High-Risk Pregnancies

A nurse is caring for a client who is in labor and experiencing incomplete uterine relaxation between hypertonic contractions. The nurse recognizes the adverse effect of this contraction pattern is:

• prolonged labor
• reduced fetal oxygen supply
• delayed cervical dilation
• increased maternal stress

A nurse is caring for a client who is in active labor and reports severe back pain. During assessment, the fetus is noted to be in the occiput posterior position. Which of the following maternal positions should the nurse suggest to the client to facilitate normal labor progress?

• hands and knees
• lithotomy
• trendelenburg
• supine with a rolled towel under one hip

A nurse is caring for a client who is admitted to the labor and delivery unit. With the use of Leopold’s maneuver, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe?

• precipitous labor
• premature rupture of membranes
• post-maturity syndrome
• prolapsed umbilical cord

A nurse is caring for a client who is at 42 weeks of gestation and in active labor. The nurse should understand that the fetus is at risk for which of the following?

• intrauterine growth restriction
• hyperglycemia
• meconium aspiration
• polyhydramnios

A nurse is caring for a client in active labor. When last examined 2 hr. ago, the client’s cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states “my water broke.” The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vaginal examination, noticing clear fluid and a pulsing loop of umbilical cord in the client’s vagina. Which of the following actions should the nurse perform first?

• place the client in the Trendelenburg position
• apply pressure to the presenting part with her fingers
• administer oxygen at 10L/min via a face mask
• call for assistance

Two clients arrive at the labor and delivery triage area at the same time. The first client states that her water has been leaking, but that she hasn’t had any contractions. The second client says she’s having 1-minute contractions every 3 minutes and that she feels like pushing. How should a nurse prioritize these clients? 

• It doesn’t matter which client receives priority; they’re at the same stage in labor.
• Triage observation is appropriate for both clients at this time.
• The nurse should assign priority to the first client. Her leaking amniotic fluid indicates she will go into labor soon.
• The nurse should assign priority to the second client. Her signs and symptoms indicate that her baby’s birth is imminent.

A client in labor tells the nurse-midwife that she feels a strong urge to push. Physical examination reveals that her cervix is not completely dilated. The nurse-midwife tells her not to push yet. What is the rationale for this instruction?

• Early pushing may cause edema and impede fetal descent.
• The fetus hasn’t rotated into the proper position.
• Pushing at this time may cause rupture of the membranes.
• The nurse-midwife isn’t ready to assist her.

The nurse providing care for the laboring woman understands that accelerations with fetal movement:

• Are caused by umbilical cord compression
• Warrant close observation
• Are caused by uteroplacental insufficiency
• Are reassuring 

What kind of fetal anomalies are most often associated with oligohydramnios?

• cardiac
• gastrointestinal
• renal
• neurologic

A pregnant woman at 25 weeks age of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is the most accurate?

• "That must have been a coincidence; babies can't respond like that."
• "The fetus is demonstrating the aural reflex."
• "Let me know if it happens again; we need to report that to your midwife."
• "Babies respond to sound starting at approximately 24 weeks of gestation."