Chapter 21: Complications Occurring Before Labor and Delivery: PREPU

A client at 35 weeks' gestation is now in stable condition after being admitted for vaginal bleeding. Which assessment should the nurse prioritize? 1 Fetal heart tones 2 Signs of shock 3 Infection 4 Uterine stabilization

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A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? 1 Depressed deep tendon reflexes 2 Tachypnea 3 Bradycardia 4 Elevated blood glucose

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A client in preterm labor is receiving magnesium sulfate IV and appears to be responding well. Which finding on assessment should the nurse prioritize? 1 Depressed deep tendon reflexes 2 Tachypnea 3 bradycardia 4Elevated blood glucose

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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? 1 preterm labor 2 normal labor 3 dystocia 4 precipitate labor

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A nurse is teaching a 42-week nulliparous pregnant woman about labor induction which is being recommended by her health care provider. The nurse determines that the woman needs additional teaching when she identifies which assessment as being done before induction? 1Leopold's maneuver 3fetal dating 4Bishop scoring 5amniotic fluid studies

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A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? 1"I'll make sure to limit the amount of long distance traveling I do." 2"Stress isn't a problem that is related to preterm labor." 3Separating pregnancies by about a year should be helpful." 4"I'll need extra iron in my diet so I have a extra for the baby."

1

A pregnant patient is diagnosed with placenta previa. Which action should the nurse implement immediately for this patient? 1 Assess fetal heart sounds with an external monitor. 2 Help the patient remain ambulatory to reduce bleeding. 3 Assess uterine contractions by an internal pressure gauge. 4 Prepare for a vaginal examination to assess the extent of bleeding.

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A woman recovering from cesarean birth in the hospital and who was catheterized complains of a feeling of burning on urination and a feeling of frequency. Which of the following should be the next nursing action? 1 Obtain a clean-catch urine specimen 2 Administer amoxicillin, as prescribed 3 Encourage her to drink large amounts of fluid 4 Suggest that she take an oral analgesic

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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? 1 Risk for fetal infection related to early rupture of membranes 2 Hopelessness related to potential loss of pregnancy 3 Anticipatory grieving related to high probability for fetal death from placental dysfunction 4 Powerlessness related to inability to sustain pregnancy

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During a prenatal ultrasound, the client is discovered to have a placenta succenturiata. Following delivery of the fetus and placenta, which nursing assessment is most important? 1 Assessment for hemorrhage 2 Assessment for pain 3 Assessment for a thrombus 4 Assessment for shortness of breath

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The nurse is monitoring a primipara who has been receiving oxytocin and is now in hypertonic labor. If the nurse notes the fetal heart rate has suddenly dropped, which action should the nurse prioritize? 1 Decrease the oxytocin drip rate. 2 Turn the client on the left side. 3 Administer a tocolytic medication. 4 Assist with McRoberts maneuver.

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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? 1 11 2 8 3 6 4 3

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The nurse is admitting a woman at 32 weeks' gestation in preterm labor. The nurse should question the order for magnesium sulfate after noting which assessment finding? 1Cervical dilation of 5 cm 2Strong, regular contractions 3Fetus in a breech presentation 4A spontaneous abortion in an earlier pregnancy

1 If cervical dilation has already progressed too far, labor cannot be halted. Tocolytics are usually not administered if cervical dilation is greater than 3 to 4 cm. A breech presentation of the fetus is not cause to question the administration of a tocolytic agent, nor is a spontaneous abortion in an earlier pregnancy.

A group of nurses are reviewing information about mastitis and its causes in an effort to develop a teaching program on prevention for postpartum women. The nurses demonstrate understanding of the information when they focus the teaching on ways to minimize risk of exposure to which organism? 1 E. coli 2 S. aureus 3 Proteus 4 Klebsiella

2

A nurse is describing the risks associated with prolonged pregnancies as part of an inservice presentation. Which factor would the nurse be least likely to incorporate in the discussion as an underlying reason for problems in the fetus? 1 aging of the placenta 2 increased amniotic fluid volume 3 meconium aspiration 4 cord compression

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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? 1 bronchodilators 2 tocolytic therapy 3 muscle relaxants 4 anti-anxiety therapy

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The nurse is caring for a client after experiencing a placental abruption. Which finding is the priority to report to the health care provider? 1hematocrit of 36% 245 ml urine output in 2 hours 3hemoglobin of 13 g/dl 4platelet count of 150,000 mm3

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The nurse is performing a postpartum check on a 40-year-old client. Which nursing measure is appropriate? 1 Place the client in a supine position with her arms overhead for the examination of her breasts and fundus. 2 Instruct the client to empty her bladder before the examination. 3 Wear sterile gloves when assessing the pad and perineum. 4 Perform the examination as quickly as possible.

