ch. 21 maternity prep u

woman receiving an oxytocin infusion for labor induction develops contractions that occur every minute and last 75 seconds. Uterine resting tone remains at 20 mm Hg. Which action would be most appropriate? Stop the infusion immediately. Notify the birth attendant. Continue to monitor contractions and fetal heart rate. Slow the oxytocin infusion to the initial rate.

Stop the infusion immediately.

A nurse is caring for a client at 30 weeks' gestation who had preterm premature rupture of membranes (PROM) 25 hours ago. The client has a temperature of 102°F (38.9°C) and a foul-smelling odor from the vagina. Which medication order should the nurse question? Erythromycin 500 mg IV Tylenol 650 mg by mouth Ampicillin 1 GM IV Magnesium sulfate 2 GM IV/hr

Magnesium sulfate 2 GM IV/hr

The nurse understands the need to be aware of the potential of bleeding disorders in pregnant clients. Which disorder should she be aware of that occurs in the second trimester? Hydatidiform mole (molar pregnancy) Placenta previa Cervical insufficiency Spontaneous abortion (miscarriage) Ectopic pregnancy

Placenta previa

A woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? Possible fetal death or injury Preterm labor that was undiagnosed Premature separation of the placenta Placenta previa obstructing the cervix

Premature separation of the placenta

A client whose membranes have prematurely ruptured is admitted to the hospital. Which nursing intervention is a priority?

Routine monitoring of vital signs

A pregnant woman at term is in the obstetrics unit for induction in the morning. Her membranes rupture, and the external fetal monitor shows deep variable decelerations. For what should the nurse immediately check the patient? Amniotic fluid embolus Umbilical cord prolapse Placental abruption Amniotic fluid infection

Umbilical cord prolapse

The nurse is caring for a client who has remained in stable condition at 37 weeks' gestation. The client's condition suddenly changes. Which assessment change should the nurse prioritize? Size and contour of the abdomen Vaginal bleeding and no pain Uterine contractions with vaginal mucus Fundal height and fetal heart rate

Vaginal bleeding and no pain

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. decreased C-reactive protein levels cloudy malodorous fluid elevated maternal pulse rate abdominal tenderness fetal bradycardia

abdominal tenderness elevated maternal pulse rate cloudy malodorous fluid

After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? breast stimulation laminaria amniotomy prostaglandin

amniotomy

A nurse is conducting a review course on tocolytic therapy for perinatal nurses. After teaching the group, the nurse determines that the teaching was successful when they identify which drugs as being used for tocolysis? Select all that apply. misoprostol dinoprostone nifedipine indomethacin magnesium sulfate

nifedipine magnesium sulfate indomethacin

When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment? vaginal discharge cervical ripening fundal height fetal heart rate

cervical ripening

A woman is admitted to the labor suite with contractions every 5 minutes lasting 1 minute. She is postterm and has oligohydramnios. What does this increase the risk of during birth? fetal hydrocephalus shoulder dystocia macrosomia cord compression

cord compression

A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? bradycardia tachypnea elevated blood glucose depressed deep tendon reflexes

depressed deep tendon reflexes

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption (abruptio placentae) during labor? gestational diabetes gestational hypertension macrosomia low parity

gestational hypertension

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? fetal heart tones signs of shock infection uterine stabilization

fetal heart tones

A client has been admitted with placental abruption (abruptio placentae). She has lost 1,200 ml of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae? grade 2 grade 4 grade 1 grade 3

grade 2

A pregnant client at 35 weeks' gestation arrives at the clinic with bright, red vaginal spotting. An ultrasound indicates that the placenta is partially covering the cervical os. The nurse interprets this as which? grade II - Marginal previa grade III- Partial previa grade I - Low lying placenta grade IV- Complete previa

grade III- Partial previa

A client is entering her 42nd week of gestation and is being prepared for induction of labor. The nurse recognizes that the fetus is at risk for which condition? hemorrhage macrosomia infection dystocia

macrosomia

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

premature rupture of membranes

A young woman experiencing contractions arrives at the emergency department. After examining her, the nurse learns that the client is at 33 weeks' gestation. What treatment can the nurse expect this client to be prescribed? anti-anxiety therapy tocolytic therapy muscle relaxants bronchodilators

