Ch 32
Upon assessment of a pregnant client, the nurse concludes that the client is less likely to have a preterm delivery. Which client clinical finding led the nurse to conclude this?
Cervical length is more than 30 mm. The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself, in terms of effacement and dilatation. Clients having a cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus might not increase the risk of preterm labor.
The nurse observes that a client has a decreased uterine size and has lost 5 lbs. at 42 weeks of gestation. Which signs should the nurse assess in the neonate after birth? Select all that apply. 1 Seizures 2 Long nails 3 Dry and peeling skin 4 High body temperature 5 Meconium-stained skin
Long nails Dry and peeling skin Meconium-stained skin Reduced uterine size and a maternal weight loss of 3 lb/week or more are clinical manifestations of postterm pregnancies. Postterm infants are at an increased risk of meconium aspiration. These infants are most likely to have postmaturity syndrome, which is characterized by long nails, dry and peeling skin, and meconium-stained skin. Seizures (indicative of cerebral palsy) and high body temperature (indicative ofsepsis) are the complications associated with infants who are born to women with chorioamnionitis during labor.
A pregnant client experienced preterm labor at 30 weeks gestation. Upon assessing the client the nurse finds that the newborn is at risk of having cerebral palsy. Which medication administration should the nurse perform to prevent cerebral palsy in the newborn? 1 Calcium gluconate. 2 Magnesium sulfate. 3 Glucocorticoid drugs. 4 Antibiotic medications.
Magnesium sulfate Newborns who are born before 32 weeks' gestation may be at risk of cerebral palsy. Administering magnesium sulfate to the client can prevent this risk, because it would delay delivery. Calcium gluconate is administered when the preterm child has magnesium toxicity. This intervention would not help to prevent cerebral palsy. Also, the newborn would not have a fully developed respiratory system. Therefore, administering glucocorticoids to the pregnant client would help to prevent risk of respiratory depression in the baby. However, it does not help in preventing cerebral palsy. Administering antibiotics during labor would help prevent neonatal group B streptococci infection.
A pregnant client who is in preterm labor has been prescribed dexamethasone (Decadron). What benefit of the drug would the nurse identify in the client? 1 Maturation of fetal lungs 2 Relaxation of smooth muscles 3 Inhibition of uterine contractions (UCs) 4 Central nervous system (CNS) depression
Maturation of fetal lungs Dexamethasone (Decadron) is a glucocorticoid and is administered to clients having preterm labor, because it promotes fetal lung maturation. The drug facilitates the release of enzymes that induce production or release of lung surfactant. Tocolytics are used to inhibit UCs. Magnesium sulfate is a CNS depressant. Tocolytics also causes the relaxation of smooth muscles
The fetal fibronectin test of a pregnant client is positive, and her cervical length is found to be 32 mm. What will the nurse interpret from these observations regarding the client's pregnancy status? 1 Normal gestation labor. 2 Indicated preterm labor. 3 Spontaneous preterm labor. 4 Miscarriage in the next week.
Normal gestation labor The cervical length and fibronectin test help to identify the risk of preterm delivery in the client. If the cervical length of the client is greater than 30 mm, the client would not have preterm labor, irrespective of having the symptoms of preterm labor. Because the cervical length of the patient is 32 mm, the client may have normal gestational labor. Cervical length and the fibronectin test do not indicate whether the client would have a miscarriage. If the cervical length is less than 30 mm, the client may have indicated or spontaneous preterm labor.
Which client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?
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.
The nurse is preparing to administer terbutaline (Brethine) to a pregnant client who is in preterm labor. What questions should the nurse ask the patient before drug administration to promote drug safety? Select all that apply. 1 "Do you experience urinary frequency?" 2 "Do you ever have hyperthyroidism?" 3 "Do you suffer from any cardiac disease?" 4 "Do you suffer from nausea and vomiting?" 5 "Do you have pregnancy-induced diabetes?"
