Prep U 4

A nursing instructor highlights which risk factors associated with preterm labor? (SATA) a) weight of fetus b) uterine or cervical abnormalities c) history of previous preterm birth d) current multiple gestation pregnancy e) weight of pregnant mother

b) uterine or cervical abnormalities c) history of previous preterm birth d) current multiple gestation pregnancy

A client in the first stage of labor is diagnosed with dystocia involving the powers of labor. What would the nurse identify as the problem? a) Fetus is in a different position or presentation. b) Contractions are insufficient to cause fetus descent. c) Uterine contractions are too weak or uncoordinated. d) Pelvis is either android type or platypelloid type.

c) Uterine contractions are too weak or uncoordinated. Rationale: When there are problems with the powers causing dystocia during the first stage of labor, the uterine contractions are too weak or uncoordinated to cause adequate cervical effacement and dilatation. During the second stage of labor, the nurse should observe if the contractions and the pushing are insufficient to cause descent of the fetus. A fetus that is in a different position or presentation is a problem with the passenger. A pelvis that is either android type or platypelloid type is a problem with the passageway and is not related to dystocia.

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: a) no infection is present. b) infection is present. c) birth is unlikely within the 2 next weeks. d) birth is likely within the next 2 weeks.

c) birth is unlikely within the 2 next weeks. Rationale: Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that birth is unlikely within 2 weeks following the test. It does not diagnose infection

A nurse is monitoring a client with spontaneous abortion who has been prescribed misoprostol. Which symptoms are common adverse effects associated with misoprostol? (SATA) a) headache b) constipation c) dyspepsia d) tachycardia e) hypotension

c) dyspepsia d) tachycardia e) hypotension Rationale: Adverse effects commonly associated with misoprostol include dyspepsia, hypotension, tachycardia, diarrhea, abdominal pain, and vomiting

The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called? a) external rotation b) internal rotation c) external version d) vaginal manipulation

c) external version

A nurse is caring for a client who is experiencing acute onset of dyspnea and hypotension. The health care provider suspects the client has amniotic fluid embolism. What other signs or symptoms would alert the nurse to the presence of this condition in the client? (SATA) a) hyperglycemia b) hematuria c) pulmonary edema d) arrhythmia e) cyanosis

c) pulmonary edema e) cyanosis Rationale: The nurse should monitor cyanosis and pulmonary edema when caring for a client with amniotic fluid embolism. Other signs and symptoms of this condition include hypotension, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest. Hematuria if uterine ruptures

A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment? a) decreased urine output b) blood pressure of 130/88 mm Hg c) uterine hypertonicity d) active genital herpes infection

c) uterine hypertonicity Rationale: The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful? a) "My blood pressure will continue to be increased for about 6 more months." b) "I will be sure to avoid getting pregnant for at least 1 year." c) "I won't use my birth control pills for at least a year or two." d) "My intake of iron will have to be closely monitored for 6 months."

b) "I will be sure to avoid getting pregnant for at least 1 year." Rationale: After evacuation of trophoblastic tissue (hydatiform mole), long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for one year, and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided.

When caring for a client with premature rupture of membranes (PROM), the nurse observes an increase in the client's pulse. What should the nurse do next? a) Assess for cord compression. b) Assess the client's temperature. c) Monitor the fetus for respiratory distress. d) Monitor the client for preterm labor.

b) Assess the client's temperature. Rationale: A temperature elevation or an increase in the pulse of a client with PROM would indicate infection.

Which is the best question the nurse can ask a woman who is leaving the hospital after experiencing a complete spontaneous abortion? a) "Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" b) "Did you know that 75 percent of women who are trying to get pregnant experience spontaneous abortions like you have?" c) "Are you going to try again?" d) "May I give you some resources that you can use to try to stop smoking?"

a) "Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?"

