ANDU 2050 EXAM IV High Risk Birth

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Immediately after the forceps-assisted birth of an infant, the nurse should: a.Assess the infant for signs of trauma. b.Give the infant prophylactic antibiotics. c.Apply a cold pack to the infant's scalp. d.Measure the circumference of the infant's head The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would put the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.

With regard to the process of augmentation of labor, the nurse should be aware that it: a.Is part of the active management of labor that is instituted when the labor process is unsatisfactory. b.Relies on more invasive methods when oxytocin and amniotomy have failed. c.Is a modern management term to cover up the negative connotations of forceps-assisted birth. d.Uses vacuum cups. Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods. Forceps-assisted births and vacuum-assisted births are appropriately used at the end of labor and are not part of augmentation.

In evaluating the effectiveness of oxytocin induction, the nurse would expect: a.Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. b.The intensity of contractions to be at least 110 to 130 mm Hg. c.Labor to progress at least 2 cm/hr dilation. d At least 30 mU/min of oxytocin will be needed to achieve cervical dilation. The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.

A laboring woman's amniotic membranes have just ruptured. The immediate action of the nurse is to: A assess the fetal heart rate (FHR) pattern. B perform a vaginal examination. C inspect the characteristics of the fluid. D assess maternal temperature. The first nursing action after the membranes are ruptured is to check the FHR. Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy). Performing a vaginal examination, inspecting fluid characteristics, and assessing maternal temperature should be done after the FHR and pattern are assessed.

A pregnant patient is administered misoprostol (Cytotec) to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. What does the nurse do to alleviate the symptoms? A Administer terbutaline (Brethine). B Administer oxytocin (Pitocin) infusion. C Give a magnesium containing antacid. D Increase the time between doses. The patient is taking misoprostol (Cytotec) medication for labor induction. Vomiting and diarrhea are the adverse effects of the drug. These effects can be reversed by the administration of terbutaline (Brethine) by the subcutaneous route. To prevent the adverse effects, dosing intervals must be increased before the administration. However, increasing the dosing intervals will not be helpful in alleviating these symptoms. Oxytocin (Pitocin) can be given 4 hours after administering the last dose of misoprostol (Cytotec). This is usually given if the labor has not occurred, and it does not prevent the adverse effects of misoprostol (Cytotec). Magnesium containing antacids should not be given to the patients who are taking misoprostol (Cytotec) medication because they interact with each other.

A pregnant patient reports lack of sleep for the past few days. The nurse finds that the patient drinks less water and also eats fewer foods. Which intervention should the nurse follow during the labor to ease the delivery of the child? A Position the patient favorably. B Give a soothing massage to patient. C Administer an analgesic for pain relief. D Encourage the ambulation of the patient. Insomnia and inadequate nutrition may result in the lack of bearing down efforts in the patient. The nurse should position the patient in a favorable position so that the gravitational force helps in pushing the baby through the birth canal. Massage may soothe the patient, but it may not help in achieving the voluntary movement required for bearing down. Analgesic administration reduces the pain due to excess uterine contractions (UCs), but it does not assist the mother in pushing the fetus. Ambulation is not advisable in this patient who is already exhausted due to the inadequate achievement of bearing down.

A pregnant patient who is in preterm labor has been prescribed dexamethasone (Decadron). What benefit of the drug would the nurse identify in the patient? A Maturation of fetal lungs B Relaxation of smooth muscles C Inhibition of uterine contractions (UCs) D Central nervous system (CNS) depression Dexamethasone (Decadron) is a glucocorticoid that is administered to patients 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.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? A Placing the woman in the knee-chest position. B Covering the cord in a sterile towel saturated with warm normal saline. C Preparing the woman for a cesarean birth. D Starting oxygen by face mask. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although preparing the woman for a cesarean birth is an appropriate intervention, relieving pressure on the cord is the nursing priority. If the cervix is fully dilated, the nurse should prepare for immediate vaginal birth. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer O2 by facial mask at 8 to 10 L/min until birth is complete. This intervention should be initiated after pressure is relieved on the cord.

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a.Placing the woman in the knee-chest position b.Covering the cord in sterile gauze soaked in saline c.Preparing the woman for a cesarean birth d.Starting oxygen by face mask The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a.Stimulate fetal surfactant production. b.Reduce maternal and fetal tachycardia associated with ritodrine administration. c.Suppress uterine contractions. d.Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

Before the physician performs an external version, the nurse should expect an order for a: a.Tocolytic drug. c.Local anesthetic. b.Contraction stress test (CST). d.Foley catheter. A tocolytic drug will relax the uterus before and during version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. The bladder should be emptied; however, catheterization is not necessary.

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? A Teach gentle lower extremity exercises to the patient. B Suggest that the patient lie in the supine position in bed. C Provide a calm and soothing atmosphere to the patient. D Give tocolytic medications as per the physician's prescription. The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient 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 patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a.Viral c.Cervical b.Periodontal d.Urinary tract The infections that increase the risk of preterm labor and birth are all bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, it is important for the client to participate in early, continual, and comprehensive prenatal care. Evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent infection. Cervical infections of a bacterial nature have been linked to preterm labor and birth. The presence of urinary tract infections increases the risk of preterm labor and birth.

The fetal fibronectin test of a pregnant patient is positive, and her cervical length is found to be 32 mm. What will the nurse interpret from these observations regarding the patient's pregnancy status? A Normal gestational labor B Indicated preterm labor C Spontaneous preterm labor D Miscarriage in the next week The cervical length and fibronectin test help to identify the risk of preterm delivery in the patient. If the cervical length of the patient is greater than 30 mm, the patient would not have preterm labor, irrespective of having the symptoms of preterm labor. As the cervical length of the patient is 32 mm, the patient may have normal gestational labor. Cervical length and the fibronectin test do not indicate whether the patient would have a miscarriage. If the cervical length is less than 30 mm, the patient may have indicated or spontaneous preterm labor.

The nurse is assessing a pregnant patient and finds that the patient has inflammation around the teeth and bleeding of the gums. What should the nurse tell the patient after the assessment? A "You might be at risk for preterm labor." B "Your baby might have spina bifida." C "You may be at risk of having a miscarriage." D "Your baby might have delayed tooth eruption." According to research, the patients who have periodontal diseases like gingivitis, inflammation around the teeth, and bleeding of gums may have an increased risk of preterm labor. Down syndrome and hypothyroidism would cause a delay in tooth eruption in the infant. Periodontal diseases would not cause miscarriage, because it does not affect fetal development. Spina bifida results from a deficiency of folate, not from maternal periodontal diseases.

