Complicated Intrapartum Bonus Quiz
A pregnant woman who is past her due date is hospitalized for a labor induction. Which drug should be administered to the client? 1 Clomiphene 2 Menotropins 3 Dinoprostone 4 Choriogonadotropin alfa
Dinoprostone Dinoprostone is a prostaglandin that stimulates uterine contractions to promote the progression of labor. Clomiphene, menotropins, and choriogonadotropin alfa are fertility drugs that are used to increase the likelihood of conception in an infertile woman.
What assessments should be done before administering uterine stimulants to induce labor? Select all that apply. 1 The cervix must be ready for labor induction. 2 Sympathomimetic drugs can be administered. 3 An intrauterine device for birth control can be used. 4 The fetal heart rate and contractions should be documented. 5 The mother's blood pressure, pulse rate, and respirations should be assessed.
145 Cervical ripening is important for the induction of labor and delivery of the fetus. The fetal heart rate should be documented to assure the safety of the fetus. The mother's vital signs should be monitored regularly to detect medical conditions. Sympathomimetic drugs should be avoided because they may cause severe hypertension. The presence of an intrauterine device may cause an inflammatory response in the uterus.
Which gestational period is appropriate for the administration of corticosteroids during preterm labor? 1 Less than 20 weeks 2 20 to 24 weeks 3 24 to 34 weeks 4 More than 34 weeks
24 to 34 weeks If preterm labor occurs during 24 to 34 weeks of gestation and if labor is unavoidable, corticosteroids should be administered to promote lung maturity. Labors occurring before 20 weeks of gestation usually results in a nonviable fetus; corticosteroids would not need to be administered. Corticosteroids do not promote lung maturation during 20 to 24 weeks of gestation. Fetal lungs mature at 34 weeks of gestation. A fetus in this period of gestation would not require the administration of corticosteroids if labor is unavoidable.
A client at 32 weeks' gestation is admitted to the birthing unit because she is having regular labor contractions. A prescription for 6 mg of intramuscular dexamethasone, twice a day for 2 days, is issued. The client asks why she needs this medicine. The nurse explains that this corticosteroid is prescribed because it does what? 1 Promotes sleep 2 May stop contractions 3 Relaxes uterine muscles 4 Accelerates fetal lung maturity
Accelerates fetal lung maturity Dexamethasone is a glucocorticoid that aids fetal production of surfactant, which is needed for postnatal lung expansion; it is not until 35 weeks' gestation that there is enough surfactant to confirm fetal lung maturity by way of amniocentesis. Glucocorticoids are not sedatives. Tocolytics, not glucocorticoids, may stop contractions. Tocolytics, not glucocorticoids, relax the uterine muscles.
A nurse is teaching a class of expectant parents regarding potential complications that may result in the need for a cesarean birth. What common indication for a cesarean birth should the nurse discuss? 1 Placenta previa 2 Primary uterine inertia 3 Incompetent cervical os 4 Cephalopelvic disproportion
Cephalopelvic disproportion Statistically, cephalopelvic disproportion is the most common indication for a first-time cesarean birth. Unless the placenta covers the os (placenta previa) or hemorrhage occurs, vaginal birth is preferred. Primary uterine inertia may be improved by rest and hydration followed by an infusion of oxytocin (Pitocin), which promotes vaginal birth. Incompetent cervical os is more likely to cause a preterm birth.
In which clinical situation would cervical ripening drugs be prescribed to pregnant women? 1 There is a need for a termination of pregnancy. 2 The cervical status indicates a Bishop score of 6. 3 Uterine contractions occur after 25 weeks of gestation. 4 Uterine contractions occur after 18 weeks of gestation.
Correct2 The cervical status indicates a Bishop score of 6 Cervical-ripening drugs are used to soften the cervix and improve uterine muscle tone. The cervical status of a Bishop score of 6 indicates a need for cervical-ripening drugs such as dinoprostone. Contractions that occur within 25 weeks of gestation are called preterm labor. Uterine contractions that occur within 18 weeks of pregnancy are due to the presence of a nonviable fetus. Cervical ripening drugs are not issued during the termination of a pregnancy.