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The nurse would be alert for possible placental abruption during labor when assessment reveals which finding? 1 macrosomia 2 gestational hypertension 3 gestational diabetes 4 low parity

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After teaching a review class to a group of perinatal nurses about various methods for cervical ripening, the nurse determines that the teaching was successful when the group identifies which method as surgical? 1 breast stimulation 2 amniotomy 3 laminaria 4 prostaglandin

2 Amniotomy, also known as artificial rupture of membranes (AROM) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider

A nurse is explaining to a group of nurses new to the labor and birth unit about about methods used for cervical ripening. The group demonstrates understanding of the information when they identify which method as a mechanical one? 1herbal agents 2laminaria 3membrane stripping 4 amniotomy

2 Laminaria is a hygroscopic dilator that is used as a mechanical method for cervical ripening. Herbal agents are a nonpharmacologic method. Membrane stripping and amniotomy are considered surgical methods.

The nurse is monitoring a woman who is receiving oxytocin IV to assist with uterine irritability. Which action should the nurse prioritize if the woman's contractions are determined to be 80 seconds in length after 1 hour of administration of the oxytocin? 1 Slow the infusion to under 10 gtts per minute. 2 Increase the flow rate of the main line infusion. 3 Discontinue the oxytocin infusion. 4 Continue to monitor contraction duration every 2 hours.

3

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents? 1 "I need a cesarean section if I develop this problem." 2 "If I develop this complication, I will have bright red vaginal bleeding," 3 "Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." 4 "Since I am over 30, I run a much higher risk of developing this problem."

3

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption are discussed. What comment validates accurate learning by the parents? 1"I need a cesarean section if I develop this problem." 2If I develop this complication, I will have bright red vaginal bleeding," 3"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain." 4Since I am over 30, I run a much higher risk of developing this problem."

3 If uterine contractions lengthen beyond 70 seconds, there is apt to be an interference with fetal circulation. Discontinuing the infusion allows contractions to shorten in length and allow fetal nourishment. The nurse would not increase the flow rate of the main line infusion or slow the infusion without the primary care provider's prescription. Uterine contractions are monitored continuously.

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. 1 Administer betamethasone to mature the fetal lungs. 2 Ask the woman to drink 32 ounces (1 L) of water. 3 Discontinue the oxytocin infusion. 4 Administer an IV bolus of fluids. 5 Apply oxygen to the woman via mask at 8 to 10 L/min.

3, 4, 5

A nurse is conducting an assessment of a woman who has experienced PROM. Which finding would lead the nurse to suspect infection as the cause of a client's PROM? 1 yellow-green fluid 2 blue color on Nitrazine testing 3 ferning 4 foul odor

4

During active labor, the nurse notes a decrease in the baby's fetal heart rate and consults with the health care provider. The provider concurs and prescribes application of oxygen via mask, increase in IV fluids, and repositioning. The nurse should communicate which piece of information to the woman when she protests about being "tied down" in bed with IVs? 1 "An IV line will assist the staff if your baby shows signs of distress." 2 "Increasing your oxygen level will also increase the infant's oxygen level." 3 "Changing your position to side lying can prevent hypotension from inferior vena cava compression." 4 "Remember, the goal is to increase the FHR so a healthy infant can be born."

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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? 1 posterior position 2 firm 3 closed 4 shortened

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A nurse is conducting an assessment of a woman who has experienced PROM. Which finding would lead the nurse to suspect infection as the cause of a client's PROM? 1 yellow-green fluid 2 blue color on Nitrazine testing 3 ferning 4 foul odor

4 A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

Augmentation means?

an addition; the process of increasing