Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 24 Childbirth at Risk: Labor-Related Complicatons

1. What would be a normal cervical dilatation rate in a first-time mother ("primip")?
2. 1.5 c m per hour
3. Less than 1 c m cervical dilatation per hour
4. 1 c m per hour
5. Less than 0.5 c m per hour

Page Ref: 585

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Dystocia encompasses many problems in labor. What is the most common?
2. Meconium-stained amniotic fluid
3. Dysfunctional uterine contractions
4. Cessation of contractions
5. Changes in the fetal heart rate

Page Ref: 584

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Risk factors for tachysystole include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Cocaine use
2. Placental abruption
3. Low-dose oxytocin titration regimens
4. Uterine rupture
5. Smoking

Page Ref: 584

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A woman has been having contractions since 4 a.m. At 8 a.m., her cervi × is dilated to 5 c m. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (C P D) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for?
2. Oxytocin induction of labor
3. Amnioinfusion
4. Increased intravenous infusion
5. Cesarean section

Page Ref: 586

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Nonreassuring fetal status often occurs with a tachysystole contraction pattern. Intrauterine resuscitation measures may become warranted and can include which of the following measures?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Position the woman on her right side.
2. Apply oxygen via face mask.
3. Call the anesthesia provider for support.
4. Increase intravenous fluids by at least 500 m L bolus.
5. Call the physician/C N M to the bedside.

Page Ref: 585

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse is performing a vaginal exam on a client who was admitted to the birthing unit after her membranes ruptured, and discovers a cord prolapse. Which intervention is priority at this time?
2. Pushing the presenting fetal part upward
3. Administering oxygen
4. Initiating intravenous fluid
5. Inserting an indwelling bladder catheter

Page Ref: 603

Cognitive Level: Applying

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Discuss the interventions needed in caring for a woman with a prolapsed umbilical cord.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. While caring for a client admitted to the birthing unit, the nurse suspects that the client may be experiencing a uterine rupture. Which assessment finding should the nurse expect to appear first?
2. Nonreassuring fetal heart rate
3. Constant abdominal pain
4. Loss of fetal station
5. Cessation of contractions

Page Ref: 604

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Identify the signs and symptoms associated with a uterine rupture.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. What are the primary complications of placenta accreta?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Maternal hemorrhage
2. Insomnia
3. Failure of the placenta to separate following birth of the infant
4. Autonomic dysreflexia
5. Shoulder dystocia

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Risk factors for labor dystocia include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Tall maternal height
2. Labor induction
3. Small-for-gestational-age (S G A) fetus
4. Malpresentation
5. Prolonged latent phase

Page Ref: 584

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. In succenturiate placenta, one or more accessory lobes of fetal villi have developed on the placenta, with vascular connections of fetal origin. What is the gravest maternal danger?
2. Cord prolapse
3. Postpartum hemorrhage
4. Paroxysmal hypertension
5. Brachial plexus injury

Page Ref: 600

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse knows that the maternal risks associated with postterm pregnancy include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Polyhydramnios
2. Maternal hemorrhage
3. Maternal anxiety
4. Forceps-assisted delivery
5. Perineal damage

Page Ref: 587

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Describe the impact of postterm pregnancy on the childbearing family.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The client is at 42 weeks' gestation. Which order should the nurse question?
2. Obtain biophysical profile today.
3. Begin nonstress test now.
4. Schedule labor induction for tomorrow.
5. Have the client return to the clinic in 1 week.

Page Ref: 588

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Describe the impact of postterm pregnancy on the childbearing family.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. 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. What should the nurse explain to the parents?
2. The infant will need to be observed for meconium aspiration.
3. Facial edema and head molding will subside in a few days.
4. The infant will be given prophylactic antibiotics.
5. Breastfeeding will need to be delayed for a day or two.

Page Ref: 592

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The multiparous client at term has arrived to the labor and delivery unit in active labor with intact membranes. Leopold maneuvers indicate the fetus is in a transverse lie with a shoulder presentation. Which physician order is most important?
2. Artificially rupture membranes.
3. Apply internal fetal scalp electrode.
4. Monitor maternal blood pressure every 15 minutes.
5. Alert surgical team of urgent cesarean.

