When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for has increased.

Supine hypotension.

Precipitous labor.

Intrauterine infection.

Hemorrhage.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Supine hypotension, or aortocaval compression, is a risk typically associated with lying flat on the back during late pregnancy or labor, which compresses the vena cava and aorta. Rupture of membranes does not directly or significantly increase this risk; proper positioning, such as left lateral tilt, prevents this complication.

Choice B rationale

Precipitous labor is characterized by rapid labor and birth occurring within three hours of the onset of contractions. While rupture of membranes can occasionally precede or be associated with rapid progression, it is not an independent factor that substantially increases the underlying risk of a woman having a precipitous labor.

Choice C rationale

Intrauterine infection, or chorioamnionitis, is the primary risk that increases significantly after rupture of membranes, particularly if labor is prolonged. The amniotic sac provides a sterile barrier; its loss allows bacteria from the vagina to ascend into the uterus, which can infect the mother and the fetus.

Choice D rationale

Hemorrhage, or excessive bleeding, is most often associated with uterine atony, retained placental fragments, or trauma following birth. Rupture of membranes is not a direct or strong predictor of postpartum hemorrhage; this complication is primarily related to the third and fourth stages of labor.

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Correct Answer is C

Explanation

Step 1 is: Subtract 3 months from the month of the last menstrual period (LMP) and add 7 days to the day of the LMP.

Step 2 is: The LMP month is 10 (October). Subtract 3 months: 10 minus 3 equals 7 (July).

Step 3 is: The LMP day is 14. Add 7 days: 14 plus 7 equals 21.

Step 4 is: Naegele's rule also requires adjusting the year forward by one year because the calculation crosses the calendar year boundary, which is 2023 plus 1 equals 2024.

Step 5 is: The estimated due date (EDD) is July 21, 2024.

A. "Don't worry, we can get you to the bathroom and you can have a bowel movement before delivery.”. B. "This happens with most deliveries. You shouldn't worry about having a bowel movement.”. C. "When you visited the bathroom before your epidural was placed, that was your opportunity to have a bowel movement.”. D. "You are at risk for falling if you try to get out of bed. I will assist you in keeping clean while you are pushing.”. —

Correct Answer is D

Explanation

Choice A rationale

Following the administration of an epidural, the client experiences a block of sensory and motor nerve fibers below the level of the block, which significantly impairs their ability to safely ambulate or bear weight. Allowing a client who has received an epidural to ambulate to the bathroom poses an extreme risk for falls and injury due to the lower extremity motor weakness and sensory loss. Safety is the foremost priority in obstetric nursing care during the active labor phase with regional anesthesia.

Choice B rationale

While it is true that a small amount of stool may be expelled during the pushing phase due to the immense pressure being exerted on the rectum and surrounding structures, dismissing the client's concern by stating "you shouldn't worry" is non-therapeutic. The nurse should instead validate the client's concern and provide a clear, supportive explanation of the measures taken to maintain cleanliness and dignity during delivery.

Choice C rationale

This statement is an overly simplistic and unhelpful response that minimizes the client's current emotional state and physiological needs. It implies that the client missed a chance and does not address the immediate concern about having a bowel movement during the pushing stage of labor. The nurse must offer reassurance and practical, immediate guidance based on the effects of the epidural anesthesia.

Choice D rationale

This is the most appropriate and therapeutic response because it addresses the physiological limitations imposed by the epidural anesthesia, which causes lower extremity numbness and motor weakness, thereby increasing the risk for falls. Furthermore, it validates the client's concern regarding cleanliness and provides reassurance that the nurse will proactively maintain the client's hygiene and dignity throughout the birthing process.

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When planning care for a laboring woman whose membranes have ruptured, the nurse recognizes that the woman's risk for has increased.

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Naxlex Comprehensive Predictor Exams

The nurse receives a call at the provider's office with a patient asking what her estimated due date is. The last menstrual period was on 10/14/2023. Using Naegele's rule, the nurse determines that the EDD is:

Correct Answer is C

Explanation

The client has just received an epidural and is concerned about having a bowel movement while pushing and delivering her baby. Which of the following statements by the nurse is appropriate?

Correct Answer is D

Explanation

The nurse is taking an advice call from a woman at 40 weeks' gestation. The nurse instructs the patient to go to the hospital to be evaluated when the patient states which of the following?

With regard to primary and secondary powers, the maternity nurse should know that:

Which complaint made by a client at 35 weeks of gestation requires additional assessment?

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:

The client has just received an epidural and is concerned about having a bowel movement while pushing and delivering her baby. Which of the following statements by the nurse is appropriate?

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is:

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping:

Which FHR finding would concern the nurse during labor?