Labor and Birth Complications #2

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information would the nurse include? a. "Because this is a repeat procedure, you are at the lowest risk for complications." b. "Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." c. "Because this is your second cesarean birth, you will recover faster." d. "You will not need preoperative teaching because this is your second cesarean birth."

B ("Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures" is the most appropriate statement. It is not accurate to state that the woman is at the lowest risk for complications. Both maternal and fetal risks are associated with every cesarean section. "Because this is your second cesarean birth, you will recover faster" is not an accurate statement. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each client each time. Preoperative teaching should always be performed, regardless of whether the client has already had this procedure.)

A maternal indication for the use of vacuum extraction is: a. A wide pelvic outlet. b. Maternal exhaustion. c. A history of rapid deliveries. d. Failure to progress past 0 station.

B (A mother who is exhausted may be unable to assist with the expulsion of the fetus. The patient with a wide pelvic outlet will likely not require vacuum extraction. With a rapid delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum extraction.)

The nurse is caring for a client whose labor is being augmented with oxytocin. He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of: a. Uterine contractions occurring every 8 to 10 minutes. b. A fetal heart rate (FHR) of 180 with absence of variability. c. The client's needing to void. d. Rupture of the client's amniotic membranes.

B (This FHR 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 are occurring every 8 to 10 minutes do not qualify as hyperstimulation. The client's 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 client experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the client's membranes have ruptured.)

Complications and risks associated with cesarean births include (Select all that apply): a. Placental abruption. b. Wound dehiscence. c. Hemorrhage. d. Urinary tract infections. e. Fetal injuries.

B, C, D, E (Placental abruption and placenta previa are both indications for cesarean birth and are not complications thereof. Wound dehiscence, hemorrhage, urinary tract infection, and fetal injuries are all possible complications and risks associated with delivery by cesarean section.)

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? a. Prolonged latent phase b. Protracted active phase c. Arrest of active phase d. Protracted descent

C (With an arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, thus indicating an arrest of labor. In the nulliparous woman a prolonged latent phase typically would last more than 20 hours. A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation). With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.)

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? A. Shifting the client to an obstetric facility B. Administering antibiotic medications to the client C. Administering antenatal glucocorticoids to the client D. Administering magnesium sulfate (Epsom salts) to the client

D (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.)

Before the physician performs an external version, the nurse should expect an order for a: a. Tocolytic drug. b. Contraction stress test (CST). c. Local anesthetic. d. Foley catheter

A (A tocolytic drug will relax the uterus before and during version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. The bladder should be emptied; however, catheterization is not necessary.)

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: a. Stimulate fetal surfactant production. b. Reduce maternal and fetal tachycardia associated with ritodrine administration. c. Suppress uterine contractions. d. Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

A (Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.)

With regard to the process of augmentation of labor, the nurse should be aware that it: a. Is part of the active management of labor that is instituted when the labor process is unsatisfactory. b. Relies on more invasive methods when oxytocin and amniotomy have failed. c. Is a modern management term to cover up the negative connotations of forceps-assisted birth. d. Uses vacuum cups.

A (Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods. Forceps-assisted births and vacuum-assisted births are appropriately used at the end of labor and are not part of augmentation.)

Which patient status is an acceptable indication for serial oxytocin induction of labor? a. Past 42 weeks' gestation b. Multiple fetuses c. Polyhydramnios d. History of long labors

A (Continuing a pregnancy past the normal gestational period is likely to be detrimental to fetal health. Multiple fetuses overdistend the uterus and make induction of labor high risk. Polyhydramnios overdistends the uterus, again making induction of labor high risk. History of rapid labors is a reason for induction of labor because of the possibility that the baby would otherwise be born in uncontrolled circumstances.)

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? A. Blood pressure of 80/60 mmHg. B. Short episode of hyperglycemia. C. Irregular episodes of dysrhythmias. D. Heart rate of less than 120 beats/min.

A (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.)

In evaluating the effectiveness of oxytocin induction, the nurse would expect: a. Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart. b. The intensity of contractions to be at least 110 to 130 mm Hg. c. Labor to progress at least 2 cm/hr dilation. d. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

A (The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.)

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? A. Teach gentle lower extremity exercises to the client. B. Suggest the client to lie in the supine position in bed. C. Provide a calm and soothing atmosphere to the client. D. Give tocolytic medications as per the physician's prescription.

A (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.)

During a prenatal visit, the nurse finds that the patient has symptoms of preterm labor. Which nursing intervention is to be followed to prevent thrombophlebitis? A. Teach gentle lower extremity exercises to the patient. B. Suggest that the patient lie in the supine position in bed. C. Provide a calm and soothing atmosphere to the patient. D. Give tocolytic medications as per the physician's prescription.