"Do you ever have hyperthyroidism?" "Do you suffer from any cardiac disease?" Do you have pregnancy-induced diabetes?" Terbutaline (Brethine) is a beta-adrenergic agonist that relaxes the smooth muscles of the body. It adversely affects cardiac function. Therefore the nurse should ask about the client's history of heart disease. Terbutaline (Brethine) may cause hyperglycemia and should be avoided in clients with gestational diabetes. It should also be avoided in clients with hyperthyroidism. The drug does not affect the urinary function or the gastrointestinal function. Therefore, history related to urine frequency and nausea and vomiting are unrelated.
A nurse is caring for a client whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of what? 1 Uterine contractions occurring every 8 to 10 minutes 2 A fetal heart rate (FHR) of 180 with absence of variability 3 The client needing to void 4 Rupture of the client's amniotic membranes
A fetal heart rate (FHR) of 180 with absence of variability A fetal heart rate (FHR) of 180 with absence of variability is nonreassuring. The oxytocin should be immediately discontinued and the physician should be notified. Uterine contractions that occur every 8 to 10 minutes do not qualify as hyperstimulation. The oxytocin should be discontinued if uterine hyperstimulation occurs. The client needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician. Unless a change occurs in the FHR pattern that is nonreassuring or the client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.
A pregnant patient is administered terbutaline (Brethine). The nurse reports to the primary health care provider that the patient has a heart rate of 134 beats per minute and blood pressure of 80/60 mm Hg. Which intervention would be helpful in preventing complications related to terbutaline (Brethine)? 1 Administer propranolol (Inderal). 2 Monitor serum potassium levels. 3 Administer 1gcalcium gluconate. 4 Assess for the presence of oligohydramnios.
Administer propranolol (Inderal Terbutaline (Brethine) is a tocolytic agent that is used in the treatment of preterm labor. A heart rate of 134 beats per minute (tachycardia) combined withblood pressure that is less than 80/60 mm Hg indicates intolerable adverse effects of the drug on the cardiovascular system. Propranolol (Inderal) is administered to reverse the cardiovascular adverse effects of terbutaline (Brethine). Serum potassium levels should be monitored in the patient receiving terbutaline (Brethine). However, it is not a priority intervention. Calcium gluconate is administered to reverse the effects of magnesium sulfate. Oligohydramnios (low amniotic fluid volume) is the adverse effect of indomethacin (Indocin) and may not be associated with terbutaline (Brethine).
The nurse examines a client at 30 weeks of gestation for cervical dilation. The nurse understands that the infant may be at risk of cerebral palsy if it is born preterm. Which intervention would help to prevent cerebral palsy? 1 Shifting the client to an obstetric facility 2 Administering antibiotic medications to the client 3 Administering antenatal glucocorticoids to the client Correct 4 Administering magnesium sulfate (Epsom salts) to the client
Administering magnesium sulfate (Epsom salts) to the client When preterm birth appears inevitable, magnesium sulfate (Epsom salts) is administered to the client at 24 to 32 weeks of gestation to prevent the risk of cerebral palsy. Clients in preterm labor should be shifted to a healthcare facility that is well-equipped to handle emergencies and take care of preterm infants. Antibiotics are administered to prevent infections. Antenatal glucocorticoids are administered to pregnant clients to prevent the risk of respiratory depression in the fetus, caused by structurally and functionally immature lungs.
The nurse is caring for a pregnant client 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. 1 Antibiotics 2 Glucocorticoids 3 Synthetic oxytocin 4 Magnesium sulfate 5 Progesterone supplementations
Antibiotics Glucocorticoids The onset of labor during 34 weeks' gestation indicates that the client 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 clients to induce labor. Therefore synthetic oxytocin will not be prescribed to the client 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.
The nurse is caring for a client with premature rupture of membranes (PROM). How should the nurse instruct the client to manage the situation? 1 "Consume excess amounts of fluids." 2 "Assess fetal movement on a daily basis." 3 "Monitor the skin for any discoloration." 4 "Place yourself in Trendelenburg position."
Assess fetal movement on a daily basis." The nurse should instruct a pregnant client with PROM to perform daily fetal movement counts. Reduction in fetal movements indicates fetal dysfunction. Clients who are administered tocolytic agents, such as nifedipine (Adalat), are instructed to consume excess fluids to prevent effects of vasodilatation. Consumption of excess fluids is unrelated to the management of PROM. Skin discoloration is observed in conditions like jaundice, but not in clients with PROM. The nurse places the client in Trendelenburg position if the client has symptoms of umbilical cord prolapse.
