A client who is pregnant with her first child has been laboring ...

[vinney12]

A client who is pregnant with her first child has been laboring for 14 hours with very minimal progress. Cervical dilatation and effacement are slow, and the nurse is unable to verify engagement of the presenting fetal part. What condition should the nurse suspect may be affecting the client's labor?
 
  1. Prolapsed cord
  2. Placenta accreta
  3. Cephalopelvic disproportion (CPD)
  4. Occiput anterior (OA) fetal position

Question 2

After a lengthy labor and delivery, a client suddenly complains of chest pain and dyspnea. The client is cyanotic, has tachycardia and blood pressure decreased to 78/36 mmHg. Based on these assessment findings, which health problem is the client experiencing?
 
  1. Infection
  2. Placenta accreta
  3. Hypertensive crisis
  4. Amniotic fluid embolus

[dellikani2015]

Answer to Question 1

3
Explanation:
1. A prolapsed cord is an umbilical cord that precedes the fetal presenting part. Fetal bradycardia is a critical indicator of prolapsed cord.
2. Placenta accreta, in which the chorionic villi attach directly to the uterine myometrium, is associated with maternal hemorrhage and failed placental separation after birth.
3. The nurse should suspect CPD when labor is prolonged, cervical dilatation and effacement are slow, and engagement of the presenting part is delayed.
4. The occiput anterior (OA) fetal position is amenable to delivery and would not represent a barrier to labor.

Answer to Question 2

4
Explanation:
1. These are not manifestations of an infection.
2. Placenta accreta occurs when the chorionic villi attach directly to the uterine myometrium. The major complications of placenta accreta include maternal hemorrhage and failure of the placenta to separate following birth of the infant.
3. The client is hypotensive.
4. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis. The condition may progress to hemorrhage, shock, and death.