A primigravida at 40 weeks of gestation is having erratic uterine contractions every 5 to 10 minutes and states that they are very painful.
Her cervix is dilated 2 cm and has not changed in 3 hours.
The woman is crying and wants an epidural.
What is the likely status of this woman's labor?
She is exhibiting hypotonic uterine dysfunction.
She is experiencing a normal latent stage.
She is exhibiting hypertonic uterine dysfunction.
She is experiencing precipitous labor.
The Correct Answer is B
Choice A rationale
Hypotonic uterine dysfunction typically occurs in the active phase of labor (after 4 cm cervical dilation) and is characterized by weak, infrequent, and ineffective contractions that do not lead to cervical change. The client in the latent phase with slow cervical change is not yet in the active phase.
Choice B rationale
The latent phase of the first stage of labor is characterized by irregular, mild to moderate contractions that cause slow, gradual cervical dilation and effacement. It can be lengthy, especially in primigravidas, and the discomfort can be significant. A cervical dilation of 2 cm with no change in 3 hours in the presence of painful, erratic contractions every 5 to 10 minutes aligns with a normal latent phase.
Choice C rationale
Hypertonic uterine dysfunction usually occurs in the latent phase and is characterized by frequent, uncoordinated, and strong contractions that are ineffective in causing cervical dilation or effacement. While the contractions are painful, they are not described as excessively strong or uncoordinated, and the client is in the expected early stage of labor.
Choice D rationale
Precipitous labor is a very rapid labor and delivery, typically lasting less than 3 hours from the onset of regular contractions to expulsion of the fetus. The client's labor is progressing slowly, with minimal cervical change over 3 hours, which is the opposite of precipitous labor.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A firm fundus displaced to the right and above the umbilicus often indicates a full bladder. The bladder, when distended, can push the uterus out of its midline position and interfere with its ability to contract effectively, potentially leading to increased bleeding. Having the client void will relieve the pressure on the uterus, allowing it to return to its midline position and remain firm.
Choice B rationale
Starting a pad count is a useful way to quantify the amount of lochia, but it does not address the immediate issue of the displaced fundus and potential bladder distention. It would be a subsequent step to monitor the bleeding after addressing the fundal position.
Choice C rationale
While fundal massage is appropriate for a soft or boggy uterus, the assessment indicates the fundus is already firm. Massaging a firm uterus is not the priority and will not address the displacement caused by a likely full bladder.
Choice D rationale
Notifying the healthcare provider is necessary if the fundus remains displaced and elevated after the client voids, as this could indicate other complications. However, the initial action should be to address the most likely cause, which is bladder distention.
Correct Answer is C
Explanation
Choice A rationale
The risk for newborn infection is primarily associated with prolonged rupture of membranes or maternal infection during labor, not directly with the administration of general anesthesia during a cesarean birth.
Choice B rationale
While the postpartum period is a time of increased risk for DVT due to hormonal changes and decreased mobility, general anesthesia itself does not significantly increase this risk compared to regional anesthesia. Surgical procedures in general increase DVT risk.
Choice C rationale
General anesthesia can lead to uterine atony, a condition where the uterus fails to contract adequately after delivery. This lack of contraction can result in postpartum hemorrhage, making postpartum bleeding the greatest risk associated with general anesthesia in this scenario.
Choice D rationale
The risk for infection is primarily associated with the surgical incision and the postpartum period in general, not specifically with the type of anesthesia used during the cesarean birth.
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