The nurse is caring for a pregnant client who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the client. Which client condition leads the nurse to such a conclusion?
Blood pressure of 80/60 mmHg. Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the client develops tachycardia greater than 130 beats/min, then the treatment should be stopped.
The nurse is caring for a pregnant client who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the client. Which client condition leads the nurse to such a conclusion? 1 Blood pressure of 80/60 mmHg. 2 Short episode of hyperglycemia. 3 Irregular episodes of dysrhythmias. 4 Heart rate of less than 120 beats/min
Blood pressure of 80/60 mmHg. Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the client develops tachycardia greater than 130 beats/min, then the treatment should be stopped.
What are the risk factors associated with preterm premature rupture of membranes (PROM)? Select all that apply
Cigarette smoking Urinary tract infection Uterine overdistention Conditions such as smoking, urinary tract infection, and uterine overdistention may cause early rupturing of membranes in a pregnant patient. Therefore, these factors are considered risk factors associated with preterm PROM. Preeclampsia is the common cause of indicated preterm birth and is not associated with preterm PROM. Short cervical length would increase the risk of PROM and may not be observed in clients with long cervical length. Non-Caucasian women are at a higher risk for spontaneous preterm birth than Caucasian women.
The nurse is teaching a group of pregnant clients 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? 1 "I will empty my bladder immediately." 2 "I will drink 2 to 3 glasses of water or juice." 3 "I will lie in the supine position for 1 hour." 4 "I will go to hospital if symptoms continue."
I will lie in the supine position for 1 hour." If there are signs and symptoms of preterm labor, the client should lie down on her side for 1 hour, because it helps improve placental and fetal circulation. The client should empty her bladder immediately, because a full bladder may sometimes irritate the uterus. Dehydration may also irritate the uterus. Therefore, the client should drink 2 to 3 glasses of water or juices. The patient should go to the hospital if the symptoms of preterm labor do not subside
The nurse is preparing to administer dexamethasone (Decadron) to a pregnant client. Which nursing intervention should the nurse perform for safe administration of the drug? Select all that apply. 1 Monitor blood pressure of the client. 2 Inform the client that it will be painful. 3 Assess blood glucose levels in the client. 4 Administer the drug by intramuscular injection. 5 Administer the oral form if the client refuses injection.
Inform the client that it will be painful. Assess blood glucose levels in the client. Administer the drug by intramuscular injection. Dexamethsone (Decadron) is a glucocorticoid used to promote fetal lung maturation. The drug can also increase blood sugar levels in the client. 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 client should be informed that the injection will be painful, because this type of truthfulness promotes client 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.
The nurse is caring for a 32-year-old pregnant client who had an onset of labor at 40 weeks' gestation. Following the labor, the nurse finds that the newborn has a low birth weight (LBW). What explanation will the nurse give to the client as to the etiology of the newborn's LBW? 1 Preterm labor. 2 Maternal age. 3 Diabetic condition of the patient. 4 Intrauterine growth restriction (IUGR).
Intrauterine growth restriction (IUGR). The low birth weight of the newborn is due to IUGR, a condition of inadequate fetal growth. It may be caused due to various conditions, such as gestational hypertension that interferes with uteroplacental perfusion. Interference with uteroplacental perfusion limits the flow of nutrients into the fetus and causes the low birth weight. The onset of labor is at 40 weeks' gestation. Therefore, it is not a preterm labor. The client's age is normal for pregnancy. Therefore, the client's age is not a reason for the low birth weight of the child. Infants born to clients with diabetes would have a high birth weight, not a low one.
A nurse providing care to a woman in labor should be aware of which fact about cesarean birth? 1 It is declining in frequency in the United States. 2 It is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. 3 It is performed primarily for the health of the mother and fetus. 4 It can be either elected or refused by women as their absolute legal right.
It is performed primarily for the health of the mother and fetus. 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.
