Deck 27: Childbirth at Risk: Labor-Related Complications

Question 1

A client has just given birth. During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to occiput presentation, and was delivered vaginally with vacuum extractor assistance. The nurse should explain to the parents that:

A) The infant will need to be observed for meconium aspiration.
B) Molding of the head will subside in a few days.
C) The infant will have prophylactic antibiotics.
D) Breastfeeding will need to be delayed for a day or two.

Answer 1

Molding of the head will subside in a few days.

Question 2

A nurse is comparing the advantages of active management of labor (AMOL) with a less interventional approach. The nurse knows that the goal of AMOL is:

A) Preventing protracted labor and arrest of progress.
B) Preventing infection from prolonged rupture of membranes.
C) Detecting and intervening in cases of precipitous labor.
D) Relieving the anxiety and fear accompanying labor.

Answer 2

Preventing protracted labor and arrest of progress.

Question 3

During labor, the fetus was in a brow presentation, but after a prolonged labor, the fetus converted to face presentation and was delivered vaginally with forceps assist. The nurse should explain to the parents that:

A) The infant will need to be observed for meconium aspiration.
B) Facial edema and head molding will subside in a few days.
C) The infant will be given prophylactic antibiotics.
D) Breastfeeding will need to be delayed for a day or two.

Answer 3

Facial edema and head molding will subside in a few days.

Question 4

A pregnant patient was in an auto accident. She presents to the labor suite from the emergency department, where she presented with a deep gash to her forearm. She had no seat belt on and was traveling at a high rate of speed. She seems very agitated, is walking continuously, and is talking very rapidly. The nurse should suspect that the patient has what type of psychological disorder?

A) Schizophrenia
B) Bipolar, manic phase
C) Social anxiety disorder
D) Obsessive-compulsive disorder

Question 5

A woman has been having contractions since 4 a.m. At 8 a.m., her cervix is dilated to 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, the nurse would anticipate preparing for:

A) Oxytocin induction of labor.
B) Amnioinfusion.
C) Increased intravenous infusion.
D) Cesarean section.

Question 6

A patient delivers within 3 hours of the onset of labor. Which of the potential maternal risks should the nurse consider when planning her care?

A) Postpartum hemorrhage
B) Macrosomic fetus
C) Oligohydramnios
D) Abruptio placentae
E) Lacerations of the cervix

Question 7

The multiparous patient at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold's maneuvers indicate the fetus is in a transverse lie with a shoulder presentation. Which 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 surgical team of urgent cesarean.

Question 8

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

Question 9

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 as regards the overall length of labor.
C) Rapid during transition.
D) Precipitous.

Question 10

The nurse knows that the maternal risks associated with postterm pregnancy include:

A) Polyhydramnios.
B) Small-for-gestational-age infant.
C) Large-for-gestational-age infant.
D) Forceps-assisted delivery.
E) Perineal damage.

Question 11

Two hours ago, a patient at 39 weeks' gestation was 3 cm dilated, 40% effaced, and +1 station. Frequency of contractions was every 5 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 3 minutes with 40-50 seconds' duration and intensity of 40 mmHg. The priority intervention would be:

A) Beginning oxytocin after assessing for CPD.
B) Giving terbutaline to stop the preterm labor.
C) Starting oxygen at 8 L/min.
D) Having the anesthesiologist give the patient an epidural.

Question 12

Which of the following potential problems would the nurse consider when planning care for a patient with a persistent occiput posterior position of the fetus?

A) Increased fetal mortality
B) Third- or fourth-degree lacerations
C) Ceasing of labor progress
D) Fetus born in posterior position
E) Intense back pain during labor

Question 13

The nurse is caring for a newborn who was just born in a precipitous delivery. What are the implications of such a birth?

A) Hypoxia from decreased uteroplacental circulation
B) Meconium-stained fluid
C) Brachial plexus injuries
D) Low temperature
E) Intracranial trauma from rapid birth and delivery

Question 14

The patient vaginally delivers an infant that weighs 4750 g. Moderate shoulder dystocia occurred during the birth. During the initial assessment of this infant, the nurse should look for:

A) Bell's palsy.
B) Bradycardia.
C) Erb palsy.
D) Petechiae.

Question 15

The nurse performs a Bishop's prelabor score for a client prior to induction of labor. The client asks for an explanation of the Bishop's score. The nurse should describe the Bishop's score as a system for cervical readiness that includes: () Standard Text:

A) Fetal station.
B) Cervical dilation.
C) Fetal presenting part.
D) Fetal movement.
E) Fetal heart rate baseline.

