Question 1

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?

Accepted Answer

Administering morphine can help decrease the intensity of contractions and promote uterine rest, which is appropriate for managing hypertonic uterine dysfunction.

Question 2

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.

Accepted Answer

A) Delivery of twins via cesarean section usually requires at least two medical personnel to be present.
B) The placement of a large-bore IV access is typically ensured for cesarean section deliveries to allow for quick administration of emergency medications or fluids if needed.
C) The usual personnel to attend delivery may not be sufficient for this particular delivery as twins being delivered by cesarean section require additional support.
D) A hospital with a Level II or III nursery is necessary in case either or both of the newborns require further medical attention.
E) The FHR for the two fetuses is monitored simultaneously, not alternately, during a cesarean section delivery.

Question 3

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?

Accepted Answer

The "three-pull rule" is a guideline for vacuum-assisted deliveries, indicating that if the baby is not delivered after three pulls with the vacuum, alternative methods of delivery should be considered to ensure the safety of both the mother and the baby.

Question 4

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

Accepted Answer

The answer of The terminology intrauterine inflammation or infection or...

Question 5

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?

Accepted Answer

Prolonged labor due to fetal dystocia can lead to neonatal asphyxia, as the fetus may not receive adequate oxygen during extended periods of pushing.

Question 6

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?

Accepted Answer

The nurse must validate the patient's understanding of the induction process before proceeding.

Question 7

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.

Accepted Answer

The nurse should alert the neonatal team and notify the primary care provider immediately due to the risk of meconium aspiration syndrome in the newborn.

Question 8

The nurse is teaching a prenatal class. For which reason does the nurse emphasize the importance of managing maternal fear during labor?

Accepted Answer

Dystocia, or difficult labor, is associated with extreme fear. Managing maternal fear during labor can help prevent or minimize the risk of dystocia.

Question 9

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.

Accepted Answer

A) Stillbirth or newborn death risk does increase in pregnancies that extend beyond 42 weeks due to various factors including placental aging.B) A larger fetal size, which is more likely in post-term pregnancies, can lead to complications during labor and delivery, such as shoulder dystocia.E) Postmature fetuses, those born after 42 weeks of gestation, often have decreased subcutaneous fat and may lack the protective coatings of vernix and lanugo, which can lead to skin issues and temperature regulation problems.

Question 10

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?

Accepted Answer

Hygroscopic dilators are used for cervical ripening in various situations, including when induction of labor is necessary. One scenario where they might be specifically chosen is in the case of fetal demise, where labor needs to be induced for a stillbirth. Unlike methods used for live births, such as prostaglandins or mechanical methods like the Foley bulb, hygroscopic dilators can be a preferred choice in managing fetal demise due to their ability to gently dilate the cervix without inducing strong contractions that could be distressing in these circumstances.

Question 11

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.

Accepted Answer

Cutting a lock of hair and obtaining foot and hand prints provide a tangible memory for the parents. Allowing the parents unlimited time to hold and touch the neonate helps them to bond with the baby and say goodbye. It is not appropriate for the nurse to express personal beliefs about religious ideas or ask the parents about any warning signs of fetal death as this may be perceived as insensitive. However, the nurse can ask the parents for the baby's name, as it acknowledges the baby's existence and individuality.

Question 12

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

Accepted Answer

The answer of The first sign of shoulder dystocia is...

Question 13

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.

Accepted Answer

Forceps used during delivery can lead to various fetal complications due to the pressure and manipulation involved. These complications include intracranial hemorrhage, cephalohematoma (a type of hemorrhage that occurs underneath the cranial bones), nerve injuries (such as facial nerve palsy), skin lacerations, and skull fractures. Each of these complications is directly related to the mechanical forces applied by the forceps on the fetus during delivery.

Question 14

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?

Accepted Answer

With slow cervical dilation and an intrauterine pressure catheter reading of 20 mm Hg, the health care provider may order augmentation of labor with oxytocin to help increase contractions and facilitate cervical dilation. Rupturing the membranes may also be an option to augment labor, but it is not the best choice based on the information provided. Cesarean delivery is not indicated based on the information given. Pain medication may be administered to provide comfort during labor, but it would not promote uterine rest.

Question 15

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?

Accepted Answer

The answer of The nurse is providing care to a...

Question 16

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.

Accepted Answer

A) Pumping up the vacuum manually to the indicated pressure ensures that the device is used within its safe operational parameters, minimizing the risk of injury to the mother or infant and reducing liability.B) Recognizing that cup detachment (pop-off) is a warning sign is crucial for preventing injury. It may indicate improper placement or excessive traction force, both of which can lead to complications.C) Releasing pressure between contractions is important to minimize the risk of scalp injury or other harm to the fetus, adhering to safe practice guidelines.D) Timing the procedure from the insertion of the cup to the birth is important for monitoring the duration of vacuum application, ensuring it does not exceed recommended time limits to prevent fetal distress or injury.

Question 17

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.

Accepted Answer

Aspiration of meconium during vaginal delivery can lead to airway obstruction, contribute to pulmonary hypertension, result in chemical pneumonitis, and cause surfactant dysfunction, all of which can negatively impact the neonate's respiratory function. There is limited evidence to suggest that meconium aspiration could create strain on cardiac function, but this is not commonly reported.

Question 18

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?

Accepted Answer

A history of cesarean due to pelvic abnormalities, such as a contracted pelvis or severe cephalopelvic disproportion, is considered a contraindication to attempting a vaginal birth after cesarean (VBAC) due to increased risk of uterine rupture. A low transverse uterine scar is ideal for VBAC, as it is associated with a lower risk of uterine rupture. The need for induction during the previous labor or the patient asking multiple questions are not relevant factors in determining eligibility for VBAC.

Question 19

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?

Accepted Answer

Synthetic oxytocin, also known as Pitocin, is a medication used to induce or augment (speed up) labor. It is identical in structure and function to the naturally occurring hormone oxytocin.

Question 20

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?

Accepted Answer

The fetal head should be engaged in the maternal pelvis to reduce the risk of umbilical cord prolapse during amniotomy.

Quiz 10: High-Risk Labor and Birth