Review Diagnosis and treatment

Prolonged and Obstructed Labor and Ruptured Uterus > Maternal & Newborn

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Diagnosis and treatment

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Total Questions : 10

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Question 1:

A nurse is using a partograph to monitor a client in labor.

What is the main purpose of using a partograph?

A. To record the maternal and fetal data during labor on a single sheet of paper B. To measure the blood pressure and temperature of the mother every hour C. To calculate the estimated date of delivery and gestational age of the fetus D. To diagnose the cause of prolonged and obstructed labor.

Answer and Explanation

Choice A:

To record the maternal and fetal data during labor on a single sheet of paper.This is the main purpose of using a partograph, which is a tool for monitoring maternal and fetal wellbeing during the active phase of labor, and a decision-making aid when abnormalities are detected.

Choice B:

Measuring the blood pressure and temperature of the mother every hour is only one of the maternal indicators that are recorded on the partograph, along with heart rate, time of rupture of membranes, uterine contractions, urine output and drugs administered.

Choice C:

Calculating the estimated date of delivery and gestational age of the fetus is not done using a partograph, but rather using other methods such as ultrasound or last menstrual period.

Choice D:

diagnosing the cause of prolonged and obstructed labor is not the main purpose of using a partograph, but rather a possible outcome of interpreting the partograph.

The partograph has two diagonal lines: an alert line and an action line.If the dilation curve crosses the action line, decisions must be made (augmentation of labor, artificial rupture of membranes, cesarean section, etc.).

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Question 2:

A nurse is assessing a client who has prolonged and obstructed labor.

Which of the following findings is a sign of obstructed labor?

A. Cervical dilation of 4 cm after 8 hours of active labor B. Fetal heart rate of 140 beats per minute C. Moulding of the fetal skull bones D. Uterine contractions of 3 in 10 minutes.

Answer and Explanation

Choice A:

it is not a sign of obstructed labour, but rather a sign of slow progress of labour.Slow progress can have many causes, such as weak contractions, maternal exhaustion, or fetal malposition.

Choice B:

it is not a sign of obstructed labour, but rather a normal finding.The normal range for fetal heart rate is 110 to 160 beats per minute.

Choice C:

is a sign of obstructed labour, which occurs when the baby cannot pass through the birth canal due to a mismatch between the size or position of the baby and the pelvis.

Choice D:

it is not a sign of obstructed labour, but rather a normal finding.The normal frequency for uterine contractions in active labour is 3 to 5 in 10 minutes.

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Question 3:

A nurse is preparing to perform a vacuum extraction for a client who has prolonged and obstructed labor.

Which of the following criteria must be met before performing this procedure? (Select all that apply).

A. The cervix must be fully dilated and effaced B. The membranes must be ruptured and clear of meconium C. The fetal head must be engaged and well-flexed D. The maternal pelvis must be adequate for vaginal delivery E. The fetal weight must be less than 2500 grams.

Answer and Explanation

Choice A:

Choice B:

The membranes must be ruptured, but they do not have to be clear of meconium. Meconium-stained amniotic fluid is not a contraindication for vacuum extraction.

Choice C:

Choice D:

Choice E:

The fetal weight does not have to be less than 2500 grams. Vacuum extraction can be performed for term or near term infants, as long as the head is engaged and the pelvis is adequate. Vacuum extraction should be avoided before 34 weeks of gestation due to increased risk of intracranial hemorrhage.

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Question 4:

A nurse is caring for a client who has prolonged and obstructed labor.

The client develops signs of infection, such as fever, tachycardia, and foul-smelling lochia.

Which of the following interventions should the nurse implement?

A. Administer antibiotics as prescribed. B. Perform an episiotomy to facilitate delivery. C. Increase the frequency of vaginal examinations. D. Encourage oral fluids and nutrition.

Answer and Explanation

Choice A:

This is because the client has signs of infection, such as fever, tachycardia, and foul-smelling lochia, which can indicate endometritis or sepsis.Antibiotics can help treat the infection and prevent complications.

Choice B:

performing an episiotomy to facilitate delivery is not indicated for a client who has prolonged and obstructed labor.

An episiotomy is a surgical incision in the perineum to enlarge the vaginal opening.It can increase the risk of infection, bleeding, and pain.

Choice C:

increasing the frequency of vaginal examinations can introduce more bacteria into the vagina and uterus, increasing the risk of infection.Vaginal examinations should be minimized for a client who has prolonged and obstructed labor.

Choice D:

encouraging oral fluids and nutrition is not sufficient to treat the infection.Oral fluids and nutrition can help prevent dehydration and malnutrition, but they do not address the underlying cause of the infection.

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Question 5:

A nurse is educating a group of pregnant women about the risk factors for prolonged and obstructed labor.

Which of the following factors should the nurse include? (Select all that apply).

A. Maternal age younger than 18 years or older than 35 years. B. Maternal height less than 150 cm or more than 180 cm. C. Fetal presentation other than vertex, such as breech or transverse. D. Fetal size larger than average, such as macrosomia or hydrocephalus. E. Fetal position posterior, such as occiput posterior or sacrum posterior.

Answer and Explanation

Choice A:

Maternal age younger than 18 years or older than 35 years is not a risk factor for prolonged and obstructed labor. It is a risk factor for preterm labor, preeclampsia, gestational diabetes and other complications.

Choice B:

Maternal height less than 150 cm or more than 180 cm is not a risk factor for prolonged and obstructed labor. It is a risk factor for cephalopelvic disproportion (CPD), which is a mismatch between the size of the fetal head and the size of the maternal pelvis.