Page Ref: 596

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse should anticipate the labor pattern for a fetal occiput posterior position to be which of the following?
2. Shorter than average during the latent phase
3. Prolonged as regards the overall length of labor
4. Rapid during transition
5. Precipitous

Page Ref: 589

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Maternal risks of occiput posterior (O P) malposition include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Blood loss greater than 1000 m L
2. Postpartum infection
3. Anal sphincter injury
4. Higher rates of vaginal birth
5. Instrument delivery

Page Ref: 589

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. If the physician indicates a shoulder dystocia during the delivery of a macrosomic fetus, how would the nurse assist?
2. Call a second physician to assist.
3. Prepare for an immediate cesarean delivery.
4. Assist the woman into McRoberts maneuver.
5. Utilize fundal pressure to push the fetus out.

Page Ref: 598

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. While performing a uterine assessment on a client in the birthing unit, the nurse notes a loss of fetal station and a change in uterine shape. The client reports constant abdominal pain, uterine tenderness, and is exhibiting signs of shock. Which condition should the nurse suspect?
2. Uterine rupture
3. Anaphylactoid syndrome of pregnancy
4. Circumvallate placenta
5. Breech presentation

Page Ref: 604

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Identify the signs and symptoms associated with a uterine rupture.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse is caring for a client experiencing a uterine rupture. Which outcome demonstrates that the plan of care has been effective for the client?
2. The mother remains hemodynamically stable throughout emergency cesarean birth.
3. The mother has additional knowledge regarding the problems, implications, and treatment plans.
4. The F H R remains in normal range with supportive measures.
5. The family is able to cope successfully with fetal or neonatal anomalies, if they exist.

Page Ref: 604

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 10 Identify complications related to uterine rupture.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. True postterm pregnancies are frequently associated with placental changes that cause a decrease in uterine-placental-fetal circulation. Complications related to alterations in placenta functioning include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Increased fetal oxygenation
2. Increased placental blood supply
3. Reduced nutritional supply
4. Macrosomia
5. Risk of shoulder dystocia

Page Ref: 587

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Describe the impact of postterm pregnancy on the childbearing family.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse examines the client's placenta and finds that the umbilical cord is inserted at the placental margin. The client 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 what?
2. Placenta accreta
3. Circumvallate placenta
4. Succenturiate placenta
5. Battledore placenta

Page Ref: 600

Cognitive Level: Remembering

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A woman is admitted to the birth setting in early labor. She is 3 c m dilated, -2 station, with intact membranes and F H R of 150 beats/min. Her membranes rupture spontaneously, and the F H R drops to 90 beats/min with variable decelerations. What would the initial response from the nurse be?
2. Perform a vaginal exam.
3. Notify the physician.
4. Place the client in a left lateral position.
5. Administer oxygen at 2 L per nasal cannula.

Page Ref: 602

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The nurse is caring for a client 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?
2. Assess the odor of the amniotic fluid.
3. Perform Leopold maneuvers.
4. Obtain an order for pain medication.
5. Complete a sterile vaginal exam.

Page Ref: 602

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. During labor, the client at 4 c m suddenly becomes short of breath, cyanotic, and hypoxic. The nurse must prepare or arrange immediately for which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Intravenous access
2. Cesarean delivery
3. Immediate vaginal delivery
4. McRoberts maneuver
5. A crash cart

Page Ref: 604

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Discuss the identification, management, and nursing care of women with anaphylactoid syndrome of pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. On assessment, a laboring client is noted to have cardiovascular and respiratory collapse and is unresponsive. What should the nurse suspect?
2. An amniotic fluid embolus
3. Placental abruption
4. Placenta accreta
5. Retained placenta

Page Ref: 604

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Discuss the identification, management, and nursing care of women with anaphylactoid syndrome of pregnancy.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A 26-year-old client is having her initial prenatal appointment. The client reports to the nurse that she suffered a pelvic fracture in a car accident 3 years ago. The client asks whether her pelvic fracture might affect her ability to have a vaginal delivery. What response by the nurse is best?
2. "It depends on how your pelvis healed."
3. "You will need to have a cesarean birth."
4. "Please talk to your doctor about that."
5. "You will be able to delivery vaginally."

