NCLEX Review about Obstetrical Malpractice
91. A nurse in labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for risk of uterine rupture if which of the following occurred?
a) forcep delivery
b) schultz presentation
c) hypotonic contractions
d) weak bearing-down efforts
92. A clinic nurse is performing a prenatal assessment on a pregnant client. The nurse would implement teaching related to the risk of abruptio placentae if which of the following information was obtained on assessment?
a) the client is 28 years of age
b) this is the second pregnancy
c) the client has a history of hypertension
d) the client performs moderate exercise on a regular daily schedule
93. A nurse is performing an initial assessment on a client who has just been told that pregnancy test is positive. Which assessment finding would indicate that the client is at risk of preterm labor?
a) the client is a 35-year old primigravida
b) the client has history of cardiac disease
c) the client's hemoglobin level is 13.5 g/dL
d) the client is a 20-year old primigravida of average weight and height
94. A nurse in labor room is monitoring a client with dysfunctional labor for signs of fetal or maternal compromise. Which of the following assessment findings would alert the nurse to compromise?
a) maternal fatigue
b) coordinated uterine contractions
c) progressive changes in the cervix
d) persistent nonreassuring fetal heart rate
95. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of slowing labor. The nurse is reviewing the physician's orders and would expect to note which of the following prescribed treatments for this condition?
a) increased hydration
b) oxytocin (Pitoxin) infusion
c) medication that will provide sedation
d) administration of a tocolytic medication
NCLEX Review about Obstetrical Malpractice : ANSWERS AND RATIONALE
91) A
- excessive fundal pressure, forcep delivery, violent bearing-down efforts, tumultuous labor, and shoulder dystocia can place a client at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing-down efforts do not add to the risk of rupture because they do not add to the stress on the uterine wall. Schultz presentation is the expulsion of the placenta with the fetal side presenting first and is not associated with uterine rupture.
92) C
- abruptio placentae is associated with conditions characterized by poor uteroplacental circulation, such as hypertension, smoking, and alcohol or cocaine abuse. The condition is also associated with physical and mechanical factors, such as overdistention of the uterus, which occurs with multiple gestation or polyhydramios. In addition, a short umbilical cord, physical trauma, and increased maternal age and parity are risk factors.
93) B
- several factors are associated with preterm labor. These include the history of medical conditions, present and past obstetric problems, social and environmental factors, and demographic factors such as race and age. Other risk factors include a multifetal pregnancy, which contributes to overdistention of the uterus, anemia, which decreases oxygen supply to the uterus, and age younger than 18 years or first pregnancy older than the age of 40.
94) D
- signs of fetal or maternal compromise include a persistent, nonreassuring fetal heart rate, fetal acidosis, and the passage of meconium. Maternal exhaustion and infection can occur if the labor is prolonged but do not indicate fetal or maternal compromise. Progressive changes in the cervix and coordinated uterine contractions are a reassuring pattern in labor.
95) B
- therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows. A cesarean birth will be performed if no progress in labor occurs. Option A, C, and D identify therapeutic measures for a client with hypertonic dysfunction.
Or go back to NCLEX Review about Obstetrical Malpractice (1-5) to start the practice test from the beginning.
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