A nurse is admitting a client who is in active labor and has had two prior cesarean births. The nurse should identify that the client is at an increased risk for which of the following complications?
Failure to progress
Abruptio placentae
Precipitous labor
Uterine rupture
The Correct Answer is D
Uterine rupture. When a client has had two prior cesarean births, she is at an increased risk for uterine rupture. Uterine rupture is a serious complication that can occur during labor, where there is a tear in the wall of the uterus. It can lead to significant blood loss for the mother and oxygen deprivation for the fetus. Other risk factors for uterine rupture include a previous uterine surgery, the use of labor-inducing drugs, and multiple gestations.
Failure to progress (choice A) refers to a labor that is not progressing as it should, and can be caused by a variety of factors, including fetal malposition or inadequate contractions. Abruptio placentae (choice B) refers to the separation of the placenta from the uterine wall before delivery, which can cause fetal distress and maternal hemorrhage. Precipitous labor (choice C) refers to a labor that progresses extremely quickly, with contractions lasting less than 3 hours from the onset of active labor. While precipitous labor can be associated with increased risk for perineal lacerations and postpartum hemorrhage, it is not typically associated with prior cesarean births.
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Correct Answer is C
Explanation
The client tested positive for group B streptococcus, which is a bacterial infection commonly found in the genital tract of women. Ampicillin is an antibiotic that is used to treat this type of infection. It is given intravenously to the client during labor to prevent the transmission of the infection to the newborn.
Correct Answer is D
Explanation
A. An HbA1C level of 6% is within the target range for a pregnant woman with type 1 diabetes, indicating good glycemic control. Therefore, it does not need to be reported to the provider.
B. Platelet levels of 170,000/mm³ fall within the normal range (150,000–450,000/mm³) and do not indicate a need for concern.
C. A hematocrit (Hct) of 34% is slightly low, but mild anemia is common during pregnancy due to increased plasma volume. This level does not usually require immediate intervention.
D. A blood urea nitrogen (BUN) level of 25 mg/dL is elevated (normal range 7–20 mg/dL) and may indicate renal impairment, which is a concern in a pregnant client with type 1 diabetes. This finding should be reported to the provider as it can signal potential kidney issues that need to be addressed.
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