What should nurses be aware of with regard to the use of tocolytic therapy to suppress uterine activity? 1 The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. 2 There are no important maternal (as opposed to fetal) contraindications. 3 Its most important function is to afford the opportunity to administer antenatal glucocorticoids. 4 If the woman develops pulmonary edema while on tocolytics, IV fluids should be given.
Its most important function is to afford the opportunity to administer antenatal glucocorticoids. 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.
For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 116 beats/minute 2 Cervix dilated 2 cm and 50% effaced 3 Score of 8 on the biophysical profile 4 One fetal movement noted in 1 hour of assessment by the mother
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 the mother has felt fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrant evaluation. A fetal heart rate of 116 beats/minute is a normal finding at 42 weeks of gestation. Cervical dilation of 2 cm with 50% effacement is a normal finding in a 42-week gestation woman. A score of 8 on the BPP is a normal finding in a 42-week gestation pregnancy.
A newborn's heart rate is 80 beats per minute. The nurse learns that during labor, the amniotic fluid was meconium stained. What further assistance should the nurse provide to the newborn? 1 Provide a large-bore suction catheter and bulb syringe. 2 Place the baby in an incubator, providing frequent backrubs. 3 Provide endotracheal tube suction assistance with ventilation. 4 Administer 5 mg of sucrose solution within the first five hours of birth.
Provide endotracheal tube suction assistance with ventilation. Oxytocin may cause uterine tachysystole, which may lead to meconium-stained amniotic fluid. Meconium contains waste products of the fetus. Meconium-stained amniotic fluid increases the risk of fetal meconium aspiration. Therefore, the newborn should be provided endotracheal suction to help remove the meconium aspirated into the lungs. The newborn's heart rate of 80 beats per minute indicates reduced heart rate that should be managed by providing ventilation support to the newborn. A large-bore suction catheter and bulb syringe are used to remove meconium ingested by the baby if the heart rate of the newborn is more than 100 beats per minute. The nurse should remove the ingested meconium first. Incubating the newborn and providing backrubs would not help to remove the meconium. A sucrose solution of 5 mg is administered to newborns with hypoglycemia. Sucrose solution is unrelated to meconium aspiration.
The nurse is caring for a pregnant client with a body mass index (BMI) of 32 kg/m2. The client gives birth at 40 weeks of gestation by cesarean. Which postpartum intervention does the nurse plan to implement after childbirth? Select all that apply. 1 Avoid ambulation until the client's BMI improves. 2 Provide sequential compression device (SCD) boots. 3 Provide the sufficient nutrition to the preterm neonate. 4 Administer glucose therapy to the client. 5 Implement strategies to prevent infection in the client.
Provide sequential compression device (SCD) boots. Implement strategies to prevent infection in the client. A BMI of 32 kg/m2 indicates that the client is obese. Obesity increases the risk of thromboembolism following the delivery. SCD boots are used postoperatively to decrease the risk of clot formation. A cesarean delivery may increase the risk of infection in clients who are obese due to concurrent morbidities. Therefore, infection control measures should be taken. The client should be encouraged to ambulate early on to prevent pulmonary and vascular complications. The neonate born after 40 weeks of gestation is considered postterm; a preterm neonate is born before 37 weeks of gestation. Aggressive glucose is appropriate for a pregnant woman who is in labor to prevent hypoglycemia, but a postoperative client may not need glucose therapy.
The nurse observes that a client has a high fever, maternal and fetal tachycardia, uterine tenderness, and vaginal discharge with a foul odor in early labor. Which signs should the nurse assess in the neonate? Select all that apply. 1 Seizures 2 Breathing difficulties 3 Laceration on the head 4 High body temperature 5 Heart rate of 110 beats per minute
Seizures Breathing difficulties High body temperature Fever, maternal and fetal tachycardia, uterine tenderness, and vaginal discharge with a foul odor are the signs of a bacterial infection called chorioamnionitis. Women with chorioamnionitis are more likely to have a cesarean birth due to dysfunctional labor. Neonatal risks include pneumonia, sepsis, and cerebral palsy. Therefore, the nurse should monitor signs like seizures (indicative of cerebral palsy), breathing difficulties (indicative of pneumonia), and a high body temperature (indicative ofsepsis) in the neonates of these clients. Neonates who are born through forceps- or vacuum-assisted birth may have a laceration on the head; however, this is not associated with chorioamnionitis. A heart rate of 110 beats per minute is a normal observation in newborns and is not a serious sign.
