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:

Accepted Answer

The statement "His blood sugars could be high after he is born" indicates a misunderstanding. In fact, babies of mothers with gestational diabetes or large babies are at risk for low blood sugars (hypoglycemia) after birth, not high blood sugars.

Question 2

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

Accepted Answer

The patient who is a 34-year-old gravida 6 at 39 weeks' gestation with twins is most likely to experience a complicated labor pattern due to the presence of multiple pregnancies. Twins are considered a risk factor for complications such as preterm labor, premature rupture of membranes, and vaginal bleeding. Additionally, the patient's advanced maternal age and high parity may also increase the risk of complications during labor and delivery.

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:

Accepted Answer

Manual removal of the placenta is a surgical procedure that can lead to bleeding, so starting an IV of lactated Ringer's would be important for hydration and the ability to administer medications and potentially blood products if necessary. Applying anti-embolism stockings and bottle-feeding the infant are not relevant to the situation, and sending the placenta to pathology would be done after it has been removed.

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?

Accepted Answer

Tachysystole in a patient with known CPD suggests that the fetus is unable to descend, and therefore a cesarean section may be necessary. Oxytocin administration and nipple stimulation may exacerbate tachysystole, and amniotomy is unlikely to resolve CPD.

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:

Accepted Answer

The patient is showing slow progress in labor (only 1 cm dilation over two hours) with less effective contractions (decreased intensity from 50 mmHg to 40 mmHg), indicating a potential need for augmentation with oxytocin. Assessing for cephalopelvic disproportion (CPD) is important before starting oxytocin to ensure there are no mechanical obstacles to vaginal delivery. The patient is not in preterm labor (39 weeks' gestation), does not require oxygen based on the information provided, and the decision for an epidural is not directly related to the progress of labor.

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?

Accepted Answer

A sterile vaginal exam is crucial to assess for umbilical cord prolapse or other complications after the rupture of membranes.

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?

Accepted Answer

The most important physician order in this scenario is to alert the surgical team of urgent cesarean. A transverse lie with shoulder presentation is a medical emergency and vaginal delivery is not possible. Artificially rupturing membranes or applying an internal fetal scalp electrode could increase the risk of compressed cord or shoulder dystocia. Monitoring maternal blood pressure every 15 minutes is important, but not the most urgent concern in this situation.

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:

Accepted Answer

The third-degree laceration involves tearing through the rectal sphincter, which is the muscle that controls bowel movements. This is the most accurate and informative response for the patient.

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?

Accepted Answer

The patient's symptoms suggest the development of an amniotic fluid embolus, a rare, but potentially life-threatening condition in which amniotic fluid, fetal cells, hair, or other debris enter the maternal circulation, causing an allergic-like reaction that can lead to cardiovascular collapse, respiratory failure, and disseminated intravascular coagulation. Placenta accreta is a condition in which the placenta attaches too deeply into the uterine wall, potentially causing hemorrhage or difficulty delivering the placenta. Infection may present with fever, chills, or uterine tenderness, but is less likely to cause sudden onset of chest pain and dyspnea. Hypertensive crisis may cause chest pain, shortness of breath, and decreased blood pressure, but the patient's history suggests a more acute cause.

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?

Accepted Answer

The slow cervical dilatation and effacement, lack of engagement of the fetal presenting part, and prolonged labor are all signs of possible cephalopelvic disproportion (CPD), which occurs when the fetal head is too large to pass through the maternal pelvis. Prolapsed cord, placenta accreta, and occiput anterior fetal position may also affect labor, but they would not necessarily present with the same symptoms as CPD.

Question 11

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

Accepted Answer

At 42 weeks' gestation, the patient is considered post-term, and it is not advisable to wait another week without intervention due to increased risks for both the mother and the baby. Options A, B, and C are appropriate actions for monitoring and managing a pregnancy at 42 weeks.

Question 12

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

Accepted Answer

Fetal occiput posterior position is associated with a prolonged and difficult labor. The overall length of labor is often longer, and progress may be slower. There may be a higher incidence of interventions such as cesarean delivery or operative vaginal delivery. The pattern of labor may also differ from the typical progression, with longer or irregular contractions during the active phase.

Question 13

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

Accepted Answer

A fibrinogen level of 50 mg/dL indicates a potential coagulopathy and should be addressed immediately to prevent bleeding complications during delivery. The other options may require attention but are not emergent concerns.

Question 14

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

Accepted Answer

A cervix dilated to 6 cm with a -2 station at 34 weeks gestation indicates preterm labor, which requires immediate intervention to prevent potential complications for the premature baby.

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?

Accepted Answer

Changing the mother's position to left lateral can improve fetal circulation and oxygenation, which is crucial in the context of meconium-stained amniotic fluid and decreased fetal heart tones.

Quiz 22: Childbirth at Risk: Labor-Related Complications

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: