Question 1

Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant?

Accepted Answer

The infant should be assessed for bruising or abrasions at the site of application,facial palsy,and subdural hematoma.Prophylactic antibiotics are not necessary with a forceps delivery.A cold pack would place the infant at risk for cold stress and is contraindicated.Measuring the circumference of the head is part of the initial nursing assessment.

Question 2

Indications for a primary cesarean birth are often nonrecurring.Therefore,a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC).Which clients would be less likely to have a successful VBAC?
(Select all that apply).

Accepted Answer

Indications for a low success rate for a VBAC delivery include a short interpregnancy interval,non-Caucasian race,gestational age longer than 40 weeks,maternal obesity,preeclampsia,fetal weight greater than 4000 g,and delivery at a rural or private hospital.

Question 3

What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?

Accepted Answer

Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytic therapy.Once the pregnancy has reached 34 weeks,however,the risks of tocolytic therapy outweigh the benefits.Important maternal contraindications to tocolytic therapy exist.Tocolytic-induced edema can be caused by IV fluids.

Question 4

A client at 39 weeks of gestation has been admitted for an external version.Which intervention would the nurse anticipate the provider to order?

Accepted Answer

A tocolytic drug will relax the uterus before and during the version,thus making manipulation easier.CST is used to determine the fetal response to stress.A local anesthetic is not used with external version.Although the bladder should be emptied,catheterization is not necessary.

Question 5

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus.The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction.What are appropriate indications for induction? (Select all that apply?)

Accepted Answer

The conditions listed are all acceptable indications for induction.Other conditions include intrauterine growth restriction (IUGR),maternal-fetal blood incompatibility,hypertension,and placental abruption.Elective inductions for the convenience of the woman or her provider are not recommended; however,they have become commonplace.Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance.Elective delivery should not occur before 39 weeks of completed gestation.

Question 6

When would an internal version be indicated to manipulate the fetus into a vertex position?

Accepted Answer

Internal version is used only during a vaginal birth to manipulate the second twin into a presentation that allows it to be vaginally born.For internal version to occur,the cervix needs to be completely dilated.

Question 7

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions.What clinical cues alert the nurse that the woman is experiencing uterine hyperstimulation?
(Select all that apply).

Accepted Answer

Uterine contractions that occur less frequently than 2 minutes apart and last longer than 90 seconds,a uterine tone over 20 mm Hg,and a nonreassuring FHR and pattern are indications of uterine hyperstimulation with oxytocin administration.Uterine contractions that occur more frequently than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction.A uterine tone less than 20 mm Hg is normal.

Question 8

What are the complications and risks associated with cesarean births?
(Select all that apply).

Accepted Answer

Pulmonary edema,wound dehiscence,hemorrhage,urinary tract infections,and fetal injuries are possible complications and risks associated with cesarean births.

Question 9

What is a maternal indication for the use of vacuum-assisted birth?

Accepted Answer

A mother who is exhausted may be unable to assist with the expulsion of the fetus.The client with a wide pelvic outlet will likely not require vacuum extraction.With a rapid delivery,vacuum extraction is not necessary.A station of 0 is too high for a vacuum-assisted birth.

Question 10

Women who are obese are at risk for several complications during pregnancy and birth.Which of these would the nurse anticipate with an obese client?
(Select all that apply).

Accepted Answer

A breech presentation is not a complication of pregnancy or birth for the client who is obese.Venous thromboembolism is a known risk for obese women.Therefore,the use of thromboembolism-deterrent (TED)hose and sequential compression devices may help decrease the chance for clot formation.Women should also be encouraged to ambulate as soon as possible.In addition to having an increased risk for complications with a cesarean birth,in general,obese women are also more likely to require an emergency cesarean birth.Many obese women have a pannus (i.e.,large roll of abdominal fat)that overlies a lower transverse incision made just above the pubic area.The pannus causes the area to remain moist,which encourages the development of infection.Obese women are more likely to begin pregnancy with comorbidities such as hypertension and type 2 diabetes.

Quiz 32: Labor and Birth Complications

Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant?

Indications for a primary cesarean birth are often nonrecurring.Therefore,a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC) .Which clients would be less likely to have a successful VBAC? (Select all that apply) .

What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?

A client at 39 weeks of gestation has been admitted for an external version.Which intervention would the nurse anticipate the provider to order?

When would an internal version be indicated to manipulate the fetus into a vertex position?

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions.What clinical cues alert the nurse that the woman is experiencing uterine hyperstimulation? (Select all that apply) .

What are the complications and risks associated with cesarean births? (Select all that apply) .

What is a maternal indication for the use of vacuum-assisted birth?

Women who are obese are at risk for several complications during pregnancy and birth.Which of these would the nurse anticipate with an obese client? (Select all that apply) .