A nurse is assessing a client who is in labor and has been pushing for 3 hours with no progress.

The nurse should identify that this client is at risk for which of the following complications? (Select all that apply.).

Postpartum infection

Postpartum hemorrhage

Maternal exhaustion

Neonatal sepsis

Neonatal hypoglycemia.

Answer and Explanation

Correct Answer : B,C

A client who is in labor and has been pushing for 3 hours with no progress is at risk for postpartum hemorrhage and maternal exhaustion. This is because a prolonged second stage of labor can cause uterine atony, which is a failure of the uterus to contract and stop bleeding after delivery. It can also cause fatigue, dehydration, and electrolyte imbalance in the mother.

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Correct Answer is D

Explanation

This is because the client has signs of concealed uterine rupture, which is a rare but serious complication of VBAC delivery.Concealed uterine rupture occurs when the uterus tears through the endometrium and myometrium, but the peritoneum remains intact.This can cause heavy vaginal bleeding, hypovolemic shock, and fetal distress.The priority nursing action is to restore the client’s blood volume and prepare for emergency surgery to deliver the fetus and repair the uterus.

A. Crowning B. Molding C. Caput succedaneum D. Shoulder dystocia.

Correct Answer is A

Explanation

Crowning is when the fetal head is visible at the vaginal opening and does not slip back in with each contraction.This indicates that the baby is ready to be born and the mother should stop pushing to avoid tearing or the need for an episiotomy.

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A nurse is assessing a client who is in labor and has been pushing for 3 hours with no progress. The nurse should identify that this client is at risk for which of the following complications? (Select all that apply.).

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Correct Answer is D

Explanation

A nurse is assessing a client who is in labor and notes that the fetal head is visible at the vaginal opening but does not advance with pushing. The nurse should identify this finding as which of the following?

Correct Answer is A

Explanation

A nurse is assessing a client who is in labor and has been pushing for 3 hours with no progress. The nurse should identify that this client is at risk for which of the following complications? (Select all that apply.).

A gush of blood is noted with the rupture of membranes. On palpation, the uterus is soft (i.e., relaxed) and the patient is not reporting any pain. An FHR deceleration down to 90 bpm is noted. What does the nurse suspect has happened?

A nurse is assisting a client who has prolonged and obstructed labor to deliver by vacuum extraction. Which of the following complications should the nurse monitor for in the newborn?

A nurse is providing emotional support to a client who had a prolonged labor and delivered a stillborn baby by cesarean section. Which of the following actions should the nurse take?

A nurse is providing discharge teaching to a client who had a ruptured uterus and a hysterectomy during labor. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A nurse is assessing a client who had a prolonged labor and is at risk for uterine atony. Which of the following findings should indicate to the nurse that the client has this condition? Select all that apply.

A nurse is caring for a client who is in active labor and experiencing shoulder dystocia. Which of the following actions should the nurse take? (Select all that apply.).

A nurse is reviewing the partograph of a client in labor. The nurse notes that the cervical dilation curve is above the alert line and below the action line. What does this indicate?

A nurse is assessing a client who is in labor and has been pushing for 3 hours with no progress.

The nurse should identify that this client is at risk for which of the following complications? (Select all that apply.).