Ch 17 Labor and Birth Complications

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse is to: 1 assess the fetal heart rate (FHR) pattern. 2 perform a vaginal examination. 3 inspect the characteristics of the fluid. 4 assess maternal temperature.

1 The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). Performing a vaginal examination, inspecting fluid characteristics, and assessing maternal temperature should be done after the FHR and pattern are assessed.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 116 beats/min 2 Cervix dilated 2 cm and 50% effaced 3 Score of 8 on the biophysical profile 4 One fetal movement noted in 1 hour of assessment by the mother

4 Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation. A fetal heart rate of 116 beats/min is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a woman at 42 weeks of gestation. A score of 8 on the BPP is a normal finding in a pregnancy at 42 weeks.

Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. 4 Reposition the woman with her hips higher than her head.

4 The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? 1 Suggesting that the patient lie on her side 2 Infusing Ringer's lactate solution intravenously 3 Increasing the terbutaline (Brethine) concentration 4 Encouraging drinking a full glass of water periodically

1 The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus.

Which technique is least effective for the woman with persistent occipitoposterior position? 1 Squat 2 Lie supine and relax 3 Sit or kneel, leaning forward with support 4 Rock the pelvis back and forth while on hands and knees

2 Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipitoanterior. Rocking the pelvis encourages rotation from occipitoposterior to occipitoanterior.

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include? 1 "Because this is a repeat procedure, you are at the lowest risk for complications." 2 "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." 3 "Because this is your second cesarean birth, you will recover faster." 4 "You will not need preoperative teaching because this is your second cesarean birth."

2 Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? 1 Propranolol (Inderal) 2 Clindamycin (Cleocin) 3 Morphine (MS Contin) 4 Terbutaline (Brethine)

3 The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor.

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor? 1 Incomplete uterine relaxation 2 Maternal fatigue and exhaustion 3 Maternal sedation with narcotics 4 Administration of tocolytic drugs

1 A high uterine resting tone, with inadequate relaxation between contractions, reduces maternal blood flow to the placenta and decreases fetal oxygen supply. Maternal fatigue usually does not decrease uterine blood flow. Maternal sedation will sedate the fetus but should not decrease blood flow. Tocolytic drugs decrease contractions. This will increase uterine blood flow.

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order? 1 Intravenous (I.V.) propranolol (Inderal) 2 1 g I.V. calcium gluconate 3 Oral dose of 20 mg of nifedipine (Adalat) 4 500 mg of I.V. calcium chloride for 30 minutes

1 Terbutaline (Brethine) is a beta-adrenergic agonist that is used as a tocolytic to reduce uterine contractions (UCs) in preterm labor. The patient has a heart rate of 135 beats/min, which implies that the patient has intolerance to the drug and has tachycardia. Therefore the patient should be administered a beta-adrenergic blocker, such as propranolol (Inderal), to reverse the adverse effects of terbutaline (Brethine). Administering calcium gluconate, nifedipine (Adalat), and calcium chloride does not help to reduce the adverse effects of terbutaline (Brethine) in the patient. Rather, 1 g of calcium gluconate and 500 mg of calcium chloride are administered in case of magnesium sulfate toxicity. Nifedipine (Adalat) is a calcium channel blocker, which should not be given after terbutaline (Brethine) because it affects the patient's heart rate and blood pressure.

The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion? 1 Blood pressure of 80/60 mm Hg 2 Short episode of hyperglycemia 3 Irregular episodes of dysrhythmias 4 Heart rate of less than 120 beats/min

1 Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the patient develops tachycardia greater than 130 beats/min, then the treatment should be stopped.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? 1 Placing the woman in the knee-chest position. 2 Covering the cord in a sterile towel saturated with warm normal saline. 3 Preparing the woman for a cesarean birth. 4 Starting oxygen by face mask.

1 The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although preparing the woman for a cesarean birth is an appropriate intervention, relieving pressure on the cord is the nursing priority. If the cervix is fully dilated, the nurse should prepare for immediate vaginal birth. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer O2 by facial mask at 8 to 10 L/min until birth is complete. This intervention should be initiated after pressure is relieved on the cord.