Which factors would lead to an increased likelihood of uterine rupture? Select all that apply. 1 Preterm singleton pregnancy 2 G3P3 with all vaginal deliveries 3 Short interval between pregnancies 4 Labor patient receiving a trial labor (TOL) following a VBAC delivery 5 Patient who had a primary caesarean section with a classical incision
Short interval between pregnancies Labor patient receiving a trial labor (TOL) following a VBAC delivery Patient who had a primary caesarean section with a classical incision The shorter the interval time between pregnancies/deliveries increases the risk for uterine rupture. A labor patient who is having a TOL following a VBAC is at increased risk for uterine rupture. A patient who has a C section with a classical incision into the uterus is at increased risk for uterine rupture. A pregnant woman with a singleton pregnancy (one fetus) even if preterm is not considered to be at increased risk for uterine rupture. A multipara who has had all deliveries via the vaginal route is not considered to be at an increased risk for uterine rupture.
The nurse is assessing a pregnant client with multifetal gestation. Upon reviewing the medical history, the nurse finds that the client had preterm delivery during the first pregnancy. What will the nurse do to help prevent preterm delivery in the client during the second pregnancy?
Suggest that the client avoid smoking. To prevent preterm labor the nurse can suggest health promotion activities to the client, such as avoiding smoking. This helps to promote intrauterine growth and fetal development. The nurse should suggest that the client get proper rest and care at home. The nurse should not suggest that the client increase physical activity, which could even worsen the condition. Progesterone supplements, like progesterone (Prometrium) suppositories and 17-alpha hydroxy progesterone injections, are ineffective in preventing preterm birth in clients with multifetal gestation.
A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for continuation of the tocolytic effect? 1 Buccal oxytocin (Pitocin) 2 Terbutaline sulfate (Brethine) 3 Calcium gluconate (Calgonate) 4 Magnesium sulfate (Magnesium sulfate)
Terbutaline sulfate (Brethine) The woman receiving decreasing doses of magnesium sulfate often is switched to oral terbutaline to maintain tocolysis. Buccal oxytocin increases the strength of contractions and is used to augment or stimulate labor. Buccal oxytocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate usually is given intravenously or intramuscularly. The client must be hospitalized for magnesium therapy because of the serious side effects of this drug.
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? 1 Estriol is not found in maternal saliva. 2 Irregular, mild uterine contractions are occurring every 12 to 15 minutes. 3 Fetal fibronectin is present in vaginal secretions. 4 The cervix is effacing and dilated to 2 cm.
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 pregnant client has painful lower abdominal cramps and a mucoid vaginal discharge. Upon further examination, the nurse concludes that the client may have a low risk of having a preterm delivery. What finding led the nurse to this conclusion? 1 The client had a previous cesarean birth. Correct 2 The client has a cervical length of 40 mm. 3 The client has preexisting diabetes mellitus. Incorrect 4 The client has symptoms of chronic hypertension
The client has a cervical length of 40 mm. Painful, lower abdominal cramps and a mucoid vaginal discharge are symptoms of preterm labor. The cervical length is a good predictor of preterm birth. Women whose cervical length is greater than 30 mm are unlikely to experience premature birth, even if they have symptoms of preterm labor. The cervix needs to prepare itself for childbirth in terms of effacement and dilatation. A previous cesarean birth does not indicate that the woman will likely not have a preterm delivery. Preexisting diabetes and chronic hypertension are preterm birth risk factors.
