Chapter 22 Birth-Related Procedures

1) The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client's chart requires immediate intervention?

1. "Multipara, transverse lie."

2. "Primipara, frank breech ballotable."

3. "Multipara, 32 weeks, complete breech."

4. "Primipara, failed ECV last week."

Answer: 3

3. ECV is not attempted until 36 weeks. This client is too early in her pregnancy for ECV.

2) The clinical nurse coordinator is meeting with a group of nursing students in post conference to teach about caring for women who undergo artificial rupture of membranes (AROM) by way of amniotomy. Which nursing student's statement indicates that the teaching has been effective?

1. "For women who undergo artificial rupture of membranes, vaginal examinations should be limited."

2. "In most cases, it is appropriate to assess the fetal heart rate (FHR) right after the artificial rupture of membranes is performed."

3. "Amniotomy is contraindicated for use in labor augmentation."

4. "Women who undergo artificial rupture of membranes should be advised that they will experience a 'dry birth.'"

Answer: 1

Explanation: 1. Following AROM, because there is now an open pathway for organisms to ascend into the uterus, the number of vaginal exams must be kept to a minimum to reduce the chance of introducing an infection.

3) Induction of labor is planned for a 31-year-old primipara due to insulin-dependent diabetes. The client is 39 weeks' gestation. She reports that she feels as though her baby has "flipped" in her abdomen. Which nursing action is most important?

1. Evaluate fetal maturity.

2. Administer dinoprostone (Prepidil) vaginal gel.

3. Implement continuous electronic fetal monitoring (EFM).

4. Notify the client's healthcare provider that the patient feels as though her baby has changed position.

Answer: 4

4. Because malpresentation, such as breech, is a relative contraindication to induction of labor, the client will require additional evaluation by her physician before proceeding.

4) The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous client states: "I can reduce the likelihood that I'll tear or need an episiotomy if I:

1. "Push in a semi-sitting position."

2. "Make sure I push long and hard."

3. "Begin regular perineal massage."

4. "Pull back on my legs when pushing."

Answer: 3

3. Perineal massage has been shown to decrease the need for episiotomy in primiparous clients.

5) The nurse is completing discharge teaching for a client who delivered two days ago. Which statement indicates that further information is required?

1. "Because I have a midline episiotomy, I should keep my perineum clean."

2. "Soaking in the tub will help my mediolateral episiotomy to heal."

3. "I can take ibuprofen (Motrin) when my perineum starts to hurt."

4. "The tear I have through my rectum is unrelated to my episiotomy."

Answer: 4

4. This statement is incorrect. Midline episiotomies tend to tear posteriorly toward the rectum.

6) The client requires vacuum extraction assistance. To provide easier access to the fetal head, the healthcare provider cuts a mediolateral episiotomy. After delivery, the client asks what kind of episiotomy was performed. What is the best response for the nurse to make?

1. "The episiotomy goes straight back toward your rectum."

2. "The episiotomy is from your vagina toward the urethra."

3. "The episiotomy is cut diagonally away from your vagina."

4. "The episiotomy extends from your vagina into your rectum."

Answer: 3

3. Mediolateral episiotomy is angled from the vaginal opening toward the buttock.

7) The client is recovering from a delivery that included a midline episiotomy. Her perineum is swollen and sore. The client is asking for her ice pack to be refreshed. The best response from the nurse is:

1. "I'll get you one right away."

2. "You only need to use one ice pack."

3. "You need to leave it off for at least 20 minutes and then reapply."

4. "I'll bring you an extra so that you can change it when you are ready."

Answer: 3

3. Optimal effects from the use of an ice pack occur when it is applied for 20 to 30 minutes and then removed for at least 20 minutes before being reapplied.

8) The nurse is training a nurse new to the labor and delivery unit. They are caring for a laboring client who is undergoing a forceps delivery. Which action requires intervention?

1. Regional anesthesia is administered via pudendal block.

2. The client is instructed to push between contractions.

3. Fetal heart tones are consistently between 110 and 115.

4. Bladder is emptied using a straight catheter.

Answer: 2

2. The client should only push during contractions, not between contractions.

9) The client has been pushing for two hours and is exhausted. The physician is performing a vacuum extraction birth. What finding is expected?

