considered adequate to descend before labor. If the fetus turned to a breech position, a cesarean birth would have been scheduled. The woman's bladder can be emptied via catheter while she is in bed, so this should not be the problem.
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? a). 45 ml urine output in 2 hours b). hemoglobin of 13 g/dl (130 g/L) c). hematocrit of 36% (0.36) d). platelet count of 150,000 mm3
45 ml urine output in 2 hours The nurse knows a placental abruption places the client at high risk of hemorrhage. A decreased urine output indicates decreased perfusion from blood loss. The hematocrit, hemoglobin, and platelet counts are all within expected levels.
A woman in active labor suddenly sits up, clutches her chest, screams with pain, and then collapses back on the bed. The RN notes she is unconscious and a bluish-gray color. Which interventions are considered the priority for the nurse to implement? Select all that apply. -Begin CPR immediately. -Start oxytocin at 4 mu/min and titrate upward every 5 minutes. -Apply oxygen mask and start oxygen at 10 L/min. -Call lab and request 4 units of whole blood stat. -Place stethoscope on the abdomen to verify fetal heart rate.
Apply oxygen mask and start oxygen at 10 L/min. Begin CPR immediately. Amniotic fluid embolism occurs when amniotic fluid is forced into an open maternal uterine blood sinus after a membrane rupture or partial premature separation of the placenta. The clinical picture is dramatic. The immediate management is oxygen administration by face mask or cannula. Within minutes, she will need CPR; however, CPR may be ineffective because these procedures do not relieve the pulmonary constriction. Blood still cannot circulate to the lungs. Death may occur within minutes. Taking time to listen to FHR is not the priority. Oxytocin will not help with embolism. If the woman survives and develops DIC, fibrinogen is the blood product of choice.
The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? a). After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. b). Start oxytocin drip, piggyback to main IV line to port closest to client. c). Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each. d). Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.
Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The rate should not be increased by more than 2 milliunits at a time. When the infusion is administered, the oxytocin solution should be "piggybacked" to a maintenance IV solution such as Ringer's lactate and the piggyback added to the main infusion at the port closest to the woman. Infusions are usually begun at a rate of 1 to 2 milliunits/min. If there is no response, the infusion is gradually increased every 30 to 60 minutes by small increments of 1 to 2 milliunits/min until contractions begin.
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. -Administer betamethasone to mature the fetal lungs. -Ask the woman to drink 32 ounces (1 L) of water. -Discontinue the oxytocin infusion. -Administer an IV bolus of fluids. -Apply oxygen to the woman via mask at 8 to 10 L/min.
Discontinue the oxytocin infusion. Administer an IV bolus of fluids. Apply oxygen to the woman via mask at 8 to 10 L/min. The danger of hyperstimulation is that a fetus needs 60 to 90 seconds between contractions in order to receive adequate oxygenation from placenta blood vessels. Hyperstimulation is usually defined as five or more contractions in a 10-minute period or contractions lasting more than 2 minutes in duration or occurring within 60 seconds of each other. Several interventions such as asking the woman to turn onto her left side to improve blood flow to the uterus, administering an IV fluid bolus to dilute the level of oxytocin in the maternal blood stream, and administering oxygen by mask at 8 to 10 L are all helpful interventions for hyperstimulation. The surest method to relieve hyperstimulation is to immediately discontinue the oxytocin infusion. The lungs should be mature if a woman is undergoing induction. Drinking water takes too long to be absorbed and dilute the blood stream, so IV fluids are best.
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). Administer oxytocin intravenously at 10 mU/minute. c). Rupture membranes. d). Insert a Foley catheter into the endocervical canal.
Insert a Foley catheter into the endocervical canal. A Bishop score of less than 6 indicates that a cervical ripening method should be used before inducing labor. A low Bishop score is not an indication for cesarean birth; there are several other factors that need to be considered for a cesarean birth. A Bishop score of less than 6 indicates that vaginal birth will be unsuccessful and prolonged because the duration of labor is inversely correlated with the Bishop score.
