Chapter 21 OB test 2

oxytocin is discontinued if:

uterine hyperstimulation occurs with contraction duration longer than 90 seconds

A physician orders oral tocolytic therapy for a woman with preterm labor. Which agent would the nurse be least likely to administer? a. Terbutaline b. Indomethacin c. Nifedipine d. Magnesium sulfate

d. Magnesium sulfate Explanation: Magnesium sulfate is only given IV for preterm labor

A woman in labor is receiving oxytocin. Which of the following would the nurse need to be alert for potentially occurring? a. Hypertension b. Uterine hypotonicity c. Fetal distress d. Water intoxication

d. Water intoxication Explanation: Oxytocin can lead to water intoxication and can cause hypotension

A nurse assess a client in labor and suspects hypotonic uterine dysfunction. Which intervention would the nurse most likely expect to include in the plan of care for this client? a. preparing woman for amniotomy b. providing comfortable environment c. encouraging woman to assume hands- and-knees position d. administering oxytocin

d. administering oxytocin

A client has been admitted to the unit for tocolytic therapy. The nurse recognizes all except which of the following tocolytics may be used in this woman's care plan? a. Magnesium sulfate b. Terbutaline c. Indomethacin d. Corticosteroids

d. corticosteriods

What is precipitate labor?

labor completed in less than 3 hours

Commonly used diagnostic testing for preterm labor risk assessment

-CBC count - urinalysis -amniotic fluid analysis - fetal fibronectin testing -cervical length -transvaginal ultrasound -salivary estriol -home monitoring of uterine activity

Common drugs given for preterm labor

-Magnesium sulfate -Indomethacin -Nifedipine -Betamethasone (promotes fetal lung maturity)

Drugs for cervical ripening & labor induction

-dinoprostone -misoprostol (cytotec) - oxytocin (pitocin)

adverse effects of piton infusion

-hyperstimulation of uterus -initially decrease blood pressure

Contraindications to BVAC

-prior classic uterine incision -prior transfundal uterine surgery -uterine scar other than low-transverse cesarean scar -contracted pelvis

used to determine maternal readiness for labor by evaluating whether the cervix is favorable by rating: dilation, effacement, consistency, and position

Bishop Score

What is an amniotomy?

process of inserting cervical hook (amniohook) through cervical os to deliberately rupture membranes)

What is oliogohydramnios?

scant amount or absence of amniotic fluid

What is an episiotomy?

surgical incision of perineal body to enlarge outlet

What is an amnioinfusion?

technique by which warm, sterile normal saline or lactated ringers solution is introduced into uterus to supplement amount of amniotic fluid

A 19-year-old nulliparous is in early labor with erratic contractions. An assessment notes that she is remaining at 3 cm. There is also a concern that the uterus is not fully relaxing between contractions. Which of the following complications is a concern? a. Reduced oxygen to the fetus b. Cephalopelvic disproportion c. Precipitate labor d. Ruptured uterus

a. reduced oxygen to fetus

What is Dystocia?

abnormal or difficult labor slow abnormal progression leading cause of primary c/s delivery

After teaching a class about various methods for cervical ripening, the instructor determines that the teaching was successful when the class identifies which of the following as a surgical method? a. Laminaria b. Amniotomy c. Breast stimulation d. Prostaglandin

b. Amniotomy

What are hypertonic contractions?

when uterus never fully relaxes

what are hypotonic contractions?

when uterus relaxes too much and has ineffective contractions

Risks of using forceps on newborns

bruising, edema, facial laceration, cephalhematoma, transient facial paralysis, cerebral hemorrhage

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic therapy, the nurse recognizes this will prolong the pregnancy for which of the following? a. 2 to 7 days b. 4 to 8 days c. 6 to 10 days d. 1 to 5 days

a. 2-7 days

The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse would know that macrosomia would indicate the fetus weighs which of the following? a. 4,000 g or more b. 4,500 g or more c. 3,000 g or more d. 3,500 g or more

a. 4,000 g or more

A woman is to undergo labor induction. The nurse determines that the woman most likely requires cervical ripening if her Bishop score is: a. 5 b. 6 c. 7 d. 8

a. 5 Explanation: A bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction

The nurse is assessing the woman who has a forceps-assisted birth for complications. Which of the following would be least likely to occur in the mother? a. Caput succedaneum b. Perineal hematoma c. Infection of episiotomy d. Cervical lacerations

a. Caput succedaneum

Certain pharmaceuticals can be used to attain cervical ripening in women who need assistance in cervical ripening. They have also often continued into labor without further agents to stimulate uterine contractions. The nurse is aware that the FDA has approved the use of which of the following as a cervical ripening agent? a. Dinoprostone b. Misoprostol c. Oxytocin d. Magnesium sulfate

a. DInoprostone

A client at 33 weeks' gestation is calling the office with various complaints and is very concerned. The nurse recognizes which of the following as indicating the client is potentially going into preterm labor? (Select all that apply.) a. General sense of discomfort b. Irregular contractions c. GI upset (nausea, vomiting, diarrhea) d. Achiness in the thighs e. Low, dull backache

a. General sense of discomfort c. GI upset (nausea, vomiting, diarrhea) d. Achiness in the thighs e. Low, dull backache

A 26-year-old female, G1,P0, presents to the emergency department with complaints of regular uterine contractions. Since she is in her 36th week of gestation, the nurse recognizes which of the following is potentially occurring? a. Preterm labor b. Dystocia c. Precipitate labor d. Normal labor

a. preterm labor

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes all except which of the following are potential concerns for the infant? a. Macrosomia b. Hydramnios c. Brachial plexus injuries d. Shoulder dystocia

b. hydramnios

The health care provider is recommending induction of labor for a 42-week nulliparous client. All except which of the following will be important to assess before induction? a. Fetal dating b. Amniotic fluid studies c. Leopold position d. Bishop scoring

c. Leopold position Explanation: Before labor induction is started, fetal maturity (dating, ultrasound, amniotic fluid studies) and cervical readiness (vaginal examination, Bishop scoring) must be assessed. Leopold maneuver is a technique for determining the position of the fetus as it moves through the labor process

A woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate? a. Continue to monitor contractions and fetal heart rate. b. Slow the oxytocin infusion to the initial rate. c. Stop the infusion immediately. d. Notify the birth attendant.

c. Stop the infusion immediately.

Risks of vacuum extractor on newborn

cephalhematoma and jaundice

The nurse plays a major role in assessing the progress of labor. Which of the following is a simple rule that the nurse will use to monitor the progress? a. 1 cm per hour for fetal descent b. 2 cm per hour for fetal descent c. 2 cm per hour for cervical dilation d. 1 cm per hour for cervical dilation

d. 1 cm per hour for cervical dilation

After assessing the processing labor of a client, the nurse suspects the fetus is in a persistent occiput posterior position. Which of the following findings would lead the nurse to suspect that? a. Contractions most forceful in the middle of uterus rather than the fundus b. Lack of cervical dilation past 2 cm c. Fetal buttocks as the presenting part d. Complaints of severe back pain

d. Complaints of severe back pain

A client has arrived to the birthing center in labor, requesting a VBAC. The nurse knows that she would be a good candidate after reading her previous history due to which of the following? a. Had prior classic uterine incision b. Had prior transfundal uterine surgery c. Has contracted pelvis d. Has previous lower abdominal incision

d. Has previous lower abdominal incision

What is a tocolytic drug?

drug that promotes uterine relaxation by interfering with uterine contractions may prolong labor 2-7 days