A nurse is caring for a postpartum client who is a G2 P2002, delivered a 4200 gram neonate vaginally after 4 hours of labor.
Based on the client's delivery information, what postpartum complication is the client at risk for?
Postpartum hemorrhage.
Vaginal laceration.
Uterine inversion.
Postpartum hypertension.
Correct Answer : A,B
Choice A rationale
Postpartum hemorrhage (PPH) is a significant risk for this client due to several factors including a macrosomic neonate (birth weight >4000 grams), which causes overdistention of the uterus. Uterine overdistention stretches the muscle fibers, impairing the uterus's ability to contract effectively (uterine atony) after birth, which is the leading cause of PPH (normal blood loss range: ≤ 500 mL for vaginal birth).
Choice B rationale
A rapid labor (4 hours) and the birth of a macrosomic neonate (4200 grams) increase the risk of vaginal lacerations and tears to the soft tissues of the birth canal. The rapid passage of a large fetal head/shoulder diameter can cause uncontrolled and forceful tearing, often extending into the perineal musculature, leading to potential complications and excessive blood loss.
Choice C rationale
Uterine inversion, the collapse of the fundus into the endometrial cavity, is a rare but severe complication. While associated with factors like aggressive cord traction or fundal pressure, this client's history of macrosomia and rapid labor primarily increases the risk for uterine atony and lacerations, making inversion a much less likely, though possible, complication.
Choice D rationale
Postpartum hypertension (PHTN) is generally related to a history of pre-eclampsia or chronic hypertension. This client's presentation of macrosomia and rapid labor primarily increases the risk for mechanical/anatomical complications like uterine atony and lacerations rather than a primary vasospastic or systemic vascular disorder such as PHTN.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["C","D","F"]
Explanation
Choice A rationale
Prolonged rupture of membranes (PROM), especially beyond 18-24 hours, significantly increases the risk of intrauterine infection (chorioamnionitis) for both mother and fetus. Infection is a contraindication or at least a major caution for a trial of labor after cesarean (TOLAC) as it adds physiological stress and could necessitate an urgent repeat cesarean, complicating recovery. The normal range for time from rupture to delivery is generally under 24 hours.
Choice B rationale
A current separation of the symphysis pubis (diastasis symphysis pubis), often causing significant pelvic girdle pain and instability, presents a mechanical risk during labor and vaginal delivery. The excessive strain and pressure of pushing could exacerbate the separation, leading to severe maternal morbidity, chronic pain, and long-term musculoskeletal dysfunction, thus generally contraindicating a TOLAC.
Choice C rationale
Placenta previa, which occurs when the placenta covers the cervix, necessitating the previous cesarean, is an obstetric indication not expected to recur in subsequent pregnancies with the same certainty as issues like contracted pelvis or certain uterine incision types. With no recurrent previa and an otherwise favorable presentation, the client is a good candidate for a trial of labor after cesarean (TOLAC) because the prior indication was temporary.
Choice D rationale
A breech presentation, which describes the fetus positioned with the buttocks or feet first, was the fetal indication for the previous cesarean section. Assuming the current fetus is in a cephalic (head-down) presentation, this non-recurrent fetal issue makes the client a suitable candidate for a trial of labor after cesarean (TOLAC), as the uterus itself and the maternal pelvis are likely accommodating.
Choice E rationale
Group B streptococcal (GBS) colonization is a common bacterial finding in the lower genital tract, typically managed with prophylactic intravenous antibiotics (e.g., Penicillin) during labor. GBS positivity is a standard infectious risk factor managed with antibiotics and does not contraindicate a trial of labor after cesarean (TOLAC) itself, as it is routinely treated to prevent neonatal sepsis.
Choice F rationale
The gynecoid pelvis is considered the most favorable pelvic shape for vaginal delivery due to its rounded inlet, adequate mid-pelvis, and wide subpubic arch, which allows for optimal fetal head engagement and rotation. This favorable anatomy increases the likelihood of a successful trial of labor after cesarean (TOLAC) and is a strong positive predictive factor.
Correct Answer is D
Explanation
Choice A rationale
Placing a rolled towel under the client's knees causes increased pressure on the popliteal space, potentially compressing the popliteal vein, which increases the risk of deep vein thrombosis (DVT) in the client. This is particularly concerning during labor due to physiologic hypercoagulability and potential for immobility. The priority action must focus on fetal and maternal well-being following rupture of membranes (ROM). This action is non-essential and potentially harmful.
Choice B rationale
While notifying the healthcare provider is crucial, it is not the immediate priority when there is a risk of a severe complication like umbilical cord prolapse following the spontaneous rupture of membranes (ROM). The nurse's immediate action must be to rule out or intervene for fetal distress or cord prolapse. The provider can be notified after the initial fetal status assessment is complete, especially the fetal heart rate (FHR).
Choice C rationale
Administering oxygen via a non-rebreather mask (NRB) is indicated for maternal or fetal hypoxemia or distress, or as part of resuscitation measures. In an initially stable client without signs of severe respiratory distress or non-reassuring fetal heart rate (FHR) patterns, oxygen administration is not the priority. The initial action must be a rapid assessment of fetal status, specifically ruling out cord prolapse after rupture of membranes (ROM).
Choice D rationale
Rupture of membranes (ROM) prior to the fetal head being engaged or firmly applied to the cervix creates a significant risk for umbilical cord prolapse, which is a fetal emergency causing acute fetal hypoxemia due to cord compression. The immediate priority is to assess the fetal heart rate (FHR) and perform a sterile vaginal exam (SVE) to palpate for the prolapsed cord and assess the presenting part. FHR assessment detects distress; SVE detects the prolapse.
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