A nurse is providing prenatal care to a pregnancy client. At which time would the nurse expect to screen the client for group B streptococcus infection? a) 36 weeks' gestation b) 32 weeks' gestation c) 16 weeks' gestation d) 28 week' gestation

a) 36 weeks' gestation

A client reports to her obstetrician a significant amount of bright red, painless vaginal bleeding. A sonogram reveals that her placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures should the nurse initiate? (SATA) a) Determine from the client the time the bleeding began and about how much blood has been lost. b) Perform a pelvic examination. c) Obtain baseline vital signs. d) Continue to assess blood pressure every 5 to 15 minutes. e) Attach external monitoring equipment to record fetal heart sounds. f) Place the woman on bed rest in a side-lying position.

a) Determine from the client the time the bleeding began and about how much blood has been lost. c) Obtain baseline vital signs. d) Continue to assess blood pressure every 5 to 15 minutes. e) Attach external monitoring equipment to record fetal heart sounds. f) Place the woman on bed rest in a side-lying position.

A client is 2 weeks past her due date, and her health provider is considering whether to induce labor. Which conditions must be present before induction can take place? (SATA) a) The fetus is in a longitudinal lie. b) Cephalopelvic disproportion is present. c) There is absence of eclampsia. d) A presenting part is engaged. e) The cervix is ripe. f) Maternal blood pressure is normal.

a) The fetus is in a longitudinal lie. d) A presenting part is engaged. e) The cervix is ripe. Rationale: Before induction of labor is begun in term and postterm pregnancies, the following conditions should be present: the fetus is in a longitudinal lie; the cervix is ripe, or ready for birth; a presenting part is engaged; there is no cephalopelvic disproportion; and the fetus is estimated to be mature by date (over 39 weeks) or demonstrated by a lecithin-sphingomyelin ratio or ultrasound biparietal diameter to rule out preterm birth. Normal maternal blood pressure and absence of eclampsia are not conditions required for induction; in fact, severe hypertension and eclampsia are conditions that may necessitate induction

A nursing student doing a rotation in labor and birth correctly identifies which medications as most commonly used for tocolysis? (SATA) a) atosiban b) indomethacin c) magnesium sulfate d) nitroglycerin e) nifedipine

a) atosiban b) indomethacin c) magnesium sulfate e) nifedipine

A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which additional signs and symptoms suggest the presence of molar pregnancy? (SATA) a) elevated hCG levels b) whitish discharge from the vagina c) hyperemesis gravidarum d) absence of fetal heart sound e) dyspareunia

a) elevated hCG levels c) hyperemesis gravidarum d) absence of fetal heart sound Rationale: The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum In molar pregnancy, a brownish vaginal bleeding is seen

A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? (SATA) a) preterm labor b) abruptio placenta c) spontaneous abortion d) placenta previa e) prolapsed cord

a) preterm labor b) abruptio placenta e) prolapsed cord Rationale: The associated conditions and complications of premature rupture of the membranes are infection, prolapsed cord, abruptio placenta, and preterm labor.

The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do? a) Place the client in a knee-chest position. b) Bolus the client with another dose of medication through the epidural. c) Turn the client on her left side. d) Prepare the client for a cesarean birth.

d) Prepare the client for a cesarean birth.

A nurse is caring for a client undergoing treatment for ectopic pregnancy. Which symptom is observed in a client if rupture or hemorrhaging occurs before the ectopic pregnancy is successfully treated? a) painless bright red vaginal bleeding b) tetanic contractions c) fetal distress d) phrenic nerve irritation

d) phrenic nerve irritation Rationale: The symptoms if rupture or hemorrhaging occurs before successfully treating the pregnancy are lower abdomen pain, feelings of faintness, phrenic nerve irritation, hypotension, marked abdominal tenderness with distension, and hypovolemic shock.

Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What is a sign or symptom of a ruptured fallopian tube? a) rectal pain b) bilateral abdominal pain c) unilateral abdominal pain d) shoulder pain

d) shoulder pain Rationale: Rarely, a woman may present with late signs, such as shoulder pain or hypovolemic shock. These signs are associated with tubal rupture, which occurs when the pregnancy expands beyond the tube's ability to stretch.

A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if which condition occurs? a) uterine hypotonicity b) hypertension c) fetal distress d) water intoxication

d) water intoxication Rationale: Oxytocin can lead to water intoxication and can cause hypotension. Uterine hypertonicity is a possible adverse effect of oxytocin administration