tocolytic therapy

A nurse is preparing to teach a class to pregnant women about the signs of preterm labor and what to do if these occur. Which signs of preterm labor should the nurse include in the presentation? Select all that apply. feeling of pelvic pressure or fullness nausea, vomiting, and diarrhea leaking of fluid from the vagina uterine contractions, cramping, low back pain increase in vaginal discharge feelings of stress

uterine contractions, cramping, low back pain feeling of pelvic pressure or fullness increase in vaginal discharge nausea, vomiting, and diarrhea leaking of fluid from the vagina

A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply. "Gently massage your breasts at least once each day." "Take tub baths instead of showers." "Be sure to perform fetal kick counts about once every 3 days." "Check your temperature each day, reporting any increase immediately." "If you notice your belly starting to tighten, call your health care provider."

"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately."

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? fetal heart rate within normal range gradual onset of symptoms firm, rigid uterus on palpation absence of pain

firm, rigid uterus on palpation

A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM? foul odor ferning blue color on nitrazine paper yellow-green fluid

foul odor

The nurse is preparing to talk to a group of pregnant women about elective induction and why it is not highly recommended. Which statements should she include in her presentation? Select all that apply. It significantly increases instrumented birth. It significantly increases the risk of cesarean birth. It significantly increases the weight of the newborn. It significantly increases the use of epidural analgesia. It significantly increases the admissions to the neonatal ICU.

t significantly increases the risk of cesarean birth. It significantly increases instrumented birth. It significantly increases the use of epidural analgesia. It significantly increases the admissions to the neonatal ICU.

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching? Placental abruption results in painless, bright red vaginal bleeding during labor. Placenta previa is an abnormally implanted placenta that is too close to the cervix. Placenta previa causes painful, dark red vaginal bleeding during pregnancy. Placental abruption requires "watchful waiting" during labor and birth.

Placenta previa is an abnormally implanted placenta that is too close to the cervix.

The nurse is assessing a multipara client at 28 weeks' gestation who may be experiencing labor. Which findings should the nurse prioritize? Cervical length of 2.7 cm Irregular mild contractions every 10 to 15 minutes Positive fetal fibronectin Positive ferning

Positive fetal fibronectin

The nurse provides education to a postterm pregnant client. information will the nurse include to assist in early identification of potential problems? "Increase your fluid intake to prevent dehydration." "Be sure to measure 24-hour urine output daily." "Monitor your bowel movements for constipation." "Continue to monitor fetal movements daily."

"Continue to monitor fetal movements daily."

A nurse is teaching a pregnant woman at risk for preterm labor about what to do if she experiences signs and symptoms. The nurse determines that the teaching was successful when the woman makes which statement? "I'll drink several glasses of water." "I'll try to move my bowels." "I'll lie down with my legs raised." "I'll sit down to rest for 30 minutes."

"I'll drink several glasses of water."

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents? "I need a cesarean section if I develop this problem." "If I develop this complication, I will have bright red vaginal bleeding," "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." "Since I am over 30, I run a much higher risk of developing this problem."

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

the nurse is providing care to several pregnant women who may be scheduled for labor induction. The nurse identifies the woman with which Bishop score as having the best chance for a successful induction and vaginal birth? 7 5 3 11

11

The nurse is caring for a client after experiencing a placental abruption (abruptio placentae). Which finding is the priority to report to the health care provider? hematocrit of 36% (0.36) hemoglobin of 13 g/dl (130 g/L) platelet count of 150,000 mm3 45 ml urine output in 2 hours

45 ml urine output in 2 hours

A woman is to undergo labor induction. The nurse determines that the woman requires cervical ripening if her Bishop score is: 5. 9. 7. 6.

5

A woman who had preterm labor and preterm PROM successfully halted has reached week 36 of pregnancy and is doing well on home care. Which of the following nursing diagnoses should the nurse prioritize for this client? Powerlessness related to inability to sustain pregnancy Risk for fetal infection related to early rupture of membranes Hopelessness related to potential loss of pregnancy Anticipatory grieving related to high probability for fetal death from placental dysfunction

Risk for fetal infection related to early rupture of membranes

A woman is going to have labor induced with oxytocin. Which statement reflects the induction technique the nurse anticipates the primary care provider will prescribe? Administer oxytocin diluted as a "piggyback" infusion. Administer oxytocin in a 20 cc bolus of saline. Administer oxytocin in two divided intramuscular sites. Administer oxytocin diluted in the main intravenous fluid.

