High risk labor and birth

19. The terminology intrauterine inflammation or infection or both or Triple I is now used instead of the term ____________________.

chorioamnionitis

20. The first sign of shoulder dystocia is the ____________________ of the fetal head against the maternal perineum after delivery of the head.

retraction

The nurse is providing care to a patient who is at 41 weeks gestation. Which factor about the patient does the nurse consider as an indication of late-term or post-term pregnancy? 1. Fetus is identified as a male 2. Patient's multiparity status 3. Delivered two babies at 38 weeks 4. History of regular menstruation

ANS 1 Several risk factors for post-term pregnancy have been identified, including carrying a male fetus

4. The nurse is providing care for a patient in the second phase of labor. After more than 4 hours of pushing, the nurse suspects fetal dystocia. Which is the greatest risk related to the nurse's suspected complication? 1. Neonatal asphyxia related to prolonged labor 2. Fetal injury confirmed by the presence of bruising 3. Greater risk for maternal lacerations 4. Increased consideration for a cesarean delivery

ANS 1 The greatest concern related to fetal dystocia is the complication of fetal asphyxia related to a prolonged labor

5. A patient arrives at labor and delivery for the induction labor for her first child. The patient tells the nurse, "I can't believe how easy this is just to pick a day, sign a paper, and have a baby." Which action does the nurse take before the induction process? 1. Call the health care provider to validate patient understanding. 2. Check the patient's chart for an informed consent. 3. Explain the possible complications of induction to the patient. 4. Report an incidence of probable malpractice by the health care provider

ANS 1 The nurse needs to call the health care provider and validate patient understanding about potential risks and complications related to labor induction

15. The nurse is providing care to a patient who is in labor. The patient's membranes rupture spontaneously, and the nurse notices meconium-stained amniotic fluid. Which actions does the nurse immediately perform? Select all that apply. 1. Alert the neonatal team of a possible meconium aspiration neonate. 2. Promote fetal well-being by placing the patient on her left side. 3. Test the stained fluid for percentage of meconium content. 4. Administer oxygen to the mother to help prevent fetal hypoxia. 5. Notify the primary care provider about the presence of meconium

ANS 1, 5 The nurse will immediately inform the neonatal resuscitation team that they may expect a meconium aspiration neonate. It is imperative that resuscitation occur immediately in order to avoid or decrease respiratory complications. The nurse immediately notifies the primary care provider about the meconium-stained amniotic fluid, which may be an indicator of fetal distress

12. When assisting with a vacuum-assisted vaginal delivery, the nurse is aware that adherence to which guidelines for the vacuum device will minimize the nurse's liability in vacuum-assisted vaginal births? Select all that apply. 1. Pump up the vacuum manually to the pressure indicated on the pump. 2. Recognize that cup detachment (pop off) is a warning sign. 3. Understand that pressure should be released between contractions. 4. The procedure is timed from insertion of the cup into the vagina until the birth. 5. The cup should not be on the fetal head for longer than 5 to 10 minutes.

ANS 1,2,3,4 Pump up the vacuum manually to the pressure indicated on the pump, not to exceed 500 to 600 mm Hg. The nurse needs to be aware that cup detachment (pop off) is a warning that too much ineffective force is being exerted on the fetal head. It is important to understand that pressure should be released between contractions; retention of unnecessary pressure increases the risk for fetal injury. The procedure is timed from point of insertion of the cup into the vagina until the birth. If the vacuum-assisted delivery does not occur after three attempts within 15 to 20 minutes, cesarean is indicated

A patient in labor receives high-level regional anesthesia, which inhibits her ability to push during the second state of labor. The primary care provider will use forceps to aid in the delivery of the fetus. Which fetal complications is the nurse aware of being related to a forceps birth? Select all that apply. 1. Intracranial hemorrhage 2. Cephalohematoma 3. Nerve injuries 4. Skin lacerations 5. Skull fracture

ANS 1,2,3,4,5 Intracranial hemorrhage is a possible complication of a forceps delivery and results from pressure on the fetal head by the forceps during birth. Cephalohematoma is a possible complication of a forceps delivery and results from pressure on the head, which causes the rupture of small blood vessels and the collection of blood beneath the scalp. Nerve injuries are a possible complication of a forceps delivery and result from the pulling action of moving the fetus down the birth canal. Skin lacerations are a possible complication of forceps delivery and result primarily during the insertion of the forceps. Skull fracture is a possible complication of a forceps delivery and results from pressure on the fetal skull during insertion of the forceps and/or when exerting pressure during extraction of the fetus.