The nurse is assessing a pregnant patient with multifetal gestation. Upon reviewing the medical history, the nurse finds that the patient had preterm delivery during the first pregnancy. What will the nurse do to prevent preterm delivery in the patient during the second pregnancy? A Suggest that the patient avoids smoking and consuming alcohol. B Suggest that the patient increases physical activity to prevent risk. C Administer progesterone (Prometrium) suppositories to the patient. D Administer a 17-alpha hydroxyprogesterone injection to the patient. To prevent preterm labor, the nurse can suggest health promotion activities to the patient, such as avoiding smoking and alcohol consumption. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the patient get proper rest and care at home. The nurse should not suggest that the patient increase physical activity, which could worsen the condition. Progesterone supplements, such as progesterone (Prometrium) suppositories and 17-alpha hydroxyprogesterone injections, are ineffective in preventing preterm birth in patients with multifetal gestation.

The nurse is teaching about the use of primrose oil to a pregnant patient. Which statement would the nurse include in the teaching? "Primrose oil helps: A Ripen the cervix." B Prevent vaginal infections." C Reduce the risk of preterm labor." D Improve uterine contractions (UCs)." Evening primrose oil is an alternative method used to ripen the cervix of a pregnant patient before labor. Maintaining good hygiene conditions and cleaning the vaginal region regularly prevent vaginal infections. Premature labor risk is not reduced by primrose oil, because it usually occurs as a result of the rupturing of membranes prematurely. UCs or labor stimulations are improved by using castor oil.

The nurse observes that a pregnant patient who is taking terbutaline (Brethine) treatment has a heart rate of 135 beats/min. Which medication administration does the nurse expect the primary health care provider (PHP) to order? A Intravenous (I.V.) propranolol (Inderal) B 1 g I.V. calcium gluconate C Oral dose of 20 mg of nifedipine (Adalat) D 500 mg of I.V. calcium chloride for 30 minutes Terbutaline (Brethine) is a beta-adrenergic agonist that is used as a tocolytic to reduce uterine contractions (UCs) in preterm labor. The patient has a heart rate of 135 beats/min, which implies that the patient has intolerance to the drug and has tachycardia. Therefore the patient should be administered a beta-adrenergic blocker, such as propranolol (Inderal), to reverse the adverse effects of terbutaline (Brethine). Administering calcium gluconate, nifedipine (Adalat), and calcium chloride does not help to reduce the adverse effects of terbutaline (Brethine) in the patient. Rather, 1 g of calcium gluconate and 500 mg of calcium chloride are administered in case of magnesium sulfate toxicity. Nifedipine (Adalat) is a calcium channel blocker, which should not be given after terbutaline (Brethine) because it affects the patient's heart rate and blood pressure.

Which patient status is an acceptable indication for serial oxytocin induction of labor? a.Past 42 weeks' gestation c.Polyhydramnios b.Multiple fetuses d.History of long labors Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus and make induction of labor high risk. Polyhydramnios overdistends the uterus, again making induction of labor high risk.

While caring for a patient who is treated with terbutaline (Brethine), the nurse tries to reduce pressure on the patient's cervix to prevent preterm labor. Which nursing action would be most relevant? A Suggesting that the patient lie on her side B Infusing Ringer's lactate solution intravenously C Increasing the terbutaline (Brethine) concentration D Encouraging drinking a full glass of water periodically The nurse should suggest that the patient lie on her side, because this enhances placental perfusion and reduces the pressure on the cervix. Ringer's lactate solution is infused when amniotic fluid levels are lowered in a pregnant patient. Water intake prevents dehydration during labor, but it does not reduce pressure on the cervix. Nurses should not increase the terbutaline (Brethine) concentration. This may cause adverse effects and can be fatal to the mother and the fetus.

The nurse is caring for a pregnant patient who had an onset of labor during 34 weeks' gestation. What does the nurse expect the primary health care provider (PHP) to prescribe? Select all that apply. A Antibiotics B Glucocorticoids C Synthetic oxytocin D Magnesium sulfate E Progesterone supplementations The onset of labor during 34 weeks' gestation indicates that the patient has preterm labor. In such a condition, antibiotics and glucocorticoids should be prescribed and administered to the patient. Antibiotics are prescribed to prevent neonatal group B streptococcal infection. Glucocorticoids are prescribed to reduce the neonatal morbidity and mortality. Synthetic oxytocin is administered in patients to induce labor. Therefore synthetic oxytocin will not be prescribed to the patient because of the onset of labor. Magnesium sulfate is administered when the labor is induced before 32 weeks' gestation. Progesterone supplementation is administered before the onset of labor to prevent preterm birth.

A,B

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? Select all that apply. A Unstable coronary artery disease B Previous cesarean birth C Placenta previa D Initial blood pressure of 132/87 E History of three spontaneous abortions Indications for cesarean birth include: maternal: (1) specific cardiac disease (e.g., Marfan syndrome, unstable coronary artery disease) (2) specific respiratory disease (e.g., Guillain-Barré syndrome) (3) conditions associated with increased intracranial pressure (4) mechanical obstruction of the lower uterine segment (tumors, fibroids) (5) mechanical vulvar obstruction (e.g., extensive condylomata) (6) hstory of previous cesarean birth; fetal: (1) abnormal fetal heart rate (FHR) or pattern (2) malpresentation (e.g., breech or transverse lie) (3) active maternal herpes lesions (4) maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL (5) congenital anomalies; maternal-fetal: (1) cysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor) (2) placental abruption (3) placenta previa (4) elective cesarean birth (cesarean on maternal request). The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth.

A,B,C

The nurse observes that a pregnant patient has a high temperature and a foul smell of amniotic fluid during labor. Which possible complications would the nurse find in the patient and in the neonate after the delivery? Select all that apply. A The neonate may have pneumonia. B The patient may have a pelvic abscess. C The patient may have impaired lactation. D The patient may have supine hypotension. E The neonate may have bacteremia and sepsis. High maternal fever and a foul odor of amniotic fluid are indicative of chorioamnionitis, which is a bacterial infection of the amniotic cavity. The patient with chorioamnionitis is prone to have a cesarean birth. Therefore the nurse should monitor the possible risks of cesarean birth, like pelvic abscess, neonatal pneumonia, neonatal bacteremia, and sepsis. Impaired lactation and supine hypotension are not complications associated with chorioamnionitis. Impaired lactation may be caused due to a reduction in prolactin levels. Lying in the supine position causes supine hypotension.

A,B,E

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? a.Estriol is not found in maternal saliva. b.Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c.Fetal fibronectin is present in vaginal secretions. d.The cervix is effacing and dilated to 2 cm. Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.