A primary health care provider orders an ultrasound for a pregnant client before attempting external cephalic version (ECV). Upon assessing the client's ultrasound report, the nurse suspects that the primary health care provider will not attempt ECV. Which findings support the nurse's expectation? Select all that apply. 1 The client has a nuchal cord. 2 The client is Rh negative. 3 The client has oligohydramnios. 4 The fetal heart rate is 120 beats per minute. 5 The client has uterine anomalies
The client has a nuchal cord. The client has oligohydramnios. The client has uterine anomalies ECV is performed to change the fetus from a breech to a vertex presentation by applying pressure on the abdomen. ECV is contraindicated in certain conditions, including the presence of a nuchal cord, oligohydramnios, and uterine anomalies. ECV should be avoided if the ultrasound shows any of the complications mentioned. ECV is not contraindicated in Rh-negative client. Patients with an Rh-negative blood group are administered Rh immunoglobulin before performing ECV. A fetal heart rate of 120 beats per minute is considered normal, and ECV is not contraindicated in this condition.
The nurse is monitoring a pregnant client after amniotomy. Which observation would indicate a likelihood of umbilical cord compression? 1 The fetal heart rate (FHR) confirms tachycardia. 2 The client's vaginal drainage has a foul-smell. 3 The client has maternal chills frequently. 4 The fetal heart rate (FHR) has variable decelerations.
The fetal heart rate (FHR) has variable decelerations. Amniotomy is performed in a pregnant client in order to rupture the membranes artificially. After the procedure, the nurse should closely monitor the FHR. Reduced FHR and variable decelerations in FHR indicate that the client's umbilical cord is compressed. The nurse should immediately inform the primary health care provider of the client's condition. Tachycardia or increased FHR are common manifestations observed after amniotomy. Tachycardia does not require immediate clinical action. Maternal chills and foul-smelling vaginal discharge after amniotomy indicate infection of the ruptured membranes. However, this would not be a reason to expect umbilical cord compression.
The nurse is administering glucocorticoids to a pregnant woman in preterm labor. When explaining the purpose of this medication to the client, which response by the nurse is accurate? 1 To prevent fetal cerebral palsy 2 To prevent early birth of the fetus 3 To prevent gestational hypertension 4 To prevent fetal respiratory distress syndrome
To prevent fetal respiratory distress syndrome Preterm birth causes respiratory distress in the newborn due to underdeveloped lung activity. Antenatal glucocorticoids are administered to a pregnant client who is at the risk of preterm labor to prevent fetal respiratory distress syndrome. Tocolytic agents such as magnesium sulfate (Epsom salts), are found to reduce the incidence of cerebral palsy in the child, and are unrelated to glucocorticoids. Gestational hypertension is observed in clients who have a familial history of hypertension and may not be prevented by administering glucocorticoids. Glucocorticoids have no impact on delaying preterm birth.
With regard to dysfunctional labor, nurses should be aware of what? 1 Women who are underweight are more at risk. 2 Women experiencing precipitous labor have a labor that lasts less than 3 hours. 3 Hypertonic uterine dysfunction is more common than hypotonic dysfunction. 4 Abnormal labor patterns are most common in younger women.
Women experiencing precipitous labor have a labor that lasts less than 3 hours. Precipitous labor lasts less than 3 hours. Short women who are 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 older women.
The nurse is caring for a newborn after a vacuum-assisted birth. What changes should the nurse monitor in the newborn? Select all that apply.
Yellow discoloration of skin Listlessness Poor sucking patterns After a vacuum-assisted birth, the newborn might be at the risk of hyperbilirubinemia as the bruising resolves, which may cause neonatal jaundice. So, the nurse should monitor the newborn for yellow discoloration of the skin. A vacuum-assisted birth may cause cerebral irritation in the newborn, which manifests as listlessness and poor sucking. Inability to pass urine may indicate structural anomalies and may not be due to vacuum delivery. Difficulty in breathing can be caused by many factors and not necessarily due to vacuum delivery.
A client had a previous cesarean birth. What are the criteria in order to try having a vaginal birth during the second pregnancy? Select all that apply
Clinically adequate pelvis Previous low transverse incision No history of uterine rupture
The nurse is preparing to perform a fetal fibronectin test for a pregnant client. Which intervention should the nurse perform to collect the sample for the test? 1 Take a blood sample from the forearm. 2 Take a sample of patient's amniotic fluid. 3 Ask the patient to provide a urine sample. 4 Collect the vaginal secretions using a swab.
