Question 1

There are five patients in active labor in the labor unit. Which women should the nurse monitor carefully for the potential of uterine rupture?

Accepted Answer

The answer of There are five patients in active labor...

Question 2

The patient at term has a suspected small pelvis. The fetus has an estimated weight of 4200 g (9 pounds 4 ounces). Spontaneous labor has begun, and the patient is now at 6 cm. The nurse understands that the most important nursing action for this patient is to:

Accepted Answer

Assisting the patient to squat during the second stage can help widen the pelvic outlet, facilitating the delivery of a large baby through a small pelvis.

Question 3

A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 beats/min. Her membranes rupture spontaneously, and the FHR drops to 90 beats/min with variable decelerations. The initial response from the nurse would be to:

Accepted Answer

The answer of A primigravida is admitted to the birth...

Question 4

In caring for a patient with a uterine rupture, the nurse determines which nursing diagnoses to be appropriate?

Accepted Answer

A uterine rupture can lead to a significant risk for impaired gas exchange, as the rupture may cause bleeding and compromise the patient's respiratory function. Fear and anxiety are also appropriate nursing diagnoses, as the patient may be afraid of the potential consequences of the rupture and uncertain about what lies ahead in terms of their medical care. Impaired coping is also appropriate, as the patient may struggle to manage the stress and emotional impact of this traumatic event. Impaired physical mobility may not be relevant in this particular case, as the rupture is not specifically related to the patient's ability to move or be mobile.

Question 5

The client delivered thirty minutes ago. Her blood pressure and pulse are stable. Scant vaginal bleeding is taking place. The nurse should prepare for which procedure?

Accepted Answer

Given the information that the client has stable vital signs and scant vaginal bleeding after delivery, the nurse should prepare for manual removal of the placenta. This suggests that the placenta may not have been delivered yet, which can lead to complications if not addressed.

Question 6

During labor, the patient at 4 cm suddenly becomes dyspneic, cyanotic, and hypotensive. The nurse must prepare or arrange immediately for:

Accepted Answer

The answer of During labor, the patient at 4 cm...

Question 7

The 26-year-old primiparous patient is having her initial prenatal appointment. The patient reports to the nurse that she suffered a pelvic fracture in a car accident 3 years ago. The patient asks whether her pelvic fracture might affect her ability to have a vaginal delivery. What response by the nurse is best?

Accepted Answer

The nurse can provide initial information by stating that it depends on how the patient's pelvis healed. Further assessment by the healthcare provider will be necessary to determine if a vaginal delivery is feasible or if a cesarean birth is necessary. The nurse can also educate the patient on the different factors that can affect vaginal delivery, such as baby size and position. It is important for the patient to discuss her medical history with her doctor and to follow their recommendations for a safe delivery. Simply telling the patient that she will or will not be able to deliver vaginally without further assessment could be inappropriate and potentially harmful.

Question 8

The nurse caring for a patient in labor anticipates fetal macrosomia and shoulder dystocia. Appropriate management of shoulder dystocia is essential in order to prevent which fetal complications?

Accepted Answer

Shoulder dystocia is a birth emergency where one or both of the baby's shoulders get stuck inside the mother's pelvis during delivery. This situation can lead to several complications for the baby, including brachial plexus injury (damage to the nerves that supply the arms and hands), fractured clavicle (due to excessive force applied to free the shoulder), asphyxia (lack of oxygen due to delayed delivery), and neurological damage (resulting from asphyxia or direct trauma). Puerperal infection is a maternal complication, not a fetal one, and is not directly related to shoulder dystocia.

Question 9

The patient has delivered a 4200g fetus. The physician performed a midline episiotomy, which extended into a third-degree laceration. The patient asks the nurse where she tore. Which response is best? "The episiotomy extended and tore:

Accepted Answer

A third-degree laceration involves the vaginal tissue, perineal skin, and extends through the perineal muscles and the anal sphincter, but not the rectal mucosa.

