Chapter 10: Early Onset of Labor

Question 1

risk factors of preterm labor

Answer 1

infection, previous preterm birth, multifetal, smoking, substance use, abuse, lack of prenatal care, uterine abnormalities, low pregnancy weight

Question 2

expected findings of preterm labor

Answer 2

uterine contractions, pressure in pelvis, cramping, low backache, GI cramping, diarrhea, urinary frequency, vaginal discharge

Question 3

physical assessment findings of preterm labor

Answer 3

change in vaginal discharge or blood, change in dilation, regular uterine contractions at least every 10 min for more than an hour, premature rupture of membranes, discomfort

Question 4

fetal fibronectin

Answer 4

protein in vaginal secretions found during early and late pregnancy, indicates inflammation if found 24-34 weeks

Question 5

diagnostic procedures for preterm labor

Answer 5

swab vaginal secretions, measure for shortened endocervical length, obtain cervical cultures, perform BPP and/or NST

Question 6

ways to stop uterine contractions in preterm labor

Answer 6

modified bed rest, no sex, hydration, treating infections

Question 7

nifedipine

Answer 7

calcium channel blocker used to suppress contractions

Question 8

nifedipine nursing actions

Answer 8

monitor for headache, dizziness, nausea, orthostatic hypotension, do not administer with magnesium sulfate or beta-adrenergic agonist

Question 9

nifedipine patient education

Answer 9

slowly change positions from supine to upright, maintain hydration

Question 10

magnesium sulfate

Answer 10

tocolytic that is a CNS depressant and relaxes smooth muscle to inhibit uterine activity

Question 11

magnesium sulfate contraindications

Answer 11

active vaginal bleeding, dilation over 6 cm, chorioamnionitis, over 34 weeks gestation, acute fetal distress, nifedipine, myasthenia gravis

Question 12

magnesium sulfate nursing actions

Answer 12

monitor closely and discontinue if there are signs of pulmonary edema, monitor for ADRs

Question 13

magnesium sulfate ADRs

Answer 13

hot flashes, diaphoresis, burning at IV site, nausea, vomiting, drowsiness, blurred vision, headache, non-reactive nonstress test, reduced fetal heart rate variability

Question 14

magnesium sulfate toxicity

Answer 14

loss of deep tendon reflexes, urinary output less than 30 mL/hr or 100 mL/4 hr, respirations less than 12/min, pulmonary edema, severe hypotension, or chest pain

Question 15

magnesium sulfate patient education

Answer 15

notify nurse of blurred vision, headache, nausea, vomiting, or difficulty breathing

Question 16

terbutaline

Answer 16

beta-adrenergic agonist used as a tocolytic for inhibiting uterine activity

Question 17

terbutaline nursing actions

Answer 17

assess for history of cardiac disease, pregestational
or gestational diabetes, preeclampsia with severe features of eclampsia, severe gestational hypertension, hyperthyroidism, or significant hemorrhage

Question 18

terbutaline ADRs

Answer 18

chest discomfort, palpitations, dysrhythmia,
tachycardia, tremors, nervousness, vomiting,
hypokalemia, hyperglycemia, and hypotension

Question 19

terbutaline patient education

Answer 19

notify if heart rate greater than 130/ min, chest pain, cardiac arrhythmias, myocardial
infarction, blood pressure less than 90/60 mm Hg, or
pulmonary edema

Question 20

terbutaline administration

Answer 20

0.25 mg subcutaneously every 4 hr, for up to 24 hr

Question 21

indomethacin

Answer 21

NSAID that suppresses preterm labor by blocking prostaglandins to suppress contractions

Question 22

indomethacin nursing actions

Answer 22

discontinue if patient has signs of pulmonary edema, do not administer for over 48 hours, do not administer for over 32 weeks gestation, give with food or rectally, monitor neonate at birth

Question 23

indomethacin patient education

Answer 23

notify provider if experiencing blurred vision, headache, nausea, vomiting, ringing in the ears, or difficulty breathing

Question 24

betamethasone

Answer 24

glucocorticoid, enhances fetal lung maturity and surfactant production in fetuses 24-34 weeks, given with PROM

Question 25

betamethasone nursing actions

Answer 25

administer 12 mg IM for two doses 24 hr apart, ideally every 24 hr for less than 7 days before delivery, administer in ventral gluteal or vests lateralis, monitor for hyperglycemia, assess infant’s lung sounds

Question 26

betamethasone patient education

Answer 26

report signs of pulmonary edema

Question 27

premature rupture of membranes (PROM)

Answer 27

spontaneous rupture of amniotic membranes prior to onset of true labor, usually signifies onset of true labor if pregnancy is at term

Question 28

preterm premature rupture of membranes (PPROM)

Answer 28

premature spontaneous rupture of membranes from 20-37 wks gestation

Question 29

risk factors for PROM and PPROM

Answer 29

infection, prior preterm birth, shortening of cervix, 2nd or 3rd trimester bleeding, pulmonary or connective tissue disorders, low BMI, copper or ascorbic acid deficiency, tobacco or substance use

Question 30

PROM and PPROM assessment

Answer 30

presence of clear fluid, asses for prolapsed umbilical cord by checking for abrupt FHR variable or prolonged deceleration and palpable cord at the introitus

Question 31

PROM and PPROM lab test

Answer 31

positive nitrazine paper test (blue, pH 6.5-7.5) or positive ferning test

Question 32

PROM and PPROM nursing care

Answer 32

obtain vaginal cultures, limit vaginal exams, provide reassurance, assess vitals every 2 hrs and call provider if temp over 100, monitor FHR and contractions, hydration, CBC, likely prescription for 7 day course antibiotics

Question 33

ampicillin

Answer 33

antibiotic for treating chorioamnionitis

Question 34

ampicillin nursing actions

Answer 34

obtain vaginal, urine, and blood cultures before administration

Question 35

complications of PROM and PPROM

Answer 35

infection (chorioamnionitis), placental abruption, umbilical cord compression or prolapse, fetal pulmonary hypoplasia, death

Question 36

PROM and PPROM patient education

Answer 36

limited activity, hydrate, self assess for contractions, record daily kick count, no sex, report foul smelling discharge, no baths, take temp every 4 hr and report if over 100