chap 10 & 11
A patient's labor is not progressing, and she is diagnosed with dystocia. Which specific type of dystocia is the most common reason for a primary cesarean section?
A.Uterine dystocia
B.Shoulder dystocia
C.Fetal dystocia
D.Pelvic dystocia
A.Uterine dystocia
During a delivery, the fetal head emerges but then retracts against the perineum, a phenomenon known as the 'turtle sign'. What is the first maneuver the nurse should help facilitate to resolve this shoulder dystocia?
A.Emergency cesarean section
B.The Woods corkscrew maneuver
C.The McRoberts maneuver
D.Application of fundal pressure
C.The McRoberts maneuver That's right!This maneuver, involving hyperflexing the mother's legs to her abdomen, changes the pelvic angle and is the initial intervention for shoulder dystocia
Under which circumstances is Rho(D) immune globulin indicated for administration to a postpartum patient?
A. Both the mother and the baby are Rh-negative.
B. An Rh-negative mother gives birth to an Rh-positive baby, and the mother is Coombs' negative.
C. An Rh-negative mother gives birth to an Rh-positive baby, and the mother is Coombs' positive.
D. An Rh-positive mother gives birth to an Rh-negative baby.
B.
An Rh-negative mother gives birth to an Rh-positive baby, and the mother is Coombs' negative.
Right answer
This injection prevents the Rh-negative mother from forming antibodies against the baby's Rh-positive blood; a negative Coombs' test confirms she has not been sensitized yet.
A patient experiences a postpartum hemorrhage, and the provider orders methylergonovine. The nurse should verify the patient does not have a history of which condition before administering the medication?
A.Asthma
B.Hypertension
D.Anemia
B.HypertensionThat's right!The source material's table explicitly lists hypertension (HTN) as a contraindication for methylergonovine due to its potent vasoconstrictive effects.
According to the updated definition in the source material, postpartum hemorrhage is defined as a cumulative blood loss of 1,000 mL or more, or blood loss accompanied by what other sign?
A.Symptoms of hypovolemia.
B.The saturation of one perineal pad in one hour.
C.The presence of a boggy fundus.
D.A 5% drop in hemoglobin.
A.
Symptoms of hypovolemia.
Right answer
The definition includes either the quantitative blood loss of 1,000 mL or more, or blood loss of any amount that leads to clinical signs of hypovolemia like tachycardia or hypotension.
Upon vaginal examination of a laboring patient whose membranes have just ruptured, the nurse feels a pulsating structure ahead of the fetal presenting part. What is the nurse's immediate priority?
A.Administer 10 L/min of oxygen via a non-rebreather mask.
B.Place the patient in a knee-chest position.
C.Notify the healthcare provider and call for help
.D.Manually lift the presenting part off the umbilical cord.
.Manually lift the presenting part off the umbilical cord.That's right!The highest priority is to relieve pressure on the cord to restore blood flow to the fetus; the nurse's hand must remain in place until delivery.
A patient is being evaluated for a trial of labor after cesarean (TOLAC). Which finding in her history is a contraindication for a TOLAC and subsequent VBAC?
A.The current pregnancy is a multiple gestation
B.A prior delivery of a macrosomic infant
C.A prior classical uterine incision
D.One prior low transverse cesarean section
C.
A prior classical uterine incisionA woman who is rubella-nonimmune receives the MMR vaccine during the postpartum period. What is the most critical piece of discharge teaching the nurse must provide regarding this immunization?
A.You must avoid becoming pregnant for the next 4 weeks.
B.This vaccine will also provide immunity to your newborn through breast milk.
C.You may experience a low-grade fever and a rash.
D.You will need a booster shot at your 6-week follow-up appointmen
A.
You must avoid becoming pregnant for the next 4 weeks.
That's right!
The rubella vaccine is a live attenuated virus, and there is a theoretical risk to a fetus if pregnancy occurs shortly after vaccination.
A patient with pregestational diabetes has just given birth. What change regarding her insulin requirements should the nurse anticipate in the immediate postpartum period?
A. Her insulin requirements will remain the same as during pregnancy.
B. She will be switched from insulin to an oral hypoglycemic agent.
C. Her insulin requirements will significantly increase.
D.Her insulin requirements will decrease.
3. A nurse is performing a postpartum assessment. Which of the following findings would be considered normal in a client who is 2 days postpartum? (Select all that apply.)
