There are four clients in active labor in the labor suite.
Which of the clients should the nurse monitor carefully for a potential uterine rupture?
Age 15, G3 P0020, in active labor.
Age 22, G1 P0000, eclampsia.
Age 25, G4 P3003, last delivery by cesarean section.
Age 32, G2 P0100, first baby died during labor.
The Correct Answer is C
Choice A rationale
A 15-year-old, G3 P0020, although young, doesn't have an increased risk of uterine rupture related to prior surgical deliveries or other known factors.
Choice B rationale
A 22-year-old, G1 P0000 with eclampsia requires close monitoring for complications related to eclampsia but not specifically for uterine rupture.
Choice C rationale
A 25-year-old, G4 P3003 with a previous cesarean section is at increased risk for uterine rupture due to the scar from the prior surgery which could weaken under the stress of labor.
Choice D rationale
A 32-year-old, G2 P0100's history of a prior fetal demise does not specifically increase the risk of uterine rupture unless accompanied by other risk factors. .
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Correct Answer is C
Explanation
Choice A rationale
While maternal lacerations are a risk during childbirth, they are not the greatest risk in cases of fetal dystocia. The focus is primarily on fetal wellbeing.
Choice B rationale
Fetal injury such as bruising can occur with dystocia, but the primary concern is the potential for severe, life-threatening complications.
Choice C rationale
Neonatal asphyxia related to prolonged labor is the greatest risk with fetal dystocia. Prolonged labor can lead to decreased oxygen supply to the fetus, causing asphyxia and
potential brain injury.
Choice D rationale
Increased consideration for a cesarean delivery is a possible outcome of fetal dystocia, but it is a management decision rather than a direct risk to the baby’s immediate health.
Correct Answer is B
Explanation
Choice A rationale
While massaging the fundus and ensuring IV access are correct initial actions, methylergonovine (Methergine) is typically used for patients without hypertensive history due to its
potential to raise blood pressure.
Choice B rationale
This option correctly identifies initial steps and appropriate medication. Carboprost-tromethamine (Hemabate) is effective in controlling postpartum hemorrhage and can be safely
used in patients with hypertension when oxytocin is insufficient.
Choice C rationale
Quantifying blood loss is essential but it is not an immediate priority when the patient is showing signs of significant bleeding and instability. Immediate intervention to control bleeding
takes precedence.
Choice D rationale
Assisting the patient to the restroom and then massaging the fundus overlooks the immediate need to control bleeding. This approach may delay necessary treatment and increase
the risk of further hemorrhage.
Choice E rationale
Straight catheterization and oxytocin maintenance are part of the management of postpartum hemorrhage but do not address the immediate need to ensure uterine contraction and
control active bleeding as effectively as the initial steps outlined in Choice B. .