A,C

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What findings indicate that preterm labor may be occurring? Select all that apply. A Uterine contractions more frequently than every 10 minutes for 1 hour or more. B Fetal fibronectin is present in vaginal secretions. C The cervix is effacing and dilated to 2 cm. D Fetal heart rate of 150 beats/minute Uterine contractions occurring more frequently than every 10 minutes persisting for 1 hour or more and cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Fetal heart rate is normal.

A,C

What are the causes of indicated preterm labor? Select all that apply. A Herpes infection B Multifetal gestation C Gestational diabetes D Chronic hypertension E Second trimester bleeding Preterm labor may be spontaneous or indicated. Indicated preterm labor is a means to resolve the maternal and fetal risk. The factors that can cause indicated preterm labor include gestational diabetes, chronic hypertension, and herpes infection. Spontaneous preterm labor is caused due to early initiation of the labor process. The factors responsible for spontaneous labor are multifetal gestation and bleeding during the second trimester.

A,C,D

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply): a.Rupture of membranes at or near term. b.Convenience of the woman or her physician. c.Chorioamnionitis (inflammation of the amniotic sac). d.Post-term pregnancy. e.Fetal death. These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation.

A,C,D,E

During the first phase of labor, a pregnant patient reports having severe pain and expresses the fear of lack of progress in the birth process. Which nursing actions would help the patient have progress in labor? Select all that apply. A Provide a warm bath for the patient. B Assess the fetal heart rate (FHR) and pattern. C Check the characteristics of the amniotic fluid. D Administer morphine (MS Contin) as prescribed. E Prepare for insertion of an intrauterine pressure catheter (IUPC). The patient reports severe and painful labor and expresses fear about the lack of progress in labor. This shows that the contractions are ineffective in order to cause cervical dilation and effacement to progress. This is caused by hypertonic uterine dysfunction, because the uterus may not completely relax between contractions. Therefore the nurse should aim to inhibit uterine contractions (UCs), reduce pain, and encourage sleep in the patient. Consequently, the nurse has to provide a warm bath for the patient and administer analgesics such as morphine (MS Contin) as prescribed. The other interventions, such as assessment of FHR and pattern, characteristics of the amniotic fluid, and insertion of IUPC, are not useful in the case of hypertonic uterine dysfunction. Instead, these are used in the case of hypotonic uterine dysfunction.

A,D

Which technique is least effective for the woman with persistent occipito posterior position? A Squat B Lie supine and relax C Sit or kneel, leaning forward with support D Rock the pelvis back and forth while on hands and knees Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipito anterior. Rocking the pelvis encourages rotation from occipito posterior to occipito anterior.

Which technique is least effective for the woman with persistent occipitoposterior position? A Squat B Lie supine and relax C Sit or kneel, leaning forward with support D Rock the pelvis back and forth while on hands and knees Lying supine increases discomfort. The woman typically complains of severe back pain from the pressure of the fetal head (occiput) pressing against her sacrum. Squatting aids both rotation and fetal descent. A sitting or kneeling position may help the fetal head to rotate to occipitoanterior. Rocking the pelvis encourages rotation from occipitoposterior to occipitoanterior.

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, which information should the nurse include? A "Because this is a repeat procedure, you are at the lowest risk for complications." B "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C "Because this is your second cesarean birth, you will recover faster." D "You will not need preoperative teaching because this is your second cesarean birth." Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.

The primary health care provider (PHP) reports that the baby of a patient may have an injury resulting from shoulder dystocia during labor. What patient clinical condition should the nurse infer from the report? A Preterm labor B Postterm pregnancy C Secondary uterine inertia D Hypertonic uterine dysfunction Shoulder dystocia is the fetal risk in pregnant women that is associated with an increase in birth weight (macrosomia) resulting from a prolonged pregnancy. In preterm labor the fetus may have reduced birth weight, which does not increase the risk of shoulder dystocia. Secondary uterine inertia is also called hypotonic uterine dysfunction. Hypotonic uterine dysfunction and hypertonic uterine dysfunction have no relation with delay in pregnancy and do not cause shoulder dystocia.

A maternal indication for the use of vacuum extraction is: a.A wide pelvic outlet. c.A history of rapid deliveries. b.Maternal exhaustion. d.Failure to progress past 0 station. A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.

A nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of: A uterine contractions occurring every 8 to 10 minutes. B a fetal heart rate (FHR) of 180 with absence of variability. C the woman needing to void. D rupture of the woman's amniotic membranes. An FHR of 180 with absence of variability is non-reassuring. The oxytocin should be discontinued immediately and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The woman 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 non-reassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman's membranes have ruptured.

A pregnant patient experienced preterm labor at 30 weeks' gestation. Upon assessing the patient, 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? A Calcium gluconate to the pregnant patient B Magnesium sulfate to the pregnant patient C Glucocorticoid drugs to the pregnant patient D Antibiotic medications to the pregnant patient Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the patient can prevent this risk as 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 patient would help to prevent the 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.

A pregnant patient has been administered magnesium sulfate as prescribed. Following the assessment, the nurse reports to the primary health care provider (PHP) that the patient's respiratory rate is 11 breaths/min. Which medication administration can the nurse expect from the PHP? A Dextrose solution intravenously to the patient B Calcium gluconate intravenously to the patient C Ringer's lactate solution intravenously to the patient D Increased doses of magnesium sulfate to the patient A respiratory rate of 11 breaths/min in the patient who is administered magnesium sulfate indicates magnesium toxicity. Administering calcium gluconate can counteract this. Ringer's lactate solution would help in reduced amniotic fluid levels, but it does not reduce the effect of magnesium sulfate. Dextrose solution is given for the treatment of maternal ketoacidosis. Magnesium sulfate should be discontinued when the respiratory levels are lowered in the pregnant patient.

A pregnant patient is receiving tocolytic therapy with magnesium sulfate. Under which patient circumstance would the nurse suggest to discontinue the therapy? A Blood pressure is 120/80 mm Hg. B Respiratory rate is 10 breaths/min. C Urine output is 40 mL/hr. D Serum magnesium level is 5 mEq/L. Magnesium sulfate is used as a tocolytic. However, it can cause severe adverse effects. Therefore the nurse should closely monitor the patient. A respiratory rate of 10 breaths/mine indicates that the patient has respiratory depression, which is an adverse effect of magnesium sulfate. Therefore the nurse should stop administration of the drug. A blood pressure of 120/80 mm Hg is normal and does not require discontinuation of magnesium sulfate. Urine output of 40 mL/hr indicates normal urine output; therefore the nurse need not discontinue the therapy. The therapeutic serum magnesium level should be 5 mEq/L to exert its action. Therefore, if the serum magnesium level is 5 mEq/L, the nurse need not discontinue the therapy, because it would not cause toxic effects.

