OB EAQ Birth and Labor Complications
A pregnant client who is in preterm labor has been prescribed dexamethasone (Decadron). What benefit of the drug would the nurse identify in the client? 1 Maturation of fetal lungs 2 Relaxation of smooth muscles 3 Inhibition of uterine contractions (UCs) 4 Central nervous system (CNS) depression
Answer: 1 Dexamethasone (Decadron) is a glucocorticoid and is administered to clients having preterm labor, because it promotes fetal lung maturation. The drug facilitates the release of enzymes that induce production or release of lung surfactant. Tocolytics are used to inhibit UCs. Magnesium sulfate is a CNS depressant. Tocolytics also causes the relaxation of smooth muscles.
During a prenatal visit, the nurse finds that the client has decreased mobility and symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? 1 Teach gentle lower extremity exercises to the client. 2 Suggest the client to lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the client. 4 Give tocolytic medications as per the physician's prescription.
Answer: 1 The health care provider may recommend reduced activity for the client experiencing preterm labor, depending on the severity of the symptoms. As a result, the client may be at risk for thrombophlebitis due to limited activity. The nurse should teach the client how to perform gentle exercises of the lower extremities. Suggesting that the client lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the client 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 client's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the client to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.
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, the nurse includes which information? 1 "Because this is a repeat procedure, you are at the lowest risk for complications." 2 "Even though 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."
Answer: 2 "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." is the most appropriate response. "Because this is a repeat procedure, you are at the lowest risk for complications." is not accurate. Maternal and fetal risks are associated with every cesarean section. "Because this is your second cesarean birth, you will recover faster." is not accurate. Physiologic and psychologic recovery from a cesarean section are multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of what? 1 Uterine contractions occurring every 8 to 10 minutes 2 A fetal heart rate (FHR) of 180 with absence of variability 3 The client needing to void 4 Rupture of the client's amniotic membranes
Answer: 2 A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring. The oxytocin should be immediately discontinued and the physician should be notified. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The oxytocin should be discontinued if uterine hyperstimulation occurs. The client 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 nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.
The nurse is administering glucocorticoids to a pregnant woman in preterm labor. When explaining the purpose of this medication to the client, which response by the nurse is accurate? 1 To prevent fetal cerebral palsy 2 To prevent early birth of the fetus 3 To prevent gestational hypertension 4 To prevent fetal respiratory distress syndrome
Answer: 4 Preterm birth causes respiratory distress in the newborn due to underdeveloped lung activity. Antenatal glucocorticoids are administered to a pregnant client who is at the risk of preterm labor to prevent fetal respiratory distress syndrome. Tocolytic agents such as magnesium sulfate (Epsom salts), are found to reduce the incidence of cerebral palsy in the child, and are unrelated to glucocorticoids. Gestational hypertension is observed in clients who have a familial history of hypertension and may not be prevented by administering glucocorticoids. Glucocorticoids have no impact on delaying preterm birth.
While assisting a primary health care provider performing amniotomy, the nurse observes part of the umbilical cord protruding from the client's vagina. The nurse immediately positions the client in the Trendelenburg position and inserts a finger into her vagina. What additional care does the client need to prevent complications? 1 Perform large-bore catheter suction. 2 Prepare for an emergency C-section. 3 Administer calcium gluconate intravenously. 4 Administer terbutaline (Brethine) subcutaneously.
Answer: 2 Amniotomy may cause prolapse of the umbilical cord, in which the cord lies below the presenting part of the fetus. A prolapsed cord causes fetal hypoxia, because the supply of oxygen to the fetus is reduced. A cesarean birth should be performed to prevent further complications. Large-bore catheter suction is performed to remove the aspirated meconium from the newborn, and is unrelated to cord prolapse. Calcium gluconate is administered to a pregnant client who develops magnesium sulfate toxicity. Calcium gluconate is unrelated to cord prolapse. Terbutaline (Brethine) is administered to treat tachysystole in the pregnant client and is unrelated to cord prolapse.