Page Ref: 605

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 9 Delineate the effects of pelvic contractures on labor and birth.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A fetal weight is estimated at 4490 grams in a client at 38 weeks' gestation. Counseling should occur before labor regarding which of the following?
2. Mother's undiagnosed diabetes
3. Likelihood of a cesarean delivery
4. Effectiveness of epidural anesthesia with a large fetus
5. Need for early delivery

Page Ref: 597

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Discuss the implications of macrosomia and hydrocephalus on the woman and the fetus.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A woman has been in labor for 16 hours. Her cervi × is dilated to 3 c m and is 80% effaced. The fetal presenting part is not engaged. The nurse would suspect which of the following?
2. Breech malpresentation
3. Fetal demise
4. Cephalopelvic disproportion (C P D)
5. Abruptio placentae

Page Ref: 605

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 9 Delineate the effects of pelvic contractures on labor and birth.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. What is one of the most common initial signs of nonreassuring fetal status?
2. Meconium-stained amniotic fluid
3. Cyanosis
4. Dehydration
5. Arrest of descent

Page Ref: 588

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 11 Discuss complications of the third and fourth stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. 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. What should the nurse prepare to do?
2. Start an I V of lactated Ringer's.
3. Apply anti-embolism stockings.
4. Bottle-feed the infant.
5. Send the placenta to pathology.

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 11 Discuss complications of the third and fourth stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. The client delivered 30 minutes ago. Her blood pressure and pulse are stable. Vaginal bleeding is scant. The nurse should prepare for which procedure?
2. Abdominal hysterectomy
3. Manual removal of the placenta
4. Repair of perineal lacerations
5. Foley catheterization

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 11 Discuss complications of the third and fourth stages of labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. Lacerations of the cervi × or vagina may be present when bright red vaginal bleeding persists in the presence of a well-contracted uterus. The incidence of lacerations is higher among which of the following childbearing women?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Over the age of 35
2. Have not had epidural block
3. Have had an episiotomy
4. Have had a forceps-assisted or vacuum-assisted birth
5. Nulliparous

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Identify complications related to uterine rupture.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. After delivery, it is determined that there is a placenta accreta. Which intervention should the nurse anticipate?
2. 2 L oxygen by mask
3. Intravenous antibiotics
4. Intravenous oxytocin
5. Hysterectomy

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. What is required for any woman receiving oxytocin (Pitocin)?
2. C P R
3. Continuous electronic fetal monitoring
4. Administering oxygen by mask
5. Nonstress test

Page Ref: 586

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss dysfunctional labor patterns.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. 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?
2. "The episiotomy extended and tore through your rectal mucosa."
3. "The episiotomy extended and tore up near your vaginal mucous membrane."
4. "The episiotomy extended and tore into the muscle layer."
5. "The episiotomy extended and tore through your anal sphincter."

Page Ref: 606

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Discuss the implications of macrosomia and hydrocephalus on the woman and the fetus.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A fetus has a brow cephalic presentation. Which head shape should the nurse expect when the infant is delivered?

Page Ref: 586

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A laboring patient is attempting a vaginal birth. An episiotomy has already been performed and the healthcare provider is prepared to extend the episiotomy if necessary. What is this fetus's most likely presentation?

Page Ref: 591

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. During an intrapartum vaginal examination the following is palpated. In which type of presentation is this fetus?

1. Breech
2. Shoulder
3. Occiput face
4. Occiput brow

Page Ref: 594

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 3 Summarize various types of fetal malposition and malpresentation and possible associated problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. A patient's placenta it is identified as having a double fold of chorion and amnion that formed a ring around the umbilical cord on the fetal side of the placenta. What should the nurse expect when examining this placenta?

Page Ref: 601

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 5 Analyze the implications of abnormal placenta and umbilical cord variations.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.

1. During an intrapartum vaginal examination the following is assessed. In which position should the patient be placed at this time?

1. Supine
2. Side-lying
3. Lithotomy
4. Knee-chest

Page Ref: 603

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 6 Discuss the interventions needed in caring for a woman with a prolapsed umbilical cord.

M N L L O: Demonstrate use of the nursing process in the care of the woman with labor-related complications.