NUR 306: Vsim Amelia Sung Pre/Pro-
Test (answered)
Shoulder dystocia is a complication of Labor related to which of these factors?
- Prolonged second stage of labor
Explanation: Should dystocia occurs when the anterior fetal shoulder gets stuck behind the
mother's pubic bone. A prolonged second stage of labor is a factor related to the presence of the
shoulder dystocia. Uterine contractions are usually of adequate strength. The vlume of amniotic
fluid and the length of the active phase of labor are not risk factors for shoulder dystocia
Which of the following pregnancy-related conditions increases increase the risk for shoulder
dystocia?
- Uncontrolled maternal gestational diabetes
Explanation: Uncontrelled gestational diabetes leads to fetal macrosomia, fat pads at the fetal
neck, and increased maternal weight gain, all factors that increase the incidence of shoulder
dystocia. Preeclampsia and IUGR both result insmaller infants and thus do not increase the risk
of shoulder dystocia. Hyperemesis, While it can continue throughout the pregnancy, is generally
a problem of the first trimester and not related to the delievery
A patient is admitted to the labor and delievery unit at 40 weeks gestation. Which of the
following pieces of information collected during the patient interview would be most significant
in alerting the nurse to the potential for shoulder dystocia (SATA)
- Maternal height 5 ft, 3 in
Estimated fetal weight 8 lbs, 13 oz or more
Maternal weight gain greater than 50 lb
Explanation: Excessive maternal weight gain, short stature of the mother, and high estimated
fetal weigh are risk factors for shoulder dystocia. Ethnicity is a demographic factor not
associated with this condition. Previous delivery is evidence that she is able to deliver an infant
of that size, and an active phase of labor lasting 4 hours is not a significant finding.
, When a shoulder dystocia amergency is anticipated, what additional actions should be
implemented by the nurse (sata)
- Put a step stool at the bedside
Explain to the patient and family what may happen
Have extra staff available if needed
Explanation: The stool is so the provider can apply suprapubic pressure by standing directly over
the patient. Extra staff is needed to implement the maneuvers used to deliver the fetal shoulder.
Communication to the patient and the family about what might happen in the delivery room will
help to prepare them and to decrease their anxiety. Removing the family from the delivery room
is not therapeutic response and will further increase their anxiety. A consent for a ceasarean
delivery is not appropriate at this time
The nurse has assessed that the patient is in labor and at risk for shoulder dystocia. After delivery
of the fetal head, the nurse states in a clear, loud voice, " fetal heart rate 90 bpm with minimal
variability" why is it important for the nurse to communicate this information
- To inform the provider about the fetal status
Explanation: A call-out is a clear and concise statement of data or an event that everyone on the
health care team needs to know to care for the patient effectively. Changes int he FHR are not
routinely announced in the delivery room, but in this situation the call-out by the nurse is
important to give data to the provider so the provider can evaluate the fetal status and determine
the next course of action. The patient is focused on pushing out the fetus, so the information is
not for her benefit. The nurse's interpretation of the routine fetal activity is documented in the
patient's chart, not verbally
What is a positive turtle sign
- The fetal head emerges and then retracts tightly against the perineal floor
Explanation: A positive turtle sign is when the head delivers and that is retracted back and rests
firmly against the perineum
What is the first action by the nurse to assist with the delivery of the fetal shoulders and body
when there is a shoulder dystocia
Test (answered)
Shoulder dystocia is a complication of Labor related to which of these factors?
- Prolonged second stage of labor
Explanation: Should dystocia occurs when the anterior fetal shoulder gets stuck behind the
mother's pubic bone. A prolonged second stage of labor is a factor related to the presence of the
shoulder dystocia. Uterine contractions are usually of adequate strength. The vlume of amniotic
fluid and the length of the active phase of labor are not risk factors for shoulder dystocia
Which of the following pregnancy-related conditions increases increase the risk for shoulder
dystocia?
- Uncontrolled maternal gestational diabetes
Explanation: Uncontrelled gestational diabetes leads to fetal macrosomia, fat pads at the fetal
neck, and increased maternal weight gain, all factors that increase the incidence of shoulder
dystocia. Preeclampsia and IUGR both result insmaller infants and thus do not increase the risk
of shoulder dystocia. Hyperemesis, While it can continue throughout the pregnancy, is generally
a problem of the first trimester and not related to the delievery
A patient is admitted to the labor and delievery unit at 40 weeks gestation. Which of the
following pieces of information collected during the patient interview would be most significant
in alerting the nurse to the potential for shoulder dystocia (SATA)
- Maternal height 5 ft, 3 in
Estimated fetal weight 8 lbs, 13 oz or more
Maternal weight gain greater than 50 lb
Explanation: Excessive maternal weight gain, short stature of the mother, and high estimated
fetal weigh are risk factors for shoulder dystocia. Ethnicity is a demographic factor not
associated with this condition. Previous delivery is evidence that she is able to deliver an infant
of that size, and an active phase of labor lasting 4 hours is not a significant finding.
, When a shoulder dystocia amergency is anticipated, what additional actions should be
implemented by the nurse (sata)
- Put a step stool at the bedside
Explain to the patient and family what may happen
Have extra staff available if needed
Explanation: The stool is so the provider can apply suprapubic pressure by standing directly over
the patient. Extra staff is needed to implement the maneuvers used to deliver the fetal shoulder.
Communication to the patient and the family about what might happen in the delivery room will
help to prepare them and to decrease their anxiety. Removing the family from the delivery room
is not therapeutic response and will further increase their anxiety. A consent for a ceasarean
delivery is not appropriate at this time
The nurse has assessed that the patient is in labor and at risk for shoulder dystocia. After delivery
of the fetal head, the nurse states in a clear, loud voice, " fetal heart rate 90 bpm with minimal
variability" why is it important for the nurse to communicate this information
- To inform the provider about the fetal status
Explanation: A call-out is a clear and concise statement of data or an event that everyone on the
health care team needs to know to care for the patient effectively. Changes int he FHR are not
routinely announced in the delivery room, but in this situation the call-out by the nurse is
important to give data to the provider so the provider can evaluate the fetal status and determine
the next course of action. The patient is focused on pushing out the fetus, so the information is
not for her benefit. The nurse's interpretation of the routine fetal activity is documented in the
patient's chart, not verbally
What is a positive turtle sign
- The fetal head emerges and then retracts tightly against the perineal floor
Explanation: A positive turtle sign is when the head delivers and that is retracted back and rests
firmly against the perineum
What is the first action by the nurse to assist with the delivery of the fetal shoulders and body
when there is a shoulder dystocia
