Women with previous uterine scars are prone to uterine rupture, especially if oxytocin or forceps are used.

If a woman complains of a sharp pain accompanied by the abrupt cessation of contractions, suspect uterine rupture, a medical emergency.

Immediate surgical delivery is indicated to save the fetus and mother.

Based on this information, which of the following nursing actions is most appropriate?

Administer oxygen via face mask and start an IV line

Notify the provider and prepare for emergency cesarean section

Perform a vaginal exam and check for fetal parts in the abdomen

Reassure the woman and monitor her vital signs and fetal heart rate

Answer and Explanation

The Correct Answer is B

This is because uterine rupture is a life-threatening complication that requires immediate surgical intervention to save the mother and the fetus.

Delaying the delivery can result in hemorrhage, shock, infection, and fetal death.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

Caput succedaneum is a swelling of the scalp that can occur after vacuum extraction delivery.It is caused by the pressure of the suction cup on the baby’s head and usually resolves within a few days.

A. A boggy uterus B. A firm fundus at the umbilicus C. Excessive lochia rubra D. Clots larger than a quarter E. A pulse rate of 110/min

Correct Answer is ["A"]

Explanation

A boggy uterus is a sign of uterine atony, which is the failure of the uterus to contract sufficiently after childbirth.

This can lead to excessive bleeding and postpartum hemorrhage.

A firm fundus at the umbilicus is a normal finding after delivery and indicates that the uterus is contracting well.

Excessive lochia rubra is also a sign of uterine atony and postpartum hemorrhage.Lochia rubra is the vaginal discharge composed of blood, mucus, and tissue from the placenta and the uterus lining that occurs after childbirth.

It is normal for the first 3 to 4 days, but it should gradually decrease in amount and change in color.

Clots larger than a quarter are abnormal and indicate excessive bleeding.

A pulse rate of 110/min is a sign of tachycardia, which can be caused by blood loss, infection, or pain.

A normal pulse rate for an adult is between 60 and 100 beats per minute.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

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.

Correct Answer is ["A"]

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.)

A nurse is caring for a client who has prolonged labor and is at risk for infection. Which of the following actions should the nurse take to reduce this risk? (Select all that apply.)

A nurse is evaluating a client who has prolonged and obstructed labor for signs of postpartum hemorrhage. Which of the following findings is an early indicator of postpartum hemorrhage?

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?

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 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)?

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 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.)