Deck 27: Intrapartum Complications

Question 1

Birth for the nulliparous client with a fetus in a breech presentation is usually:

A) cesarean section.
B) vaginal birth.
C) vacuumed extraction.
D) forceps-assisted birth.

Answer 1

cesarean section.

Question 2

Which pelvic shape is most conducive to vaginal labor and birth?

A) Android
B) Gynecoid
C) Platypelloid
D) Anthropoid

Answer 2

Gynecoid

Question 3

A pregnant client with premature rupture of membranes is at higher risk for postpartum infection. Which assessment data indicate a potential infection?

A) Fetal heart rate, 150 beats/min
B) Maternal temperature, 99° F
C) Cloudy amniotic fluid, with strong odor
D) Lowered maternal pulse and decreased respiratory rates

Answer 3

Cloudy amniotic fluid, with strong odor

Question 4

A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?

A) Perform Leopold maneuvers.
B) Perform a vaginal examination.
C) Apply warm saline soaks to the vagina.
D) Place the client in a high Fowler position.

Question 5

A client in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for at-home continuation of the tocolytic effect?

A) Buccal oxytocin (Pitocin)
B) Terbutaline sulfate (Brethine)
C) Calcium gluconate (Calgonate)
D) Magnesium sulfate

Question 6

Which factor should alert the nurse to the potential for a prolapsed umbilical cord?

A) Oligohydramnios
B) Pregnancy at 38 weeks of gestation
C) Presenting part at a station of -3
D) Meconium-stained amniotic fluid

Question 7

Which technique is least effective for the client with persistent occiput posterior position?

A) Squatting
B) Lying supine and relaxing
C) Sitting or kneeling, leaning forward with support
D) Rocking the pelvis back and forth while on hands and knees

Question 8

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?

A) Incomplete uterine relaxation
B) Maternal fatigue and exhaustion
C) Maternal sedation with narcotics
D) Administration of tocolytic drugs

Question 9

A client who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache. She asks what pain reliever is safe for her to take. The best nursing response is:

A) "You should come into the office and let the doctor check you."
B) "Acetaminophen is acceptable during pregnancy. You should not take aspirin, however."
C) "Back pain is common at this time during pregnancy because you tend to stand with a sway back."
D) "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication."

Question 10

Which action by the nurse prevents infection in the labor and birth area?

A) Using clean techniques for all procedures
B) Keeping underpads and linens as dry as possible
C) Cleaning secretions from the vaginal area by using a back to front motion
D) Performing vaginal examinations every hour while the client is in active labor

Question 11

Which intervention should be incorporated in a plan of care for a labor client who is experiencing hypertonic labor? Vaginal exam is unchanged from prior exam-3 cm, 80% effaced, and 0 station presenting part vertex.

A) Augmentation of labor with oxytocin (Pitocin)
B) AROM
C) Performing a vaginal exam to denote progress
D) Preparing the client for epidural administration as ordered by the physician

Question 12

Which assessment finding indicates uterine rupture?

A) Fetal tachycardia occurs.
B) The client becomes dyspneic.
C) Labor progresses unusually quickly.
D) Contractions abruptly stop during labor.

Question 13

Which is (are) the priority nursing assessment(s) for the client having tocolytic therapy with terbutaline (Brethine)?

A) Intake and output
B) Maternal blood glucose level
C) Internal temperature and odor of amniotic fluid
D) Fetal heart rate, maternal pulse, and blood pressure

Question 14

A client who has had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. Which should be the nurse's priority action?

A) Notify the health care provider promptly.
B) Observe for abnormally high uterine resting tone.
C) Decrease the rate of nonadditive intravenous fluid.
D) Reposition the client with her hips slightly elevated.

Question 15

The fetus in a breech presentation is often born by cesarean birth because:

A) the buttocks are much larger than the head.
B) compression of the umbilical cord is more likely.
C) internal rotation cannot occur if the fetus is breech.
D) postpartum hemorrhage is more likely if the client delivers vaginally.

Question 16

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken by the nurse in response to this request?

