BN Ch. 68 High-Risk Pregnancy And Childbirth

Question 1

A/an _________ abortion occurs when the fetus has died but remains in the uterus.

Answer 1

Missed

Question 2

If the pregnant client contracts rubella early in pregnancy, fetal _________ or abnormality is a strong possibility.

Answer 2

Malformation

Question 3

Phototherapy is often useful in treating neonatal _________.

Answer 3

Jaundice

Question 4

Labor that occurs before the end of the 37th week of gestation is called ________.

Answer 4

Pre-term

Question 5

__________ agents may be given to stop the contractions.

Answer 5

Tocolytic

Question 6

A breast infection most commonly caused by Staphylococcus aureus

Answer 6

Mastitis

Question 7

An inflammation of the bladder caused by a microorganism

Answer 7

Cystitis

Question 8

An infection in any part of the reproductive tract occurring after childbirth

Answer 8

Puerperal Infection

Question 9

A clot in a blood vessel with resultant inflammation

Answer 9

Thrombophlebitis

Question 10

Write the correct sequence of steps for assisting with emergency childbirth.
1. Keep the newborn warm. Tie off the umbilical cord in two places but do not cut the umbilical cord.
2. Have the client hold the newborn and initiate breastfeeding. Get medical assistance as soon as possible.
3. Follow aseptic technique as closely as possible, and make sure the membranes have ruptured.
4. Make sure the newborn’s airway is clear before the first breath. Initiate respiration in the newborn.

Answer 10

3Follow aseptic technique as closely as possible, and make sure the membranes have ruptured.
4Make sure the newborn’s airway is clear before the first breath. Initiate respiration in the newborn.
1 Keep the newborn warm. Tie off the umbilical cord in two places but do not cut the umbilical cord.
2Have the client hold the newborn and initiate breastfeeding. Get medical assistance as soon as possible.

Question 11

What is amniotomy?

Answer 11

Amniotomy is a method of inducing labor by rupturing the amniotic membranes with a special hook.

Question 12

What is Bandl ring, and when is it seen?

Answer 12

When uterine rupture threatens, a Bandl ring may be noticeable, with a thickened upper segment and a thin distended lower segment of the uterus.

Question 13

What is a nuchal cord?

Answer 13

As the fetus moves within the uterus, the umbilical cord may become wrapped around the neck. This condition is known as nuchal cord.

Question 14

How is vacuum extraction done?

Answer 14

During vacuum extraction, a round, soft plastic cup is placed on the fetal head. Suction is created by a special pump to secure the cup to the presenting part (the fetal head), and traction is exerted to ease the fetus gently out of the birth canal.

Question 15

What is done in internal version?

Answer 15

In internal version, the fetus is turned with the birth attendant’s sterile gloved hand inside the uterus.

Question 16

A nurse is caring for a pregnant client with diabetes.
a. Which client and family teachings would a nurse provide for this client?

Answer 16

The nurse should provide the following client and family teachings to a pregnant woman with diabetes:
• How to self-test blood for glucose several times a day.
• How to adjust the diet and insulin based on glucose level.
• How to take insulin injections, if the client has not taken insulin previously.
• How to recognize signs of hyperglycemia and hypoglycemia.
• What to do if hyperglycemia or hypoglycemia is suspected.
• How to recognize signs and symptoms of beginning preeclampsia

Question 17

Why is it important to take special care of pregnant client with diabetes?

Answer 17

Pregnant women with diabetes require special care because diabetes is usually more difficult to control during pregnancy. If the woman becomes hyperglycemic, acidosis or diabetic coma may result. If she becomes hypoglycemic, there may be fetal hypoxia. It is important for the nurse to teach the mother how to count the number of baby movements in one day to monitor the activity of the baby.

Question 18

An adolescent client is in labor in the 36th week of gestation.
a. Define preterm labor.

Answer 18

Labor that occurs before the end of the 37th week of gestation is preterm labor.

Question 19

How would preterm labor be managed?

Answer 19

The client is placed on bed rest. Tocolytic agents may be given to stop the contractions if there is no fetal distress, the membranes are intact, and the cervix is dilated fewer than 4 cm. Medica- tions are usually administered intravenously until contractions cease, after which they may be administered orally. The client and fetus must be monitored closely for the remainder of the pregnancy.

Question 20

Why would the nurse assess for signs and symptoms of labor frequently in adolescent clients who are pregnant?

Answer 20

Assessment for signs and symptoms of labor is required frequently in adolescent clients who are pregnant because they have an increased risk for preterm labor, poor nutrition, and noncompliance with care.

Question 21

During an emergency delivery, a client had a laceration that involved the anal sphincter.
Which degree of laceration would the nurse document it as?
a. First degree
b. Second degree
C. Third degree
d. Fourth degree

Answer 21

C. Third degree

*rAtionAle: Third-degree laceration involves the anal sphincter. First-degree laceration involves the perineal skin and vaginal mucous membranes. Second-degree laceration involves muscles of the perineal body. Fourth-degree laceration extends to the anal canal.