The nurse is providing care for a patient who is at 42 weeks gestation. The patient's primary care provider is suggesting induction, but the patient is resistant. Which facts can the nurse provide if the patient asks about allowing labor to start spontaneously? Select all that apply. 1. Stillbirth or newborn death increases in pregnancies beyond 42 weeks. 2. There is a greater chance of developing complications because of larger fetal size. 3. Maternal death rate is higher if the pregnancy is continued beyond 42 weeks. 4. Post-term fetuses are prone to developmental delays related to uterine hypoxia. 5. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo.

ANS 1,2,5 One of the greatest concerns about post-term pregnancy is the increased risk of stillbirth or infant death. The fetus who is post-term is most likely to exhibit macrosomia, a condition that contributes to a higher risk for complications associated with both the mother and fetus. Postmature fetuses have decreased subcutaneous fat and lack vernix and lanugo. However, although the nurse can present this as factual information, it is likely to have little influence on the patient's decision.

A patient who is pregnant expresses a desire to attempt a vaginal delivery after a cesarean birth 2 years before. The primary care provider initiates trial of labor after cesarean (TOLAC) and vaginal birth after cesarean (CVAC) screening. The nurse is aware that which patient information will likely disqualify the patient for CVAC? 1. A low transverse uterine scar 2. Cesarean due to pelvic abnormalities 3. First labor needed to be induced 4. Patient asks multiple questions

ANS 2 The fact that the patient had a cesarean for pelvic abnormalities will disqualify her for TOLAC/CVAC; pelvic abnormalities are permanent.

6. The nurse in labor and delivery is preparing to initiate labor induction with the administration of oxytocin. After research about oxytocin, the nurse is aware of which fact about the drug? 1. Hypothalamus stimulation increases circulating oxytocin. 2. Synthetic oxytocin is identical to endogenous oxytocin. 3. The half-life of oxytocin is 1 hour, supporting close monitoring. 4. Action from IV oxytocin administration is less than 1 minute.

ANS 2 The nurse is aware from drug research that synthetic oxytocin is identical to endogenous oxytocin

7. The nurse is providing care for a patient who is admitted for cervical ripening. The health care provider has prescribed the use of a hygroscopic dilator. Which conclusion is the nurse likely to draw from the prescribed method of cervical ripening? 1. This method is quicker than hormonal ripening. 2. The patient has a history of cesarean childbirth. 3. The method may be indicative of fetal demise. 4. This patient is being treated for active herpes

ANS 3 Currently, hygroscopic dilators are used primarily during pregnancy termination rather than for cervical ripening in term pregnancies. Pregnancy termination may be necessary due to fetal demise. 4

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor? 1. Fear promotes feelings of exhaustion. 2. Mothers cannot enjoy the actual birth. 3. Dystocia is associated with extreme fear. 4. Fear during labor causes postpartum depression

ANS 3 Extreme maternal fear or exhaustion can result in catecholamine release interfering with uterine contractility, a condition that will cause dystocia

3. The nurse is providing care for a primip patient in active labor. Cervical dilation has progressed 0.5 cm in 2 hours. Intrauterine pressure catheter reading is 20 mm Hg. Which action does the nurse anticipate next? 1. Rupture of uterine membranes by the nurse 2. Preparation for a cesarean delivery due to signs of fetal distress 3. Augmentation of labor with oxytocin per health care provider's order 4. Medicating the patient with pain medication to promote uterine rest

ANS 3 The action the nurse will anticipate is the augmentation of labor with administration of the prescribed oxytocin

2. The nurse is providing care to a patient who is diagnosed with dystocia related to hypertonic uterine dysfunction. Which medical intervention does the nurse implement for this patient? 1. Explain to the family that the patient needs rest before labor continues. 2. Assist the patient to relax by providing back and neck massage. 3. Administer morphine to decrease contractions and promote uterine rest. 4. Discuss how the patient's fear is interfering with the progression of labor.