A) Put pressure on the fundus.
B) Ask the physician if he or she would like you to prepare for a surgical method of birth.
C) Tell the client not to push until you prepare vacuum extraction device for physician.
D) Reposition the client to facilitate birth.

Question 17

After a birth complicated by a shoulder dystocia, the infant's Apgar scores were 7 at 1 minute and 9 at 5 minutes. The infant is now crying vigorously. The nurse in the birthing room should:

A) palpate the infant's clavicles.
B) encourage the parents to hold the infant.
C) perform a complete newborn assessment.
D) give supplemental oxygen with a small face mask.

Question 18

A laboring client in the latent phase is experiencing uncoordinated irregular contractions of low intensity. How should the nurse respond to complaints of constant cramping pain?

A) "You are only 2 cm dilated, so you should rest and save your energy for when the contractions get stronger."
B) "Let me take off the monitor belts and help you get into a more comfortable position."
C) "You must breathe more slowly and deeply so there is greater oxygen supply for your uterus. That will decrease the pain."
D) "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

Question 19

Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A) A primigravida who is 17 years old
B) A 22-year-old multiparous client with ruptured membranes
C) A primigravida who has requested no analgesia during her labor
D) A multiparous client at 39 weeks of gestation who is expecting twins

Question 20

Which nursing action should be initiated first when there is evidence of prolapsed cord?

A) Notify the health care provider.
B) Apply a scalp electrode.
C) Prepare the mother for an emergency cesarean birth.
D) Reposition the mother with her hips higher than her head.

Question 21

Emergency measures used in the treatment of a prolapsed cord include which of the following? (Select all that apply.)

A) Administration of oxygen via face mask at 8 to 10 L/min
B) Maternal change of position to knee-chest
C) Administration of tocolytic agent
D) Administration of oxytocin (Pitocin)
E) Vaginal elevation
F) Insertion of cord back into vaginal area

Question 22

A 20-year-old gravida 1, para 0, is determined to be at 42 weeks' gestation on admission to the labor and birth unit. The client is not in labor at the current time but has been sent over by her physician to be admitted for the induction of labor. The client indicates to you that she would rather go home and wait for natural labor to start. How should the nurse respond to the client's request?

A) There is no way to tell if any complications would arise. Because the client is not presenting with any problems, the nurse should call the health care provider and inform her or him of the client's decision to go home and wait.
B) Inform the client that there are a number of serious concerns related to a postdate pregnancy and that she would be better off to be monitored in a clinical setting.
C) Tell the client that an assessment will be done and if there are no findings indicating that an induction of labor would be favorable, the client will be sent home.
D) Tell the client that confirmation of a due date can be off by 2 weeks and possibly be even later than 42 weeks, so it is better to follow the physician's directions.

Question 23

Which assessment finding indicates a complication in the client attempting a vaginal birth after cesarean (VBAC)?

A) Complaint of pain between the scapulae
B) Change in fetal baseline from 128 to 132 bpm
C) Contractions every 3 minutes lasting 70 seconds
D) Pain level of 6 on scale of 0 to 10 during acme of contraction

Question 24

A labor client has been diagnosed with cephalopelvic disproportion (CPD) following attempts at pushing for 2 hours with no progress. Based on this information, what birth method is available?

A) Vaginal birth with vacuum extraction
B) Augmentation of labor with oxytocin (Pitocin) to improve contraction pattern and strengthen contractions
C) Cesarean section
D) Insertion of Foley catheter into empty bladder to provide more room for fetal descent

Question 25

Which presentation is least likely to occur with a hypotonic labor pattern?

A) Prolonged labor duration
B) Fetal distress
C) Maternal comfort during labor
D) Irregular labor contraction pattern

Question 26

The labor nurse is providing care to a multigravida with moderate to strong contractions every 2 to 3 minutes, duration 45 to 60 seconds. On admission, her cervical assessment was 5 cm, 80%, and -2. An epidural was administered shortly thereafter. Two hours after admission, her contraction pattern remains the same and her cervical assessment is 5 cm, 90%, and -2. What is the nurse's next action?