A (The health care provider may recommend reduced activity or complete bed rest for the patient experiencing preterm labor, depending on the severity of the symptoms. As a result, the patient may be at risk for thrombophlebitis due to limited activity. The nurse should teach the patient how to perform gentle exercises of the lower extremities. Suggesting that the patient lie in the supine position may cause supine hypotension. Instead, the nurse can suggest that the patient 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 patient's anxiety, but this intervention does not prevent thrombophlebitis. Tocolytic medications are given to the patient to inhibit uterine contractions (UCs), but they do not prevent thrombophlebitis.)

Immediately after the forceps-assisted birth of an infant, the nurse should: a. Assess the infant for signs of trauma. b. Give the infant prophylactic antibiotics. c. Apply a cold pack to the infant's scalp. d. Measure the circumference of the infant's head.

A (The infant should be assessed for bruising or abrasions at the site of application, facial palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps delivery. A cold pack would put the infant at risk for cold stress and is contraindicated. Measuring the circumference of the head is part of the initial nursing assessment.)

The exact cause of preterm labor is unknown and believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Select the type of infection that has not been linked to preterm births. a. Viral b. Periodontal c. Cervical d. Urinary tract

A (The infections that increase the risk of preterm labor and birth are all bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, it is important for the client to participate in early, continual, and comprehensive prenatal care. Evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent infection. Cervical infections of a bacterial nature have been linked to preterm labor and birth. The presence of urinary tract infections increases the risk of preterm labor and birth.)

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

A (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.)

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

A (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. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.)

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

A (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.)

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? A. Suggest that the client avoid smoking. B. Suggest that the client increase physical activity to prevent risk. C. Administer progesterone (Prometrium) suppositories to the client. D. Administer a 17-alpha hydroxy progesterone injection to the client.

A (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.)

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. These include (Select all that apply): a. Rupture of membranes at or near term. b. Convenience of the woman or her physician. c. Chorioamnionitis (inflammation of the amniotic sac). d. Post-term pregnancy. e. Fetal death.

A, C, D, E (These are all acceptable indications for induction. Other conditions include intrauterine growth retardation (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks' completed gestation.)

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. A. The client has a nuchal cord. B. The client is Rh negative. C. The client has oligohydramnios. D. The fetal heart rate is 120 beats per minute. E. The client has uterine anomalies

A, C, E (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.)

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? A. Perform large-bore catheter suction. B. Prepare for an emergency C-section. C. Administer calcium gluconate intravenously. D. Administer terbutaline (Brethine) subcutaneously.

B (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 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: A. uterine contractions occurring every 8 to 10 minutes. B. a fetal heart rate (FHR) of 180 with absence of variability. C. the woman needing to void. D. rupture of the woman's amniotic membranes.

B (An FHR of 180 with absence of variability is non-reassuring. 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 non-reassuring 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.)

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

B (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.)

While caring for the patient who requires an induction of labor, the nurse should be cognizant that: a. Ripening the cervix usually results in a decreased success rate for induction. b. Labor sometimes can be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor.

B (Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.)

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance: a. The terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy. c. Low birth weight is anything below 3.7 pounds. d. In the United States early in this century, preterm birth accounted for 18% to 20% of all births.

B (Before 20 weeks, it is not viable (miscarriage); after 37 weeks, it can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (37 weeks) regardless of weight; low birth weight describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth weight is anything less than 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.)

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? A. Swollen legs B. Respiratory rate C. Eating patterns D. Maternal chills

B (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.)

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? A. Calcium gluconate. B. Magnesium sulfate. C. Glucocorticoid drugs. D. Antibiotic medications.

B (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.)

Which drug is used for treating a client with severe postpartum bleeding? A. Nifedipine (Adalat) B. Oxytocin (Pitocin) C. Propranolol (Inderal) D. Metronidazole (Flagyl)

B (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.)

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation, which information should the nurse include? A. "Because this is a repeat procedure, you are at the lowest risk for complications." B. "Although this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures." C. "Because this is your second cesarean birth, you will recover faster." D. "You will not need preoperative teaching because this is your second cesarean birth."

B (Physiologic and psychological recovery from a cesarean birth is multifactorial and individual to each woman each time. Maternal and fetal risks are associated with every cesarean birth. Preoperative teaching should always be performed regardless of whether the woman has already had this procedure.)

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? a. Assessing deep tendon reflexes (DTRs) b. Assessing for chest discomfort and palpitations c. Assessing for bradycardia d. Assessing for hypoglycemia

B (Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include chest pain and palpitations. Assessing DTRs would not address these concerns. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic effect leads to hyperglycemia, not hypoglycemia.)