ANS 3 The medical intervention of administering a pain medication, such as morphine, will decrease uterine contractions and allow the uterus to rest

16. During a vaginal delivery, the primary care provider notices greenish yellow coloration on the fetal head during crowning. Intrapartum suctioning is performed as soon as the fetus's head is delivered. The nurse understands the aspiration of meconium will have which effects on the neonate's respiratory function? Select all that apply. 1. Result in airway obstruction 2. Contribute to pulmonary hypertension 3. Result in chemical pneumonitis 4. Cause surfactant dysfunction 5. Create strain on cardiac function

ANS: 1, 2, 3, 4 Meconium aspiration syndrome (MAS) will result in airway obstruction, which is relative to the amount and consistency of the aspirated meconium. Due to airway obstruction related to MAS, there is a high risk for the development of pulmonary hypertension. Chemical pneumonitis is inflammation of the bronchial structures of the lungs caused by chemicals and/or substances that are foreign to the lungs. The presence of meconium or the medications used to treat MAS could be sources for the condition. If the meconium is aspirated deeply enough, the air sacs may be coated with the aspirate, which will interfere with the functioning of surfactant

A patient at 34 weeks gestation is in labor with twins. The primary care provider decides the fetuses need to be delivered by cesarean. Which medical and nursing interventions will be in place for this delivery? Select all that apply. 1. Delivery is attended by two medical personnel. 2. The placement of a large-bore IV access is ensured. 3. The usual personnel to attend delivery is arranged. 4. A hospital with a Level II or III nursery is selected. 5. The FHR for the two fetuses is monitored alternately

ANS: 1, 2, 4 For multiple births, either two experienced obstetricians or one obstetrician and a board-certified midwife will attend the delivery. The nurse will make sure that a large-bore IV access is in place for fluid replacement in case of hemorrhage or need for emergency fluid replacement and anesthesia administration Due to the possibilities of fetal distress or need of special care related to immaturity, the cesarean needs to be performed in a hospital with either a Level II or III nursery.

The nurse is attending to a patient who just delivered a term fetus who was stillborn. Which nursing interventions will the nurse use to provide emotional support to the couple? Select all that apply. 1. Express the belief that a little angel was sent to heaven. 2. Cut a lock of the neonate's hair and get foot and hand prints. 3. Ask the parents what name they are giving their baby. 4. Inquire if the patient had any warning of fetal death. 5. Allow parents unlimited time to hold and touch the neonate

ANS: 2, 5 The parents need to have mementoes of the baby. Items may include photographs of the infant, locks of hair, name bracelets, footprints, measuring tape, name certificates, quilts, clothing, poems, or sympathy cards The neonate is wrapped in a blanket and given to the parents to hold and touch for as long as they wish. Other family members may be included as the parents wish

A patient who is at 39 weeks gestation is scheduled for amniotomy. The nurse is aware that which criteria must be met before the procedure? 1. Ultrasound indicates the umbilical cord is away from the cervix. 2. The nurse must have certification to perform the procedure. 3. The fetal head is currently engaged in the maternal pelvis. 4. Prior amniotic fluid leakage must be validated before the procedure

ANS: 3 An important criterion for performing an amniotomy is for the fetal head to be engaged in the maternal pelvis. Lack of engagement will result in a prolonged labor and/or an increased risk for infection

The nurse is assisting the primary care provider with a vacuum-assisted delivery because of a prolonged second stage of labor. The nurse will inform the primary care provider when which guideline of the procedure is met? 1. Extension of the episiotomy is performed. 2. Signs of fetal compromise have resolved. 3. Patient is under full anesthesia status. 4. The "three-pull rule" has been achieved

ANS: 4 The nurse will inform the care provider when the "three-pull rule" guideline for vacuum-assisted delivery has be achieved. There should be a maximum of three attempts for a period of 15 minutes.