Chapter 21

A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed? tocolytic therapy anti-anxiety therapy bronchodilators muscle relaxants

tocolytic therapy

During their experience in L & D, a group of nursing students are observing a woman who is having uncoordinated contractions where the monitor shows some contractions close together, followed by a long period without any contractions. The nurse asks the students, "Which medication may help to stimulate a more effective, consistent pattern of contractions?" Which medication would be considered the best answer? oxytocin betamethasone morphine sulfate terbutaline

oxytocin

A woman in labor for over 12 hours has made very little progress. The health care provider thinks that her contractions lack the force needed to propel the infant downward through the birth canal. The provider asks a group of nursing students which hormone may need to be given to increase the force of the contraction. Which hormone would be the best answer? oxytocin, a posterior pituitary hormone luteinizing hormone, an anterior pituitary hormone antidiuretic hormone, a posterior pituitary hormone growth hormone, an anterior pituitary hormone

oxytocin, a posterior pituitary hormone

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common? breech presentation persistent occiput posterior position multifetal pregnancy macrosomia

persistent occiput posterior position

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? Notify the birth attendant. Slow the oxytocin infusion to the initial rate. Continue to monitor contractions and fetal heart rate. Stop the infusion immediately.

Stop the infusion immediately.

A nurse is conducting an in-service program for a group of labor and birth unit nurses about cesarean birth. The group demonstrates understanding of the information when they identify which conditions as appropriate indications? Select all that apply. prolonged labor previous cesarean birth fetal distress active genital herpes infection placenta previa

active genital herpes infection placenta previa previous cesarean birth fetal distress

A woman with a history of crack cocaine use disorder is admitted to the labor and birth area. While caring for the client, the nurse notes a sudden onset of fetal bradycardia. Inspection of the abdomen reveals an irregular wall contour. The client also reports acute abdominal pain that is continuous. Which condition would the nurse suspect? umbilical cord prolapse amniotic fluid embolism shoulder dystocia uterine rupture

uterine rupture

woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? Administer oxytocin diluted in the main intravenous fluid. Administer oxytocin in a 20 cc bolus of saline. Administer oxytocin diluted as a "piggyback" infusion. Administer oxytocin in two divided intramuscular sites.

Administer oxytocin diluted as a "piggyback" infusion.

A birth room nurse notes that after the provider attempts to remove the placenta, a ball of tissue appears in the woman's vagina accompanied by massive amount of gushing blood. Immediately the woman's vital signs reveal: BP 70/48 mm Hg, pulse rate 150 bpm, and mucous membranes are pale. Which interventions should be the priority for the nurse? Select all that apply. Apply oxygen mask at 10 L/min. Call environmental services to mop up the blood. Give the provider assistance by helping reinsert the uterus back through the cervical opening. Assist the provider in pulling harder on the placenta to get it removed quicker. Discontinue the IV oxytocin infusion.

Discontinue the IV oxytocin infusion. Apply oxygen mask at 10 L/min.

A multigravida client at 31 weeks' gestation is admitted with confirmed preterm labor. As the nurse continues to monitor the client now receiving magnesium sulfate, which assessment findings will the nurse prioritize and report immediately to the RN or health care provider? Pain in the abdomen, shoulder, or back Respiratory depression, hypotension, absent tendon reflexes Severe lower back pain, leg cramps, sweating Low potassium or elevated glucose, tachycardia, chest pain

Respiratory depression, hypotension, absent tendon reflexes

The nurse would prepare a client for amnioinfusion when which action occurs? Fetal presenting part fails to rotate fully and descend in the pelvis. The fetus shows abnormal fetal heart rate patterns. Maternal pushing is compromised due to anesthesia. Severe variable decelerations occur and are due to cord compression.

Severe variable decelerations occur and are due to cord compression.

