A nurse is monitoring a client who had a vaginal birth after cesarean (VBAC) delivery.

The nurse notes that the client has a boggy uterus, heavy vaginal bleeding, and signs of hypovolemic shock.

The nurse suspects that the client has a concealed uterine rupture.

What is an appropriate nursing action for this client?

Massage the fundus and administer methylergonovine as prescribed

Insert an indwelling urinary catheter and measure urine output

Apply ice packs to the perineum and elevate the client’s legs

Start a large-bore IV line and administer crystalloid fluids as prescribed.

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is D

Explanation

All of the above factors should be considered when discussing the possibility of vaginal birth after cesarean (VBAC).

Here’s why:

• The type of uterine incision used in the previous cesarean delivery affects the risk of uterine rupture during VBAC.A low transverse incision is associated with the lowest risk, while a high vertical incision is associated with the highest risk.

• The gestational age of the current pregnancy affects the success rate of VBAC.The optimal time for VBAC is between 39 and 40 weeks of gestation.Attempting VBAC before 37 weeks or after 41 weeks may increase the risk of complications.

• The presentation and position of the fetus affects the feasibility and safety of VBAC.A breech presentation, a transverse lie, or a posterior position may make vaginal delivery difficult or impossible.A cephalic presentation and an anterior position are more favorable for VBAC.

A. Oxygen mask and tubing B. Blood products and IV fluids C. Cardiotocograph and electrodes D. Suction catheter and bulb syringe E. Uterine packing and forceps.

Correct Answer is ["A","B"]

Explanation

Oxygen mask and tubing and blood products and IV fluids should be readily available for a client who has a ruptured uterus.This is because a ruptured uterus can cause severe hemorrhage, hypovolemia, and fetal distress.The client and the fetus may need oxygen therapy and blood transfusion to prevent hypoxia and shock.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is counseling a client who has a small pelvis and wants to have a vaginal delivery. Which of the following factors should the nurse consider when discussing the possibility of vaginal birth after cesarean (VBAC)?

Correct Answer is D

Explanation

A nurse is preparing to assist with an emergency cesarean delivery for a client who has a ruptured uterus. Which of the following equipment should the nurse have readily available? (Select all that apply.)

Correct Answer is ["A","B"]

Explanation

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 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 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 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 reviewing the risk factors for uterine rupture with a group of nursing students. Which of the following risk factors should the nurse include? (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 evaluating a client who has prolonged labor and suspects uterine rupture. Which of the following findings should alert the nurse to this complication?