O'Meara Prep U CH 21

A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching

"It's okay for my husband and me to have sexual intercourse."

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."

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

11

A client is admitted to the unit in preterm labor. In preparing the client for tocolytic drug therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used

2 to 7 days

The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider

45 ml urine output in 2 hours

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is

5 A Bishop score less than 6 usually indicates that a cervical ripening method should be used before labor induction.

A 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 as a "piggyback" infusion.

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient

Assess fetal heart sounds with an external monitor.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client

Assess fetal heart sounds.

When educating the post-term pregnant client, what should the nurse be sure to include to prevent fetal complications

Be sure to monitor fetal movements daily.

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.

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider

Check for a full bladder.

A pregnant patient receiving intravenous oxytocin for 1 hour has contractions lasting 80 seconds. What should the nurse do first for this patient

Discontinue the oxytocin infusion.

The nurse is monitoring a woman who is receiving IV oxytocin to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin

Discontinue the oxytocin infusion.

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize

Fetal heart tones

A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms

If rhythmical, they could indicate preterm labor.

A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which of the following tests would the nurse expect to be used to predict fetal lung maturity when the client goes into labor

Lecithin/sphingomyelin ratio

The nurse is assessing a multipara client at 28 weeks' gestation who may be experiencing labor. Which findings should the nurse prioritize

Positive fetal fibronectin

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

Preterm labor

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

Risk for fetal infection related to early rupture of membranes

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

Shortened explanation: A ripe cervix is shortened, centered (anterior), softened, and partially dilated. An unripe cervix is long, closed, posterior, and firm.

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

Turn off the oxytocin.

A nurse is reviewing an article about preterm prelabor rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply

UTI low SES (low socioeconomic status) Smoking

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. For what should the nurse immediately check the patient

Umbilical cord prolapse

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.

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

When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment

cervical ripening

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth

cord compression

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply

elevated maternal pulse rate abdominal tenderness cloudy malodorous fluid

A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM

foul odor

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor

gestational hypertension

A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus

increased amniotic fluid volume

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

indomethacin nifedipine magnesium sulfate

A nurse is explaining to a group of nurses new to the labor and birth unit about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one

laminaria

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

A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer

magnesium sulfate

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

A patient who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the patient that pelvic rest involves which of the following

placing nothing in the vagina

A patient who is at 7 months' gestation presents to the emergency department with reports of a large gush and continuous leaking of fluid from her vagina. She does have some slight pelvic pressure but denies any contractions. This patient is showing clinical signs of which of the following

premature rupture of membranes

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

preterm labor

Preterm premature rupture of membranes (PROM) can be a serious complication of labor. What is the most common cause of preterm PROM

ruptured membranes

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

The nurse is monitoring a primipara who has been receiving oxytocin and is now in hypertonic labor. If the nurse notes the fetal heart rate has suddenly dropped, which action should the nurse prioritize

Decrease the oxytocin drip rate.

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

Black cohosh

Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply

a)Septicemia b)Abruptio placenta e)Severe preeclampsia

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

A nurse is preparing an in-service program about labor and the hormones involved with the initiation of labor. Which information would the nurse include as believing to play a role in the onset of labor

withdrawal of progesterone

A nursing student doing a rotation in labor and birth correctly identifies which medications as most commonly used for tocolysis? Select all that apply

• magnesium sulfate • atosiban • indomethacin • nifedipine