Question 16

The patient has undergone an ultrasound, which estimated fetal weight at 4500 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 collarbone broken."

Question 17

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

A) Obtain biophysical profile today.
B) Begin nonstress test now.
C) Schedule labor induction for tomorrow.
D) Have the patient return to the clinic in 1 week.

Question 18

If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, the nurse would assist by:

A) Calling a second physician to assist.
B) Preparing for an immediate cesarean delivery.
C) Assisting the woman into McRoberts maneuver.
D) Utilizing fundal pressure to push the fetus out.

Question 19

For which patient should the labor and delivery nurse care first?

A) 26-year-old primip with a history of depression stating that she can't labor successfully and will need a cesarean
B) 28-year-old multip with a diagnosis of schizophrenia who is oriented to person, place, time, and location
C) 24-year-old primip diagnosed 6 years ago with bipolar disease who is moving constantly and refusing to lie in the bed
D) 30-year-old multip with an anxiety disorder who experienced tachycardia and tachypnea on the last shift

Question 20

The nurse is seeing a patient in the clinic who states that she had precipitous deliveries with her first two babies. With this history, the nurse will want to provide what care?

A) Monitoring the woman for cervical effacement
B) Monitoring the woman for cervical dilatation later in the pregnancy
C) Scheduling an induction
D) Using magnesium sulfate to stop labor
E) Giving the woman sedatives to relax the uterus

Question 21

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

A) Age 15, G3 in active labor
B) Age 22, G1 with eclampsia
C) Age 25, G4, last delivery by cesarean section
D) Age 32, G2, first baby died during labor
E) Age 27, G2, last delivery 11 months ago

Question 22

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:

A) Assist the patient to squat during the second stage.
B) Encourage oral fluids and carbohydrate intake.
C) Assess the cervix for change every 8 hours.
D) Inform the couple that labor might be prolonged.

Question 23

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:

A) Perform a vaginal exam.
B) Notify the physician.
C) Place the patient in a left lateral position.
D) Administer oxygen at 2 L per nasal cannula.

Question 24

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

A) Risk for Impaired Gas Exchange
B) Fear related to unknown
C) Impaired Individual Coping
D) Impaired Physical Mobility
E) Anxiety

Question 25

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?

A) Abdominal hysterectomy
B) Manual removal of the placenta
C) Repair of perineal lacerations
D) Foley catheterization

Question 26

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

A) CPR.
B) Cesarean delivery.
C) Immediate vaginal delivery.
D) McRoberts maneuver.
E) A crash cart.

Question 27

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?

A) "It depends on how your pelvis healed."
B) "You will need to have a cesarean birth."
C) "Please talk to your doctor about that."
D) "You will be able to delivery vaginally."

Question 28

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?

A) Brachial plexus injury
B) Fractured clavicle
C) Asphyxia
D) Neurological damage
E) Puerperal infection

Question 29

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:

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

Question 30

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

A) Mother's undiagnosed diabetes.
B) Likelihood of a cesarean delivery.
C) Effectiveness of epidural anesthesia with a large fetus.
D) Need for early delivery.

Question 31

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

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

Question 32

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:

A) Breech malpresentation.
B) Fetal demise.
C) Cephalopelvic disproportion (CPD).
D) Abruptio placentae.

Question 33

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 7 hours."
D) Multip at 34 weeks diagnosed with oligohydramnios: "Cervix 6 cm, -2 station, up to walk in hallway."

Question 34

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

A) 2 L oxygen by mask
B) Intravenous antibiotics
C) Intravenous oxytocin
D) Hysterectomy

Question 35

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:

A) Placenta accreta.
B) Circumvallate placenta.
C) Succenturiate placenta.
D) Battledore placenta.

Question 36

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 maneuvers.
C) Obtain an order for pain medication.
D) Complete a sterile vaginal exam.

Question 37

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:

A) An amniotic fluid embolus.
B) Placental abruption.
C) DIC.
D) Congestive heart failure.

Question 38

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

A) Late decelerations.
B) Bradycardia.
C) Loss of ability to determine fetal station.
D) Tachycardia.
E) Early decelerations.

Question 39

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:

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

Question 40

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

A) Abdominal hysterectomy
B) Manual removal of the placenta
C) Repair of perineal lacerations
D) Foley catheterization