Choice C:

Fetal presentation other than vertex, such as breech or transverse, and fetal size larger than average, such as macrosomia or hydrocephalus, are risk factors for prolonged and obstructed labor.

Choice D:

Fetal presentation other than vertex, such as breech or transverse, and fetal size larger than average, such as macrosomia or hydrocephalus, are risk factors for prolonged and obstructed labor.

Choice E:

Fetal position posterior, such as occiput posterior or sacrum posterior, is not a risk factor for prolonged and obstructed labor. It is a risk factor for back pain during labor, prolonged second stage of labor and instrumental delivery.

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Question 6:

A nurse is caring for a client who has a history of risk factors for ruptured uterus.

What are some of the risk factors that the nurse should assess? (Select all that apply.).

A. Previous cesarean section. B. Uterine fibroids. C. Multiparity. D. Gestational diabetes. E. Induced labor.

Answer and Explanation

Choice A:

Previous cesarean section can leave a scar on the uterus that can tear open during contractions or pressure from the baby.

Choice B:

Uterine fibroids are benign tumors that can distort the shape of the uterus and interfere with its ability to contract and relax normally.

Choice C:

Multiparity means having given birth to more than one child. This can stretch and thin the uterine wall over time and make it more prone to rupture.

Choice D:

Gestational diabetes does not directly affect the integrity of the uterine wall. It can cause other complications such as macrosomia (large baby) or preeclampsia (high blood pressure), but these are not risk factors for uterine rupture by themselves.

Choice E:

Induced labor can involve the use of drugs such as oxytocin or prostaglandins that can cause strong and frequent contractions that can put too much stress on the uterine wall. Induced labor can also involve artificial rupture of membranes or insertion of a balloon catheter that can increase the risk of infection or trauma to the uterus.

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Question 7:

A nurse is performing a physical examination of a mother and the fetus who are suspected to have a ruptured uterus.

What are some of the signs and symptoms that the nurse should look for? (Select all that apply.).

A. Abdominal pain, tenderness, and rigidity B. Fetal parts palpable through the abdominal wall or under the pubic bone C. Vaginal bleeding and signs of shock D. Fetal heart rate above 160 beats per minute E. Absent or decreased fetal movements.

Answer and Explanation

Choice A:

Choice B:

fetal parts palpable through the abdominal wall or under the pubic bone are not a sign of uterine rupture, but of uterine inversion. This is a rare condition where the uterus turns inside out after delivery.

Choice C:

Choice D:

fetal heart rate above 160 beats per minute is not a sign of uterine rupture, but of fetal tachycardia. This is a condition where the fetus’s heart rate is abnormally fast, usually due to maternal fever, infection, dehydration, or fetal distress.

Choice E:

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Question 8:

A nurse is reviewing the laboratory tests of a client who has a ruptured uterus.

What are some of the tests that the nurse should expect to be ordered for this client?

A. Complete blood count B. Blood type and cross-match C. Coagulation profile D. All of the above.

Answer and Explanation

Choice A:

a CBC alone is not enough to evaluate the client’s condition.

Choice B:

a blood type and cross-match alone is not enough to evaluate the client’s condition.

Choice C:

a coagulation profile alone is not enough to evaluate the client’s condition.

Choice D:

A client who has a ruptured uterus is at risk of severe hemorrhage and shock, so the following tests are necessary to assess the blood loss and prepare for possible transfusion:

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Question 9:

A nurse is preparing a client who has a ruptured uterus for an emergency cesarean section.

What are some of the indications for this procedure?

A. Fetal distress or demise B. Severe maternal hemorrhage or shock C. Complete uterine rupture or large uterine tear D. All of the above.

Answer and Explanation

Choice A:

fetal distress or demise is not the only indication for an emergency cesarean section in case of a ruptured uterus.

Choice B:

severe maternal hemorrhage or shock is not the only indication for an emergency cesarean section in case of a ruptured uterus.

Choice C:

complete uterine rupture or large uterine tear is not the only indication for an emergency cesarean section in case of a ruptured uterus.

Choice D:

indications for an emergency cesarean section in case of a ruptured uterus.A ruptured uterus is a serious complication where the uterus tears or breaks open, usually along the scar line of a previous C-section delivery.It can cause severe maternal hemorrhage or shock, fetal distress or demise, and complete uterine rupture or large uterine tear.

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Question 10:

A nurse is assisting a client who has an incomplete uterine rupture or small uterine tear with a vacuum extraction delivery.

What are some of the criteria for this procedure?

A. Adequate cervical dilation and descent of the fetal head B. No evidence of fetal distress or demise C. No contraindication such as prematurity, bleeding disorder, or hydrocephalus D. All of the above.

Answer and Explanation

Choice A:

adequate cervical dilation and descent of the fetal head are necessary but not sufficient conditions for vacuum extraction delivery.There are other factors that need to be considered, such as the position and size of the baby, the shape of the mother’s pelvis, and the availability of skilled personnel.

Choice B:

no evidence of fetal distress or demise is also a necessary but not sufficient condition for vacuum extraction delivery.Fetal distress or demise may indicate the need for an emergency cesarean section instead of an assisted vaginal delivery.

Choice C:

no contraindication such as prematurity, bleeding disorder, or hydrocephalus is also a necessary but not sufficient condition for vacuum extraction delivery.These conditions may increase the risk of complications or injuries for the mother or the baby during vacuum extraction.

Choice D:

All of the above are criteria for vacuum extraction delivery.Vacuum extraction is a method of assisted vaginal delivery that can help get the baby out when labor is stalled in the second stage.It involves applying a suction cup to the baby’s head and pulling while the mother pushes.

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Total Questions : 10

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Diagnosis and treatment

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