A) Palpate the patient's bladder for fullness.
B) Contact the health care provider for a prescription to augment the labor.
C) Obtain an order for an internal pressure catheter.
D) Reassure the patient that she is making adequate progress.

Question 27

Which assessment finding in the postpartum client following a uterine inversion indicates normovolemia?

A) Blood pressure of 100/60 mm Hg
B) Urine output >30 mL/hr
C) Rebound skin turgor <5 seconds
D) Pulse rate <120 beats/min

Question 28

A client is diagnosed with anaphylactoid syndrome. Which therapeutic intervention does the nurse suspect will be included in the plan of care?

A) Normal amniotic fluid
B) Initiation of CPR and other life support measures
C) Respiratory treatments with nebulizers
D) Internal fetal monitoring

Question 29

When increasing the IV infusion rate of terbutaline (Brethine) 0.01 mg/min every 30 minutes, the nurse knows to stop increasing the rate when the:

A) maximum dose of 0.1 mg/min is reached.
B) systolic blood pressure falls below 110 mm Hg.
C) contractions are less than two in a 10-minute period.
D) maternal heart rate remains over 120 beats/min.

Question 30

A pregnant client who has had a prior obstetric history of preterm labors is pregnant with her third child. The physician has ordered an fFN (fetal fibronectin) test. Which instructions should be given to the client related to this clinical test?

A) Client must be NPO prior to testing.
B) Blood work will be drawn every week to help confirm the start of preterm labor.
C) Client should refrain from sexual activity prior to testing.
D) A urine specimen will be collected for testing.

Question 31

Which intervention would be most effective if the fetal heart rate drops following a spontaneous rupture of the membranes?

A) Apply oxygen at 8 to 10 L/min.
B) Stop the Pitocin infusion.
C) Position the client in the knee-chest position.
D) Increase the main line infusion to 150 mL/hr.

Question 32

When reviewing the prenatal record of a client at 42 weeks' gestation, the nurse recognizes that induction of labor is indicated based on the finding of:

A) reduced amniotic fluid volume.
B) cervix 2 cm at last prenatal visit.
C) fundal height measured at the xyphoid process.
D) 1-pound weight gain at each of the last two weekly visits.

Question 33

Which finding by the nurse on a vaginal exam would be a concern if a spontaneous rupture of the membranes occurred?

A) Cephalic presentation
B) Left occiput position
C) Dilation 2 cm
D) Presenting part at -3 station

Question 34

Which finding would indicate an adverse response to terbutaline (Brethine)?

A) Fetal heart rate (FHR) of 134 bpm
B) Heart rate of 122 bpm
C) Two episodes of diarrhea
D) Fasting blood glucose level of 100 mg/dL

Question 35

A dose of dexamethasone 12 mg was administered to a client in preterm labor at 8:30 AM on March 12. The nurse knows that the next dose must be scheduled for:

A) 2:30 PM on March 12.
B) 8:30 PM on March 12.
C) 8:30 AM on March 13.
D) 2:30 PM on March 13.

Question 36

Which presentation is most likely to occur with a hypertonic labor pattern? (Select all that apply.)

A) Increased risk for placenta previa
B) Painful uterine contractions
C) Increased resting tone
D) Uterine vasodilation
E) Increased uterine pressure
F) Effective uterine contraction

Question 37

An obstetric client has been identified as being high risk and so has had activities restrictions (placed on bed rest) placed on her until the end of the pregnancy. Currently, she is at 32 weeks' gestation and has two other children at home, ages 3 and 6. The client's husband works at home. A nursing diagnosis of Impaired home maintenance is noted. Which statement potentially identifies a long-term goal?

A) The client and husband will be able to adapt their schedules accordingly to meet activities of daily living until the client's next scheduled antepartum visit the following week.
B) The client and husband will hire a nanny to act as an additional caregiver for the next month.
C) The client will continue to take care of her children at home, taking frequent rest periods.
D) The client and husband will make arrangements for child care routine activity assistance for the rest of the pregnancy.