Question 22

A pregnant client has spontaneously lost three successive pregnancies previously.
Which term best describes this?
a. Inevitable abortion
b. Missed abortion
C. Recurrent spontaneous abortion
d. Complete abortion

Answer 22

C. Recurrent spontaneous abortion

• rAtionAle: Recurrent spontaneous abortion means that a woman has spontaneously lost three or more successive pregnancies. An abortion in which the loss of the products of conception cannot be prevented is known as an inevitable abortion. A missed abortion occurs when the fetus has died but remains in the uterus. Complete abortion occurs when the woman spontaneously expels all the products of conception

Question 23

During an assessment, a nurse instructs a pregnant client to consult a healthcare provider immediately if they have any vaginal bleeding during the last trimester.
Such bleeding is usually caused by placenta previa. Which is a predisposing factor of placenta previa?

a. Previous vaginal delivery
b. Early fertilization of the ovum
c. Maternal age older than 40 years
D. Closely spaced pregnancies

Answer 23

D. Closely spaced pregnancies

• rAtionAle: Closely spaced pregnancies are a predisposing factor for placenta previa. Previous cesarean section leaving behind a uterine scar, not a previous vaginal delivery, may predispose to placenta previa. Late, not early, fertilization of the ovum also predisposes to the condition. Maternal age greater than 40 years predisposes to complications such as Down syndrome but not placenta previa.

Question 24

After delivery, a client’s placenta has failed to separate. Which is the most appropriate action in this condition?

a. Ultrasound examination
b. Manual removal of the placenta
c. Postpartum uterine D&C
D. Support and monitoring of vital signs

Answer 24

D. Support and monitoring of vital signs

• rAtionAle: Nursing measures in a client whose placenta has failed to separate include support and monitoring of vital signs. The birth attendant may need to remove the placenta manually and may perform a postpartum uterine D&C. Ultrasound examination should be done by the healthcare provider.

Question 25

A client has premature rupture of membranes. Interventions for this condition are listed below in random order. Arrange the interventions according to priority.
a. Induction of labor
b. Admission of the client
c. Ultrasound examination
d. Amniocentesis

Answer 25

b. Admission of the client
c. Ultrasound examination
d. Amniocentesis
a. Induction of labor

• rAtionAle: The client should be admitted to the healthcare facility when premature rupture of membranes occurs. The client and fetus are then assessed. Ultrasound and amniocentesis will determine fetal maturity. An ultrasound scan should always precede amniocentesis, to determine the location of the placenta and the fetal parts. Labor is induced if the fetus is sufficiently mature.

Question 26

Which complication is more likely in an adolescent pregnancy?
a. Placenta previa
b. Hydramnios
C. Preterm labor
d. Hypotonic dystocia

Answer 26

C. Preterm labor

• rAtionAle: Preterm labor is more common in adolescent pregnancy. The older grand multipara may be more likely to have placenta previa, hydramnios, or hypotonic dystocia.

Question 27

A client who is breastfeeding their baby complains of painful and swollen breasts and is febrile. Which action would the nurse ask the client to do in order to prevent mastitis complication?
a. Nurse the baby on the unaffected breast only.
b. Place cold packs on the breasts.
C. Follow the antibiotic therapy regimen strictly.
d. Move around as much as possible.

Answer 27

C. Follow the antibiotic therapy regimen strictly.

*rAtionAle: The client with mastitis should follow the antibiotic therapy regimen directed by the healthcare provider. She should not nurse the baby on the unaffected breast only, place cold packs on the breasts, or move around too much. She should have mandatory bed rest. She should continue to nurse the newborn on both breasts, beginning with the unaffected breast to ease the let-down reflex on the other side. She should use hot packs on the breast for comfort.

Question 28

A client is diagnosed with pregnancy-induced hypertension. Which precaution would the nurse tell the client and their family to take?
a. Keep the client’s room well-lit.
b. Avoid sedating the client.
c. Ask the client to ambulate.
D. Decrease external stimuli and stress.

Answer 28

D. Decrease external stimuli and stress.

• rAtionAle: The nurse should ensure that there are no external stimuli or stress that would disturb the client. The room is kept quiet and fairly dark and sedatives are given to prevent convulsions. The client should be on bed rest and not asked to ambulate.

Question 29

A client in labor is admitted to a healthcare facility with a prolapsed cord. Which actions would the nurse take? Select all that apply.
A. Notify the healthcare provider at once and prepare for resuscitation.
b. Place the client in the left lateral position.
c. Perform a sterile vaginal examination immediately.
D. Cover cord with moistened sterile towels.
E. Hold the presenting part away from the cord.

Answer 29

A. Notify the healthcare provider at once and prepare for resuscitation.
D. Cover cord with moistened sterile towels.
E. Hold the presenting part away from the cord.

• rAtionAle: If the client has a prolapsed cord, the nurse should notify the healthcare provider at once and prepare for resuscitation. If the cord has prolapsed outside the vagina, it is covered with sterile towels and moistened with warm, sterile normal saline. This measure prevents drying and caking of the cord and fetal blood. The nurse must insert a sterile gloved hand into the vagina to hold the fetal presenting part away from the cord. This measure ensures that fetal circulation is not cut off while the woman is prepared for an emergency cesarean delivery. The nurse should place the woman in the Trendelenburg or knee–chest position as ordered, to avoid compression of the cord. The left lateral position is not beneficial. The healthcare provider and not the nurse should perform a sterile vaginal examination.

Question 30

A client is being given preoperative care for cesarean delivery. Which role does the nurse take in preoperative care?
A. Assess for symptoms of fetal distress.
b. Administer general anesthesia to the client.
c. Administer perineal care and oxytocic drugs.
d. Perform external version to turn the fetus.

Answer 30

A. Assess for symptoms of fetal distress

• rAtionAle: The nurse should assess for symptoms of fetal distress or any unusual discomfort the client might experience. The client is given an epidural (spinal anesthetic), and not a general anesthetic, so that the fetus does not experience any respiratory problems. Administration of perineal care and oxytocic drugs is done during the postoperative period. The birth attendant performs an external version to turn the fetus to a more desirable presentation for a vaginal delivery, not a cesarean delivery.