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy? 1 Suggest that the patient avoids smoking and consuming alcohol. 2 Suggest that the patient increases physical activity to prevent risk. 3 Administer progesterone (Prometrium) suppositories to the patient. 4 Administer a 17-alpha hydroxyprogesterone injection to the patient.

1 To prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the patient get proper rest and care at home. The nurse should not suggest that the patient increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation.

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? 1 Teach gentle lower extremity exercises to the patient. 2 Suggest that the patient lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the patient. 4 Give tocolytic medications as per the physician's prescription.

1 The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe? Select all that apply. 1 Antibiotics 2 Glucocorticoids 3 Synthetic oxytocin 4 Magnesium sulfate 5 Progesterone supplementations

1, 2 The onset of labor during 34 weeks' gestation indicates that the patient has preterm labor. In such a condition, antibiotics and glucocorticoids should be prescribed and administered to the patient. Antibiotics are prescribed to prevent neonatal group B streptococcal infection. Glucocorticoids are prescribed to reduce the neonatal morbidity and mortality. Synthetic oxytocin is administered in patients to induce labor. Therefore synthetic oxytocin will not be prescribed to the patient because of the onset of labor. Magnesium sulfate is administered when the labor is induced before 32 weeks' gestation. Progesterone supplementation is administered before the onset of labor to prevent preterm birth.

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? 1 Calcium gluconate to the pregnant patient 2 Magnesium sulfate to the pregnant patient 3 Glucocorticoid drugs to the pregnant patient 4 Antibiotic medications to the pregnant patient

2 Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk as it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore administering glucocorticoids to the pregnant patient would help to prevent the risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.

The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? 1 Infuse nifedipine (Adalat) along with terbutaline (Brethine). 2 Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. 3 Provide a glass full of orange juice before administering nifedipine (Adalat). 4 Provide the patient with calcium supplements before administering nifedipine (Adalat).

2 Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required.

The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the: 1 Heart rate of the fetus 2 Blood pressure of the patient 3 Respiration rate of the patient 4 Blood sugar levels in the patient

2 The nurse should monitor the blood pressure of the patient after administering nifedipine (Adalat). It is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. Nifedipine (Adalat) does not alter fetal heart rate or respiration rate and blood sugar levels of the patient. Heart rate of the fetus is monitored when other classes of tocolytics are administered. Respiration rate is monitored when oxytocin (Pitocin) is administered to the patient. Blood sugar levels are monitored in patients with diabetes who are receiving glucocorticoid therapy.

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? 1 Buccal oxytocin (Pitocin) 2 Terbutaline sulfate (Brethine) 3 Calcium gluconate (Calgonate) 4 Magnesium sulfate (Magnesium sulfate)

2 The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: 1 uterine contractions occurring every 8 to 10 minutes. 2 a fetal heart rate (FHR) of 180 with absence of variability. 3 the woman needing to void. 4 rupture of the woman's amniotic membranes.

2 An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured.

The nurse is preparing to administer dexamethasone (Decadron) to a pregnant patient. Which nursing intervention should the nurse perform for safe administration of the drug? Select all that apply. 1 Monitor blood pressure of the patient. 2 Inform the patient that it will be painful. 3 Assess blood glucose levels in the patient. 4 Administer the drug by intramuscular injection. 5 Administer the oral form if patient refuses injection.

2, 3, 4 Dexamethasone (Decadron) is a glucocorticoid used to promote fetal lung maturation. The drug can also increase blood sugar levels in the patient. Therefore the nurse should monitor the blood sugar levels to assess the need for an increased insulin dose. The drug should be given by intramuscular injection in the ventral gluteal or vastus lateralis muscle for better absorption. The patient should be informed that the injection will be painful, because this type of truthfulness promotes patient cooperation. The drug does not affect blood pressure levels, and it does not need to be monitored. The oral form is not beneficial in promoting fetal lung maturation and should not be administered.

A pregnant patient is suspected to have preterm labor. The nurse is preparing to collect the vaginal discharge for conducting the fetal fibronectin test. What interventions are necessary before collecting the sample to ensure accuracy of the test? Select all that apply. 1 Instruct the patient to drink 2 glasses of water. 2 Check for the presence of vaginal bleeding in the patient. 3 Ask about history of sexual intercourse in the past 24 hours. 4 Ask the patient to empty the bladder before collecting the sample. 5 Assess the patient to see if the amniotic membranes have ruptured.