Question 10

A fetal weight is estimated at 4490 grams in a gravida 1 at 38 weeks' gestation. Counseling should occur before labor regarding the:

Accepted Answer

With a estimated fetal weight of 4490 grams, this fetus is considered macrosomic and increases the risk of shoulder dystocia during delivery. Due to this increased risk, the likelihood of a cesarean delivery should be discussed with the patient before labor.

Question 11

The client has delivered a 4200 g fetus. The physician performed a midline episiotomy, which extended into a third-degree laceration. The client asks the nurse where she tore. Which response is best? "The episiotomy extended and tore

Accepted Answer

A third-degree laceration involves the anal sphincter complex, which means the episiotomy extended through the rectal sphincter.

Question 12

A woman has been in labor for 16 hours. Her cervix is dilated to 3 cm and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect:

Accepted Answer

The prolonged labor with minimal cervical change indicates a potential issue with the size of the maternal pelvis compared to the fetal head, also known as cephalopelvic disproportion (CPD). The lack of engagement of the fetal presenting part further suggests this possibility. Breech malpresentation, fetal demise, and abruptio placentae would likely present with different signs and symptoms.

Question 13

The charge nurse is reviewing charting on patients in the maternal-child triage unit. Which entry requires immediate intervention?

Accepted Answer

The entry for the multip at 34 weeks with oligohydramnios and a cervix dilated to 6 cm requires immediate intervention because she is in active labor preterm, and walking in the hallway could lead to rapid progression of labor, which needs to be closely monitored in a controlled environment.

Question 14

After delivery, it is determined that there is a placenta accreta. Which intervention should the nurse anticipate?

Accepted Answer

Placenta accreta occurs when the placenta attaches too deeply into the uterine wall, making it difficult to separate during delivery. In severe cases, a hysterectomy may be necessary to prevent life-threatening hemorrhage. Oxygen, antibiotics, and oxytocin may be used in the postpartum period for various other reasons, but are not specific to placenta accreta.

Question 15

The nurse examines the patient's placenta and finds that the umbilical cord is inserted at the placental margin. The patient comments that the placenta and cord look different than they did for her first two births. The nurse should explain that this variation in placenta and cord is called a:

Accepted Answer

Battledore placenta refers to the condition where the umbilical cord is inserted at or near the margin of the placenta, rather than in the center. This is a variation from the typical central insertion seen in most pregnancies.

Question 16

The nurse is caring for a gravida 5 in active labor. The membranes spontaneously rupture, with a large amount of clear amniotic fluid. Which nursing action is most important to undertake at this time?

Accepted Answer

A sterile vaginal exam is crucial to assess for umbilical cord prolapse or fetal position after the rupture of membranes, especially in a multiparous woman.

Question 17

On assessment, a labor patient is noted to have frothy sputum, a heart rate of 110, and a large amount of continuous vaginal bleeding. The nurse should suspect:

Accepted Answer

An amniotic fluid embolus can present with symptoms such as frothy sputum (due to pulmonary edema), tachycardia, and hemorrhage, which are consistent with the patient's presentation.

Question 18

The nurse is caring for a patient who could be at risk for uterine rupture. The nurse is monitoring the fetus closely for:

Accepted Answer

The answer of The nurse is caring for a patient...

Question 19

The client gave birth to a 7 pound, 14 ounce female 30 minutes ago. The placenta has not yet delivered. Manual removal of the placenta is planned. The nurse should prepare to:

Accepted Answer

Starting an IV of lactated Ringer's is important for the manual removal of the placenta as it helps to prevent hypovolemia and maintain hydration.

Question 20

The patient delivered 30 minutes ago. Her blood pressure and pulse are stable. Vaginal bleeding is scant. The nurse should prepare for which procedure?

Accepted Answer

Given the context of recent delivery and the absence of significant bleeding or instability, the most likely procedure to prepare for is the manual removal of the placenta. This is indicated if the placenta has not been delivered spontaneously within a certain time frame after childbirth, suggesting it may be retained.

Quiz 27: Childbirth at Risk: Labor-Related Complications