A 20-year-old gravida 1, para 0, is determined to be at 42 weeks' ...

[Redwolflake15]

A 20-year-old gravida 1, para 0, is determined to be at 42 weeks' gestation on admission to the labor and birth unit. The client is not in labor at the current time but has been sent over by her physician to be admitted for the induction of labor.
 
  The client indicates to you that she would rather go home and wait for natural labor to start. How should the nurse respond to the client's request?
 
  a. There is no way to tell if any complications would arise. Because the client is not presenting with any problems, the nurse should call the health care provider and inform her or him of the client's decision to go home and wait.
  b. Inform the client that there are a number of serious concerns related to a postdate pregnancy and that she would be better off to be monitored in a clinical setting.
  c. Tell the client that an assessment will be done and if there are no findings indicating that an induction of labor would be favorable, the client will be sent home.
  d. Tell the client that confirmation of a due date can be off by 2 weeks and possibly be even later than 42 weeks, so it is better to follow the physician's directions.

Question 2

During the course of the birth process, the physician suspects that a shoulder dystocia is occurring and asks the nurse for assistance. Which priority action should be taken by the nurse in response to this request?
 
  a. Put pressure on the fundus.
  b. Ask the physician if he or she would like you to prepare for a surgical method of birth.
  c. Tell the client not to push until you prepare vacuum extraction device for physician.
  d. Reposition the client to facilitate birth.

[mjbamaung]

Answer to Question 1

ANS: B
The most serious concern related to a postdate pregnancy is that of fetal compromise based on the fact that the placenta function deteriorates. Although one can appreciate that the client wants to have a natural labor experience, some women do not go into labor for various physiologic reasons. Therefore, it is best for the client to remain in a supervised clinical setting. Indicating that the client could possibly go home would place the client at risk and the nurse at risk for practicing outside of his or her scope of practice. Even though there can be a difference in the calculated due date, it is highly unlikely that the pregnancy has gone longer than 42 weeks.

Answer to Question 2

ANS: B
In the presence of a suspected shoulder dystocia, a surgical birth method is typically indicated to avoid complications from this type of abnormal presentation. Fundal pressure is no longer recommended as a treatment strategy because it can cause additional problems. Vacuum extraction will not help solve this birth issue and may lead to further complications. Repositioning of the client may not be effective to relieve this condition and facilitate birth.

[Redwolflake15]

TYSM

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