Review Complications and outcomes

Umbilical cord prolapse > Maternal & Newborn

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Complications and outcomes

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Total Questions : 5

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Question 1:

A nurse is caring for a client who is in labor and has a prolapsed umbilical cord.

Which of the following actions should the nurse take first?

A. Apply warm saline-soaked gauze to the exposed cord B. Place the client in a knee-chest position C. Administer oxygen via face mask at 10 L/min D. Notify the provider and prepare for an emergency cesarean delivery.

Answer and Explanation

Choice A:

Applying warm saline-soaked gauze to the exposed cord can prevent drying and atrophy of the cord, but it does not relieve cord compression.

Choice B:

This is because this position can reduce the pressure of the fetal presenting part on the prolapsed cord and improve fetal oxygenation.The nurse should also notify the provider and prepare for an emergency cesarean delivery, but this is not the first action to take.

Choice C:

Administering oxygen via face mask at 10 L/min can increase maternal oxygen saturation and fetal oxygen delivery, but it does not address the cause of cord prolapse.

Choice D:

Notifying the provider and preparing for an emergency cesarean delivery is a necessary action, but it is not the first priority.The nurse should first try to relieve cord compression by placing the client in a knee-chest position.

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Question 2:

A nurse is reviewing the electronic fetal monitor tracing of a client who has a prolapsed umbilical cord.

Which of the following fetal heart rate patterns indicates cord compression and hypoxemia?

A. Episodic accelerations B. Fibrillation C. Moderate tachycardia D. Severe variable decelerations

Answer and Explanation

Choice A:

Episodic accelerations are transient increases in fetal heart rate above the baseline, usually indicating fetal well-being.

Choice B:

Fibrillation is an irregular and rapid contraction of the atria of the heart, which is not a normal fetal heart rate pattern.

Choice C:

Moderate tachycardia is a slightly elevated fetal heart rate above the normal range of 110 to 160 beats per minute, which may be caused by maternal fever, fetal infection, fetal anemia, or fetal hypoxia.

Choice D:

Severe variable decelerations indicate cord compression and hypoxemia in a fetus with a prolapsed umbilical cord.Variable decelerations are abrupt decreases in fetal heart rate below the baseline, usually associated with uterine contractions.Severe variable decelerations are defined as having a nadir of less than 70 beats per minute or lasting longer than 60 seconds.

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Question 3:

A nurse is teaching a group of pregnant clients about the risk factors for umbilical cord prolapse.

Which of the following factors should the nurse include? (Select all that apply.)

A. Premature rupture of membranes B. Breech presentation C. Polyhydramnios D. Post-term pregnancy E. Multiple gestation

Answer and Explanation

Choice A:

Premature rupture of membranes, especially when the presenting part of the fetus is high in the pelvis, can allow the cord to slip down into the cervix and vagina.

Choice B:

Breech presentation, such as a footling breech, can make it easy for the cord to slip between and past the fetal feet and into the pelvis.

Choice C:

Polyhydramnios, or excessive amniotic fluid around the fetus, can create more space for the cord to move and prolapse.

Choice D:

Post-term pregnancy is not a risk factor for umbilical cord prolapse. Post-term pregnancy can cause other complications such as fetal macrosomia, placental insufficiency and meconium aspiration.

Choice E:

Multiple gestation is not a risk factor for umbilical cord prolapse. Multiple gestation can cause other complications such as preterm labor, preeclampsia and fetal growth restriction.

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Question 4:

A nurse is assisting with the delivery of a client who has a prolapsed umbilical cord.

Which of the following interventions should the nurse perform to relieve cord compression until delivery?

A. Elevate the presenting part with a sterile gloved hand B. Push the cord back into the vagina with gentle pressure C. Clamp and cut the cord as quickly as possible D. Wrap the cord loosely around the fetal neck

Answer and Explanation

Choice A:

Elevate the presenting part with a sterile gloved hand.This intervention helps to relieve cord compression until delivery by preventing the fetus from pushing down on the cord.The umbilical cord is the lifeline of the fetus and any compression can cause fetal hypoxemia and distress.

Choice B:

Pushing the cord back into the vagina with gentle pressure can cause more damage to the cord and increase the risk of infection.

Choice C:

Clamping and cutting the cord as quickly as possible will cut off the fetal blood supply and oxygenation.

Choice D:

Wrapping the cord loosely around the fetal neck can cause strangulation and compromise fetal circulation.

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Question 5:

A nurse is assessing a newborn who was delivered after a prolonged umbilical cord prolapse.

Which of the following findings should alert the nurse to possible neurological damage?

A. Hypotonia B. Jaundice C. Tachypnea D. Petechiae

Answer and Explanation

Choice A:

Hypotonia is a condition of low muscle tone and weakness that can indicate neurological damage due to lack of oxygen and blood flow to the brain.Umbilical cord prolapse is a rare but serious complication that occurs when the umbilical cord drops out of the cervix before the baby during delivery, which can compress the cord and reduce or stop the oxygen and nutrient supply to the baby.This can result in brain damage, cerebral palsy, or fetal death.

Choice B:

Jaundice is a common condition in newborns that causes yellowing of the skin and eyes due to high levels of bilirubin in the blood.

It is usually not a sign of neurological damage, but rather a result of immature liver function or increased breakdown of red blood cells.

Choice C:

Tachypnea is a condition of rapid breathing that can indicate respiratory distress or infection in newborns.

Choice D:

Petechiae are small red or purple spots on the skin caused by bleeding under the skin.

They can occur in newborns due to trauma during delivery, low platelet count, infection, or clotting disorders.

They are not a sign of neurological damage, but rather a sign of bleeding or inflammation.

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Total Questions : 5

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Complications and outcomes

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