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1. A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred?
- Hypotonic contractions
- Forceps delivery
- Schultz delivery
- Weak bearing down efforts
2. 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?
- Hysteria compounded by the flu
- Placental abruption
- Uterine rupture
- Dysfunctional labor
3. During the period of induction of labor, a client should be observed carefully for signs of:
- Severe pain
- Uterine tetany
- Umbilical cord prolapse
4. At what stage of labor is the mother is advised to bear down?
- When the mother feels the pressure at the rectal area
- During a uterine contraction
- In between uterine contraction to prevent uterine rupture
- Anytime the mother feels like bearing down
5. When uterine rupture occurs, which of the following would be the priority?
- Limiting hypovolemic shock
- Obtaining blood specimens
- Instituting complete bed rest
- Inserting a urinary catheter
Answers & Rationales
- B. Forceps delivery. Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.
- 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.
- 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.
- B. During a uterine contraction. The primary power of labor and delivery is the uterine contraction. This should be augmented by the mother’s bearing down during a contraction.
- A. Limiting hypovolemic shock With uterine rupture, the client is at risk for hypovolemic shock. Therefore, the priority is to prevent and limit hypovolemic shock. Immediate steps should include giving oxygen, replacing lost fluids, providing drug therapy as needed, evaluating fetal responses and preparing for surgery. Obtaining blood specimens, instituting complete bed rest, and inserting a urinary catheter are necessary in preparation for surgery to remedy the rupture.