The nurse administers magnesium sulfate (Epsom salts) to stop labor in a pregnant client. Which symptoms should the nurse monitor to ensure the client's safety? 1 Swollen legs 2 Respiratory rate 3 Eating patterns 4 Maternal chills
Answer: 2 Magnesium sulfate (Epsom salts) is administered to a pregnant client to stop labor. Magnesium sulfate (Epsom salts) causes respiratory depression as a toxic effect. Therefore, the nurse should monitor the respiratory rate of the client. Swollen legs or edema is acommon observation during labor, which is caused by increased abdominal contents. Edema is unrelated to magnesium sulfate. Magnesium sulfate (Epsom salts) does not alter a client's eating habits. Maternal chills are observed in clients with membrane rupture and are unrelated to magnesium sulfate (Epsom salts).
A pregnant client experienced preterm labor at 30 weeks gestation. Upon assessing the client 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. 2 Magnesium sulfate. 3 Glucocorticoid drugs. 4 Antibiotic medications.
Answer: 2 Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the client can prevent this risk, because 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 client would help to prevent 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.
Which drug is used for treating a client with severe postpartum bleeding? 1 Nifedipine (Adalat) 2 Oxytocin (Pitocin) 3 Propranolol (Inderal) 4 Metronidazole (Flagyl)
Answer: 2 Oxytocin (Pitocin) is a synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. Nifedipine (Adalat) is a calcium channel blocker that is used intocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse intolerable cardiovascular effects of terbutaline (Brethine). Metronidazole (Flagyl) is a broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean birth.
Upon assessment of a pregnant client, the nurse concludes that the client is less likely to have a preterm delivery. Which client clinical finding led the nurse to conclude this? 1 Previous cesarean birth. 2 Preexisting diabetes mellitus. 3 Cervical length is more than 30 mm. 4 Symptoms of chronic hypertension.
Answer: 3 The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself, in terms of effacement and dilatation. Clients having a 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 might not increase the risk of preterm labor.
Of what should a nurse providing care to a woman in labor be aware regarding cesarean birth? 1 Is declining in frequency in the United States 2 Is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do 3 Is performed primarily for the benefit of the fetus 4 Can be either elected or refused by women as their absolute legal right
Answer: 3 The most common indications for cesarean birth are dangers to the fetus related to labor and birth complications. Cesarean births are increasing in the United States. Wealthier women who have health insurance and who give birth in a private hospital are more likely to experience cesarean birth. A woman's right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.
The nurse is monitoring a pregnant client after amniotomy. Which observation would indicate a likelihood of umbilical cord compression? 1 The fetal heart rate (FHR) confirms tachycardia. 2 The client's vaginal drainage has a foul-smell. 3 The client has maternal chills frequently. 4 The fetal heart rate (FHR) has variable decelerations.
Answer: 4 Amniotomy is performed in a pregnant client in order to rupture the membranes artificially. After the procedure, the nurse should closely monitor the FHR. Reduced FHR and variable decelerations in FHR indicate that the client's umbilical cord is compressed. The nurse should immediately inform the primary health care provider of the client's condition. Tachycardia or increased FHR are common manifestations observed after amniotomy. Tachycardia does not require immediate clinical action. Maternal chills and foul-smelling vaginal discharge after amniotomy indicate infection of the ruptured membranes. However, this would not be a reason to expect umbilical cord compression.
Which statement is most likely to be associated with a breech presentation? 1 Least common malpresentation 2 Descent is rapid 3 Diagnosis by ultrasound only 4 High rate of neuromuscular disorders
Answer: 4 Fetuses with neuromuscular disorders have a higher rate of breech presentation, perhaps because they are less capable of movement within the uterus. Breech is the most common malpresentation, affecting 3% to 4% of all labors. Descent is often slow because the breech is not as good a dilating wedge as is the fetal head. Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound.
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 120 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
Answer: 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 120 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.
The nurse is caring for a 32-year-old pregnant client who had an onset of labor at 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 client 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).
Answer: 4 The low birth weight of the newborn is due to IUGR, a condition of inadequate fetal growth. It may be caused due to 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 low birth weight. The onset of labor is at 40 weeks' gestation. Therefore, it is not a preterm labor. The client's age is normal for pregnancy. Therefore, the client's age is not a reason for the low birth weight of the child. Infants born to clients with diabetes would have a high birth weight, not a low one.
