High Risk L&D, & Complications
A nurse is providing prenatal care to a pregnancy client. At which time would the nurse expect to screen the client for group B streptococcus infection?
36 weeks' gestation Explanation: All pregnant women should be screened for group B streptococcus infection at 35 to 37 weeks' gestation.
Sometimes an ectopic pregnancy occurs outside the woman's uterus. This usually occurs in one of the fallopian tubes. If the embryo continues to grow, it may rupture the tube. What is a sign or symptom of a ruptured fallopian tube?
shoulder pain Explanation: Rarely, a woman may present with late signs, such as shoulder pain or hypovolemic shock. These signs are associated with tubal rupture, which occurs when the pregnancy expands beyond the tube's ability to stretch
A nurse is monitoring a client with spontaneous abortion who has been prescribed misoprostol. Which symptoms are common adverse effects associated with misoprostol? Select all that apply.
• dyspepsia • hypotension • tachycardia Explanation: Adverse effects commonly associated with misoprostol include dyspepsia, hypotension, tachycardia, diarrhea, abdominal pain, and vomiting. Constipation and headache are not adverse effects commonly associated with misoprostol
A client visits a health care facility reporting amenorrhea for 10 weeks, fatigue, and breast tenderness. Which additional signs and symptoms suggest the presence of molar pregnancy? Select all that apply.
• elevated hCG levels • absence of fetal heart sound • hyperemesis gravidarum Explanation: The signs and symptoms of molar pregnancy include an elevated hCG level, absence of fetal heart sounds, and hyperemesis gravidarum. Whitish discharge from the vagina and dyspareunia (painful sexual intercourse) are seen in cases of infection not in molar pregnancy. In molar pregnancy, a brownish vaginal bleeding is seen
A nursing student doing a rotation in labor and birth correctly identifies which medications as most commonly used for tocolysis? Select all that apply.
• magnesium sulfate • atosiban • indomethacin • nifedipine Explanation: Medications commonly used for tocolysis include magnesium sulfate, atosiban, indomethacin, and nifedipine. These drugs are used "off label," meaning that they are effective but have not been officially tested and developed for this purpose by the Food and Drug Administration
A pregnant client is brought to the health care facility with signs of premature rupture of the membranes (PROM). Which conditions and complications are associated with PROM? Select all that apply.
• prolapsed cord • preterm labor • abruptio placenta Explanation: The associated conditions and complications of premature rupture of the membranes are infection, prolapsed cord, abruptio placenta, and preterm labor. Spontaneous abortion and placenta previa are not associated conditions or complications of premature rupture of the membranes
A nursing instructor highlights which risk factors associated with preterm labor? Select all that apply.
• uterine or cervical abnormalities • history of previous preterm birth • current multiple gestation pregnancy Explanation: The top risk factors for preterm labor include history of previous preterm birth, current multiple gestation pregnancy, and uterine or cervical abnormalities. The weight of the fetus or mother does not cause preterm labor
Which is the best question the nurse can ask a woman who is leaving the hospital after experiencing a complete spontaneous abortion?
"Do you have someone to talk to, or may I give you the names and numbers for some possible grief counselors?" Explanation: When a woman has a spontaneous abortion one important consideration is the emotional needs of the woman once she is home. She may not want to talk about the loss for a period of time, but the nurse needs to determine her support system for the future. Asking the woman if she is "going to try again" is an inappropriate question for the nurse to ask and diminishes the experience of having a spontaneous abortion. Giving the woman statistical information on spontaneous abortions is not appropriate when this client needs support and caring concern. Offering to give the client resources to aid in smoking cessation is not addressed in the scenario, so this is an inappropriate response
After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful?
"I will be sure to avoid getting pregnant for at least 1 year." Explanation: After evacuation of trophoblastic tissue (hydatiform mole), long-term follow-up is necessary to make sure any remaining trophoblastic tissue does not become malignant. Serial hCG levels are monitored closely for one year, and the client is urged to avoid pregnancy for 1 year because it can interfere with the monitoring of hCG levels. Iron intake and blood pressure are not important aspects of follow up after evacuation of a hydatiform mole. Use of a reliable contraceptive is strongly recommended so that pregnancy is avoided
When caring for a client with premature rupture of membranes (PROM), the nurse observes an increase in the client's pulse. What should the nurse do next?
Assess the client's temperature. Explanation: A temperature elevation or an increase in the pulse of a client with PROM would indicate infection. Increase in the pulse does not indicate preterm labor or cord compression. The nurse should monitor FHR patterns continuously, reporting any variable decelerations suggesting cord compression. Respiratory distress syndrome is one of the perinatal risks associated with PROM
The nurse is monitoring a client in labor who has had a previous cesarean section and is trying a vaginal birth with an epidural. The nurse observes a sudden drop in blood pressure, increased heart rate, and deep variable deceleration on the fetal monitor. The client reports severe pain in her abdomen and shoulder. What should the nurse prepare to do?
Prepare the client for a cesarean birth. Explanation: The findings are consistent with uterine rupture. An abrupt change in the fetal heart rate pattern is often the most significant finding associated with uterine rupture. Others are reports of pain in the abdomen, shoulder, or back in a laboring woman who had previous good pain relief from epidural anesthesia. Falling blood pressure and rising pulse may be associated with hypovolemia caused by occult bleeding. The treatment is immediate cesarean birth.