2, 3, 5 The fetal fibronectin test is performed to determine whether the patient has preterm labor. Amniotic fluid can affect the accuracy of the test. Therefore the nurse should check to see if the amniotic membranes are intact before collecting the vaginal secretions. Vaginal bleeding can also result in negative results and should be identified before collecting the sample. The nurse should also check whether the patient has had sexual intercourse in the past 24 hours, because it may reduce the accuracy of the results and cause a false-negative result. Drinking water and emptying the bladder have no effect on the test results. Therefore these interventions are not necessary before conducting the test.

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. 1 Fluid intake 2 Respiratory status 3 Body temperature 4 Level of consciousness 5 Deep tendon reflexes

2, 4, 5 Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? 1 Internal version 2 Vaginal delivery 3 Cesarean section 4 External cephalic version

3 Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has: 1 A stillbirth. 2 Placental abruption. 3 Prolonged pregnancy. 4 Elevated uterine contractions (UCs)

3 Meconium is the stool of the neonate, which is usually observed after the birth. When meconium is observed in amniotic fluid, it signifies that the patient has prolonged pregnancy. A stillbirth signifies the death of the fetus, which is not related to the presence of meconium in the amniotic fluid. Placental abruption causes early birth, whereas lowered estrogen levels cause prolonged birth. Elevated UCs is a sign of labor, which does not cause meconium in the amniotic fluid.

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with: 1 Shoulder dystocia. 2 Umbilical cord prolapse. 3 Aspiration pneumonia. 4 Brachial plexus injury

3 Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia.

The nurse is caring for a 32-year-old pregnant patient who had an onset of labor during 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the patient as to the etiology of the newborn's LBW? 1 Preterm labor 2 Maternal age 3 Diabetic condition of the patient 4 Intrauterine growth restriction (IUGR

3 The LBW of the newborn is the result of IUGR, a condition of inadequate fetal growth. It may be caused by various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the LBW. The onset of labor is at 40 weeks' gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for the LBW of the child. Infants born to patients with diabetes would have a high birth weight, not a low one.

Upon assessment of a pregnant patient, the nurse concludes that the patient is less likely to have a preterm delivery. Which patient clinical finding led the nurse to conclude this? 1 Previous cesarean birth 2 Preexisting diabetes mellitus 3 Cervical length of more than 30 mm 4 Symptoms of chronic hypertension

3 The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself in terms of effacement and dilation. Patients having cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus may not increase the risk of preterm labor.

The nurse observes that a pregnant patient at 36 weeks' gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation? 1 Monitor the blood glucose levels in the patient on a regular basis. 2 Ensure that the propranolol (Inderal) is available for administration. 3 Prepare to administer intravenous magnesium sulfate (Epsom salt). 4 Assess fetal ductus arteriosus and neonatal pulmonary hypertension.

3 This patient at 36 weeks' gestation is considered preterm based on a cervical dilation of 5 cm. With membranes intact, the therapeutic plan of care would include stopping the labor process. Magnesium sulfate (Epsom salt) may be administered to the patient to prevent cerebral palsy of the fetus that may occur due to preterm birth. Therefore the nurse has to prepare for the administration of magnesium sulfate intravenously to the patient. Assessment of blood glucose levels is not useful to prevent preterm birth. Propranolol (Inderal) is used to reverse the adverse effects of terbutaline (Brethine), and it is not useful to prevent preterm birth. Assessment of fetal ductus arteriosus and neonatal pulmonary hypertension is useful when indomethacin (Indocin) is administered to the patient but not before administering magnesium sulfate (Epsom salt) to the patient.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? 1 Internal version 2 Vaginal delivery 3 Cesarean section 4 External cephalic version

3 Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? 1 Vaginal delivery 2 Vacuum-assisted delivery 3 Cesarean section delivery 4 Forceps-assisted delivery

3 Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation? 1 Administer propranolol (Inderal). 2 Administer intravenous fluids. 3 Administer 1 g calcium gluconate. 4 Inform the primary health care provider (PHP).

