1. Nurse Olive asseses a client for evidence of postpartum hemorrhage during the third stage of labor. Early signs of this postpartum complication include:a. an increased pulse rate, decreased respiratory rate, and increased blood pressure.b. a decreased pulse rate, increased respiratory rate, and increased blood pressure.c. a decreased pulse rate, decreased respiratory rate, and increased blood pressure.d. an increased pulse rate, increased respiratory rate, and decreased blood pressure.

2. Which of the following is not true regarding the third stage of labor?

a. Care should be taken in the administration of bolus of oxytocin because it can cause hypertensionb. Signs of placental separation are lengthening of the cord, sudden gush of blood and sudden change in shape of the uterusc. It ranges from the time of expulsion of the fetus to the delivery of the placentad. The placenta is delivered approximately 5-15 minutes after delivery of the baby

3. A direct cause of mis-management of the third stage of labor is:

a. inversion of the uterusb. cord prolapsec. prolonged labord. all of these

4. A client has just started the third stage of labor. Which of the following nursing actions have priority at this time?

1. Encouraging the client to push2. Administration of an oxytocic medication3. Physical assessment of the infant4. Promotion of the bonding process

5. While assisting a multiparous client to the bathroom for the first time 1 hour after a vaginal delivery of a viable neonate, the nurse notes that the client's urine has two small blood clots in the measuring container. Which of the following should the nurse do next?"

a.) Massage the client's fundus vigorously.b.) Ask the client if she passed clots with her previous deliveries.c.) Review the client's records for the length of the 3rd stage of labor.d.) Document this observation as a normal finding.

48. Nurse Julia is aware that Labor is divided into how many stages?a. Fiveb. Threec. Twod. Four

49. Jannah, who is in labor receives epidural anesthesia. The nurse should assess carefully for which adverse reaction to the anesthetic agent?a. Hypotensive crisisb. Fetal tachycardiac. Renal toxicityd. Increased beat-to-beat variability in the fetal heart rate (FHR)

50. To promote comfort during labor, Nurse Michelle advises a client to assume certain positions and avoid others. Which position may cause maternal hypotension and fetal hypoxia?a. Lateral positionb. Squatting positionc. Supine positiond. Standing position

Rationale

1. Answer D. An increased pulse rate followed by an increased respiratory rate and decreased blood pressure may be the first signs of postpartum hemorrhage and hypovolemic shock.

2. Answer A. Care should be taken in the administration of bolus of oxytocin because it can cause hypertension

3. Answer A. inversion of the uterus

4. Answer C. The infant's physical condition is a priority at on eand five minutes after delivery. The physical assessment done at this time is known as Apgar scoring.

5. Answer D. The passage of two small blood clots from a multiparous woman 1 hour after a vaginal delivery is not an unusual occurrence. The nurse should continue to monitor the client and document this as a normal finding. The nurse should never massage a postpartum client's fundus vigorously because of the risk for uterine inversion and discomfort to the mother. Asking whether the client passed clots with her previous deliveries is irrelevant. The length of the third stage of labor has no relation to whether or not the client passes clots.

48. Answer D. Labor is divided into four stages: first stage, onset of labor to full dilation; second stage, full dilation to birth of the baby; third stage, birth of the placenta; and fourth stage, 1-hour postpartum. The first stage is divided into three phases: early, active, and transition.

49. Answer A. Hypotensive crisis may occur after epidural anesthesia administration as the anesthetic agent spreads through the spinal canal, blocking sympathetic innervation. Other signs and symptoms of hypotensive crisis associated with epidural anesthesia may include fetal bradycardia (not tachycardia) and decreased (not increased) beat-to-beat variability in the FHR. Urine retention, not renal toxicity, may occur during the postpartum period.

50. Answer C. The supine position causes compression of the clients aorta and inferior vena cava by the fetus. This, in turn, inhibits maternal circulation, leading to maternal hypotension and, ultimately, fetal hypoxia. The other positions promote comfort and aid labor progress. For instance, the lateral, or side-lying, position improves maternal and fetal circulation, enhances comfort, increases maternal relaxation, reduces muscle tension, and eliminates pressure points. The squatting position promotes comfort by taking advantage of gravity. The standing position also takes advantage of gravity and aligns the fetus with the pelvic angle.