Collect the vaginal secretions using a swab. The fetal fibronectin test is conducted to assess whether a client is at risk for preterm labor. Fetal fibronectin is a glycoprotein found in the vaginal secretions during early and late pregnancy. In order to conduct the test the nurse should collect the vaginal secretions using a swab and send it for analysis. Urine, blood, and amniotic fluid are not collected for a fetal fibronectin test, because they may not contain adequate glycoprotein levels.
The nurse is assessing a pregnant client who takes nifedipine (Adalat). What instruction does the nurse provide to ensure the client's safety?
Consume adequate fluids.
A client is administered magnesium sulfate (Epsom salts) as a part of tocolytic therapy. Which signs and symptoms should the nurse monitor in the client? Select all that apply. 1 Diplopia 2 Tremors 3 Hot flushes 4 Drowsiness 5 Tachycardia
Diplopia Hot flushes Drowsiness Magnesium sulfate (Epsom salt) is a tocolytic agent that relaxes smooth muscles, including those of the uterus during preterm labor. Diplopia, hot flushes, and drowsiness are maternal adverse effects of magnesium sulfate (Epsom salt). Tremors and tachycardia are not associated with magnesium sulfate (Epsom salt).
If a pregnant client suspects signs and symptoms of preterm labor, which conditions would lead the client to go to hospital immediately? Select all that apply. 1 Nausea and vomiting 2 Upper back pain 3 Fluid leakage from vagina 4 Presence of vaginal bleeding 5 Contractions every 10 minutes
Fluid leakage from vagina Presence of vaginal bleeding Contractions every 10 minutes Fluid leakage from the vagina indicates rupture of the amniotic membranes. The client 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 fetal perfusion. Therefore the client should go to the hospital immediately. Uterine contractions (UCs) after every 10 minutes indicate active labor and the client should go to the hospital immediately. Nausea and vomiting and upper back pain do not indicate labor. The client need not seek immediate medical attention for these conditions.
The nurse is teaching a group of pregnant clients about early identification of preterm labor. What signs and symptoms of preterm labor should the nurse include in the teaching? Select all that apply. 1 Upper abdominal pain 2 Increased vaginal discharge 3 Presence of vaginal bleeding 4 Decreased urinary frequency 5 Painful uterine contractions (UCs)
Increased vaginal discharge Presence of vaginal bleeding Painful uterine contractions (UCs) Any pregnant client runs the risk of having preterm labor and should be educated to identify its signs and symptoms. Painful uterine contractions (UCs) are a sign of preterm labor, caused by the body's attempt to deliver the baby. The client may show signs of vaginal bleeding due to a rupture of the membranes. Preterm labor can also be identified by changes in the color or amount of vaginal discharge. During labor the vaginal discharge usually increases and becomes brown to red in color. Preterm labor is also characterized by an increase in urine frequency and pain in lower abdomen. Therefore a decrease in urine frequency and upper abdominal pain do not indicate preterm labor.
A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? 1 Place the woman in the knee-chest position. 2 Cover the cord in a sterile towel saturated with warm normal saline. 3 Prepare the woman for a cesarean birth. 4 Start oxygen by face mask.
Place the woman in the knee-chest position. 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 this 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 delivery. Cesarean birth is indicated only if cervical dilation is not complete. The nurse should administer oxygen by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.
While assisting a primary health care provider performing amniotomy, the nurse observes part of the umbilical cord protruding from the client's vagina. The nurse immediately positions the client in the Trendelenburg position and inserts a finger into her vagina. What additional care does the client need to prevent complications? 1 Perform large-bore catheter suction. 2 Prepare for an emergency C-section. 3 Administer calcium gluconate intravenously. 4 Administer terbutaline (Brethine) subcutaneously.
Prepare for an emergency C-section. Amniotomy may cause prolapse of the umbilical cord, in which the cord lies below the presenting part of the fetus. A prolapsed cord causes fetal hypoxia, because the supply of oxygen to the fetus is reduced. A cesarean birth should be performed to prevent further complications. Large-bore catheter suction is performed to remove the aspirated meconium from the newborn, and is unrelated to cord prolapse. Calcium gluconate is administered to a pregnant client who develops magnesium sulfate toxicity. Calcium gluconate is unrelated to cord prolapse. Terbutaline (Brethine) is administered to treat tachysystole in the pregnant client and is unrelated to cord prolapse.
