Exam 1: Chapter 22 Complications Ocurring DURING Labor and Delivery

A woman develops a pathologic retraction ring during labor. On assessment, you would expect to find its appearance as which? A) A mottling surrounding the cervix. B) An ecchymotic area over the symphysis pubis. C) A line of indentation over the lower abdomen. D) A protrusion over the uterine fundus.

A) A mottling surrounding the cervix.

The nurse is requested to assist the physician with an external version. What intervention should the nurse perform prior to and immediately after the external version? A) A nonstress test B) An electrocardiogram C) Administer tocolytics D) Administer a narcotic analgesic

A) A nonstress test

A nurse is providing care to a couple who have experienced intrauterine fetal demise.Which action would be least effective in assisting a couple at this time? A) Avoid any discussion of the situation with the couple. B) Allow the couple to spend as much time as they want with their stillborn infant. C) Give the parents a lock of the infant's hair. D) Assist the family in making arrangements for their stillborn infant.

A) Avoid any discussion of the situation with the couple.

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) 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 is caring for a client who is experiencing acute onset of dyspnea and hypotension. The health care provider suspects the client has amniotic fluid embolism. What other signs or symptoms would alert the nurse to the presence of this condition in the client? Select all that apply A) cyanosis B) arrhythmia C) hyperglycemia D) hematuria E) pulmonary edema

A) cyanosis E) pulmonary edema The nurse should monitor cyanosis and pulmonary edema when caring for a client with amniotic fluid embolism. Other signs and symptoms of this condition include hypotension, cyanosis, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest. Arrhythmia, hematuria, and hyperglycemia are not known to occur in cases of amniotic fluid embolism. Hematuria is seen in clients having uterine rupture.

The nursing student correctly identifies which risk factors for developing dystocia? Select all that apply A) epidurals B) excessive analgesia C) multiple gestation D) maternal exhaustion E) maternal diabetes F) high fetal station at complete cervical dilation G) shoulder dystocia

A) epidurals B) excessive analgesia C) multiple gestation D) maternal exhaustion F) high fetal station at complete cervical dilation G) shoulder dystocia Early identification and prompt interventions for dystocia are essential to minimize risk to the woman and fetus. Factors associated with increased risk for dystocia include epidurals, excessive analgesia, multiple gestations, maternal exhaustion, ineffetive pushing technique, longer first stage of labor, fetal birth weight, maternal age of >35, ineffective uterine contractions, and high fetal station at complete cervical dilation.

A nurse is caring for an antenatal mother diagnosed with umbilical cord prolapse. For which should the nurse monitor the fetus? A) fetal hypoxia B) preeclampsia C) coagulation defects D) placental pathology

A) fetal hypoxia

A client has arrived to the birthing center in labor, requesting a VBAC. The nurse knows that she would be a good candidate after reading the client's previous history based on which finding? A) has previous lower abdominal incision B) had prior classic uterine incision C) had prior transfundal uterine surgery D) has contracted pelvis

A) has previous lower abdominal incision

A nurse is providing care to a multiparous client. The client has a history of cesarean births. The nurse anticipates the need to closely monitor the client for which condition? A) placenta accreta B) placenta abruption C) preeclampsia D) oligohydramnios

A) placenta accreta

After teaching a couple about what to expect with their planned cesarean birth, which statement indicates the need for additional teaching? A) "Holding a pillow against my incision will help me when I cough." B) "I'm going to have to wait a few days before I can start breastfeeding." C) "I guess the nurses will be getting me up and out of bed rather quickly." D) "I'll probably have a tube in my bladder for about 24 hours or so."

B) "I'm going to have to wait a few days before I can start breastfeeding."

A woman arrives in the L & D unit in the beginning early phase with her contractions 5 to 8 minutes apart and dilated 1 cm. Thirty minutes later the nurse finds the woman in hard, active labor and 8 cm dilated. The nurse calls for assistance, prepares for a precipitate birth, and monitors the woman for which priority assessment caused by a rapid birth? A) Assess bladder for fullness. B) Check perineal area frequently for bleeding. C) Assess the woman's breathing and intervene if necessary. D) Assess and administer pain medication as needed.

B) Check perineal area frequently for bleeding.

The nurse is receiving shift handoff for a client with dystocia. Which nursing interventions are most appropriate in the plan of care? Select all that apply A) Bedrest in the side- lying position B) Nipple stimulation C) Administration of an enema D) Administration of a tocolytic E) Emotional support

B) Nipple stimulation C) Administration of an enema E) Emotional support

A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? A) less than 5 hours B) less than 3 hours C) less than 4 hours D) less than 8 hours

B) less than 3 hours

When caring for a client requiring a forceps-assisted birth, the nurse would be alert for: A) increased risk for uterine rupture. B) potential lacerations and bleeding. C) increased risk for cord entanglement. D) damage to the maternal tissues.

B) potential lacerations and bleeding.

Mrs. Carter is admitted to the labor and birth unit. The lab results of her cervical culture for group B streptococcal were positive. What priority intervention will be initiated? A) Preparation for cesarean section to prevent exposure of the baby. B) Observation of the baby in newborn intensive care unit for 72 hours. C) Ampicillin or cefazolin intravenous is given before delivery. D) Culture of mother and baby within 24 hours after birth.

C) Ampicillin or cefazolin intravenous is given before delivery.

A patient who comes to the emergency department states that she has not felt any fetal movement for several days. The physician who cannot hear a heartbeat suspects fetal death. Once fetal death is confirmed by ultrasound, the physician immediately induces labor. Why is it important in this case to induce labor as soon as possible? A) to lessen the grief B) to distract the patient C) to prevent coagulopathy D) to prevent infection

C) to prevent coagulopathy

A nurse is reading a journal article about cesarean births and the indications for them. Place the indications for cesarean birth below in the proper sequence from most frequent to least frequent. All options must be used. A. Fetal malpresentation B. Multiple gestation C. Labor dystocia D. Abnormal fetal heart rate tracing E. Suspected macrosomia

C. Labor dystocia D. Abnormal fetal heart rate tracing A. Fetal malpresentation B. Multiple gestation E. Suspected macrosomia

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) Bolus the client with another dose of medication through the epidural. B) Place the client in a knee—chest position. C) Turn the client on her left side. D) Prepare the client for a cesarean birth.

D) 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 good 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.

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) Include a set of piper forceps when the table is prepped. B) Apply pressure to the woman's lower back with a fisted hand. C) Assist with Nitrazine and fern tests. D) Prepare to assist with external version.

D) Prepare to assist with external version.

A woman in active labor with a history of two previous cesarean births is being monitored frequently as she tries to have a vaginal birth. Suddenly, the woman grabs the nurse's hand and states, "Something inside me is tearing." The nurse notes her blood pressure is 80/50 mm Hg, pulse rate 130mbpm 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? A) compression on the inferior vena cava B) an amniotic embolism to the lungs C) an undiagnosed abdominal aorta aneurysm D) uterine rupture

D) uterine rupture