A nurse assesses a client in the labor room and finds that the client's Bishop score for her cervical status is 6. Which medication may be administered to this client? 1 Oxytocin Dinoprostone 3 Mifepristone 4 Methylergonovine
Dinoprostone Dinoprostone is a synthetic derivative of naturally occurring prostaglandin E2. This drug is used for cervical ripening when there is an obstetric need for labor induction. Mifepristone is given to induce an abortion. Methylergonovine is used to reduce postpartum hemorrhage. Oxytocin is given to enhance labor during the gestation period.
A nurse assesses a primigravida who has been in labor for 5 hours. The fetal heart rate tracing is reassuring. Contractions, which are of mild intensity, are lasting 30 seconds and are 3 to 5 minutes apart. An oxytocin infusion is prescribed. What is the priority nursing intervention at this time? 1 Checking cervical dilation every hour 2 Keeping the labor environment dark and quiet 3 Infusing oxytocin by piggybacking into the primary line 4 Positioning the client on the left side throughout the infusion
Infusing oxytocin by piggybacking into the primary line Piggybacking the oxytocin infusion allows it to be discontinued, if necessary, while permitting the vein to remain open by way of the primary intravenous line. Cervical dilation is checked when there is believed to be a change, not on a regular basis. Unless specifically requested by the client, there is no reason to maintain a dark, quiet labor environment. Although positioning the client on her left side is recommended, it is not the primary concern at this time; there are no data to indicate maternal hypotension.
The nurse is counseling a client who is experiencing preterm contractions in the thirty-fifth week of gestation and whose cervix is dilated 2 cm. What should the nurse teach this client regarding sexual intercourse at this time? 1 It should be limited to once a week 2 It is prohibited because it may stimulate labor 3 It should be restricted to the side-lying position 4 It is permitted as long as penile penetration is shallow
It is prohibited because it may stimulate labor Prostaglandins in semen may stimulate labor, and penile contact with the cervix may increase myometrial contractility. Sexual intercourse may cause labor to progress; it is contraindicated for the rest of the pregnancy. The position is irrelevant, because sexual intercourse is contraindicated for the rest of the pregnancy. Regardless of the extent of penile penetration, sexual intercourse may precipitate labor; it is contraindicated for the rest of the pregnancy.
A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered? 1 Nifedipine 2 Indomethacin 3 Betamethasone Magnesium sulfate
Magnesium sulfate Magnesium sulfate is used to prevent preterm labor in pregnant women with hypertension. To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug. Nifedipine is a calcium channel blocker that inhibits myometrial activity by blocking the calcium influx. Indomethacin is a nonsteroidal antiinflammatory agent used along with sucralfate to protect the stomach. Betamethasone is a corticosteroid used when preterm labor is not maintained by other treatments and delivery is proceeding.
Which drug would be least likely observed in the prescription of a client with severe hypotension who is managing preterm labor? 1 Nifedipine 2 Terbutaline 3 Indomethacin 4 Dexamethasone
Nifedipine Nifedipine is a calcium channel blocker used to maintain pregnancy in preterm labor. Because it is a calcium channel blocker, nifedipine can cause hypotension so it should not be used in a client with severe hypotension. Terbutaline and indomethacin are used to maintain a pregnancy in preterm labor. Dexamethasone is used to maintain a pregnancy in preterm labor when other tocolytics are not beneficial.
Which drug is used to prevent preterm labor? 1 Oxytocin 2 Nifedipine 3 Raloxifene 4 Clomiphene
Nifedipine Nifedipine is used to prevent preterm labor because it inhibits myometrial activity by blocking the influx of calcium. Oxytocin may be used to induce labor. Raloxifene is used to prevent postmenopausal osteoporosis. Clomiphene is used to cause ovulation.
An infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. Which condition should the nurse carefully assess this newborn for? 1 Facial paralysis 2 Cephalhematoma 3 Brachial plexus injury 4 Spinal cord syndrome
Brachial plexus injury Brachial plexus paralysis (Erb-Duchenne palsy) is the most common injury associated with dystocia related to a shoulder presentation; it is caused by pressure and traction on the brachial plexus during the birth process. The newborn's face is not involved with a shoulder presentation. Cephalhematoma is a soft-tissue injury of the head and is not related to shoulder dystocia. Spinal cord syndrome is associated with a breech presentation and is not related to shoulder dystocia.
A woman is receiving an oxytocin infusion to augment her labor. She begins to moan loudly, and the nurse notes that the contractions are becoming more intense and prolonged, with little or no rest period between them. What should the nurse do first in response to the client's reaction? 1 Notify the primary healthcare provider. 2 Continue the fetal monitoring. 3 Discontinue the oxytocin infusion. 4 Place the client in the knee-chest position.
Discontinue the oxytocin infusion. The infusion must be stopped because the uterus is being hyperstimulated; this compromises adequate fetal oxygenation and blood flow to the placenta. The primary healthcare provider should be notified after the oxytocin infusion has been stopped. Continuing fetal monitoring without first discontinuing the oxytocin infusion places the fetus at a greater risk for developing hypoxia. The priorities are to decrease uterine activity and increase blood flow to the uterus; the knee-chest position promotes neither.
After a cesarean birth a nurse performs fundal checks every 15 minutes. The nurse determines that the fundus is soft and boggy. What is the priority nursing action at this time? 1 Elevating the client's legs 2 Massaging the client's fundus 3 Increasing the client's oxytocin drip rate 4 Examining the client's perineum for bleeding
Massaging the client's fundus Gentle massage stimulates muscle fibers, resulting in firming the tone of the fundus; it also helps expel any clots that may be interfering with contraction of the fundus. Elevating the client's legs will increase return of blood from the extremities but will not improve the tone of the client's fundus. Increasing the client's oxytocin drip rate will be done if uterine massage is ineffective. Examining the client's perineum for bleeding should not be the first action at this time; gentle massage to contract the fundus is the priority.
A post-dated pregnant client is admitted to the hospital for labor induction. Which medication would the primary healthcare provider prescribe? 1 Oxytocin 2 Nifedipine 3 Indomethacin 4 Methylergonovine
Oxytocin Oxytocin is given to induce uterine contractions when normal labor does not occur in the final weeks of gestation. Nifedipine and indomethacin are used to control preterm labor. Methylergonovine is used to control postpartum hemorrhage.
A nurse explains preterm labor to a group of nursing students. Which description of preterm labor indicates effective teaching? 1 Preterm labor is defined as contractions during the delivery. 2 Preterm labor is defined as contractions induced by prostaglandins. 3 Preterm labor is defined as contractions between 20 and 36 weeks of gestation. 4 Preterm labor is defined as contractions occurring before 20 weeks of gestation.
Preterm labor is defined as contractions between 20 and 36 weeks of gestation. Preterm labor involves uterine contractions that can proceed to delivery; these contractions occur between 20 and 36 weeks of gestation. Contractions induced by prostaglandins are known as Braxton Hicks contractions; these occur in the final weeks of pregnancy. Contractions occurring before 20 weeks of gestation are not associated with preterm labor. Contractions occurring during delivery are called full-term labor.
A client who is in preterm labor at 34 weeks' gestation is receiving intravenous tocolytic therapy. The frequency of her contractions increases to every 10 minutes, and her cervix dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority nursing care be directed at this time? 1 Reduction of anxiety associated with preterm labor 2 Promotion of maternal and fetal well-being during labor 3 Supportive communication with the client and her partner 4 Helping the family cope with the impending preterm birth
Promotion of maternal and fetal well-being during labor Labor is continuing, and promotion of the well-being of both client and fetus is the priority nursing care during this period. Reduction of anxiety associated with preterm labor, supportive communication with the client and her partner, and helping the family cope with the impending preterm birth each address just one aspect of this client's needs and must be dealt with in the context of the priority need.