Which statement is most likely to be associated with a breech presentation? 1 Least common malpresentation 2 Descent is rapid 3 Diagnosis by ultrasound only 4 High rate of neuromuscular disorders
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.
Which drug is administered to treat chorioamnionitis in a patient during labor? 1 Clindamycin (Cleocin) 2 Metronidazole (Flagyl) 3 Gentamycin (Garamycin) 4 Dexamethasone (Decadron)
Gentamycin (Garamycin) Chorioamnionitis is a bacterial infection of the amniotic cavity. The infection is treated with antibiotics like gentamycin (Garamycin) during labor. Clindamycin (Cleocin) and metronidazole (Flagyl) are antibiotics used to treat chorioamnionitis after cesarean birth. Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.
In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, the nurse includes which information?
"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." is the most appropriate response. "Because this is a repeat procedure, you are at the lowest risk for complications." is not accurate. Maternal and fetal risks are associated with every cesarean section. "Because this is your second cesarean birth, you will recover faster." is not accurate. Physiologic and psychologic recovery from a cesarean section are multifactorial and individual to each client each time. Preoperative teaching should always be performed regardless of whether the client has already had this procedure.
What are the possible risk factors associated with indicated preterm birth? Select all that apply
Herpes infection Gestational diabetes Chronic hypertension Preterm births can be either spontaneous or indicated. Conditions that pose a danger to fetal or maternal health may be resolved by indicated preterm birth. These conditions include herpes infection, gestational diabetes, and hypertension in the mother. The clients with these conditions undergo indicated preterm birth to ensure the neonate's safety. Clients with a history of preterm birth and second trimester bleeding are at risk of spontaneous preterm birth.
What are the causes of indicated preterm labor? Select all that apply.
Herpes infection Gestational diabetes Chronic hypertension 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.
During a prenatal visit, the nurse finds that the client has decreased mobility and symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? 1 Teach gentle lower extremity exercises to the client. 2 Suggest the client to lie in the supine position in bed. 3 Provide a calm and soothing atmosphere to the client. 4 Give tocolytic medications as per the physician's prescription.
Teach gentle lower extremity exercises to the client The health care provider may recommend reduced activity for the client experiencing preterm labor, depending on the severity of the symptoms. As a result, the client may be at risk for thrombophlebitis due to limited activity. The nurse should teach the client how to perform gentle exercises of the lower extremities. Suggesting that the client lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the client lie in a side-lying position to help enhance placental perfusion. The nurse can provide a calm and soothing atmosphere to facilitate coping so as to reduce the client's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the client to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.
Which nursing action should be initiated first when there is evidence of prolapsed cord? 1 Notify the health care provider. 2 Apply a scalp electrode. 3 Prepare the woman for an emergency cesarean birth. 4 Reposition the woman with her hips higher than her head.
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.
The nurse is caring for a pregnant client 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. 1 Fluid intake 2 Respiratory status 3 Body temperature 4 Level of consciousness 5 Deep tendon reflexes
Respiratory status Level of consciousness 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.
The nurse is assessing a pregnant client who has a history of migraine headaches. Which tocolytic agent is contraindicated in the client? 1 Nifedipine (Adalat) 2 Evening primrose oil 3 Terbutaline (Brethine) 4 Magnesium sulfate (Epsom salts)
Terbutaline (Brethine) Beta2-adrenergic agonists like terbutaline (Brethine) are contraindicated in clients with migraine headaches because these drugs may increase the episodes of migraine. Nifedipine (Adalat) is contraindicated in hypertensive clients, but not in clients with migraine. Evening primrose oil and magnesium sulfate (Epsom salts) are tocolytic agents used to reduce oxytocin (Pitocin) usage, and are not contraindicated in clients with migraine headaches.
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. Correct 1 Unstable coronary artery disease Correct 2 Previous cesarean birth Correct 3 Placenta previa 4 Initial blood pressure of 132/87 Incorrect 5 History of three spontaneous abortions
Unstable coronary artery disease Previous cesarean birth Placenta previa 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) History 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) Dysfunctional 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.
