O'Meara Prep U Ch: 22
The nurse performs a vaginal exam on a mother in active labor. The cervix has dilated to 5 cm but the fetal head remains at a -2 station. The nurse interprets these findings as
pelvic dystocia.
A biophysical profile has been completed on a pregnant woman. The nurse interprets which score as normal
9
A client appears to be resting comfortably 12 hours after giving birth to her first child. In contrast, she labored for more than 24 hours, the primary care provider had to use forceps to deliver the baby, and she had multiple vaginal examinations during labor. Based on this information what postpartum complication is the client at risk for developing
infection
A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate
providing a comfortable environment with dim lighting
Four hours after delivery a mother suddenly complains of not being able to breathe and is gasping for breath. The nurse administers oxygen and calls for help. Which type of oxygen delivery device would be most appropriate for the nurse to utilize
Nonrebreather mask
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)
The nurse is caring for a laboring mother. The mother continues to complain of back pain. The nurse instructs the mother the pain is occurring because the fetus is in which position
Occiput posterior
Which statement by the nurse would be considered inappropriate when comforting a family who has experienced a stillborn infant
"I know you are hurting, but you can have another baby in the future."
The experienced labor and birth nurse knows to evaluate progress in active labor by using which simple rule
1 cm/hour for cervical dilation
The nursing student demonstrates an understanding of dystocia with which statement
Dystocia is diagnosed after labor has progressed for a time.
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
A 39-year-old multigravida with diabetes presents at 32 weeks' gestation reporting she has not felt movement of her fetus. Assessment reveals the fetus has died. The nurse shares with the mother that the institution takes pictures after the birth and asks if she would like one. What is the best response if the mother angrily says no and starts crying
Tell her that the hospital will keep the photos for her in case she changes her mind.
The nurse is caring for a client who underwent a cesarean birth 24 hours ago. Which assessment finding indicates the need for further action
The fundus is located 2 fingerbreadths above the umbilicus.
The nurse is assisting with a G2P1, 24-year-old client who has experienced an uneventful pregnancy and is now progressing well through labor. Which action should be prioritized after noting the fetal head has retracted into the vagina after emerging
Use McRoberts maneuver.
A woman experiences an amniotic fluid embolism as the placenta is delivered. The nurse's firstaction would be to
administer oxygen by mask.
The nursing student doing a rotation in obstetrics is talking to her preceptor about dystocia. She asks what is meant by the term "expulsive forces," better known as the "powers." The preceptor correctly tells her that the "powers" include which factors? Select all that apply
c) position d) fetal development e) presentation
The mother has suffered an amniotic fluid embolism. She has a sudden onset of tachycardia, weak thready pulses, is pale and diaphoretic. The nurse recognizes these symptoms as
cardiogenic shock.
A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect
uterine rupture
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 which can prolong labor. Which compounds is the nurse referring to in the explanation
Catecholamines Rationale: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.
The mother comes to her prenatal appointment. She tells the nurse that it feels like the baby is kicking on her bladder and it is harder to breathe. The nurse suspects the fetus is in breech position. Which procedure would the nurse implement to determine the position of the baby
Leopold maneuvers
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 16-year-old client has been in the active phase of labor for 14 hours. An ultrasound reveals that the likely cause of delay in dilation (dilatation) is cephalopelvic disproportion. Which intervention should the nurse most expect in this case
cesarean birth
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
hypotonic contractions
A woman is in the hospital only 15 minutes when she begins to give birth precipitously. The fetal head begins to emerge as the nurse walks into the labor room. The nurse's best action would be to
place a hand gently on the fetal head to guide birth.
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 an "arrested descent." The woman asks, "Why is this happening?" Which response is the best answer to this question
"More than likely you have cephalopelvic disproportion (CPD) where baby's head cannot make it through the canal."
The nurse is teaching an antepartum class to first-time mothers. A mother asks the nurse if she should stay in bed when her contractions start. How should the nurse respond
"No, walking actually shortens the first stage of labor."
The nurse is caring for a client who underwent a cesarean birth one day ago. After listening to the nurse's discussion about the plan of care, the client indicates that she is in a great deal of pain and does not wish to ambulate until the next day. What response by the nurse is most appropriate
"Walking is the best way to prevent complications such as blood clots."
The nurse is to administer 3 million units penicillin G to a laboring mother as group B streptococcus (GBS) prophylaxis every 4 hours. The medication label states there are 3 million units of penicillin G in 50 mL D5W. The medication should infuse over 60 minutes. How many mL/hr should the nurse set the pump to deliver each dose of this medication
50ml/hr
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 evaluating care provided to a patient giving birth to her first child. Which outcome regarding labor indicates that care has been effective
Client achieved 4 cm of dilation after 7 hours of labor.
The fetus of a pregnant patient is in a breech presentation. Where will the nurse auscultate fetal heart sounds
High in the abdomen
A woman with class II heart disease is experiencing an uneventful pregnancy and is now prescribed bed rest at 36 weeks' gestation by her health care provider. The nurse should point out that this is best accomplished with which position
Lie in a semi-recumbent position.
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 priorityfetal assessment the health care provider should focus on at this time
Look for late decelerations on monitor, which is associated with fetal anoxia.
A laboring client has been pushing without delivering the fetal shoulders. The primary care provider determines the fetus is experiencing shoulder dystocia. What intervention can the nurse assist with to help with the birth
McRoberts maneuver
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 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
Uterine contractions are weak and ineffective.
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 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
Uterine rupture
The nurse is evaluating the fetal heart rate rhythm strip and determines that the amplitude varies with a rate 15 to 20 beats/min. What does this assessment finding indicate to the nurse about variability
Variability is normal.
A client is experiencing shoulder dystocia during birth. The nurse would place priority on performing which assessment postbirth
brachial plexus assessment
Which intervention would be most important when caring for the client with breech presentation confirmed by ultrasound
continuing to monitor maternal and fetal status
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
It is necessary for the mother to have a forceps delivery. To reduce complications from this procedure, the nurse should:
empty the mother's bladder.
The nurse is monitoring the uterine contractions of a woman in labor. The nurse determines the woman is experiencing hypertonic uterine dysfunction based on which contraction finding
erratic.
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
A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration
fourth degree
During a difficult labor of an infant in the face presentation, the nurse notes the infant has a large amount of facial edema with bruising and ecchymosis. Which assessment would be the priority for this infant
patent airway
A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer
uterine stimulants
