1. Laura is a 26-year-old G2P1 who had a caesarean delivery for
fetal distress with her first pregnancy. Laura is now struggling with
deciding between a repeat caesarean delivery or attempting a VBAC.
(Learning Objective 9)
A. In order to ensure that Laura has the facts to assist her in
her decision, explain the risks of a repeat caesarean delivery.
B. Laura can’t understand why more women don’t want to try a VBAC delivery. Discuss the possible reasons for this.
C. Describe the management of care for a woman attempting a VBAC delivery.
2. Carol, age 17, is pregnant with her first child. Her menstrual
dates are accurate and her date of conception is limited to one possible
day. Her physician gives her an EDC of March 28th. Carol has gone
past her due date and refuses to have her labor induced. Carol states,
“My grandmother says that the baby will come when it is good and ready.”
It is now April 14th and Carol is at 42 3/7 weeks’ gestation. She
calls the office and reports that she is having a significant lower
backache and she just passed “a glob of bloody mucus” from her vagina.
(Learning Objective 5)
A. Discuss the risks a prolonged pregnancy places on Carol.
B. What risks are there for Carol’s unborn baby?
C. Describe the nursing care required for women in labor with a prolonged pregnancy.
Chapter 22: Nursing Management of the Postpartum Woman at Risk
1. Amy calls the office 3 days after delivering a healthy baby girl
and tells you she is passing small clots and feels like her bleeding is
heavier than it should be. You advise Amy to come into the clinic to be
checked. (Learning Objectives 1, 2, 3, and 6)
What are the “four T’s” that need to be assessed in a possible case of postpartum hemorrhage?
Amy also tearfully tells you that she is experiencing anxiety and
feelings of being overwhelmed. What is she experiencing, and what
education are you going to provide?
2. Alyssa, age 26, had a cesarean delivery 7 days ago and is
breast-feeding her baby. She calls the office today and reports that she
has a temperature of 102. (Learning Objective 5)
Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
What additional questions do you want to ask her to try to ascertain the cause of her fever?
3. Describe the care required to treat each of these infections.
Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions
1. On the evening shift in the special care nursery, you are paged to
delivery room 5. When you arrive, the labor nurse says the baby has
been stuck in the birth canal for a while, and the fetal heart tones are
down. They use the vacuum suction to assist delivery. The doctor gets
the baby out and places the infant on the radiant warmer. You are the
resuscitating nurse for the infant, and you observe the following: the
infant is limp, pale, gasping, has poor tone, and the heart rate is 101.
(Learning Objective 1)
What are your first actions to aid in this infant’s recovery?
What Apgar score would you assign at 1 minute with these results? Explain the score for each category.
2. Tammi is an 18-year-old single mother who delivered a full-term
infant 3 days ago. The father is not involved, and Tammi’s aunt is her
support person. The infant is very fussy in the nursery, with mild
tremors noted. Tammi is having a hard time feeding her baby, the baby
spits up a lot and he does not console easily. The physician has been
called to assess the infant. (Learning Objective 7)
What is the probable cause of the infant’s symptoms, and what questions do you need to ask the mother?
What is the acronym of the tool used in assessing the infant’s
condition, and what are the top three substances used that can cause
Name what measures are used to test for this condition and on whom you perform the test.
3. Mandy just gave birth vaginally to her first child. Mandy and
James had attended prenatal classes and had a natural childbirth. They
were totally unprepared to see that baby “Rose” has a severe left-sided
unilateral cleft lip and cleft palate. James is having a hard time with
this and just keeps staring at the baby. Mandy begins to cry and states
“I thought I was going to breast-feed my baby and now it’s impossible.”
(Learning Objectives 12, 14, and 15)
A. Discuss the implications for bottle feeding and breast-feeding a
baby with a unilateral cleft lip. Is it possible for Mandy to
B. What is involved in the surgical correction of the defect? When can she eventually have a “normal” mouth and facial features?
C. What other problems may develop for Rose since she has this type of defect?