Chapter 21 Childbirth at Risk: Labor-Related Complications

Chapter 21   Childbirth at Risk: Labor-Related Complications

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) A client who sustained a difficult, lengthy labor and delivery is conversing with the nurse. Suddenly, the client 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?

1. Placenta accreta
2. Infection
3. Hypertensive crisis
4. Amniotic fluid embolus

Answer:  4

Explanation:  1. Placenta accreta occurs when the chorionic villi attach directly to the uterine myometrium. The major complications of placenta accreta include maternal hemorrhage and failure of the placenta to separate following birth of the infant. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis.

2. This client’s symptoms have a severe, sudden onset that is consistent with amniotic fluid embolus. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis.
3. The client is hypotensive and is demonstrating signs and symptoms that are consistent with amniotic fluid embolus, including chest pain, dyspnea, tachycardia, hypotension and cyanosis.
4. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis. The condition may progress to hemorrhage, shock, and death.

Page Ref: 439-440

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Coordination of care

Learning Outcome:  LO 21.7-Summarize the identification, maternal and fetal-neonatal implications, clinical therapy, and nursing care management of the woman with an amniotic fluid embolus.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

2) 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 client’s labor?

1. Cephalopelvic disproportion (CPD)
2. Prolapsed cord
3. Placenta accreta
4. Occiput anterior (OA) fetal position

Answer:  1

Explanation:  1. The nurse should suspect CPD when labor is prolonged, cervical dilatation and effacement are slow, and engagement of the presenting part is delayed.

2. A prolapsed cord is an umbilical cord that precedes the fetal presenting part. Fetal bradycardia is a critical indicator of prolapsed cord. This client is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with CPD.
3. Placenta accreta, in which the chorionic villi attach directly to the uterine myometrium, is associated with maternal hemorrhage and failed placental separation after birth. This client is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with CPD.
4. The occiput anterior (OA) fetal position is amenable to delivery and would not represent a barrier to labor. This client is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with CPD.

Page Ref: 440-441

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 21.3-Relate the various types of fetal malposition and malpresentation, risks, and clinical therapy to the nursing care management for each.

MNL LO:  Discuss abnormalities or conditions associated with, and management of labor dystocia.

 

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

1. 34-year-old gravida 6 at 39 weeks’ gestation with twins
2. 22-year-old gravida 1 at 23 weeks’ gestation with ruptured membranes
3. 30-year-old gravida 3 at 41 weeks’ gestation and estimated fetal weight 7 pounds 8 ounces
4. 43-year-old gravida 2 at 37 weeks’ gestation with hypertension

Answer:  1

Explanation:  1. Twins at term will cause overdistention of the uterus, putting the client at risk for development of a hypotonic labor pattern. Her high parity also increases the risk for a hypotonic labor pattern.

2. Although this client is high-risk, especially for infection, neonatal lung immaturity, and respiratory distress syndrome, this client has no risk factors for an abnormal labor pattern.
3. This client has an average-sized fetus and no risk factors for either hypertonic or hypotonic labor pattern development.
4. Hypertension does not impact labor pattern; this client has no risk factors for either hypertonic or hypotonic labor pattern development.

Page Ref: 427-428

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 21.1-Compare tachysystolic and hypotonic labor patterns, including risks, clinical therapy, and nursing care management.

MNL LO:  Discuss abnormalities or conditions associated with, and management of labor dystocia.

 

4) Two hours ago, the 39-weeks’-gestation client was 3 cm dilated, 40 percent 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 percent effaced, and +1 station. Frequency of contractions is now every 3 minutes with 40 to 50 seconds’ duration with intensity of 40 mmHg. The priority intervention would be:

1. Begin oxytocin after assessing for CPD.
2. Give Terbutaline to stop the preterm labor.
3. Start oxygen at 8 L/min.
4. Have anesthesia give the client an epidural.

Answer:  1

Explanation:  1. The client is having hypertonic contractions. The presence of CPD can prolong labor, so it is important to rule this out. Oxytocin (Pitocin) can create a more productive labor pattern by strengthening the contractions.

2. Terbutaline would not be recommended. The contraction pattern needs to be enhanced and not stopped.
3. Oxygen will not hurt, but it is not the priority.
4. An epidural will not change the contraction pattern.

Page Ref: 427-428

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 21.1-Compare tachysystolic and hypotonic labor patterns, including risks, clinical therapy, and nursing care management.

MNL LO:  Discuss abnormalities or conditions associated with, and management of labor dystocia.