A client in the first stage of labor is diagnosed with dystocia involving the powers of labor. What would the nurse identify as the problem?
Uterine contractions are too weak or uncoordinated. Explanation: When there are problems with the powers causing dystocia during the first stage of labor, the uterine contractions are too weak or uncoordinated to cause adequate cervical effacement and dilatation. Contractions are insufficient to cause fetal descent; the fetus being in a different position or presentation, and pelvis being either android type or platypelloid type are not the results of dystocia. During the second stage of labor, the nurse should observe if the contractions and the pushing are insufficient to cause descent of the fetus. A fetus that is in a different position or presentation is a problem with the passenger. A pelvis that is either android type or platypelloid type is a problem with the passageway and is not related to dystocia
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:
birth is unlikely within the 2 next weeks. Explanation: Fetal fibronectin is a protein that helps the placenta and fetal membranes adhere to the uterus during pregnancy. A negative result (absence of fetal fibronectin) is a reliable indicator that birth is unlikely within 2 weeks following the test. It does not diagnose infection
The nurse is assisting a primary care provider to attempt to manipulate the position of the fetus in utero from a breech to cephalic position. What does the nurse inform the client the procedure is called?
external version Explanation: External version is the process of manipulating the position of the fetus in order to try to turn the fetus to a cephalic presentation.
A nurse is caring for a client undergoing treatment for ectopic pregnancy. Which symptom is observed in a client if rupture or hemorrhaging occurs before the ectopic pregnancy is successfully treated?
phrenic nerve irritation Explanation: The symptoms if rupture or hemorrhaging occurs before successfully treating the pregnancy are lower abdomen pain, feelings of faintness, phrenic nerve irritation, hypotension, marked abdominal tenderness with distension, and hypovolemic shock. Painless bright red vaginal bleeding occurring during the second or third trimester is the clinical manifestation of placenta previa. Fetal distress and tetanic contractions are not the symptoms observed in a client if rupture or hemorrhaging occurs before successfully treating an ectopic pregnancy
A nurse is caring for a client who is scheduled to undergo an amnioinfusion. The nurse would question this prescription if which finding is noted upon client assessment?
uterine hypertonicity Explanation: The nurse should ensure that the client does not have uterine hypertonicity to confirm that amnioinfusion is not contraindicated. Other factors that enforce contraindication of amnioinfusion include vaginal bleeding of unknown origin, umbilical cord prolapse, amnionitis, and severe fetal distress. Active genital herpes infection is a condition that enforce contraindication of labor induction rather than amnioinfusion. Urine output and blood pressure do not determine a client's ability to receive an amnioinfusion
A nurse is administering oxytocin to a woman in labor. The nurse monitors the infusion closely and notifies the health care provider if which condition occurs?
water intoxication Explanation: Oxytocin can lead to water intoxication and can cause hypotension. Uterine hypertonicity is a possible adverse effect of oxytocin administration. Oxytocin does not cross the placental barrier, and no fetal problems have been observed.
A client reports to her obstetrician a significant amount of bright red, painless vaginal bleeding. A sonogram reveals that her placenta has implanted low in the uterus and is partially covering the cervical os. Which immediate care measures should the nurse initiate? Select all that apply.
• Place the woman on bed rest in a side-lying position. • Determine from the client the time the bleeding began and about how much blood has been lost. • Obtain baseline vital signs. • Continue to assess blood pressure every 5 to 15 minutes. • Attach external monitoring equipment to record fetal heart sounds. Explanation: With the exception of performing a pelvic examination, all of the answers are appropriate immediate care measures for the client with placenta previa. The nurse should never attempt a pelvic or rectal examination with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa might tear the placenta further and initiate massive hemorrhage, possibly fatal to both mother and child
A client is 2 weeks past her due date, and her health provider is considering whether to induce labor. Which conditions must be present before induction can take place? Select all that apply
• The fetus is in a longitudinal lie. • The cervix is ripe. • A presenting part is engaged. Explanation: Before induction of labor is begun in term and postterm pregnancies, the following conditions should be present: the fetus is in a longitudinal lie; the cervix is ripe, or ready for birth; a presenting part is engaged; there is no cephalopelvic disproportion; and the fetus is estimated to be mature by date (over 39 weeks) or demonstrated by a lecithin-sphingomyelin ratio or ultrasound biparietal diameter to rule out preterm birth. Normal maternal blood pressure and absence of eclampsia are not conditions required for induction; in fact, severe hypertension and eclampsia are conditions that may necessitate induction
A nurse is caring for a client who is experiencing acute onset of dyspnea and hypotension. The health care provider suspects the client has amniotic fluid embolism. What other signs or symptoms would alert the nurse to the presence of this condition in the client? Select all that apply.
• cyanosis • pulmonary edema Explanation: The nurse should monitor cyanosis and pulmonary edema when caring for a client with amniotic fluid embolism. Other signs and symptoms of this condition include hypotension, cyanosis, seizures, tachycardia, coagulation failure, disseminated intravascular coagulation, uterine atony with subsequent hemorrhage, adult respiratory distress syndrome, and cardiac arrest. Arrhythmia, hematuria, and hyperglycemia are not known to occur in cases of amniotic fluid embolism. Hematuria is seen in clients having uterine rupture.
