N137 Labor and Birth Complications

The nurse is assessing a pregnant client who takes nifedipine (Adalat). What instruction does the nurse provide to ensure the client's safety? 1 Consume adequate fluids. 2 Take medication on an empty stomach. 3 Avoid eating foods high in carbohydrates. 4 Administer medication under medical supervision.

1 The potent vasodilator effect of nifedipine (Adalat) causes variations in the blood pressure of a pregnant client. So, the nurse advises the client to consume adequate fluids to maintain blood pressure. Nifedipine (Adalat) is best tolerated when taken with food. Hence, the nurse does not ask the client to take the medication on empty stomach. Clients on glucocorticoids are advised to avoid carbohydrate-rich foods, because glucocorticoids increase glucose levels in the body, and are unrelated to nifedipine (Adalat). Nifedipine (Adalat) is taken orally and does not require medical supervision to administer it.

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.

4 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. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your knowledge about that condition would help you choose the correct response (e.g., cholecystectomy = low-fat, high-protein, low-calorie diet).

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.

1 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 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? 1 Suggest that the client avoid smoking. 2 Suggest that the client increase physical activity to prevent risk. 3 Administer progesterone (Prometrium) suppositories to the client. 4 Administer a 17-alpha hydroxy progesterone injection to the client.

1 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. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.

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 what? 1 Uterine contractions occurring every 8 to 10 minutes. 2 A fetal heart rate (FHR) of 180 with absence of variability. 3 The woman needing to void. 4 Rupture of the woman's amniotic membranes.

2 An FHR of 180 with absence of variability 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 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 nonreassuring 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. Test-Taking Tip: Be alert for grammatical inconsistencies. If the response is intended to complete the stem (an incomplete sentence) but makes no grammatical sense to you, it might be a distractor rather than the correct response. Question writers typically try to eliminate these inconsistencies.

The nurse administers magnesium sulfate (Epsom salts) to stop labor in a pregnant client. Which symptoms should the nurse monitor to ensure the client's safety? 1 Swollen legs 2 Respiratory rate 3 Eating patterns 4 Maternal chills

2 Magnesium sulfate (Epsom salts) is administered to a pregnant client to stop labor. Magnesium sulfate (Epsom salts) causes respiratory depression as a toxic effect. Therefore, the nurse should monitor the respiratory rate of the client. Swollen legs or edema is acommon observation during labor, which is caused by increased abdominal contents. Edema is unrelated to magnesium sulfate. Magnesium sulfate (Epsom salts) does not alter a client's eating habits. Maternal chills are observed in clients with membrane rupture and are unrelated to magnesium sulfate (Epsom salts). Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

Which drug is used for treating a client with severe postpartum bleeding? 1 Nifedipine (Adalat) 2 Oxytocin (Pitocin) 3 Propranolol (Inderal) 4 Metronidazole (Flagyl)

2 Oxytocin (Pitocin) is a synthetic hormone used to induce labor and to control severe postpartum bleeding by making the uterus contract. Nifedipine (Adalat) is a calcium channel blocker that is used intocolytic therapy for preterm labor. Propranolol (Inderal) is used to reverse intolerable cardiovascular effects of terbutaline (Brethine). Metronidazole (Flagyl) is a broad-spectrum antibiotic that is used to treat chorioamnionitis after cesarean 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.

2 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 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."

2 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. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

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)

2 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.

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)

2,3,5 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.

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

2,4,5 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.

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware of what? 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 client develops pulmonary edema while on tocolytics, IV fluids should be given.

3 Buying time for antenatal glucocorticoids to accelerate fetal lung development might 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.

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."

3 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.

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? 1 Previous cesarean birth. 2 Preexisting diabetes mellitus. 3 Cervical length is more than 30 mm. 4 Symptoms of chronic hypertension.

3 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.

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.

3 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 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. 1 A history of postpartum hemorrhage 2 A previous classical vertical incision 3 Clinically adequate pelvis 4 Previous low transverse incision 5 No history of uterine rupture

3,4,5 A vaginal birth is possible after a previous caesarean delivery if the pelvis is found to be adequate to provide room for childbirth. A previous low transverse incision poses less risk of rupture and a vaginal delivery may be possible. A client with no history of uterine rupture would have less risk of uterine rupture during the vaginal delivery. A history of postpartum hemorrhage may not affect the risk associated with a second vaginal delivery in women with a history of first caesarean delivery. A previous vertical incision on the uterus increases the risk of uterine rupture.

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

3,4,5 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. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.

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.

4 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.

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

4 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 client situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor? 1 A primigravida who is 17 years old 2 A 22-year-old multiparous woman with ruptured membranes 3 A primigravida who has requested no analgesia during her labor 4 A multiparous woman at 39 weeks of gestation who is expecting twins

4 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. Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? 1 Fetal heart rate of 120 beats/min 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

4 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 120 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. Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care.

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.

4 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.

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.

2 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. Test-Taking Tip: Relax during the last hour before an exam. Your brain needs some recovery time to function effectively.

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.

2 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. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options. Example: If the item relates to and identifies stroke rehabilitation as its focus and only one of the options contains the word stroke in relation to rehabilitation, you are safe in identifying this choice as the correct response.

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.

3 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.

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

4 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. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.

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).

4 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. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.

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.

1 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. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? 1 Placing the woman in the knee-chest position. 2 Covering the cord in a sterile towel saturated with warm normal saline. 3 Preparing the woman for a cesarean birth. 4 Starting oxygen by face mask.

1 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 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

1,3,5 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. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

The primary health care provider prescribes magnesium sulfate (Epsom salts) for a client to prevent preterm labor. Following administration, the nurse observes that the client has a respiratory rate of 10 breaths/minute and deep tendon reflexes. Based on these findings, what interventions would help to prevent complications in the client? 1 Give an oral dose of 10 mg nifedipine (Adalat). 2 Administer propranolol (Inderal) intravenously. 3 Infuse 500 mg of calcium chloride intravenously for 30 minutes. 4 Administer 6 mg of dexamethasone (Decadron) intramuscularly.

3 Magnesium sulfate is a tocolytic that is administered to the patient at 24 to 32 weeks of gestation to prevent the risk of preterm birth. A respiratory rate of 10 breaths/minute (below 12 breaths/minute) and deep tendon reflexes are intolerable adverse effects of the drug. Therefore, 500 mg of calcium chloride is infused intravenously for 30 minutes to reverse the magnesium sulfate (Epsom salt) toxicity. Nifedipine (Adalat) is a calcium channel blocker that should not be administered concurrently with magnesium sulfate (Epsom salt), because it results in skeletal muscle blockade. Propranolol (Inderal) is used to reverse the intolerable cardiovascular effects of terbutaline (Brethine). Dexamethasone (Decadron) is an antenatal glucocorticoid that is used to prevent the risk of respiratory distress syndrome in the fetus.

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.

4 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.

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 4 Administering magnesium sulfate (Epsom salts) to the client

4 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. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.