Administer oxytocin diluted as a "piggyback" infusion.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Administer amnioinfusion. Assess fetal heart sounds. Administer oxygen at 10 L/min by face mask. Place the woman in Trendelenburg position.

Assess fetal heart sounds.

A client's membranes have just ruptured. Her fetus is presenting breech. Which action should the nurse do immediately to rule out prolapse of the umbilical cord in this client? Administer oxygen at 10 L/min by face mask. Place the woman in Trendelenburg position. Assess fetal heart sounds. Administer amnioinfusion.

Assess fetal heart sounds.

During a prenatal ultrasound, the client is discovered to have a placenta succenturiata. Following delivery of the fetus and placenta, which nursing assessment is most important? Assessment for shortness of breath Assessment for a thrombus Assessment for hemorrhage Assessment for pain

Assessment for hemorrhage

The nurse in a busy L & D unit is caring for a woman beginning induction via oxytocin drip. Which prescription should the nurse question with regard to titrating the infusion upward for adequate contractions? After one hour, titrate the infusion upward by 1 to 2 mu/min until contractions are adequate. Start oxytocin drip, piggyback to main IV line to port closest to client. Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min. Discontinue infusion if contractions are every 2 minutes lasting 60 to 90 seconds each.

Begin infusion at 10 milliunits (mu)/min and titrate every 15 minutes upward by 5 mu/min.

A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? Black cohosh Jasmine Skullcap Catnip

Black cohosh

Before calling the health care provider to report a slow progression or an arrest of labor, several assessments need to be made. What other maternal assessment does the nurse need to make prior to calling the health care provider? Make sure the client is lying on her left side. Make sure the epidural medication is turned down. Check for a full bladder. Assess vital signs every 30 minutes.

Check for a full bladder.

The nurse is monitoring a woman who is receiving IV oxytocin to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin? Continue to monitor contraction duration every 2 hours. Increase the flow rate of the main line infusion. Discontinue the oxytocin infusion. Slow the infusion to under 10 gtts per minute.

Discontinue the oxytocin infusion.

A laboring woman is receiving oxytocin IV to augment her labor and 2 hours later begins having contractions every 2 minutes lasting 60 to 90 seconds each with little, if any, rest time in between the contractions. At this time, which interventions would be the priority for the nurse caring for this client? Select all that apply. Apply oxygen to the woman via mask at 8 to 10 L/min. Ask the woman to drink 32 ounces (1 L) of water. Discontinue the oxytocin infusion. Administer an IV bolus of fluids. Administer betamethasone to mature the fetal lungs.

Discontinue the oxytocin infusion. Administer an IV bolus of fluids. Apply oxygen to the woman via mask at 8 to 10 L/min.

A pregnant woman at 31 weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply. "Drink two or three glasses of water." "Stop what you are doing and rest." "Try emptying your bladder." "Walk around the house for the next half hour." "Lie down on your back."

Drink two or three glasses of water." "Try emptying your bladder." "Stop what you are doing and rest."

A pregnant patient reports feeling pain similar to menstrual cramps. What should the nurse explain about this patient's symptoms? Lying down for a few hours will help them stop. If rhythmical, they could indicate preterm labor. They are false labor and do not need to be reported. Exercise helps reduce the frequency of them.

If rhythmical, they could indicate preterm labor.

