Chapter 21: PrepU - Complications Occurring Before Labor and Delivery
A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? 1- Fetal heart tones 2- Signs of shock 3- Infection 4- Uterine stabilization
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A client has been admitted with abruptio placentae. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? 1- grade 2 2- grade 1 3- grade 3 4- grade 4
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A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? 1- Depressed deep tendon reflexes 2- Tachypnea 3- Bradycardia 4- Elevated blood glucose
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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? 1- 2 to 7 days 2- 1 to 5 days 3- 6 to 10 days 4- 4 to 8 days
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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: 1- birth is unlikely within the 2 next weeks. 2- birth is likely within the next 2 weeks. 3- no infection is present. 4- infection is present.
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A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? 1- magnesium sulfate 2- nifedipine 3- indomethacin 4- betamethasone
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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? 1- magnesium sulfate 2- nifedipine 3- indomethacin 4- bethamethasone
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A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 1- 5. 2- 6. 3- 7. 4- 9.
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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? 1- betamethasone 2- magnesium sulfate 3- indomethacin 4- nifedipine
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A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation? 1- x-ray 2- ultrasound 3- aspiration 4- palpation
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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? 1- bronchodilators 2- tocolytic therapy 3- muscle relaxants 4- anti-anxiety therapy
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A nurse is explaining to a group of nurses new to the labor and birth unit about about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? 1- herbal agents 2- laminaria 3- membrane stripping 4- amniotomy
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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? 1- breast stimulation 2- amniotomy 3- laminaria 4- prostaglandin
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Although many women envision a plan of how labor will go, sometimes complications happen, and their plan is no longer achieveable. When this happens, what is the best question the nurse can ask the woman at this time? 1- "Do you think your baby knows how you wanted your labor to progress?" 2- "What do you consider your primary goal for the outcome of this pregnancy?" 3- "Have you ever had your plans changed in the middle of the project?" 4- "How do you handle events that do go your way?"
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A pregnant client arrives at the clinic for a regular antenatal check-up. Examinations and weight recording reveal a slow fetal weight gain. About which of the following pregnancy-related risks should the nurse alert the client? 1- Prolonged labor 2- Pre-eclampsia 3- Preterm labor 4- Uterine infections
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Hypertonic labor is labor that is characterized by short, irregular contractions without complete relaxation of the uterine wall in between contractions. Hypertonic labor can be caused by an increased sensitivity to oxytocin. What would the nurse do for a client who is in hypertonic labor because of oxytocin augmentation? 1- Increase the oxytocin. 2- Turn off the oxytocin. 3- Increase the methotrexate. 4- Turn off the methotrexate.
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The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider? 1- hematocrit of 36% 2- 45 ml urine output in 2 hours 3- hemoglobin of 13 g/dl 4- platelet count of 150,000 mm3
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The nurse would be alert for possible placental abruption during labor when assessment reveals which finding? 1- macrosomia 2- gestational hypertension 3- gestational diabetes 4- low parity
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A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is post-term and has oligohydramnios. What does this increase the risk of during birth? 1- fetal hydrocephalus 2- macrosomia 3- cord compression 4- shoulder dystocia
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The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents? 1- "I need a cesarean section if I develop this problem." 2- "If I develop this complication, I will have bright red vaginal bleeding," 3- "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." 4- "Since I am over 30, I run a much higher risk of developing this problem."
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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? 1- dysfunctional labor pattern 2- postterm status 3- prolonged ruptured membranes 4- overdistended uterus
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A nurse is conducting an assessment of a woman who has experienced PROM. Which finding would lead the nurse to suspect infection as the cause of a client's PROM? 1- yellow-green fluid 2- blue color on Nitrazine testing 3- ferning 4- foul odor
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The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? 1- posterior position 2- firm 3- closed 4- shortened
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The nurse understands the need to be aware of the potential of bleeding disorders in her pregnant clients. Which disorder should she be aware of that occurs in the second trimester? 1- Hydatidiform mole 2- Spontaneous abortion 3- Ectopic pregnancy 4- Placenta previa 5- Cervical insufficiency
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A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? 1- Black cohosh 2- Skullcap 3- Catnip 4- Jasmine
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A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient? 1- Assess fetal heart sounds with an external monitor. 2- Help the patient remain ambulatory to reduce bleeding. 3- Assess uterine contractions by an internal pressure gauge. 4- Prepare for a vaginal examination to assess the extent of bleeding.
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A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client? 1- complications of a postterm pregnancy 2- complications of preterm labor 3- complications of placenta previa 4- placental abruption
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A primigravida at 28 weeks' gestation comes to the clinic for a check-up. She tells the nurse that her mother gave birth to both of her children prematurely, and she is afraid that the same will happen to her. Which risk factors associated with preterm birth would the nurse discuss with the client? Select all that apply. 1- history of previous preterm birth 2- current multiple gestation pregnancy 3- large-for-gestational age fetus 4- uterine or cervical abnormalities 5- previous cesarean birth
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A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which factor would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus? 1- aging of the placenta 2- increased amniotic fluid volume 3- meconium aspiration 4- cord compression
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A client 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 occurring? 1- preterm labor 2- normal labor 3- dystocia 4- precipitate labor
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A full-term pregnant client is being assessed for induction of labor. Her Bishop score is less than 6. Which prescription would the nurse anticipate? 1- Insert a Foley catheter into the endocervical canal. 2- Prepare the client for a cesarean birth. 3- Administer oxytocin intravenously at 10 mU/minute. 4- Rupture membranes.
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A woman in active labor has just had her membranes ruptured to speed up labor. The nurse is concerned the woman is experiencing a prolapse of the umbilical cord when the nurse notices which pattern on the fetal heart monitor? 1- variable deceleration pattern 2- fetal heart rate (FHR) increase to 200 beats/min 3- early deceleration with each contraction 4- late deceleration with late recovery following contraction
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A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client? 1- Risk for fetal infection related to early rupture of membranes 2- Hopelessness related to potential loss of pregnancy 3- Anticipatory grieving related to high probability for fetal death from placental dysfunction 4- Powerlessness related to inability to sustain pregnancy
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After an hour of oxytocin therapy, a woman in labor states she feels dizzy and nauseated. The nurse's best action would be to: 1- assess the rate of flow of the oxytocin infusion. 2- administer oral orange juice for added potassium. 3- assess her vaginally for full dilation. 4- instruct her to breathe in and out rapidly.
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During a prenatal ultrasound, the client is discovered to have a placenta succenturiata. Following delivery of the fetus and placenta, which nursing assessment is most important? 1- Assessment for hemorrhage 2- Assessment for pain 3- Assessment for a thrombus 4- Assessment for shortness of breath
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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? 1- Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. 2- After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. 3- Start oxytocin drip, piggyback to main IV line to port closest to client. 4- Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.
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The nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? 1- 11 2- 8 3- 6 4- 3
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