After a client has been in labor for 6 hours at home, and she is admitted to the birthing room. The client is dilated 5 cm and at -1 station. In the next hour her contractions gradually become irregular and are more uncomfortable. Which possibility should the nurse consider first? 1 The client is in false labor. 2 The client has a full bladder. 3 There is uterine dysfunction. 4 There is a breech presentation.
The client has a full bladder. A full bladder can impede the forces of labor, and so it must be emptied before any further assessment. The client's cervix is dilating, and therefore she is in true, not false, labor. Before the possibility of uterine dysfunction is considered, the client's bladder should be emptied to relieve the pressure of the bladder on the uterus; the client should then be observed to determine whether regular contractions have resumed. The existence of a breech presentation should have been established during the admission examination.
A client is admitted for induction of labor. An intravenous infusion of oxytocin is started. When the client's contractions begin they are 1.5 to 2 minutes in duration. While the nurse is in the room, one contraction lasts 3 minutes. What should the nurse do first? 1 Give oxygen by nasal cannula. 2 Turn off the oxytocin infusion. 3 Reposition the monitoring belts. 4 Place a call light next to the client.
Turn off the oxytocin infusion. The client has experienced a hypertonic contraction. The oxytocin must be stopped before another contraction occurs to prevent uterine rupture, fetal hypoxia, or both. Although giving oxygen is important and may eventually be done, it is not the priority. Although repositioning the monitoring belts may be necessary, it is not the priority. Placing a call light next to the client is unnecessary; the client receiving oxytocin for induction of labor should be continuously attended.
A 36-year-old woman, G1 P0, is admitted to the labor and delivery unit for oxytocin induction. She is at 40 weeks' gestation. Which condition is a contraindication to the use of oxytocin induction? 1 Chorioamnionitis 2 Postterm pregnancy 3 Active genital herpes infection 4 Hypertension associated with pregnancy
Correct3 Active genital herpes infection Oxytocin is not administered when a woman has an active genital herpes infection. In this case, the baby would be delivered by means of cesarean section to prevent it from being infected during birth. Chorioamnionitis, hypertension associated with pregnancy, and postterm pregnancy are all indications for the use of oxytocin induction.
A client at 39 weeks' gestation arrives in the birthing suite reporting that she is having regular contractions. A vaginal examination reveals that the presentation is a double-footling breech. The primary healthcare provider decides to proceed to a cesarean birth under regional anesthesia. Which intervention is important in preventing postoperative maternal complications? 1 Providing scrupulous skin care 2 Maintaining adequate hydration 3 Monitoring the vital signs frequently 4 Teaching the client how to use an incentive spirometer
Maintaining adequate hydration Because of the administration of regional anesthesia and the potential for blood loss associated with a cesarean birth, the client should be well hydrated before surgery to maintain adequate blood volume. Scrupulous skin care is not relevant; just before surgery the skin will be cleansed. Only routine monitoring of vital signs is necessary. The use of an incentive spirometer is important after general, not regional, anesthesia.
The nurse is providing care for parents who have experienced a stillbirth. What is the most appropriate intervention at this time? 1 Giving a detailed explanation of what may have caused the stillbirth 2 Providing the parents the opportunity to say goodbye to their newborn 3 Explaining that autopsy is not recommended in the setting of a stillbirth 4 Waiting to provide any information about follow-up care until the parents have had an opportunity to adjust to the grief
Providing the parents the opportunity to say goodbye to their newborn Parents should be given the opportunity to say goodbye to a stillborn baby. Because the parents may not think to ask to see the baby, the nurse should provide this opportunity. Giving a detailed explanation of possible causes of the stillbirth is nontherapeutic. An autopsy may be performed when there is a stillbirth. The decision is left to the parents. The procedure can be very important in answering the question "Why?" if there is a chance that the cause of death can be determined. Before the parents leave the hospital, arrangements for follow-up care should be made. This information should be provided immediately, because it can help the parents begin the grieving process. Many hospitals have a team consisting of a social worker, chaplain, and nurse that is called when a stillbirth occurs.
