Chapter 21: Complications Occurring Before Labor and Delivery
The nurse provides education to a postterm pregnant client. What 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." -"Continue to monitor fetal movements daily." -"Monitor your bowel movements for constipation."
"Continue to monitor fetal movements daily."
The nurse provides education to a postterm pregnant client. What 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 pregnant client at 32 weeks' gestation calls the clinic and informs the nurse that she thinks her membranes are leaking. She states that some clear fluid has run down her leg. What is the best response by the nurse? -"It is best for you to visit a hospital immediately. They can use nitrazine paper to determine if it is amniotic fluid." -"You may have just passed some urine. If it were amniotic fluid, there would be much more than that." -"Go to the hospital now because this could be very dangerous for the baby." -"There's nothing to worry about if you passed only a little bit. The membranes will seal back over."
"It is best for you to visit a hospital immediately. They can use nitrazine paper to determine if it is amniotic fluid."
A nurse is teaching a pregnant woman with preterm premature rupture of membranes (PPROM) about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching? -"I need to keep a close eye on how active my baby is each day." -"I can shower, but I shouldn't take a tub bath." -"It's okay for my husband and I to have sexual intercourse." -"I need to call my doctor if my temperature increases."
"It's okay for my husband and I to have sexual intercourse."
A client at 39 weeks' gestation is seen in the obstetric triage area with suspected rupture of membranes. The nurse places the client on the fetal monitor, which shows a fetal heart rate of 142 beats/min with no decelerations or uterine contractions. A sterile speculum examination confirms premature rupture of membranes (PROM). The health care provider and the client agree to expectantly manage the situation and the client is prepared for discharge. Based on this information, what information will the nurse include in the discharge instructions? Select all that apply. -"Report any changes in your vaginal discharge." -"Take the prescribed antibiotics as directed." -"Maintain bed rest until labor begins." -"Expect labor to begin within the next 72 hours." -"Monitor your temperature twice a day."
"Monitor your temperature twice a day." "Report any changes in your vaginal discharge." "Expect labor to begin within the next 72 hours."
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? -"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." -"If I develop this complication, I will have bright red vaginal bleeding," -"Since I am over 30, I run a much higher risk of developing this problem." -"I need a cesarean section if I develop this problem."
"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain."
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. -"Stop what you are doing and rest." -"Lie down on your back." -"Drink two or three glasses of water." -"Walk around the house for the next half hour." -"Try emptying your bladder."
"Stop what you are doing and rest." "Drink two or three glasses of water." "Try emptying your bladder."
A woman at 41 weeks' gestation is progressing well in labor; however, the nurse notes the amniotic fluid is greenish in color. When questioned by the client for the reason for this, which explanation should the nurse provide? -"Amniotic fluid is normally green." -"This is meconium-stained fluid from the baby." -"Green might be a yeast infection and we need to culture the discharge." "You have an infection and need antibiotics."
"This is meconium-stained fluid from the baby."
A client at 42 weeks' gestation receives a vaginal insert of time-released dinoprostone at 0900 hours for cervical ripening. At which time does the nurse anticipate the client to receive oxytocin? -1590 hours -2120 hours -0950 hours -1220 hours
0950 hours
A client at 42 weeks' gestation receives a vaginal insert of time-released dinoprostone at 0900 hours for cervical ripening. At which time does the nurse anticipate the client to receive oxytocin? -2120 hours -1220 hours -1590 hours -0950 hours
0950 hours
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? -11 -5 -3 -7
11
A client is admitted to the unit in preterm labor. In preparing the client for this therapy, the nurse anticipates that the client's pregnancy may be prolonged for how long when this therapy is used? 2 to 7 days 1 to 5 days 6 to 10 days 4 to 8 days
2 to 7 days
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? -platelet count of 150,000 mm3 -45 ml urine output in 2 hours -hemoglobin of 13 g/dl (130 g/L) -hematocrit of 36% (0.36)
45 ml urine output in 2 hours
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? -Assess fetal heart sounds. -Administer amnioinfusion. -Place the woman in Trendelenburg position. -Administer oxygen at 10 L/min by face mask.