A. A positive Homan's sign in the left leg.
B. A white blood cell (WBC) count of 18,000 cells/mm³.
C. Fundus firm and at the level of the umbilicus.
D. Lochia rubra that is moderate in amount and smells like a normal menstrual flow.
B. A white blood cell (WBC) count of 18,000 cells/mm³. Right answer Slightly elevated WBC counts (up to 20,000-25,000 cells/mm³) are a normal physiological response during the immediate postpartum period.
D. Lochia rubra that is moderate in amount and smells like a normal menstrual flow. That's right! Lochia rubra is expected during the first 3 days postpartum and should have a fleshy, non-foul odor.
A laboring patient undergoing a TOLAC suddenly cries out with a sharp, tearing pain, her contractions stop, and the fetal heart rate tracing becomes severely bradycardic. The nurse should have the highest suspicion for which obstetrical emergency?
A.Prolapsed umbilical cord
B.Placental abruption
C.Amniotic fluid embolism
D.Uterine rupture
D.Uterine rupture
Right answer
The classic signs, especially in a patient with a prior uterine scar, include a tearing sensation, loss of fetal station, cessation of uterine contractions, and profound fetal distress.
When monitoring a patient 8 hours post-cesarean section, which finding constitutes a 'red trigger' according to Maternal Early Warning Criteria (MEWC)?
A.Respiratory rate of 24 breaths/min
B.Systolic blood pressure of 85 mm Hg
C.Heart rate of 115 bpm
D.Diastolic blood pressure of 95 mm Hg
B. Systolic blood pressure of 85 mm Hg
A systolic blood pressure less than 90 mm Hg is a 'red trigger' indicating potential hemodynamic instability.
A new mother on the first postpartum day is focused on her own needs for food and rest, repeatedly discusses her birth experience, and relies on the nurse for infant care. The nurse recognizes this as characteristic of which maternal process phase?
A.Taking-in phase.
B.Letting-go phase
C.Taking-hold phase
D.Attachment phase
A.Taking-in phaseThat's right!This initial phase involves the mother integrating the birth experience and being more focused on her own physiological and psychological needs.
Which assessment finding is a late sign of postpartum hemorrhage and potential hypovolemic shock?
Saturation of a perineal pad within 15 minutes
Decreased blood pressure
A boggy fundus after massage
D. Maternal anx
Decreased blood pressure
Right answer
The body initially compensates for blood loss by increasing the heart rate (tachycardia); a drop in blood pressure (hypotension) occurs later when compensatory mechanisms fail.
Select all that apply)
The nurse is caring for a client with severe postpartum hypertension (BP 168/112). Which interventions should the nurse anticipate?
A. IV labetalol or hydralazine
B. Oral nifedipine
C. Immediate discontinuation of IV fluids
D. Frequent monitoring of vital signs
E. Administering magnesium sulfate
A, B, D, E
First-line: IV labetalol/hydralazine, oral nifedipine, frequent monitoring, and magnesium sulfate (seizure prophylaxis). Stopping fluids (C) is not standard.
A laboring patient suddenly develops severe respiratory distress, hypotension, and cyanosis, followed by cardiovascular collapse. This rapid deterioration is most characteristic of which obstetric emergency?
A.Hemorrhagic shock
B.Uterine rupture
C.Anaphylactic Syndrome (Amniotic Fluid Embolism)
D.Eclampsia
C. Anaphylactic Syndrome (Amniotic Fluid Embolism)
!This rare event occurs when amniotic fluid enters the maternal circulation, causing a massive inflammatory response that leads to sudden cardiorespiratory collapse.
A patient is receiving an Oxytocin infusion to augment labor. The nurse notes six contractions in a 10-minute period. What is this condition called and what is the appropriate initial nursing response?
A.Precipitous labor; prepare for immediate delivery.
B.Hypertonic uterine dysfunction; administer morphine for pain.
C.Uterine dystocia; increase the Oxytocin infusion rate.
D.Tachysystole; decrease or discontinue the Oxytocin infusion.
D.
Tachysystole; decrease or discontinue the Oxytocin infusion.
That's right!
Tachysystole is defined as more than five contractions in 10 minutes. The priority is to reduce uterine activity by decreasing or stopping the medication causing it.
During discharge teaching for a patient with acute-onset severe hypertension, the nurse emphasizes the urgency of treatment. What is the recommended time frame for administering first-line antihypertensive agents after confirming severe hypertension?