A pregnant patient visits the clinic for a prenatal checkup during early pregnancy. The patient tells the nurse, "One of my friends told me that the chances of preterm labor can be detected by a fetal fibronectin test. How can I get this test done?" What would be the best response given by the nurse? A "You can take the test only after 35 weeks' gestation." B "I have to collect a sample of vaginal fluids for the test." C "This test is recommended only if you were born preterm." D "I have to collect your blood sample now and send it for analysis." Fibronectin is a glycoprotein used as a biomarker to test the chances of preterm labor in pregnant patients. It is found in the cervical and vaginal secretion during early and late pregnancy stages. The nurse can inform the patient that vaginal fluids would be collected for the test. This test can be done during early and late labor before 35 weeks' gestation. Blood samples are not collected for the test, because they would not contain fibronectin. This test can be recommended for any pregnant patient regardless of whether they were born preterm or not.

A pregnant patient visits the clinic for a prenatal checkup during early pregnancy. The patient tells the nurse, "One of my friends told me that the chances of preterm labor can be detected by a fetal fibronectin test. How can I get this test done?" What would be the best response given by the nurse? A "You can take the test only after 35 weeks' gestation." B"I have to collect a sample of vaginal fluids for the test." C "This test is recommended only if you were born preterm." D "I have to collect your blood sample now and send it for analysis." Fibronectin is a glycoprotein used as a biomarker to test the chances of preterm labor in pregnant patients. It is found in the cervical and vaginal secretion during early and late pregnancy stages. The nurse can inform the patient that vaginal fluids would be collected for the test. This test can be done during early and late labor before 35 weeks' gestation. Blood samples are not collected for the test, because they would not contain fibronectin. This test can be recommended for any pregnant patient regardless of whether they were born preterm or not.

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? A Propranolol (Inderal) B Clindamycin (Cleocin) C Morphine (MS Contin) D Terbutaline (Brethine) The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor.

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate? a."After the baby is born." b."When we can stabilize your preterm labor and arrange home health visits." c."Whenever the doctor says that it is okay." d."It depends on what kind of insurance coverage you have." The client's preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a woman with preterm labor is multifactorial; the goal is to prevent delivery. In many cases this may be achieved at home. Care of the preterm client is multidisciplinary and multifactorial. Managed care may dictate earlier hospital discharges or a shift from hospital to home care. Insurance coverage may be one factor in the care of clients, but ultimately client safety remains the most important factor.

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, which information would the nurse include? a."Because this is a repeat procedure, you are at the lowest risk for complications." b."Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." c."Because this is your second cesarean birth, you will recover faster." d."You will not need preoperative teaching because this is your second cesarean birth." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures" is the most appropriate statement. It is not accurate to state that the woman is at the lowest risk for complications. Both maternal and fetal risks are associated with every cesarean section. "Because this is your second cesarean birth, you will recover faster" is not an accurate statement. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed, regardless of whether the client has already had this procedure.

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: a.The terms preterm birth and low birth weight can be used interchangeably. b.Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. c.Low birth weight is anything below 3.7 pounds. d.In the United States early in this century, preterm birth accounted for 18% to 20% of all births. Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.

The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of: a.Uterine contractions occurring every 8 to 10 minutes. b.A fetal heart rate (FHR) of 180 with absence of variability. c.The client's needing to void. d.Rupture of the client's amniotic membranes. his FHR is nonreassuring. The oxytocin should be discontinued immediately, and the physician should be notified. The oxytocin should be discontinued if uterine hyperstimulation occurs. Uterine contractions that are occurring every 8 to 10 minutes do not qualify as hyperstimulation. The client's 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 caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient? A Infuse nifedipine (Adalat) along with terbutaline (Brethine). B Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. C Provide a glass full of orange juice before administering nifedipine (Adalat). D Provide the patient with calcium supplements before administering nifedipine (Adalat). Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required.

The nurse is caring for an obese patient who gave birth to a child through a cesarean delivery. Which nursing intervention should be performed for providing effective postpartum care? A Cleaning the stitches once a day with soapy water B Drying the wound by using a hair dryer at low setting C Removing the sutures as soon as the wound starts healing D Keeping the wound covered at all times for better healing The surgical wound should be kept dry at all times to prevent infections. This can be achieved by drying the wound with the help of a hair drier at a low setting. The wound should be washed several times a day with soapy water to prevent infection and promote healing. The sutures should not be removed for some more time to prevent wound disruption, which is a common problem in an obese patient. The wound should be left open for some time to prevent the formation of moisture and promote better healing.

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? a.Assessing deep tendon reflexes (DTRs) b.Assessing for chest discomfort and palpitations c.Assessing for bradycardia d. Assessing for hypoglycemia Terbutaline is a b2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations. Assessing DTRs would not address these concerns. b2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a.Ripening the cervix usually results in a decreased success rate for induction. b.Labor sometimes can be induced with balloon catheters or laminaria tents. c.Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. d.Amniotomy can be used to make the cervix more favorable for labor. Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.

With regard to dysfunctional labor, nurses should be aware that: a.Women who are underweight are more at risk. b.Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted. c.Hypertonic uterine dysfunction is more common than hypotonic dysfunction. d.Abnormal labor patterns are most common in older women. Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the contractions become weaker, is more common. Abnormal labor patterns are more common in women less than 20 years of age.

he nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the: A Heart rate of the fetus B Blood pressure of the patient C Respiration rate of the patient D Blood sugar levels in the patient The nurse should monitor the blood pressure of the patient after administering nifedipine (Adalat). It is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. Nifedipine (Adalat) does not alter fetal heart rate or respiration rate and blood sugar levels of the patient. Heart rate of the fetus is monitored when other classes of tocolytics are administered. Respiration rate is monitored when oxytocin (Pitocin) is administered to the patient. Blood sugar levels are monitored in patients with diabetes who are receiving glucocorticoid therapy.

The nurse is preparing to administer dexamethasone (Decadron) to a pregnant patient. Which nursing intervention should the nurse perform for safe administration of the drug? Select all that apply. A Monitor blood pressure of the patient. B Inform the patient that it will be painful. C Assess blood glucose levels in the patient. D Administer the drug by intramuscular injection. E Administer the oral form if patient refuses injection. Dexamethasone (Decadron) is a glucocorticoid used to promote fetal lung maturation. The drug can also increase blood sugar levels in the patient. Therefore the nurse should monitor the blood sugar levels to assess the need for an increased insulin dose. The drug should be given by intramuscular injection in the ventral gluteal or vastus lateralis muscle for better absorption. The patient should be informed that the injection will be painful, because this type of truthfulness promotes patient cooperation. The drug does not affect blood pressure levels, and it does not need to be monitored. The oral form is not beneficial in promoting fetal lung maturation and should not be administered.