The fetus of a woman in labor is determined to be in a persistent occiput posterior position. Which intervention would the nurse prioritize? a)Immediate cesarean birth b)Oxytocin administration c)Pain relief measures d)Side-lying position
Pain relief measures Intense back pain is associated with persistent occiput posterior position. Therefore, a priority is to provide pain relief measures. Counterpressure and back rubs may be helpful. Position changes that can promote fetal head rotation are important and can help to relieve some of the pain. Additionally, the woman's ability to cooperate and participate in these position changes is enhanced when she is experiencing less pain. Immediate cesarean birth is not indicated unless there is evidence of fetal distress. Oxytocin would add to the woman's already high level of pain.
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 her abdomen and shoulder. What should the nurse prepare to do? a). Place the client in a knee-chest position. b). Turn the client on her left side. c). Prepare the client for a cesarean birth. d) Bolus the client with another dose of medication through the epidural.
Prepare the client for a cesarean birth. The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous effective pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth.
A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group correctly chooses which findings as suggesting an amniotic fluid embolism? Select all that apply. -Maternal hypotension -Slow onset of fetal distress -Acute, continuous abdominal pain -Maternal tachycardia -Sudden onset of respiratory distress
Sudden onset of respiratory distress Maternal hypotension Maternal tachycardia The client with an amniotic fluid embolism commonly reports difficulty breathing. Other signs include hypotension, tachycardia, cyanosis, seizures, coagulation difficulties, and uterine atony with subsequent hemorrhage. If the mother is still in labor, the fetus may demonstrate distress with bradycardia occurring in most cases. A sudden onset of fetal distress and acute continuous abdominal pain is more often associated with uterine rupture.
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
Sudden shortness of breath Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema.
A pregnant woman at her first office visit tells the nurse, "I hope I have twins. It seems like all my friends have had twins lately!" What should the nurse tell the client about multiple births at this time? a). Incidence of twins is consistently approximately 1 in 100 conceptions. b). People giving birth at younger ages is resulting in more twins. c). The incidence is decreasing. d). The incidence is increasing.
The incidence is increasing. The nurse should tell the client that the incidence of multiple gestation is rising primarily as a result of ovarian stimulation and in vitro fertilization and an increased number of women giving birth at older ages.
A woman at 39 weeks' gestation is brought to the emergency department in labor following blunt trauma from an vehicle accident. The labor has been progressing well after the epidural when suddenly the woman reports severe pain in her back and shoulders. Which potential situation should the nurse suspect? a). Dystocia b). Fractured ribs c). Placental abruption (abruptio placentae) d). Uterine rupture
Uterine rupture A uterine rupture should be suspected in a pregnant woman who has experienced blunt trauma to the abdomen and then complains of severe pain in her back and shoulder. Uterine rupture occurs when the uterus tears open, leaving the fetus and other uterine contents exposed to the peritoneal cavity. Traumatic rupture can occur in connection with a blunt trauma. Abrupt change in the fetal heart rate pattern is often the most significant sign associated with uterine rupture. Other signs are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous good pain relief from epidural anesthesia. The scenario presented does not indicate fractured ribs from the accident. Placental abruption (abruptio placentae) presents with pain; dark red vaginal bleeding; a rigid, board-like abdomen; hypertonic labor; and fetal distress. Pain has a sudden onset and is constant, and the uterus may not relax well between contractions. Dystocia is the abnormally slow progression of labor, which is not indicated.
The nurse is assisting a primipara in the second stage of labor. The mother has been pushing now for almost 3 hours. The nurse should anticipate planning for: a). augmentation with oxytocin. b). an increase in the epidural medication. c). an operative delivery. d). a variation in pushing technique.
an operative delivery. In the second stage of labor, allowing pushing for at least 3 hours for first births and at least 2 hours for second births is recommended prior to surgical interventions. Extra time may be given for individual circumstances, including epidural anesthesia. Increasing or decreasing the epidural medication will not help. Changes in position or variations in pushing technique are unlikely to be of benefit in facilitating a more rapid birth.
