ob test #2 ch 21
The client is anxious about her prolonged pregnancy. She informs the nurse she has been doing research on the Internet and has read about certain herbs that can help to induce labor. Which response from the nurse would be appropriate?
"Please talk to your primary care provider first to ensure it is safe."
A simple rule for evaluating the progress of labor is expecting
1 cm per hour of cervical dilation
A G3, P2 woman arrives at the birthing center stating that she has been in labor for the past 18 hours. To rule out a potential protracted disorder the nurse is aware that which criterion for cervical dilation would be used?
1.5 cm per hour
A client is admitted to the unit in preterm labor. In preparing the client for this therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used?
2 to 7 days
Tocolytic drugs may prolong the pregnancy for
2 to 7 days. During this time, steroids can be given to improve fetal lung maturity, and the woman can be transported to a tertiary care center
The health care provider has determined that the source of dystocia for a woman is related to the fetus size. The nurse understands that macrosomia would indicate the fetus would weigh:
4,000 g or more
Amniotic fluid volume begins to decline by
40 weeks of gestation, possibly leading to oligohydramnios. Hemorrhage, infection, and dystocia are risk to the mother not the fetus.
A woman is to undergo labor induction. The nurse determines that the woman most likely requires cervical ripening if her Bishop score is:
5
A nurse is providing care to a couple who have experienced intrauterine fetal demise. Which action would beleast effective in assisting a couple at this time?
Avoid any discussion of the situation with the couple.
just know this
Before labor induction is started, fetal maturity (dating, ultrasound, amniotic fluid studies) and cervical readiness (vaginal examination, Bishop scoring) must be assessed
The nurse plays a major role in assessing the progress of labor. The nurse integrates understanding of the typical rule for monitoring labor progress. Which finding would the nurse correlate with this rule?
Cervix dilates 1 cm per hour.
When the nurse is assisting the parents in the grieving process after the death of their neonate, what is the nurse's most important action?
Keep the communication lines open.
A nurse is teaching a 42-week nulliparous pregnant woman about labor induction which is being recommended by her health care provider. The nurse determines that the woman needs additional teaching when she identifies which assessment as being done before induction?
Leopold position
A couple has just experienced intrauterine fetal demise. Which action by the nurse would be least effective in assisting them?
Refrain from discussing the situation with the couple.
just know this
Reports of severe back pain are associated with a persistent occiput posterior position due to the pressure of the fetal head on the woman's sacrum and coccyx.
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?
Stop the infusion immediately
pre term labor
They include change or increase in vaginal discharge; pelvic pressure; low, dull backache; menstrual-like cramps; feeling of pelvic pressure or fullness; GI upset; general sense of discomfort or unease; heaviness or aching in the thighs; uterine contractions, with or without pain; more than six contractions per hour; intestinal cramping, with or without diarrhea; and persistent contractions.
Laminaria
a hygroscopic dilator that mechanically causes cervical ripening.
Leopold maneuver i
a technique for determining the position of the fetus as it moves through the labor process.
A nurse assesses 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?
administering oxytocin
After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical
amniotomy
Dinoprostone
approved by the FDA as the only cervical ripening agent to be used; ho
Prostaglandins
are pharmacologic methods for cervical ripening.
As part of a review class for perinatal nurses, the nurse is explaining the laboratory and diagnostic tests that can be conducted to evaluate a woman's risk for preterm labor. The nurse determines that additional teaching is needed when the group identifies which test as being used?
blood chemistry levels
Betamethasone promotes fetal lung maturity by
by stimulating surfactant production.
Normal labor
can occur after the 37th week
The nurse is assessing a woman who has a forceps-assisted birth for complications. Which condition would the nurse assess in the fetus?
caput succedaneum
Which finding would lead the nurse to suspect that the fetus of a woman in labor is in hypertonic uterine dysfuction?
complaints of severe back pain
Placental perfusion becomes
compromised, thereby reducing oxygen to the fetus. This occurs in early labor and affects nulliparous women more than multiparous women
amniotomy
considered a surgical method of cervical ripening
A client has been admitted to the unit for tocolytic therapy. Which medication would the nurse be least likely to administer?
corticosteroids
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 medication as a cervical ripening agent?
dinoprostone
Cervical dilation that has not progressed past 2 cm is associated
dysfunctional labor
hands-and-knees position
elps to promote fetal head rotation with a persistent occiput posterior position.