B,C,D

Complications and risks associated with cesarean births include (Select all that apply): a.Placental abruption. b.Wound dehiscence. c.Hemorrhage. d.Urinary tract infections. e.Fetal injuries. Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section.

B,C,D,E

A pregnant patient is suspected to have preterm labor. The nurse is preparing to collect the vaginal discharge for conducting the fetal fibronectin test. What interventions are necessary before collecting the sample to ensure accuracy of the test? Select all that apply. A Instruct the patient to drink 2 glasses of water. B Check for the presence of vaginal bleeding in the patient. C Ask about history of sexual intercourse in the past 24 hours. D Ask the patient to empty the bladder before collecting the sample. E Assess the patient to see if the amniotic membranes have ruptured. The fetal fibronectin test is performed to determine whether the patient has preterm labor. Amniotic fluid can affect the accuracy of the test. Therefore the nurse should check to see if the amniotic membranes are intact before collecting the vaginal secretions. Vaginal bleeding can also result in negative results and should be identified before collecting the sample. The nurse should also check whether the patient has had sexual intercourse in the past 24 hours, because it may reduce the accuracy of the results and cause a false-negative result. Drinking water and emptying the bladder have no effect on the test results. Therefore these interventions are not necessary before conducting the test.

B,C,E

A pregnant patient was given a tocolytic drug to prevent preterm delivery. After observing that the patient has a history of migraine headaches, the primary health care provider (PHP) instructs the nurse to stop administering the drug. Which tocolytic drug was the patient most likely taking? A Nitrous oxide B Magnesium sulfate C Terbutaline (Brethine) D Prednisolone (Deltasone) Beta-2 adrenergic agonists are contraindicated in patients with migraine headaches. Terbutaline (Brethine) is a toxolytic agent and a beta-2 adrenergic agonist. Therefore the patient was prescribed terbutaline (Brethine). Nitrous oxide is an anesthetic that is contraindicated in patients with asthma but not migraine headaches. Magnesium sulfate is also used as a toxolytic and is contraindicated in patients with cardiac disorders but not migraine headaches. Prednisolone (Deltasone) is a corticosteroid, which is not contraindicated in the patients with migraine headaches.

B,C,E

The nurse is preparing to administer terbutaline (Brethine) to a pregnant patient who is in preterm labor. What questions should the nurse ask the patient before drug administration to promote drug safety? Select all that apply. A "Do you experience urinary frequency?" B "Do you ever have migraine headaches?" C "Do you suffer from any cardiac disease?" D "Do you suffer from nausea and vomiting?" E "Do you have pregnancy-induced diabetes?" Terbutaline (Brethine) is a beta-adrenergic agonist that relaxes the smooth muscles of the body. It adversely affects the cardiac function. Therefore the nurse should ask about the patient's history of heart disease. As it is a beta-adrenergic agonist, the drug may worsen or precipitate migraine headaches and should be avoided in such patients. Terbutaline (Brethine) may cause hyperglycemia and should be avoided in patients with gestational diabetes. The drug does not affect the urinary function or the gastrointestinal function. Therefore history related to urine frequency and nausea and vomiting are unrelated.

B,C,E

The nurse is caring for a pregnant patient who is administered magnesium sulfate to prevent preterm labor. Which parameters should the nurse assess in the patient to determine drug toxicity? Select all that apply. A Fluid intake B Respiratory status C Body temperature D Level of consciousness E Deep tendon reflexes Magnesium sulfate, when used as a tocolytic agent, depresses the central nervous system (CNS). The CNS depressive effect would be enhanced if the drug reaches toxic levels. CNS activity can be determined by assessing the respiratory status, level of consciousness, and deep tendon reflexes. A low respiratory rate, decreased level of consciousness, and slow reflexes indicate magnesium sulfate toxicity. Fluid intake and body temperature are not affected by CNS depression.

B,D,E

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)? a.Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b.Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c.Uterine tone <20 mm Hg d.Uterine tone >20 mm Hg e.Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.

B,D,E

The pregnant patient reports severe pain in the midsection of the uterus. Following the assessment, the nurse finds that the patient has frequent uterine contractions (UCs) with cervix dilation up to 2 cm. Which nursing interventions does the nurse perform? Select all that apply. A Provides hydrotherapy to the patient B Administers an analgesic to the patient C Administers oxytocin (Pitocin) to the patient D Encourages the patient to take a warm shower E Administers zolpidem (Ambien) to the patient UCs with cervical dilation up to 2 cm (less than 4 cm) would indicate that the patient is experiencing hypertonic UCs. In such a situation, analgesics should be administered to the patient to reduce the pain caused by the frequent contractions. A warm water bath can be soothing and comfortable for the patient, because it reduces the discomfort caused by the UCs. In the absence of pain, zolpidem (Ambien) can be administered for promotion of sleep and rest. Oxytocin (Pitocin) causes the uterine muscles to contract, which results in heavy contractions and pain aggravation. Hydrotherapy can be used to promote UCs in the active stage of labor.

B,D,E

A nurse providing care to a woman in labor should be aware that cesarean birth: A is declining in frequency in the United States. B is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. C is performed primarily for the health of the mother and fetus. D can be either elected or refused by women as their absolute legal right. The most common indications for cesarean birth are to preserve the health of the mother and fetus. Cesarean births are increasing in the United States. 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 birth is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a.She is exhibiting hypotonic uterine dysfunction. b.She is experiencing a normal latent stage. c.She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia. Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a.Prolonged latent phase c.Arrest of active phase b.Protracted active phase d.Protracted descent With an arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a.The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. b.There are no important maternal (as opposed to fetal) contraindications. c.Its most important function is to afford the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given. Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. There are important maternal contraindications to tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.

During the assessment of a pregnant patient, the nurse finds that the patient has a compressed umbilical cord. What instruction does the nurse expect to receive from the obstetrician? A Provide a glass of orange juice to the patient. B Suggest that the patient lie in the lateral position. C Administer Ringer's lactate solution into the uterus. D Infuse magnesium sulfate (Epsom salt) into the patient's uterus. The compression of the umbilical cord occurs in pregnant women during labor due to inadequate amniotic fluid that results in fetal hypoxia. So, amnioinfusion would resolve the problem of low amniotic fluid (oligohydramnios). Therefore, the obstetrician would instruct the nurse to administer Ringer's lactate solution or normal saline to the patient to maintain the cushioning of the umbilical cord. The intake of a glass orange juice may not be helpful in restoring the amniotic fluid volume in the patient. The patient is asked to lie in the lateral position to enhance placental perfusion but not to maintain the amniotic fluid volume. Magnesium sulfate (Epsom salt) is a tocolytic used to reduce uterine contractions (UCs) during labor. It is not used to maintain cushioning of the umbilical cord.