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? -Place the woman in Trendelenburg position. -Administer oxygen at 10 L/min by face mask. -Assess fetal heart sounds. -Administer amnioinfusion.
Assess fetal heart sounds.
After an hour of oxytocin therapy, a woman in labor states she feels dizzy and nauseated. The nurse's best action would be to: -assess the rate of flow of the oxytocin infusion. -instruct her to breathe in and out rapidly. -administer oral orange juice for added potassium. -assess her vaginally for full dilation (dilatation).
Assess the rate of flow of the oxytocin infusion.
During a prenatal ultrasound, the client is discovered to have a succenturiate placenta. Following delivery of the fetus and placenta, which nursing assessment is most important? -assessment for shortness of breath -assessment for a thrombus -assessment for pain -assessment for hemorrhage
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? -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. -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.
A nurse working with a woman in preterm labor receives a telephone report for the fetal fibronectin test done 10 hours ago. The report indicates an absence of the protein, which the nurse knows indicates: -infection is present. -birth is likely within the next 2 weeks. -no infection is present. -birth is unlikely within the 2 next weeks.
Birth is unlikely within the next 2 weeks.
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? -jasmine -catnip -skullcap -black cohosh
Black Cohosh
A nurse is providing care to a client at 32 weeks' gestation who is being evaluated for preterm labor. The client reports having mild uterine contractions every 6 to 8 minutes over the past 2 hours. A sterile speculum examination reveals the findings listed below. Which assessment finding is most indicative of preterm labor? -blood at the cervical os -cervical dilation of 3 centimeters -a shortened cervix -a positive fetal fibronectin test (fFN)
Cervical dilation of 3 centimeters
When planning the care of a client scheduled for induction of labor with exogenous oxytocin, the nurse should make which assessment? -fetal heart rate -fundal height -cervical ripening -vaginal discharge
Cervical ripening
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? -Check for a full bladder. -Make sure the epidural medication is turned down. -Assess vital signs every 30 minutes. -Make sure the client is lying on her left side.
Check for a full bladder.
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 -macrosomia -shoulder dystocia -cord compression
Cord Compression
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? -cord compression -macrosomia -shoulder dystocia -fetal hydrocephalus
Cord compression
A client at 32 weeks' gestation has been admitted to the labor and birth unit with preterm labor. Which medication would the nurse be likely to administer to reduce the risk of complications in the preterm newborn? -corticosteroids -magnesium sulfate -indomethacin -nifedipine
Corticosteroids
A pregnant client late in the second trimester comes to the emergency department with a report of painless, bright red vaginal bleeding. The client states, "It started all of a sudden and now it seems to have stopped." Placenta previa is suspected. Which action should the nurse implement immediately for this client? -Assist with insertion of internal monitoring to assess uterine pressure. -Prepare the client for a pelvic examination to assess rupture of membranes. -Determine fetal heart sounds using an external monitor. -Prepare the client for an immediate cesarean birth.
Determine fetal heart sounds using an external monitor.
A pregnant client receiving intravenous oxytocin for 1 hour has contractions lasting 85 seconds. What should the nurse do first for this client? -Continue to monitor contraction duration every 2 hours. -Slow the infusion to below 10 gtt/minute. -Increase the flow rate of the main line infusion. -Discontinue the oxytocin infusion.
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. -Administer betamethasone to mature the fetal lungs. -Discontinue the oxytocin infusion. -Apply oxygen to the woman via mask at 8 to 10 L/min. -Administer an IV bolus of fluids. -Ask the woman to drink 32 ounces (1 L) of water.
Discontinue the oxytocin infusion. Apply oxygen to the woman via mask at 8 to 10 L/min. Administer an IV bolus of fluids.
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 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 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 1 grade 2 grade 4 grade 3
Grade 2
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? -aging of the placenta -cord compression -meconium aspiration -increased amniotic fluid volume
Increased amniotic fluid volume
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 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 increta -placenta percreta -low-lying placenta -placenta accreta
Low-lying placenta
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? -infection -dystocia -macrosomia -hemorrhage
Macrosomia
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? -infection -macrosomia -dystocia -hemorrhage
Macrosomia
A primary care provider prescribes intravenous tocolytic therapy for a woman in preterm labor. Which agent would the nurse expect to administer? -magnesium sulfate -betamethasone -indomethacin -nifedipine
Magnesium Sulfate
A client at 35 weeks' gestation has been admitted due to concerns that the fetal blood vessels are too close to the cervix. Which action will the nurse prioritize when a nonstress test (NST) reveals a minor nonreassuring fetal heart pattern? -Repeat the NST in one hour. -Place the client in the Trendelenburg position. -Ask the client to empty their bladder. -Notify the health care provider immediately.