A pregnant client at 42 weeks' gestation is undergoing a scheduled induction of labor based on consideration of which factors? Select all that apply. -fetal size -complete placenta previa -abnormal fetal presentation -cervical ripeness -gestational age
cervical ripeness fetal size gestational age Factors that the care provider should consider when deciding if and when to induce labor include cervical ripeness, gestational age and fetal size, fetal pulmonary maturity, fetal ability to tolerate labor, uterine sensitivity to the proposed induced method, and maternal condition. The health care provider does not confirm abnormal fetal presentation and complete placenta previa when deciding to induce labor. Abnormal fetal presentation and complete placenta previa are considered contraindications to the induction of labor and not as positive factors.
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfunction? a). lack of cervical dilation past 2 cm b). contractions most forceful in the middle of uterus rather than the fundus c). reports of severe back pain d). fetal buttocks as the presenting part
contractions most forceful in the middle of uterus rather than the fundus 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 nurse is reading a journal article about cervical ripening agents, based on the understanding that certain pharmaceuticals can be used to attain cervical ripening in women who need assistance in this area. They have also often continued into labor without further agents to stimulate uterine contractions. Which agent would the nurse anticipate reading about as an FDA-approved agent for cervical ripening? a). magnesium sulfate b). dinoprostone c). misoprostol d). oxytocin
dinoprostone Dinoprostone is approved by the FDA as the only cervical ripening agent to be used; however, the American College of Obstetricians and Gynecologists (ACOG) acknowledges the apparent safety and effectiveness of misoprostol for this purpose as well. It is contraindicated in women with prior uterine scars. It is also known to cause hyperstimulation of the uterus, which can lead to other complications. Magnesium sulfate is used in hygroscopic dilators to assist in a mechanical method of cervical dilation (dilatation).
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). hypotonic contractions b). Braxton Hicks contractions c). uncoordinated contractions d). hypertonic contractions
hypotonic contractions With hypotonic uterine contractions, the number of contractions is unusually infrequent (not more than two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg. Hypertonic uterine contractions are marked by an increase in resting tone to more than 15 mm Hg. However, the intensity of the contraction may be no stronger than that associated with hypotonic contractions. In contrast to hypotonic contractions, these occur frequently and are most commonly seen in the latent phase of labor. Uncoordinated contractions can occur so closely together they can interfere with the blood supply to the placenta. Because they occur so erratically, such as one on top of another and then a long period without any, it may be difficult for a woman to rest between contractions or to breath effectively with contractions. Braxton Hicks contractions are sporadic contractions that occur in pregnancy before the onset of true labor.
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? a). macrosomia b). dystocia c). infection d). hemorrhage
macrosomia Fetal risks associated with a prolonged pregnancy include macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection. Amniotic fluid volume begins to decline by 40 weeks' gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia pose a risk to the mother, not the fetus.
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? a). blood pressure of 130/88 mm Hg b). decreased urine output c). active genital herpes infection d) uterine hypertonicity
uterine hypertonicity The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforces contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion.
A woman in labor with a history of drug and alcohol addiction and no prenatal care has arrived in the emergency department in active labor with cervix 5 cm dilated. An ultrasound shows the fetus in a breech presentation. As a nurse prepares to care for this woman, which assessments indicate the fetus is in distress and needs immediate help to survive? Select all that apply. -fetal heart rate decreasing into the 80s -minimal movement as the fetus descends into the pelvic opening -variable deceleration FHR pattern noted on monitor -meconium staining noted on fluid seeping from vagina -premature rupture of membranes with yellow-green color fluid that smells foul
variable deceleration FHR pattern noted on monitor fetal heart rate decreasing into the 80s Variable deceleration fetal heart rate pattern noted on the monitor signifies a possible prolapsed cord. Low fetal heart rate can be a sign of hypoxia. Meconium staining occurs because of cervical pressure on the buttocks and rectum, not because of fetal anoxia, so it is not a sign of fetal distress. It is normal for the fetus to slow in movement as it makes its way through the birth canal.