Frequent position changes would be appropriate for a woman with
h persistent occiput posterior position (problem with the passenger)
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 the client's previous history based on which finding
has previous lower abdominal incision
Contractions that are more forceful in the midsection of the uterus rather than in the fundus suggest
hypertonic uterine dysfunction
amniotic fluid embolism symptoms
hypotension, tachycardia, cyanosis, seizures, coagulation difficulties, and uterine atony with subsequent hemorrhage
Oxytocin would be appropriate for the woman experiencing
hypotonic uterine dysfunction (problem with the powers)
Magnesium sulfate is only given
intravenously for preterm labor.
A ruptured uterus
is a potential complication; however, hypoxia to the fetus would occur first.
Cephalopelvic disproportion
is usually associated with hypotonic uterine dysfunction
A client at 33 weeks' gestation is calling the office with various reports and is very concerned. The nurse recognizes which reports as indicating the client is potentially going into preterm labor? Select all that apply.
low, dull backache general sense of discomfort GI upset (nausea, vomiting, diarrhea) achiness in the thighs
A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition?
macrosomia
Fetal risks associated with a prolonged pregnancy include
macrosomia, shoulder dystocia, brachial plexus injuries, low Apgar scores, postmaturity syndrome, cephalopelvic disproportion, uteroplacental insufficiency, meconium aspiration, and intrauterine infection
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer?
magnesium sulfate
A primary care provider prescribes oral tocolytic therapy for a woman with preterm labor. The nurse explains to the client about the drugs that may be used. The nurse determines that the client needs additional teaching when she states which drug might be used?
magnesium sulfate
An amniotomy
may be used with hypertonic uterine dysfunction to augment labor
1.5 cm per hour fo
multiparous
Hypertonic uterine dysfunction
occurs when the uterus never fully relaxes between contractions.
. Precipitate labor
one that is completed in less than 3 hours from the start of contractions to birth.
Precipitate labor
one that is completed in less than 3 hours from start of contraction to birth.
Nifedipine and indomethacin are given
orally for preterm labor
Uterine hypertonicity is a possible adverse effect of
oxytocin administration.
A 26-year-old female, G1, P0, presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurrin
preterm labor
Diagnostic criteria are 1.2 cm per hour for
primiparous
Contraindications to BVAC include
prior classic uterine incision, prior transfundal uterine surgery, uterine scar other than low-transverse cesarean scar, contracted pelvis, and inadequate staff of facility if an emergency cesarean birth is required.
A woman is experiencing dystocia that appears related to psyche problems. Which intervention would be most appropriate for the nurse initiate?
providing a comfortable environment with dim lighting
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. The nurse suspects which complication?
reduced oxygen to the fetus
Dystocia
refers to a difficult labor.
After assessing a client's progress of labor, the nurse suspects the fetus is in a persistent occiput posterior position. Which finding would lead the nurse to suspect this condition?
reports of severe back pain
Corticosteroids are given to help reduce or prevent the frequency and severity of
respiratory distress syndrome in preterm infants delivered between 24 and 34 weeks' gestation.
Comfort measures
s minimize the woman's stress and promote relaxation so that she can work more effectively with the forces of labor
A nurse is presenting an in-service program about complications that can arise during labor. The nurse determines that the teaching was successful when the group identifies which findings as suggesting an amniotic fluid embolism? Select all that apply
sudden onset of respiratory distress hypotension tachycardia
A pregnant woman has just presented to the emergency department with various reports and in distress. Which finding would lead the nurse to suspect that she is experiencing an amniotic fluid embolism? Select all that apply.
sudden onset of respiratory distress hypotension tachycardia
A Bishop score less than 6 usually indicates
that a cervical ripening method should be used before labor induction
Preterm labor
the occurrence of regular uterine contractions accompanied by cervical effacement and dilation before the end of the 37th week of gestation. If not halted, it leads to preterm birth
Maternal complications include
tissue trauma, such as lacerations of the cervix, vagina, and perineum, hematoma, extension of episiotomy into the anus, hemorrhage, and infection.
Magnesium sulfate
used in hygroscopic dilators to assist in a mechanical method of cervical dilation
A sudden onset of fetal distress and acute continuous abdominal pain is associated with
uterine rupture.
A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if which condition occurs?
water intoxication
A woman in labor is receiving oxytocin. Which effect would the nurse need to be alert for potentially occurring
water intoxication
Oxytocin can lead to
water intoxication and can cause hypotension.
n amniotomy
y may be used with hypertonic uterine dysfunction to augment labor