Notify the health care provider immediately.
A client at 29 weeks' gestation is seen in obstetric triage with reports of heavy vaginal bleeding noted upon waking. The client denies abdominal pain or uterine contractions. Continuous fetal monitoring shows a normal fetal heart rate with no signs of fetal distress. Which is the likely cause of the client's condition? -placental abruption -vasa previa -disseminated intravascular coagulation (DIC) -placenta previa
Placenta Previa
A client at 29 weeks' gestation is seen in obstetric triage with reports of heavy vaginal bleeding noted upon waking. The client denies abdominal pain or uterine contractions. Continuous fetal monitoring shows a normal fetal heart rate with no signs of fetal distress. Which is the likely cause of the client's condition? -disseminated intravascular coagulation (DIC) -vasa previa -placental abruption -placenta previa
Placenta previa
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? -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. -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
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? -Placenta previa causes painful, dark red vaginal bleeding during pregnancy. -Placenta previa is an abnormally implanted placenta that is too close to the cervix. -Placental abruption requires "watchful waiting" during labor and birth. -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.
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply. -placental abruption (abruptio placentae) -septicemia -severe preeclampsia -ectopic pregnancy -isoimmunization
Placental abruption (abruptio placentae) Septicemia Severe preeclampsia
A client has arrived at the labor and delivery suite for a scheduled induction of labor. Which nursing intervention will the nurse implement before starting the oxytocin infusion? -completing an ultrasound -obtaining a urine specimen -assessing the client's lung sounds -placing on a tocodynamometer
Placing on a tocodynamometer
A client 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 client 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 woman in labor suddenly reports sharp fundal pain accompanied by slight dark red vaginal bleeding. The nurse should prepare to assist with which situation? -Preterm labor that was undiagnosed -Premature separation of the placenta -Placenta previa obstructing the cervix -Possible fetal death or injury
Premature separation of the placenta
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? -normal labor -precipitate labor -preterm labor -dystocia
Preterm labor
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? -Anticipatory grieving related to high probability for fetal death from placental dysfunction -Risk for fetal infection related to early rupture of membranes -Powerlessness related to inability to sustain pregnancy -Hopelessness related to potential loss of pregnancy
Risk for fetal infection related to early rupture of membranes
A nursing instructor identifies which of the following as increasing the chances of infection when coupled with prolonged labor? -multiple births -ruptured membranes -number of previous pregnancies -age of mother
Ruptured Membranes
A nursing instructor identifies which of the following as increasing the chances of infection when coupled with prolonged labor? -number of previous pregnancies -age of mother -ruptured membranes -multiple births
Ruptured membranes
The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? -firm -closed -shortened -posterior position
Shortened
The nurse is reviewing the physical examination findings for a client who is to undergo labor induction. Which finding would indicate to the nurse that a woman's cervix is ripe in preparation for labor induction? -shortened -posterior position -firm -closed
Shortened
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? -bronchodilators -muscle relaxants -anti-anxiety therapy -tocolytic therapy
Tocolytic therapy
A pregnant woman at the emergency department informs staff that she is at least 2 weeks past her due date. The physician begins to perform several tests to determine fetal age. The nurse anticipates that the woman's amniotic fluid volume will be decreased. How would the nurse measure the amniotic fluid in this situation? -aspiration -palpation -x-ray -ultrasound
Ultrasound
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. The nurse should immediately check the client for: -amniotic fluid embolus. -umbilical cord prolapse. -placental abruption (abruptio placentae). -amniotic fluid infection.
Umbilical cord prolapse.
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. -nifedipine -dinoprostone -indomethacin -misoprostol -magnesium sulfate
nifedipine indomethacin magnesium sulfate