A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? magnesium sulfate indomethacin corticosteroids nifedipine

corticosteroids

A nurse preceptor asks a student to list commonly used diagnostic tests for preterm labor risk assessment. Which tests should the student include? Select all that apply. amniotic fluid analysis U/A CBC thyroid level arterial blood gases

amniotic fluid analysis U/A CBC

A client with full-term pregnancy who is not in active labor has been prescribed oxytocin intravenously. The nurse would notify the health care provider if which finding is noted? prolonged ruptured membranes postterm status overdistended uterus dysfunctional labor pattern

overdistended uterus

A woman having contractions comes to the emergency department. She tells the nurse that she is at 34 weeks' gestation. The nurse examines her and finds that she is already effaced and dilated 2 cm. What is this woman demonstrating? preterm labor macrosomia dystocia normal labor

preterm labor

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 preparing the woman for an amniotomy administering oxytocin encouraging the women to change positions frequently

providing a comfortable environment with dim lighting

The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. Start oxytocin drip, piggyback to main IV line to port closest to client. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.

Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.

A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factors? Select all that apply. short maternal stature plan for pudendal block anesthetic use multiparity Body mass index 30.2 breech fetal presentation

Body mass index 30.2 breech fetal presentation short maternal stature

A shoulder dystocia situation is called in room 4. The nurse enters the room to help and the health care provider says to the nurse, "McRoberts maneuver." What does the nurse do next? Move the client into a hands-and-knees position, to straighten the sacral curve and release the posterior shoulder Push the fetal head back into the uterus and prepare the client for cesarean birth Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis Apply downward pressure above the pubic bone of the client, in an attempt to rotate the anterior shoulder

Bring the client's knees back toward the shoulders, causing hyperflexion of the hips and rotation of the pubic symphysis

A woman at 39 weeks' gestation is brought to the emergency department in labor following blunt trauma from an vehicle accident. The labor has been progressing well after the epidural when suddenly the woman reports severe pain in her back and shoulders. Which potential situation should the nurse suspect? Uterine rupture Dystocia Placental abruption (abruptio placentae) Fractured ribs

Uterine rupture

A nurse is preparing to teach a class to pregnant women about the signs of preterm labor and what to do if these occur. Which signs of preterm labor should the nurse include in the presentation? Select all that apply. increase in vaginal discharge nausea, vomiting, and diarrhea feeling of pelvic pressure or fullness uterine contractions, cramping, low back pain feelings of stress leaking of fluid from the vagina

increase in vaginal discharge feeling of pelvic pressure or fullness uterine contractions, cramping, low back pain leaking of fluid from the vagina nausea, vomiting, and diarrhea

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? hemorrhage infection macrosomia dystocia

macrosomia

The nurse who works at the local health department is preparing to give a talk on post-term pregnancies. She wants to include the fetal risks. Which risks should she include? Select all that apply. macrosomia failure to thrive cephalopelvic disproportion brachial plexus injuries shoulder dystocia

macrosomia cephalopelvic disproportion brachial plexus injuries shoulder dystocia

A nursing student working with a client in preterm labor correctly identifies which medication as being used to relax the smooth muscles of the uterus and for seizure prophylaxis and treatment in clients with preeclampsia? indomethacin magnesium sulfate nifedipine betamethasone

magnesium sulfate

A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? indomethacin nifedipine betamethasone magnesium sulfate

magnesium sulfate

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. magnesium sulfate misoprostol dinoprostone indomethacin nifedipine

magnesium sulfate indomethacin nifedipine

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer? sedatives corticosteroids tocolytics uterine stimulants

uterine stimulants

A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: birth is unlikely within the 2 next weeks. birth is likely within the next 2 weeks. no infection is present. infection is present.

birth is unlikely within the 2 next weeks.

A woman gave birth to a newborn via vaginal birth with the use of a vacuum extractor. The nurse would be alert for which possible effect in the newborn? central nervous system injury cephalohematoma asphyxia clavicular fracture

cephalohematoma