Dysfunctional Labor (Dystocia) Practice Exam

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1. A nurse is assigned to care for a client with hypotonic uterine dysfunction and signs of a slowing labor. The nurse is reviewing the physician’s orders and would expect to note which of the following prescribed treatments for this condition?

1. Medication that will provide sedation
2. Increased hydration
3. Oxytocin (Pitocin) infusion
4. Administration of a tocolytic medication

2. A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. The priority nursing intervention would be to:

1. Monitor the Pitocin infusion closely
2. Provide pain relief measures
3. Prepare the client for an amniotomy
4. Promote ambulation every 30 minutes

3. A nurse is developing a plan of care for a client experiencing dystocia and includes several nursing interventions in the plan of care. The nurse prioritizes the plan of care and selects which of the following nursing interventions as the highest priority?

1. Keeping the significant other informed of the progress of the labor
2. Providing comfort measures
3. Monitoring fetal heart rate
4. Changing the client’s position frequently

4. A client is admitted to the L & D suite at 36 weeks’ gestation. She has a history of C-section and complains of severe abdominal pain that started less than 1 hour earlier. When the nurse palpates tetanic contractions, the client again complains of severe pain. After the client vomits, she states that the pain is better and then passes out. Which is the probable cause of her signs and symptoms?

1. Hysteria compounded by the flu
2. Placental abruption
3. Uterine rupture
4. Dysfunctional labor

5. A pregnant woman who is at term is admitted to the birthing unit in active labor. The client has only progressed from 2cm to 3 cm in 8 hours. She is diagnosed with hypotonic dystocia and the physician ordered Oxytocin (Pitocin) to augment her contractions. Which of the following is the most important aspect of nursing intervention at this time?

1. Timing and recording length of contractions.
2. Monitoring.
3. Preparing for an emergency cesarean birth.
4. Checking the perineum for bulging.

6. The nurse is completing an obstetric history of a woman in labor. Which event in the obstetric history will help the nurse suspects dysfunctional labor in the current pregnancy?

1. Total time of ruptured membranes was 24 hours with the second birth.
2. First labor lasting 24 hours.
3. Uterine fibroid noted at time of cesarean delivery.
4. Second birth by cesarean for face presentation.

7. The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)?

Answer and Rationale

1. C. Oxytocin (Pitocin) infusion. Therapeutic management for hypotonic uterine dysfunction includes oxytocin augmentation and amniotomy to stimulate a labor that slows.
2. B. Provide pain relief measures. Management of hypertonic labor depends on the cause. Relief of pain is the primary intervention to promote a normal labor pattern.
3. C. Monitoring fetal heart rate. The priority is to monitor the fetal heart rate.
4. C. Uterine rupture. Uterine rupture is a medical emergency that may occur before or during labor. Signs and symptoms typically include abdominal pain that may ease after uterine rupture, vomiting, vaginal bleeding, hypovolemic shock, and fetal distress. With placental abruption, the client typically complains of vaginal bleeding and constant abdominal pain.
5. A. Timing and recording length of contractions. The oxytocic effect of Pitocin increases the intensity and durations of contractions; prolonged contractions will jeopardize the safetyof the fetus and necessitate discontinuing the drug.
6. C. Uterine fibroid noted at time of cesarean delivery.An abnormality in the uterine muscle could reduce the effectiveness of uterine contractions and lengthen the duration of subsequent labors.
7. A. Intrauterine fetal death. Intrauterine fetal death, abruptio placentae, septic shock, and amniotic fluid embolism may trigger normal clotting mechanisms; if clotting factors are depleted, DIC may occur. Placenta accreta, dysfunctional labor, and premature rupture of the membranes aren’t associated with DIC.
8. B. Full bladder. Full bladder can impede the descent of the fetal head. The nurse can readily manage this problem by doing a simple catheterization of the mother.
9. D. Progressive cervical dilation. The expected effect of Pitocin is cervical dilation. Pitocin causes more intense contractions. which can increase the pain. making answer A incorrect. Cervical effacement is caused by pressure on the presenting part. so answer B is incorrect. Answer C is opposite the action of Pitocin.
10. B. Uterine tetany. Uterine tetany could result from the use of oxytocin to induce labor. Because oxytocin promotes powerful uterine contractions, uterine tetany may occur. The oxytocin infusion must be stopped to prevent uterine rupture and fetal compromise.