In planning for home care of a woman with preterm labor, which concern must the nurse address? a Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d.Home health care providers will be necessary. Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: a.Enhance uteroplacental perfusion in an aging placenta. b.Increase amniotic fluid volume. c.Ripen the cervix in preparation for labor induction. d. Stimulate the amniotic membranes to rupture. It is accurate to state that Prepidil will be administered to ripen the cervix in preparation for labor induction. It is not administered to enhance uteroplacental perfusion in an aging placenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a.Amniotomy c.Transcervical catheter b.Intravenous Pitocin d.Vaginal insertion of prostaglandins Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction.

The least common cause of long, difficult, or abnormal labor (dystocia) is: a.Midplane contracture of the pelvis. b.Compromised bearing-down efforts as a result of pain medication. c.Disproportion of the pelvis. d.Low-lying placenta. The least common cause of dystocia is disproportion of the pelvis.

The nurse finds that the amniotic membranes in a pregnant patient who is in labor have ruptured and that the amniotic fluid is meconium-stained. What should the nurse infer from the findings? The baby has a high risk of presenting with: A Shoulder dystocia. B Umbilical cord prolapse. C Aspiration pneumonia. D Brachial plexus injury. Some babies may pass meconium even before birth, thus staining the amniotic fluid green. This meconium-stained amniotic fluid can be aspirated in the fetal lungs, increasing the risk of meconium aspiration syndrome, which may cause respiratory depression. Meconium-stained amniotic fluid does not increase the risk of shoulder dystocia. Shoulder dystocia is common when there is fetopelvic disproportion as a result of excessive fetal size or maternal pelvic abnormalities. Umbilical cord prolapse is an obstetric emergency where the umbilical cord lies below the presenting part of the fetus. Brachial plexus injury is common in babies when the vaginal delivery takes place despite shoulder dystocia.

The nurse is teaching a group of pregnant patients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching? A "I will empty my bladder immediately." B "I will drink 3 to 4 glasses of water or juice." C "I will lie in the supine position for 1 hour." D "I will go to the hospital if symptoms continue." If there are signs and symptoms of preterm labor, the patient should lie down on her side for 1 hour, because it helps improve placental and fetal circulation. The patient should empty her bladder immediately, because a full bladder may sometimes irritate the uterus. Dehydration may also irritate the uterus. Therefore the patient should drink 3 to 4 glasses of water or juices. The patient should go to the hospital if the symptoms of preterm labor do not subside.

The nurse observes that a pregnant patient at 36 weeks' gestation who is in labor has a cervical dilation of 5 cm with membranes intact. Which nursing intervention is the most appropriate in this situation? A Monitor the blood glucose levels in the patient on a regular basis. B Ensure that the propranolol (Inderal) is available for administration. C Prepare to administer intravenous magnesium sulfate (Epsom salt). D Assess fetal ductus arteriosus and neonatal pulmonary hypertension. This patient at 36 weeks' gestation is considered preterm based on a cervical dilation of 5 cm. With membranes intact, the therapeutic plan of care would include stopping the labor process. Magnesium sulfate (Epsom salt) may be administered to the patient to prevent cerebral palsy of the fetus that may occur due to preterm birth. Therefore the nurse has to prepare for the administration of magnesium sulfate intravenously to the patient. Assessment of blood glucose levels is not useful to prevent preterm birth. Propranolol (Inderal) is used to reverse the adverse effects of terbutaline (Brethine), and it is not useful to prevent preterm birth. Assessment of fetal ductus arteriosus and neonatal pulmonary hypertension is useful when indomethacin (Indocin) is administered to the patient but not before administering magnesium sulfate (Epsom salt) to the patient.

The nurse providing care to a woman in labor should understand that cesarean birth: a.Is declining in frequency in the twenty-first century in the United States. b.Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients. c.Is performed primarily for the benefit of the fetus. d.Can be either elected or refused by women as their absolute legal right. The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States in this century. 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 priority nursing care associated with an oxytocin (Pitocin) infusion is: a.Measuring urinary output. b.Increasing infusion rate every 30 minutes. c.Monitoring uterine response. d.Evaluating cervical dilation Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is also important; however, it is not the top priority during the administration of Pitocin. The infusion rate may be increased after proper assessment that it is an appropriate interval to do so. Monitoring labor progression is the standard of care for all labor patients.

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? A Internal version B Vaginal delivery C Cesarean section D External cephalic version Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a.Dilation less than 3 cm c.-2 station b.Cephalic presentation d.Right occiput posterior position The dilation of the cervix must be great enough to determine labor. The presenting part of the fetus should be engaged and well applied to the cervix before the procedure in order to prevent cord prolapse. Amniotomy is deferred if the presenting part is higher in the pelvis. ROP indicates a cephalic presentation, which is appropriate for an amniotomy.

Upon assessment of a pregnant patient, the nurse concludes that the patient is less likely to have a preterm delivery. Which patient clinical finding led the nurse to conclude this? A Previous cesarean birth B Preexisting diabetes mellitus C Cervical length of more than 30 mm D Symptoms of chronic hypertension The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself in terms of effacement and dilation. Patients having 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 may not increase the risk of preterm labor.

Upon reviewing the laboratory reports, the nurse finds that the patient has meconium in the amniotic fluid. What would the nurse infer from this finding? The patient has: A A stillbirth. B Placental abruption. C Prolonged pregnancy. D Elevated uterine contractions (UCs). Meconium is the stool of the neonate, which is usually observed after the birth. When meconium is observed in amniotic fluid, it signifies that the patient has prolonged pregnancy. A stillbirth signifies the death of the fetus, which is not related to the presence of meconium in the amniotic fluid. Placental abruption causes early birth, whereas lowered estrogen levels cause prolonged birth. Elevated UCs is a sign of labor, which does not cause meconium in the amniotic fluid.

Which factor should alert the nurse to the potential for a prolapsed umbilical cord? A Oligohydramnios B Pregnancy at 38 weeks of gestation C Presenting part at a station of -3 D Meconium-stained amniotic fluid Because the fetal presenting part is positioned high in the pelvis and is not well applied to the cervix, a prolapsed cord could occur if the membranes rupture. Hydramnios puts the woman at risk for a prolapsed umbilical cord. A very small fetus, normally preterm, puts the woman at risk for a prolapsed umbilical cord. Meconium-stained amniotic fluid shows that the fetus already has been compromised, but it does not increase the chance of a prolapsed cord.