A. Within 30 to 60 minutes
B. Within 4 to 6 hours
C. Within the first 24 hours
D. Immediately, within 5 minutes
A.
Within 30 to 60 minutes
Right answer
The source specifies that treatment should occur as soon as possible within this time frame to reduce the risk of maternal stroke, seizure, or death.
Which findings should the nurse recognize as early indicators of hypovolemic shock in a client with postpartum hemorrhage?
A. Tachycardia
B. Hypotension
C. Pallor
D. Decreased urine output
E. Altered mental status
. A, C, D
Early signs: tachycardia, pallor, decreased urine output.
Late signs: hypotension, altered mental status
A client is admitted with suspected amniotic fluid embolism. Which interventions should the nurse anticipate? (Select all that apply)
A. Administer oxygen by non-rebreather mask
B. Initiate cardiopulmonary resuscitation if needed
C. Administer tocolytic medications
D. Prepare for emergency cesarean birth if undelivered
E. Start IV fluids and blood products
Amniotic fluid embolism
Correct: A, B, D, E
A. High-flow O₂ = priority
B. CPR if needed = life-saving
D. Emergency C-section = if undelivered
E. IV fluids/blood = support circulation
C. Tocolytics → not indicated
A patient at 40 weeks gestation is admitted for induction of labor. Her cervical exam reveals that her cervix is posterior, firm, 50% effaced, and 1 cm dilated. The Bishop score is calculated to be 5. What is the most appropriate next step?
A. Initiate cervical ripening.
B. Immediately begin an oxytocin infusion.
C. Encourage the patient to ambulate for 4 hours.
D. Perform an amniotomy to augment labor.
A.
Initiate cervical ripening.
Right answer
A Bishop score of 5 indicates an unripe cervix. Ripening with mechanical or pharmacological methods is needed to increase the likelihood of a successful induction.
A patient experiences labor that progresses from onset to birth in just under 3 hours. This is known as precipitous labor. What is a primary risk for the fetus associated with this condition?
A.Hypoxia
B.Macrosomia
C.Post-term gestation
D.Intra-amniotic infection
A. Hypoxia
The notes identify that the rapid and intense nature of a precipitous birth can lead to fetal hypoxia or CNS depression due to the short intervals between strong contractions.
4. Which of the following clients is at the highest risk for developing postpartum uterine atony?
A. A G5 P5 who was induced with oxytocin and delivered a 9.8 lb infant after a 22-hour labor.
B. A client who delivered via a scheduled cesarean section due to breech presentation.
C. A G2 P2 who had a forceps-assisted delivery after 4 hours of pushing.
D. A primigravida who had a spontaneous vaginal delivery of a 7 lb infant after a 10-hour labor.
A.
A G5 P5 who was induced with oxytocin and delivered a 9.8 lb infant after a 22-hour labor.
That's right!
This client has multiple significant risk factors: grand multiparity, macrosomic infant, prolonged labor, and oxytocin induction, which all contribute to an overdistended and fatigued uterus.
5. The nurse is preparing to administer oxytocin to a client to prevent postpartum hemorrhage. The nurse understands that oxytocin achieves this effect by which of the following mechanisms? (Select all that apply.)
Stimulating uterine contractions to decrease bleeding.
Inhibiting fibrinolysis to stabilize the blood clot.
Increasing blood pressure to prevent hypovolemic shock.
Promoting coagulation and clot formation at the placental site.
Causing the uterus to contract and compress bleeding vessels.
Stimulating the production of prostaglandins.
Stimulating uterine contractions to decrease bleeding.
That's right!
The primary role of oxytocin in preventing postpartum hemorrhage is to stimulate strong, sustained uterine contractions, which constrict the blood vessels in the myometrium, thereby reducing blood loss.
Causing the uterus to contract and compress bleeding vessels.
Right answer
Oxytocin is a uterotonic medication that stimulates uterine muscle contractions, which constrict blood vessels and control bleeding from the placental site.
10. The nurse is reviewing the lab results for a client who is 24 hours postpartum. Which of the following findings would require further investigation?
Platelet count of 175,000/mm³.
B. Blood glucose of 85 mg/dL.
C. hematocrit of 30%.
D. White blood cell count of 22,000 cells/mm³.
C.
Hematocrit of 30%.
That's right!
A drop in hematocrit may indicate abnormal blood loss, especially if it is significantly lower than the prenatal value, and requires further assessment.