1. The head is delivered after eight pulls during contractions.

2. A bruise is present on the occiput that does not cross the suture line.

3. The location of the vacuum is apparent on the fetal scalp after birth.

4. Positive pressure is applied by the vacuum extraction during contractions.

Answer: 3

3. Caput in the shape of the vacuum cup is usually present immediately after birth and resolves in 2 to 3 days.

10) The client has been pushing for two hours and is exhausted. The fetal head is visible between contractions. The healthcare provider informs the client that a vacuum extractor could be used to facilitate the delivery. Which statement indicates that the client needs additional information about vacuum extraction assistance?

1. "A small cup will be put onto the baby's head, and a gentle suction will be applied."

2. "I can stop pushing and just rest if the vacuum extractor is used."

3. "The baby's head might have a bruise from the vacuum cup."

4. "The vacuum will be applied for a total of ten minutes or less."

Answer: 2

2. Vacuum extraction is an assistive delivery, and the client must continue with pushing efforts to accomplish the birth.

11) The nurse is reviewing charts of clients who underwent cesarean births by request in the last two years. The hospital is attempting to decrease costs of maternity care. What findings contribute to increased healthcare costs in clients undergoing cesarean birth by request?

1. Increased abnormal placenta implantation in subsequent pregnancies

2. Decreased use of general anesthesia with greater use of epidural anesthesia

3. Prolonged anemia, requiring blood transfusions every few months

4. Coordination of career projects of both partners leading to increased income

Answer: 1

Explanation: 1. Placenta implantation problems are more common after cesarean birth and increase healthcare costs because of the high risk care and testing required.

12) The client had a classical uterine incision for her cesarean birth. The nurse knows that the client understands implications for future pregnancies that are secondary to her classical uterine incision when the client states:

1. "The next time I have a baby, I can try to deliver vaginally."

2. "The risk of rupturing my uterus is too high for me to have any more babies."

3. "Every time I have a baby, I will have to have a cesarean delivery."

4. "I can only have one more baby."

Answer: 3

3. A classical uterine incision is made in the upper uterine segment and holds an increased risk of rupture in subsequent pregnancy, labor, and birth.

13) After being in labor for several hours with no progress, the client is diagnosed with cephalopelvic disproportion (CPD) and must have a cesarean section. The client is being prepared for a cesarean delivery in the operating room. The healthcare provider is present. The nurse knows that the last assessment the nurse should make just prior to the client's being draped for surgery is:

1. Maternal temperature.

2. Maternal urine output.

3. Vaginal exam.

4. Fetal heart tones.

Answer: 4

4. Fetal heart tones are assessed just prior to the start of surgery because the supine position can lead to fetal hypoxia.

14) The nurse is teaching a class on vaginal birth after cesarean (VBAC). Which statement by a participant indicates that additional information is needed?

1. "Since the scar on my belly goes down from my navel, I am not a candidate for a VBAC."

2. "My first baby was in a breech position, so this pregnancy I can try a VBAC if the baby is head-down."

3. "Because my hospital is so small and in a rural area, they won't let me attempt a VBAC."

4. "The rate of complications from VBAC is lower than the rate of complications from a cesarean."

Answer: 1

Explanation: 1. Skin incision is not indicative of uterine incision. Only the uterine incision is a factor in deciding if VBAC is advisable. Classical vertical incisions on the uterus have a higher rate of rupture and should not be attempted.

15) The nurse is caring for a G2P1 woman that is 37 weeks' gestation presenting for an external version. The nurse is reviewing the medical record for what contraindications to external version? Select all that apply.

1. Shoulder presentation

2. Non-reassuring fetal status

3. History of placental abruption or suspected placental abruption

4. Breech presentation

5. Severe preeclampsia

Answer: 2, 3, 5

2. This is a contraindication for external version.

3. This is a contraindication for external version.

5. This is a contraindication for external version.

16) A 41-week, G1P0 woman came to the hospital for misoprostol induction. The client asks the novice nurse, "How long will I have to wait until they start the oxytocin?" What response by the novice nurse indicates that additional information is needed? Select all that apply.

1. Oxytocin should not be administered less than 1 hour after the last misoprostol dose.

2. Oxytocin should not be administered less than 2 hours after the last misoprostol dose.

3. Oxytocin should not be administered less than 3 hours after the last misoprostol dose.

4. Oxytocin should not be administered less than 4 hours after the last misoprostol dose.

Answer: 1, 2, 3

Explanation: 1. Oxytocin should not be administered less than 4 hours after the last misoprostol dose.

2. Oxytocin should not be administered less than 4 hours after the last misoprostol dose.

3. Oxytocin should not be administered less than 4 hours after the last misoprostol dose.