4 A heart rate of 140 beats/min and chest pain indicates that the patient is having tachycardia, which is an adverse effect of terbutaline (Brethine). Therefore the nurse should report this to the PHP to obtain further instructions on the treatment. Propranolol (Inderal) is administered to reverse the cardiovascular adverse effects of terbutaline (Brethine). However, it needs to be prescribed by the PHP. Calcium gluconate is administered to reverse the effect of magnesium sulfate. Serum potassium should be monitored in the patient receiving terbutaline therapy; however, it is not a priority intervention. The patient has tachycardia and is not in a state of hypovolemic shock. Therefore intravenous fluids need not be administered to the patient.

The nurse is assisting a pregnant patient who is in labor. The nurse finds that the umbilical cord is protruding out from the vagina. With a gloved hand, the nurse attempts to put the umbilical cord into the vagina. The nurse continues to monitor the fetal heart rate, administers oxygen therapy to the patient, and increases the drip rate of the intravenous (IV) fluid. Which nursing action can lead to fetal and maternal complications? 1 Increasing the drip rate of the IV fluid 2 Monitoring fetal heart rate continuously 3 Administering oxygen therapy to the patient 4 Attempting to place the umbilical cord bac

4 A prolapsed umbilical cord can compromise the fetal perfusion. Therefore the nurse should act quickly to prevent fetal complications. The nurse should not attempt to replace the umbilical cord, as the cord can get compressed by the presenting part of the fetus, which could result in fetal hypoxia and death. Fetal heart rate should be monitored continuously to determine fetal perfusion. Oxygen therapy should be administered to the patient to promote fetal oxygenation. The drip rate of the IV fluid should be increased to promote fetal perfusion.

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? 1 Give the medication by oral route. 2 Assess platelet levels after drug administration. 3 Administer increased doses of insulin with the drug. 4 Follow a strict time interval of 24 hours between two doses

4 Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered.

The nurse is caring for a pregnant patient who has been recommended for an external cephalic version. What would the nurse do as part of the procedure? 1 Place the patient in a side position. 2 Administer oxytocin (Pitocin) intravenously. 3 Place a pillow under the maternal abdomen. 4 Administer terbutaline (Brethine) intravenously.

4 External cephalic version is the changing of the position of the fetus by the primary health care provider (PHP). As part of the procedure, the PHP advises the nurse to administer terbutaline (Brethine) to soothe the muscle activity. Patients are usually placed in supine position while performing the procedure. Therefore the nurse should not place the patient in a side-lying position. Oxytocin (Pitocin) is contraindicated as it increases the muscle activity, which may again disturb the procedure. A pillow is not encouraged while performing this procedure.

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? 1 A primigravida who is 17 years old 2 A 22-year-old multiparous woman with ruptured membranes 3 A primigravida who has requested no analgesia during her labor 4 A multiparous woman at 39 weeks of gestation who is expecting twins

4 Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

The nurse is preparing to perform a fetal fibronectin test for a pregnant patient. Which intervention should the nurse perform to collect the sample for the test? 1 Take a blood sample from the forearm. 2 Take a sample of the patient's amniotic fluid. 3 Ask the patient to provide a urine sample. 4 Collect the vaginal secretions using a swab.

4 The fetal fibronectin test is conducted to assess whether a patient is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. In order to conduct the test, the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, as they may not contain adequate glycoprotein levels.

The nurse is about to perform a vaginal examination in order to determine cervical dilation of a patient in early labor. The patient informs the nurse that as of her last provider appointment, the baby was in a breech position. This alerts the nurse that she needs to place the patient in a supine position in order to perform the digital examination. Other maternal positions may inadvertently result in: 1 Shoulder dystocia. 2 Version. 3 Increased risk of infection. 4 Membrane rupture.

4 The patient who has a fetal breech malposition should always be examined in the supine position. If the fetus is a breech malpresentation, there is a predisposition that the patient may experience rupture of membranes if a digital examination is performed while she is in the semi-Fowler position. Should the membranes rupture in early labor, the risk for a prolapsed cord increases. A version from breech to vertex position would not occur as a result of a digital examination. Scrupulous hand hygiene and standard precautions should always be performed before the examination to prevent the spread of infection in patients. A shoulder dystocia would occur during the birth, not during a vaginal examination.