Preterm premature rupture of membranes (PROM) can be a serious complication of labor. What is the most common cause of preterm PROM? Incompetent cervix Infection Macrosomia Cephalopelvic disproportion

Infection

After delivery, a patient is diagnosed with placenta succenturiata. For what procedure should the nurse prepare this patient? Emergency resuscitation of the newborn Repair of an episiotomy Manual removal of accessory lobes Lavage of the uterus

Manual removal of accessory lobes

A pregnant client arrives at the clinic for a regular antenatal check-up. Examinations and weight recording reveal a slow fetal weight gain. About which of the following pregnancy-related risks should the nurse alert the client? Uterine infections Pre-eclampsia Prolonged labor Preterm labor

Preterm labor

A multigravida client at 31 weeks' gestation is admitted with confirmed preterm labor. As the nurse continues to monitor the client now receiving magnesium sulfate, which assessment findings will the nurse prioritize and report immediately to the RN or health care provider? Low potassium or elevated glucose, tachycardia, chest pain Severe lower back pain, leg cramps, sweating Respiratory depression, hypotension, absent tendon reflexes Pain in the abdomen, shoulder, or back

Respiratory depression, hypotension, absent tendon reflexes

Hypertonic labor is labor that is characterized by short, irregular contractions without complete relaxation of the uterine wall in between contractions. Hypertonic labor can be caused by an increased sensitivity to oxytocin. What would the nurse do for a client who is in hypertonic labor because of oxytocin augmentation? Increase the methotrexate. Turn off the oxytocin. Turn off the methotrexate. Increase the oxytocin.

Turn off the oxytocin.

A nurse suspects that a client may be developing disseminated intravascular coagulation. The woman has a history of placental abruption (abruptio placentae) during birth. Which finding would help to support the nurse's suspicion? board-like abdomen inversion of the uterus severe uterine pain appearance of petechiae

appearance of petechiae

A nurse is reading a journal article about cervical ripening agents, based on the understanding that certain pharmaceuticals can be used to attain cervical ripening in women who need assistance in this area. They have also often continued into labor without further agents to stimulate uterine contractions. Which agent would the nurse anticipate reading about as an FDA-approved agent for cervical ripening? oxytocin dinoprostone misoprostol magnesium sulfate

dinoprostone

A pregnant woman comes to the birthing center, stating she is in labor and does not know far along her pregnancy is because she has not had prenatal care. A primary care provider performs an ultrasound that indicates oligohydramnios. When the client's membranes rupture, meconium is in the amniotic fluid. What does the nurse suspect may be occurring with this client?

complications of a post-term pregnancy

A nurse is describing the risks associated with post-term pregnancies as part of an in-service presentation. The nurse determines that more teaching is needed when the group identifies which factor as an underlying reason for problems concerning the fetus? cord compression increased amniotic fluid volume aging of the placenta meconium aspiration

increased amniotic fluid volume

A pregnant client is admitted to a health care facility with a diagnosis of premature rupture of membranes (PROM). Which test would the nurse expect to be used to predict fetal lung maturity when the client goes into labor? Nitrazine test lecithin/sphingomyelin ratio test for antiphospholipids reticulocyte count

lecithin/sphingomyelin ratio

A nurse is reviewing the medical record of a pregnant client. The physical exam reveals that the placenta is implanted near the internal os but does not reach it. The nurse interprets this as which condition? placenta accreta placenta percreta low-lying placenta placenta increta

low-lying placenta

A patient who experiences premature rupture of membranes can expect to be put on pelvic rest. The nurse should explain to the patient that pelvic rest involves which of the following? staying in bed at all times staying in bed with bathroom privileges placing nothing in the vagina staying off of the feet the majority of the day

placing nothing in the vagina

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? dystocia precipitate labor preterm labor normal labor

preterm labor

A client presents to the emergency department reporting regular uterine contractions. Examination reveals that her cervix is beginning to efface. The client is in her 36th week of gestation. The nurse interprets the findings as suggesting which condition is occurring? precipitate labor dystocia preterm labor normal labor

preterm labor

A nurse is reviewing an article about preterm premature rupture of membranes. Which factors would the nurse expect to find placing a woman at high risk for this condition? Select all that apply. smoking urinary tract infection high body mass index low socioeconomic status single gestations

urinary tract infection low socioeconomic status smoking

A pregnant client undergoing labor induction is receiving an oxytocin infusion. Which finding would require immediate intervention? contractions every 2 minutes, lasting 45 seconds uterine resting tone of 14 mm Hg fetal heart rate of 150 beats/minute urine output of 20 mL/hour

urine output of 20 mL/hour

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

withdrawal of progesterone