A client who has had two previous cesarean births is in active ...

[jenna1]

A client who has had two previous cesarean births is in active labor when she suddenly complains of pain between her scapulae. Which should be the nurse's priority action?
 
  a. Notify the health care provider promptly.
  b. Observe for abnormally high uterine resting tone.
  c. Decrease the rate of nonadditive intravenous fluid.
  d. Reposition the client with her hips slightly elevated.

Question 2

The fetus in a breech presentation is often born by cesarean birth because:
 
  a. the buttocks are much larger than the head.
  b. compression of the umbilical cord is more likely.
  c. internal rotation cannot occur if the fetus is breech.
  d. postpartum hemorrhage is more likely if the client delivers vaginally.

[Kjones0604]

Answer to Question 1

ANS: A
Pain between the scapulae may occur when the uterus ruptures because blood accumulates under the diaphragm. This is an emergency that requires medical intervention. Observing for high uterine resting tones should have been done before the sudden pain. High uterine resting tones put the client at high risk for uterine rupture. The client is now at high risk for shock. Nonadditive intravenous fluids should be increased. Repositioning the client with her hips slightly elevated is the treatment for a prolapsed cord. That position in this scenario would cause respiratory difficulties.

Answer to Question 2

ANS: B
After the fetal legs and trunk emerge from the client's vagina, the umbilical cord can be compressed between the maternal pelvis and the fetal head if a delay occurs in the birth of the head. The head is the largest part of a fetus. Internal rotation can occur with a breech. There is no relationship between breech presentation and postpartum hemorrhage.