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she would be able to go home. Which response by the nurse is most accurate? a. "After the baby is born." b. "When we can stabilize your preterm labor and arrange home health visits." c. "Whenever the doctor says that it is okay." d. "It depends on what kind of insurance coverage you have."

B (The client's preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a woman with preterm labor is multifactorial; the goal is to prevent delivery. In many cases this may be achieved at home. Care of the preterm client is multidisciplinary and multifactorial. Managed care may dictate earlier hospital discharges or a shift from hospital to home care. Insurance coverage may be one factor in the care of clients, but ultimately client safety remains the most important factor.)

The nurse is caring for a client with premature rupture of membranes (PROM). How should the nurse instruct the client to manage the situation? A. "Consume excess amounts of fluids." B. "Assess fetal movement on a daily basis." C. "Monitor the skin for any discoloration." D. "Place yourself in Trendelenburg position."

B (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.)

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication will be administered to: a. Enhance uteroplacental perfusion in an aging placenta. b. Increase amniotic fluid volume. c. Ripen the cervix in preparation for labor induction. d. Stimulate the amniotic membranes to rupture.

C (It is accurate to state that Prepidil will be administered to ripen the cervix in preparation for labor induction. It is not administered to enhance uteroplacental perfusion in an aging placenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.)

A pregnant patient who has chorioamnionitis gave birth to a child through cesarean section. Which medication does the nurse expect the primary health care provider (PHP) to prescribe? A. Propranolol (Inderal) B. Clindamycin (Cleocin) C. Morphine (MS Contin) D. Terbutaline (Brethine)

B (The pregnant patient had chorioamnionitis before childbirth, which implies that bacteremia may develop in the patient. Because of bacteremia, there may be wound infection or pelvic abscess after cesarean section. Therefore, after cesarean birth, the patient should be given an antibiotic, such as clindamycin (Cleocin), which acts against anaerobic organisms. Propranolol (Inderal), morphine (MS Contin), and terbutaline (Brethine) are not antibiotics and are not administered after childbirth. They are drugs used to treat complications of labor.)

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? A. Buccal oxytocin (Pitocin) B. Terbutaline sulfate (Brethine) C. Calcium gluconate (Calgonate) D. Magnesium sulfate (Magnesium sulfate)

B (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. A. Upper abdominal pain B. Increased vaginal discharge C. Presence of vaginal bleeding D. Decreased urinary frequency E. Painful uterine contractions (UCs)

B, C, E (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. A. Fluid intake B. Respiratory status C. Body temperature D. Level of consciousness E. Deep tendon reflexes

B, D, E (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.)

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cues would alert the nurse that the woman is experiencing uterine hyperstimulation (Select all that apply)? a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency c. Uterine tone <20 mm Hg d. Uterine tone >20 mm Hg e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

B, D, E (Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.)

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? A. "I will empty my bladder immediately." B. "I will drink 2 to 3 glasses of water or juice." C. "I will lie in the supine position for 1 hour." D. "I will go to hospital if symptoms continue."

C (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.)

While caring for a pregnant patient, the nurse observes that the patient has foul-smelling vaginal discharge and maternal fever. Which type of birthing method does the nurse find suitable for the patient? A. Vaginal delivery B. Vacuum-assisted delivery C. Cesarean section delivery D. Forceps-assisted delivery

C (Foul odor from the vaginal discharge, combined with maternal fever, indicates that the patient has chorioamnionitis. Cesarean delivery is preferred for the patients with chorioamnionitis. Vacuum-assisted delivery is helpful in case of prolonged labor when the mother is not sufficiently capable to bear down the fetus. Vaginal delivery is not possible in this condition because of the increased risk of chorioamnionitis and prolonged labor. Forceps-assisted delivery is useful in case of fetal malpresentation of the head and in case of insufficient efforts by the patient to bear down.)

The priority nursing care associated with an oxytocin (Pitocin) infusion is: a. Measuring urinary output. b. Increasing infusion rate every 30 minutes. c. Monitoring uterine response. d. Evaluating cervical dilation.

C (Because of the risk of hyperstimulation, which could result in decreased placental perfusion and uterine rupture, the nurse's priority intervention is monitoring uterine response. Monitoring urinary output is also important; however, it is not the top priority during the administration of Pitocin. The infusion rate may be increased after proper assessment that it is an appropriate interval to do so. Monitoring labor progression is the standard of care for all labor patients.)

