During augmentation of labor with intravenous oxytocin (Pitocin), a multiparous client becomes pale and diaphoretic and complains of severe lower abdominal pain with a tearing sensation. An abnormal FHR tracing is noted on the monitor. The nurse should suspect:

Uterine prolapse.

Uterine rupture.

Precipitous labor.

Amniotic fluid embolus.

Answer and Explanation

The Correct Answer is B

A. Uterine prolapse. Uterine prolapse occurs when the uterus descends into or outside the vagina, usually postpartum due to weakened pelvic support. It does not present with sudden, severe pain or fetal heart rate abnormalities during labor.

B. Uterine rupture. A tearing sensation, sudden severe pain, fetal heart rate abnormalities, pallor, and diaphoresis are hallmark signs of uterine rupture. This is a life-threatening emergency where the uterine wall tears, often due to prior cesarean scars, excessive oxytocin use, or grand multiparity. Immediate intervention, including emergency surgery, is required to prevent maternal and fetal death.

C. Precipitous labor. Precipitous labor is rapid labor and delivery within three hours and is not associated with severe, tearing pain. While it can cause fetal distress, it does not typically involve uterine rupture symptoms.

D. Amniotic fluid embolus. An amniotic fluid embolus presents with sudden respiratory distress, hypotension, and cardiovascular collapse due to amniotic fluid entering the maternal circulation. It does not typically cause localized severe abdominal pain or fetal distress due to uterine rupture.

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Correct Answer is A

Explanation

A. The type of uterine incision used for the cesarean. This is the most important information because the type of uterine incision determines whether a trial of labor after cesarean (TOLAC) is safe. A low transverse incision is the safest and has the lowest risk of uterine rupture, while a classical (vertical) incision carries a high risk of rupture and contraindicates vaginal birth after cesarean (VBAC).

B. The client's blood type and Rh status. While blood type and Rh status are important for managing potential complications such as Rh incompatibility, they do not determine the safety of a VBAC attempt. The uterine incision type is the key factor in assessing the risk of uterine rupture.

C. The client's response to anesthesia used for the last delivery. Although anesthesia history is relevant for planning pain management, it is not the most critical factor in determining whether the patient can safely attempt a vaginal delivery after a prior cesarean.

D. Lab values, especially hemoglobin and hematocrit. Hemoglobin and hematocrit levels help assess for anemia or blood loss risk, but they do not affect the safety of a VBAC attempt. The primary concern is uterine integrity, which is determined by the type of previous cesarean incision.

A. Transverse fetal lie B. Preterm labor C. Severe preeclampsia D. Placenta Previa E. Placental abruption

Correct Answer is ["B"]

Explanation

A. Transverse fetal lie. A transverse fetal lie is related to fetal positioning and is not a direct complication of trauma. While maternal injuries can sometimes lead to abnormal fetal positioning, a car accident does not directly cause a transverse lie.

B. Preterm labor. Trauma, including a car accident, can trigger preterm labor due to stress, uterine irritation, or placental dysfunction. Uterine contractions may begin as a response to the injury, potentially leading to preterm birth.

C. Severe preeclampsia. Preeclampsia is not a direct result of trauma. It is a pregnancy-related hypertensive disorder that develops due to vascular abnormalities rather than external injury. A car accident does not increase the risk of preeclampsia.

D. Placenta previa. Placenta previa is a condition where the placenta covers the cervix, leading to painless vaginal bleeding, but it is not caused by trauma. It is a pre-existing placental abnormality rather than a complication of an auto accident.

E. Placental abruption. Trauma, such as a car accident, significantly increases the risk of placental abruption, where the placenta prematurely detaches from the uterine wall. This can cause vaginal bleeding, abdominal pain, and fetal distress, making it a critical complication to monitor for in a pregnant trauma patient.

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During augmentation of labor with intravenous oxytocin (Pitocin), a multiparous client becomes pale and diaphoretic and complains of severe lower abdominal pain with a tearing sensation. An abnormal FHR tracing is noted on the monitor. The nurse should suspect:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A pregnant woman is just admitted to the emergency room after a head on auto accident. Her body appears to be uninjured. The nurse carefully monitors the woman for which complication(s) of pregnancy? (Select all that apply)

Correct Answer is ["B"]

Explanation

The nurse is assessing a patient who has severe preeclampsia. The assessment finding that should be reported to the physician is:

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