CH. 17

Question 1

In planning for home care of a woman with preterm labor, which concern must the nurse address?

Answer 1

Prolonged bed rest may cause negative physiologic effects.

Question 2

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?

Answer 2

Assessing for chest discomfort and palpitation.

Question 3

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, what finding would alert the nurse to possible side effects?

Answer 3

Serum magnesium level of 10 mg/dL

Question 4

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:

Answer 4

Stimulate fetal surfactant production.

Question 5

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?

Answer 5

The cervix is effacing and dilated to 2 cm.

Question 6

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 womans labor?

Answer 6

She is exhibiting hypertonic uterine dysfunction.

Question 7

Which assessment is least likely to be associated with a breech presentation?

Answer 7

Post-term gestation

Question 8

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?

Answer 8

Arrest of active phase

Question 9

In evaluating the effectiveness of oxytocin induction, the nurse would expect:

Answer 9

Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.

Question 10

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?

Answer 10

Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures.

Question 11

For a woman at 42 weeks of gestation, which finding would require further assessment by the nurse?

Answer 11

One fetal movement noted in 1 hour of assessment by the mother

Question 12

A pregnant womans amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority?

Answer 12

Placing the woman in the knee-chest position

Question 13

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:

Answer 13

Ripen the cervix in preparation for labor induction.

Question 14

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?

Answer 14

When we can stabilize your preterm labor and arrange home health visits.

Question 15

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:

Answer 15

A fetal heart rate (FHR) of 180 with absence of variability.

Question 16

Nurses should know some basic definitions concerning preterm birth, preterm labor, and low birth weight. For instance:

Answer 16

Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.

Question 17

With regard to the care management of preterm labor, nurses should be aware that:

Answer 17

The diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

Question 18

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

Answer 18

Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

Question 19

With regard to dysfunctional labor, nurses should be aware that:

Answer 19

Women experiencing precipitous labor are about the only dysfunctionals not to be exhausted.

Question 20

The least common cause of long, difficult, or abnormal labor (dystocia) is:

Answer 20

Disproportion of the pelvis.

Question 21

Nurses should be aware that the induction of labor:

Answer 21

Is rated for viability by a Bishop score.

Question 22

While caring for the patient who requires an induction of labor, the nurse should be cognizant that:

Answer 22

Labor sometimes can be induced with balloon catheters or laminaria tents.

Question 23

With regard to the process of augmentation of labor, the nurse should be aware that it:

Answer 23

Is part of the active management of labor that is instituted when the labor process is unsatisfactory.

Question 24

The nurse providing care to a woman in labor should understand that cesarean birth:

Answer 24

Is performed primarily for the benefit of the fetus.

Question 25

To provide safe care for the woman, the nurse understands that which condition is a contraindication for an amniotomy?

Answer 25

-2 station

Question 26

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.

Answer 26

Viral

Question 27

Which patient status is an acceptable indication for serial oxytocin induction of labor?

Answer 27

Past 42 weeks gestation

Question 28

The standard of care for obstetrics dictates that an internal version may be used to manipulate the:

Answer 28

Second twin from a transverse lie to a breech presentation during vaginal birth.

Question 29

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is:

Answer 29

A gravida 4 who has had all cesarean births.

Question 30

Before the physician performs an external version, the nurse should expect an order for a:

Answer 30

Tocolytic drug.

Question 31

A maternal indication for the use of vacuum extraction is:

Answer 31

Maternal exhaustion.

Question 32

The priority nursing intervention after an amniotomy should be to:

Answer 32

Assess the fetal heart rate.

Question 33

The priority nursing care associated with an oxytocin (Pitocin) infusion is:

Answer 33

Monitoring uterine response.

Question 34

Immediately after the forceps-assisted birth of an infant, the nurse should:

Answer 34

Assess the infant for signs of trauma.

Question 35

Surgical, medical, or mechanical methods may be used for labor induction. Which technique is considered a mechanical method of induction?

Answer 35

Transcervical catheter

Question 36

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)?

Answer 36

Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency
Uterine tone >20 mm Hg
Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

Question 37

Complications and risks associated with cesarean births include (Select all that apply):

Answer 37

Wound dehiscence.
Hemorrhage.
Urinary tract infections.
Fetal injuries.

Question 38

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):

Answer 38

Rupture of membranes at or near term.
Chorioamnionitis (inflammation of the amniotic sac).
Post-term pregnancy.
Fetal death.