The ultrasound scanning reports of a pregnant patient confirmed the presence of a fetus in single footling breech position. Upon reviewing the medical records, the nurse finds that the patient has previously undergone uterine surgery. Which method should be planned for the safe birth of the infant? A. Internal version B. Vaginal delivery C. Cesarean section D. External cephalic version

C (Because the fetus is present in a single footling breech and the mother has a history of uterine surgery, a cesarean section would be the safest method of delivery. This helps prevent fetal distress. The external cephalic version should not be performed in the patients who have undergone uterine surgery, because it may cause uterine injury. The internal version is usually performed for patients with multifetal gestation. This is usually preferred for the delivery of the second fetus and may also cause maternal and fetal injury. Vaginal delivery is not advisable in this type of fetal presentation, because it may result in a prolapsed umbilical cord.)

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: a. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. b. There are no important maternal (as opposed to fetal) contraindications. c. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given.

C (Buying time for antenatal glucocorticoids to accelerate fetal lung development may 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.)

With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware of what? A. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks. B. There are no important maternal (as opposed to fetal) contraindications. C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. D. If the client develops pulmonary edema while on tocolytics, IV fluids should be given.

C (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 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? A. Give an oral dose of 10 mg nifedipine (Adalat). B. Administer propranolol (Inderal) intravenously. C. Infuse 500 mg of calcium chloride intravenously for 30 minutes. D. Administer 6 mg of dexamethasone (Decadron) intramuscularly.

C (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 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? A. Provide a large-bore suction catheter and bulb syringe. B. Place the baby in an incubator, providing frequent backrubs. C. Provide endotracheal tube suction assistance with ventilation. D. Administer 5 mg of sucrose solution within the first five hours of birth.

C (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.)

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction? a. Amniotomy b. Intravenous Pitocin c. Transcervical catheter d. Vaginal insertion of prostaglandins

C (Placement of a balloon-tipped Foley catheter into the cervix is a mechanical method of induction. Other methods to expand and gradually dilate the cervix include hydroscopic dilators such as laminaria tents (made from desiccated seaweed), or Lamicel (contains magnesium sulfate). Amniotomy is a surgical method of augmentation and induction. Intravenous Pitocin and insertion of prostaglandins are medical methods of induction.)

In planning for home care of a woman with preterm labor, which concern must the nurse address? a. Nursing assessments will be different from those done in the hospital setting. b. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers will be necessary.

C (Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed. Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman. Many women will receive home health nurse visits, but care is individualized for each woman.)

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? A. Previous cesarean birth. B. Preexisting diabetes mellitus. C. Cervical length is more than 30 mm. D. Symptoms of chronic hypertension.

C (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.)

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy? a. Dilation less than 3 cm b. Cephalic presentation c. -2 station d. Right occiput posterior position

C (The dilation of the cervix must be great enough to determine labor. The presenting part of the fetus should be engaged and well applied to the cervix before the procedure in order to prevent cord prolapse. Amniotomy is deferred if the presenting part is higher in the pelvis. ROP indicates a cephalic presentation, which is appropriate for an amniotomy.)

The least common cause of long, difficult, or abnormal labor (dystocia) is: a. Midplane contracture of the pelvis. b. Compromised bearing-down efforts as a result of pain medication. c. Disproportion of the pelvis. d. Low-lying placenta.

C (The least common cause of dystocia is disproportion of the pelvis.)

The nurse providing care to a woman in labor should understand that cesarean birth: a. Is declining in frequency in the twenty-first century in the United States. b. Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients. c. Is performed primarily for the benefit of the fetus. d. Can be either elected or refused by women as their absolute legal right.

C (The most common indications for cesarean birth are danger to the fetus related to labor and birth complications. Cesarean births are increasing in the United States in this century. Wealthier 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 surgery 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 nurse providing care to a woman in labor should be aware of which fact about cesarean birth? A. It is declining in frequency in the United States. B. It is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do. C. It is performed primarily for the health of the mother and fetus. D. It can be either elected or refused by women as their absolute legal right.

C (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 primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? a. She is exhibiting hypotonic uterine dysfunction. b. She is experiencing a normal latent stage. c. She is exhibiting hypertonic uterine dysfunction. d. She is experiencing pelvic dystocia.

C (Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress. With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether. The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds. Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of these planes.)

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. A. A history of postpartum hemorrhage B. A previous classical vertical incision C. Clinically adequate pelvis D. Previous low transverse incision E. No history of uterine rupture

C, D, E (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. A. Nausea and vomiting B. Upper back pain C. Fluid leakage from vagina D. Presence of vaginal bleeding E. Contractions every 10 minutes

C, D, E (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? A. The fetal heart rate (FHR) confirms tachycardia. B. The client's vaginal drainage has a foul-smell. C. The client has maternal chills frequently. D. The fetal heart rate (FHR) has variable decelerations.