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? A Vaginal delivery B Vacuum-assisted delivery C Cesarean section delivery D Forceps-assisted delivery Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: A the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. B there are no important maternal (as opposed to fetal) contraindications. C its most important function is to afford the opportunity to administer antenatal glucocorticoids. D if the woman develops pulmonary edema while on tocolytics, IV fluids should be given. There are important maternal contraindications to tocolytic therapy. After the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Tocolytic-induced edema can be caused by IV fluids.

If a pregnant patient suspects signs and symptoms of preterm labor, which conditions would lead the patient to go to hospital immediately? Select all that apply. A Nausea and vomiting B Upper abdominal pain C Fluid leakage from vagina D Presence of vaginal bleeding E Contractions every 10 minutes Fluid leakage from the vagina indicates rupture of the amniotic membranes. The patient should seek immediate medical attention because ruptured amniotic membranes can compromise fetal health. Presence of vaginal bleeding may indicate onset of labor or placental hemorrhage, which may compromise the fetal perfusion. Therefore the patient should go to hospital immediately. Uterine contractions (UCs) after every 10 minutes indicate active labor, and the patient should go to the hospital immediately. Nausea and vomiting and upper abdominal pain do not indicate labor. The patient need not seek immediate medical attention for these conditions.

C,D,E

The nurse finds that the umbilical cord in a pregnant patient who is in labor has prolapsed, following the rupture of membranes. Which positions are suitable for the patient to promote fetal perfusion? Select all that apply. A Lithotomy B Recumbent C Trendelenburg D Modified Sims' D Knee-chest position If a prolapsed umbilical cord is not managed on time, it may result in fetal hypoxia and death. The prolapsed cord may get compressed by the presenting part of the fetus, blocking the blood supply to the fetus. The compression on the cord can be relieved by gravity facilitated by patient position. If the patient is placed in Trendelenburg, modified Sim's, or knee-chest position, the presenting part shifts off the prolapsed cord. This helps to maintain the fetal perfusion. Recumbent and lithotomy position are preferred for vaginal delivery but may not be helpful if the cord has prolapsed.

C,D,E

A pregnant patient has been administered terbutaline (Brethine) as prescribed. The nurse finds that the patient has a heart rate of 140 beats/min and complains of chest pain. What is the best nursing action in this situation? A Administer propranolol (Inderal). B Administer intravenous fluids. C Administer 1 g calcium gluconate. D Inform the primary health care provider (PHP). A heart rate of 140 beats/min and chest pain indicates that the patient is having tachycardia, which is an adverse effect of terbutaline (Brethine). Therefore the nurse should report this to the PHP to obtain further instructions on the treatment. Propranolol (Inderal) is administered to reverse the cardiovascular adverse effects of terbutaline (Brethine). However, it needs to be prescribed by the PHP. Calcium gluconate is administered to reverse the effect of magnesium sulfate. Serum potassium should be monitored in the patient receiving terbutaline therapy; however, it is not a priority intervention. The patient has tachycardia and is not in a state of hypovolemic shock. Therefore intravenous fluids need not be administered to the patient.

During the active phase of labor, the nurse prepares for the insertion of an intrauterine pressure catheter (IUPC) to a pregnant patient. What patient clinical presentation would be the reason for this intervention? A Amniotic fluid of 300 mL B Cervical dilation of 6 cm C Complete deprivation of sleep in the patient D Reduced uterine contractions (UCs) An IUPC is inserted into a pregnant patient in the active phase of labor to evaluate uterine activity (UA) accurately. Intrauterine pressure of less than 25 mm Hg may not be sufficient to cause cervical effacement and dilation. This condition also indicates that the patient has hypotonic uterine dysfunction. If the patient has reduced UCs, the nurse would insert the IUPC. Amniotic fluid of 300 mL (less than 400 mL) is evidence of premature rupture of membranes (PROM) and is not related to hypotonic uterine dysfunction. Cervical dilation of 6 cm (above 4 cm) prompts for treatment of hypertonic uterine dysfunction but not for hypotonic uterine dysfunction. If the patient had lack of sleep, then zolpidem (Ambien) would be administered to facilitate rest and sleep, but this would not warrant the insertion of the IUPC.

During the first stage of labor, a pregnant patient complains of having severe back pain. What would the nurse infer about the patient's clinical condition from the observation? A Oligohydramnios B Chorioamnionitis C Frank breech presentation D Occipitoposterior position of the fetus If a pregnant patient has severe back pain during the first stage of labor, it indicates that the fetus is in occipitoposterior position. In this position, the fetal head (occiput) exerts pressure and presses against the sacrum of the patient. Oligohydramnios, chorioamnionitis, and frank breech presentation are not associated with typical backache in pregnant women. Oligohydramnios is the presence of low amniotic fluid volume in the pregnant woman. Chorioamnionitis is a bacterial infection of the amniotic cavity, which results in high maternal fever and a foul amniotic fluid odor. If flexed hips and extended knees of fetus are observed, then it is called frank breech presentation (malpresentation).

During the second phase of labor in a pregnant patient, the nurse finds that the shoulders of the baby are not able to be delivered. The nurse informs the primary health care provider (PHP) who advises to perform the McRoberts maneuver to deliver the shoulders of the baby. What intervention should the nurse perform during the McRoberts maneuver? A Apply fundal pressure to relieve the baby's shoulders. B Instruct the patient to acquire a hands-and-knees position. C Apply suprapubic pressure to the baby's anterior shoulder. D Keep the patient's legs flexed apart with the knees on the abdomen. Shoulder dystocia is a condition where the head of the baby is born but the anterior shoulder is unable to pass down the pubic arch of the mother. Certain positions and maneuvers can help in delivery of the shoulders. McRoberts maneuver involves keeping the patient's legs flexed apart with the knees on the abdomen. This position decreases the pelvic inclination, allowing more space for the shoulders to be delivered. McRoberts maneuver does not involve applying suprapubic pressure to the baby's anterior shoulder. A hands-and-knees position is also helpful in shoulder dystocia, but it depends on the mother's mobility and is not a part of McRoberts maneuver. McRoberts maneuver does not involve applying fundal pressure.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A Fetal heart rate of 116 beats/min B Cervix dilated 2 cm and 50% effaced C Score of 8 on the biophysical profile D One fetal movement noted in 1 hour of assessment by the mother 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 116 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.

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse? a.Fetal heart rate of 116 beats/min b.Cervix dilated 2 cm and 50% effaced c.Score of 8 on the biophysical profile d.One fetal movement noted in 1 hour of assessment by the mother Self-care in a post-term 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. Normal findings in a 42-week gestation include fetal heart rate of 116 beats/min, cervix dilated 20 cm and 50% effaced, and a score of 8 on the biophysical profile.

