Deck 22: Childbirth at Risk: Labor-Related Complications

Question 1

The patient has undergone an ultrasound, which estimated fetal weight at 4,500 g (9 pounds, 14 ounces). Which statement indicates that additional teaching is needed? "Because my baby is big:

A)"I am at risk for excessive bleeding after delivery."
B)"His blood sugars could be high after he is born."
C)"My perineum could experience trauma during the birth."
D)"His shoulders could get stuck and a collar bone broken."

Answer 1

"His blood sugars could be high after he is born."

Question 2

The nurse is making patient assignments for the next shift. Which patient is most likely to experience a complicated labor pattern?

A)34-year-old gravida 6 at 39 weeks' gestation with twins
B)22-year-old gravida 1 at 23 weeks' gestation with ruptured membranes
C)30-year-old gravida 3 at 41 weeks' gestation and estimated fetal weight 7 pounds, 8 ounces
D)43-year-old gravida 2 at 37 weeks' gestation with hypertension

Answer 2

34-year-old gravida 6 at 39 weeks' gestation with twins

Question 3

The patient 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:

A)Start an IV of lactated Ringer's.
B)Apply anti-embolism stockings.
C)Bottle-feed the infant.
D)Send the placenta to pathology.

Answer 3

Start an IV of lactated Ringer's.

Question 4

The nurse is caring for a laboring patient with known cephalopelvic disproportion (CPD). The woman develops tachysystolic labor patterns. Which possible course of treatment should the nurse anticipate?

A)Oxytocin administration
B)Cesarean section
C)Nipple stimulation
D)Amniotomy

Question 5

Two hours ago, the 39-weeks'-gestation patient was 3 cm dilated, 40% effaced, and +1 station. Frequency of contractions was every five minutes with duration 40 seconds and intensity 50 mmHg. The current assessment is 4 cm dilated, 40% effaced, and +1 station. Frequency of contractions is now every three minutes with 40-50 seconds' duration with intensity of 40 mmHg. The priority intervention would be:

A)Begin oxytocin after assessing for CPD.
B)Give Terbutaline to stop the preterm labor.
C)Start oxygen at 8 L/min.
D)Have anesthesia give the patient an epidural.

Question 6

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?

A)Assess the odor of the amniotic fluid.
B)Perform Leopold's maneuver.
C)Obtain an order for pain medication.
D)Complete a sterile vaginal exam.

Question 7

The multiparous patient at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold's maneuver indicates the fetus is in a transverse lie with a shoulder presentation. What physician order is most important?

A)Artificially rupture membranes.
B)Apply internal fetal scalp electrode.
C)Monitor maternal blood pressure every 15 minutes.
D)Alert the surgical team of urgent cesarean.

Question 8

The patient has delivered a 4,200g 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:

A)"Through your rectal mucosa."
B)"Up near your urethra."
C)"Into the muscle layer."
D)"Through your rectal sphincter."

Question 9

A patient who sustained a difficult, lengthy labor and delivery is conversing with the nurse. Suddenly, the patient complains of chest pain and appears dyspneic. She is cyanotic and tachycardic, and her blood pressure has decreased to 78/36. What condition should the nurse suspect is developing?

A)Placenta accreta
B)Infection
C)Hypertensive crisis
D)Amniotic fluid embolus

Question 10

A 20-year-old woman who is pregnant with her first child has been laboring for 14 hours with very minimal progress. Cervical dilatation and effacement are slow, and the nurse is unable to verify engagement of the presenting fetal part. What condition should the nurse suspect may be affecting the patient's labor?

A)Cephalopelvic disproportion (CPD)
B)Prolapsed cord
C)Placenta accreta
D)Occiput anterior (OA) fetal position

Question 11

The primiparous patient is at 42 weeks' gestation. What order should the nurse question?

A)Obtain biophysical profile today.
B)Begin nonstress test now.
C)Schedule labor induction for tomorrow.
D)Return to the clinic in one week.

Question 12

The nurse should anticipate the labor pattern for a fetal occiput posterior position to be:

A)Shorter than average during the latent phase.
B)Prolonged with regard of the overall length of labor.
C)Rapid during transition.
D)Precipitous.

Question 13

The multiparous patient at 33 weeks has experienced an intrauterine fetal demise. What finding requires immediate intervention?

A)Temperature 99.0°F
B)Platelet count 210,000/cmm
C)Fibrinogen level 50 mg/dL
D)Family refusing fetal autopsy

Question 14

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

A)Primip at 24 weeks diagnosed with polyhydramnios: "Patient reporting shortness of breath."
B)Multip at 32 weeks: "Oligohydramnios per ultrasound secondary to fetal renal agenesis."
C)Primip at 41 weeks: "Patient reports leaking clear fluid from her vagina for seven hours."
D)Multip at 34 weeks diagnosed with oligohydramnios: "Cervix 6 cm, −2 station, up to walk in hallway."

Question 15

The laboring patient has experienced spontaneous rupture of membranes. The fluid is meconium-stained. The fetal heart tones are 100-105. Which nursing action is most important?

A)Change the mother's position from Fowler's to left lateral.
B)Insert a Foley catheter with the assistance of another nurse.
C)Notify the surgical team of an impending cesarean.
D)Decrease the IV of lactated Ringer's solution to 50 ml/hour.