D (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.)

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? a. Estriol is not found in maternal saliva. b. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. c. Fetal fibronectin is present in vaginal secretions. d. The cervix is effacing and dilated to 2 cm.

D (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.)

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? A. Estriol is not found in maternal saliva. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. The cervix is effacing and dilated to 2 cm.

D (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.)

Which statement is most likely to be associated with a breech presentation? A. Least common malpresentation B. Descent is rapid C. Diagnosis by ultrasound only D. High rate of neuromuscular disorders

D (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.)

With regard to the care management of preterm labor, nurses should be aware that: a. Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss, teaching pregnant women the symptoms probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

D (Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in not administering essential medications. Preterm labor is not necessarily long-term labor.)

Nurses should be aware that the induction of labor: a. Can be achieved by external and internal version techniques. b. Is also known as a trial of labor (TOL). c. Is almost always done for medical reasons. d. Is rated for viability by a Bishop score.

D (Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better position by a physician for an easier or safer birth. A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and are not done for medical reasons.)

The standard of care for obstetrics dictates that an internal version may be used to manipulate the: a. Fetus from a breech to a cephalic presentation before labor begins. b. Fetus from a transverse lie to a longitudinal lie before cesarean birth. c. Second twin from an oblique lie to a transverse lie before labor begins. d. Second twin from a transverse lie to a breech presentation during vaginal birth.

D (Internal version is used only during vaginal birth to manipulate the second twin into a presentation that allows it to be born vaginally. For internal version to occur, the cervix needs to be completely dilated.)

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

D (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.)

Which assessment is least likely to be associated with a breech presentation? a. Meconium-stained amniotic fluid b. Fetal heart tones heard at or above the maternal umbilicus c. Preterm labor and birth d. Post-term gestation

D (Post-term gestation is not likely to be seen with a breech presentation. The presence of meconium in a breech presentation may result from pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.)

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse? a. Fetal heart rate of 116 beats/min b. Cervix dilated 2 cm and 50% effaced c. Score of 8 on the biophysical profile d. One fetal movement noted in 1 hour of assessment by the mother

D (Self-care in a post-term 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. Normal findings in a 42-week gestation include fetal heart rate of 116 beats/min, cervix dilated 20 cm and 50% effaced, and a score of 8 on the biophysical profile.)

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/min B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D (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 116 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.)

For a woman at 42 weeks of gestation, which finding requires more assessment by the nurse? A. Fetal heart rate of 116 beats/minute B. Cervix dilated 2 cm and 50% effaced C. Score of 8 on the biophysical profile D. One fetal movement noted in 1 hour of assessment by the mother

D (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 preparing to perform a fetal fibronectin test for a pregnant client. Which intervention should the nurse perform to collect the sample for the test? A. Take a blood sample from the forearm. B. Take a sample of patient's amniotic fluid. C. Ask the patient to provide a urine sample. D. Collect the vaginal secretions using a swab.

D (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 priority nursing intervention after an amniotomy should be to: a. Assess the color of the amniotic fluid. b. Change the patient's gown. c. Estimate the amount of amniotic fluid. d. Assess the fetal heart rate.

D (The fetal heart rate must be assessed immediately after the rupture of the membranes to determine whether cord prolapse or compression has occurred. Secondary to FHR assessment, amniotic fluid amount, color, odor, and consistency is assessed. Dry clothing is important for patient comfort; however, it is not the top priority.)

Which nursing action should be initiated first when there is evidence of prolapsed cord? A. Notify the health care provider. B. Apply a scalp electrode. C. Prepare the woman for an emergency cesarean birth. D. Reposition the woman with her hips higher than her head.

D (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.)

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: a. A gravida 3 who has had two low-segment transverse cesarean births. b. A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant. c. A gravida 5 who had two vaginal births and two cesarean births. d. A gravida 4 who has had all cesarean births.

D (The risk of uterine rupture increases for the patient who has had multiple prior births with no vaginal births. As the number of prior uterine incisions increases, so does the risk for uterine rupture. Low-segment transverse cesarean scars do not predispose the patient to uterine rupture.)

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects? a. Urine output of 160 mL in 4 hours b. Deep tendon reflexes 2+ and no clonus c. Respiratory rate of 16 breaths/min d. Serum magnesium level of 10 mg/dL

D (The therapeutic range for magnesium sulfate management is 5 to 8 mg/dL. A serum magnesium level of 10 mg/dL could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 mL in 4 hours, deep tendon reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.)