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a.Urine output of 160 mL in 4 hours b.Deep tendon reflexes 2+ and no clonus c.Respiratory rate of 16 breaths/min d.Serum magnesium level of 10 mg/dL The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.

Nurses should be aware that the induction of labor: a. Can be achieved by external and internal version techniques. b.Is also known as a trial of labor (TOL). c.Is almost always done for medical reasons. d.Is rated for viability by a Bishop score. Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.

The nurse hears the fetal heart tones by placing a fetoscope above the umbilicus of a pregnant patient. What would the nurse infer from this assessment? A The head of the fetus will be observed initially during birth. B The patient cannot be administered oxytocin (Pitocin) during labor. C The patient cannot be administered terbutaline (Brethine) during labor. D The lower extremities of the fetus will be observed initially during birth. The fetal heart tones are best heard above the umbilicus when the fetus is in a breech position. In the breach position, the lower extremities of the fetus are initially observed during birth. If the fetal heart sounds are heard above the umbilicus, then the head of the fetus will not be observed initially during birth. Administering oxytocin (Pitocin) and terbutaline (Brethine) are mostly related with the uterine activity of the patient. It is not related to the fetal position and heart rate.

The nurse is about to perform a vaginal examination in order to determine cervical dilation of a patient in early labor. The patient informs the nurse that as of her last provider appointment, the baby was in a breech position. This alerts the nurse that she needs to place the patient in a supine position in order to perform the digital examination. Other maternal positions may inadvertently result in: A Shoulder dystocia. B Version. C Increased risk of infection. D Membrane rupture. The patient who has a fetal breech malposition should always be examined in the supine position. If the fetus is a breech malpresentation, there is a predisposition that the patient may experience rupture of membranes if a digital examination is performed while she is in the semi-Fowler position. Should the membranes rupture in early labor, the risk for a prolapsed cord increases. A version from breech to vertex position would not occur as a result of a digital examination. Scrupulous hand hygiene and standard precautions should always be performed before the examination to prevent the spread of infection in patients. A shoulder dystocia would occur during the birth, not during a vaginal examination.

The nurse is assisting a pregnant patient who is in labor. The nurse finds that the umbilical cord is protruding out from the vagina. With a gloved hand, the nurse attempts to put the umbilical cord into the vagina. The nurse continues to monitor the fetal heart rate, administers oxygen therapy to the patient, and increases the drip rate of the intravenous (IV) fluid. Which nursing action can lead to fetal and maternal complications? A Increasing the drip rate of the IV fluid B Monitoring fetal heart rate continuously C Administering oxygen therapy to the patient D Attempting to place the umbilical cord back A prolapsed umbilical cord can compromise the fetal perfusion. Therefore the nurse should act quickly to prevent fetal complications. The nurse should not attempt to replace the umbilical cord, as the cord can get compressed by the presenting part of the fetus, which could result in fetal hypoxia and death. Fetal heart rate should be monitored continuously to determine fetal perfusion. Oxygen therapy should be administered to the patient to promote fetal oxygenation. The drip rate of the IV fluid should be increased to promote fetal perfusion.

The nurse is caring for a 32-year-old pregnant patient who had an onset of labor during 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 patient as to the etiology of the newborn's LBW? A Preterm labor B Maternal age C Diabetic condition of the patient D Intrauterine growth restriction (IUGR) The LBW of the newborn is the result of IUGR, a condition of inadequate fetal growth. It may be caused by 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 LBW. The onset of labor is at 40 weeks' gestation, so it is not a preterm labor. The patient's age is normal for pregnancy and therefore is not a reason for the LBW of the child. Infants born to patients with diabetes would have a high birth weight, not a low one.

The nurse is caring for a pregnant patient who has been recommended for an external cephalic version. What would the nurse do as part of the procedure? A Place the patient in a side position. B Administer oxytocin (Pitocin) intravenously. C Place a pillow under the maternal abdomen. D Administer terbutaline (Brethine) intravenously.

The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? A Give the medication by oral route. B Assess platelet levels after drug administration. C Administer increased doses of insulin with the drug. D Follow a strict time interval of 24 hours between two doses. Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered.

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: a.A gravida 3 who has had two low-segment transverse cesarean births. b.A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. c.A gravida 5 who had two vaginal births and two cesarean births. d.A gravida 4 who has had all cesarean births. The risk of uterine rupture increases for the patient who has had multiple prior births with no vaginal births. As the number of prior uterine incisions increases, so does the risk for uterine rupture. Low-segment transverse cesarean scars do not predispose the patient to uterine rupture.

The priority nursing intervention after an amniotomy should be to: a.Assess the color of the amniotic fluid. b.Change the patient's gown. c.Estimate the amount of amniotic fluid. d.Assess the fetal heart rate. The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Secondary to FHR assessment, amniotic fluid amount, color, odor, and consistency is assessed.

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: a.Fetus from a breech to a cephalic presentation before labor begins. b.Fetus from a transverse lie to a longitudinal lie before cesarean birth. c.Second twin from an oblique lie to a transverse lie before labor begins. d.Second twin from a transverse lie to a breech presentation during vaginal birth. Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.

Which assessment is least likely to be associated with a breech presentation? a.Meconium-stained amniotic fluid b.Fetal heart tones heard at or above the maternal umbilicus c.Preterm labor and birth d. Post-term gestation Post-term gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.

Which nursing action should be initiated first when there is evidence of prolapsed cord? A Notify the health care provider. B Apply a scalp electrode. C Prepare the woman for an emergency cesarean birth. D Reposition the woman with her hips higher than her head. The priority is to relieve pressure on the cord. Changing the maternal position will shift the position of the fetus so that the cord is not compressed. Notifying the health care provider is a priority but not the first action. Applying a scalp electrode is not appropriate at this time. Preparing the woman for an emergency cesarean birth is not the first priority.

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? A A primigravida who is 17 years old B A 22-year-old multiparous woman with ruptured membranes C A primigravida who has requested no analgesia during her labor D A multiparous woman at 39 weeks of gestation who is expecting twins Overdistention of the uterus in a multiple pregnancy is associated with hypotonic dysfunction because the stretched uterine muscle contracts poorly. A young primigravida usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction. There is no indication that this woman's uterus is overdistended, which is the main cause of hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and there is no indication of an overdistended uterus.

Which statement is most likely to be associated with a breech presentation? A Least common malpresentation B Descent is rapid C Diagnosis by ultrasound only D High rate of neuromuscular disorders 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.

With regard to the care management of preterm labor, nurses should be aware that: a.Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b.Braxton Hicks contractions often signal the onset of preterm labor. c.Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d.The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change. Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor.

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