Exam 2 - Chapter 32 Flashcards
In planning for home care of a woman with preterm labor, which concern should thenurse
need to address?
a. Nursing assessments are different from those performed in thehospital setting.
b. Restricted activity and medications are necessary to prevent a recurrence of preterm
labor.
c. Prolonged bed rest may cause negative physiologic effects.
d. Home health care providers are 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 differ somewhat from those performed in theacute care setting, but this concern does
not need to be addressed. Restricted activity and medications may prevent preterm labor but not
in all women. In addition, theplan of care is individualized to meet theneeds of each client. Many
women receive home health nurse visits, but care is individualized for each woman
Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.
B - Terbutaline is a beta2-adrenergic agonist that affects themothers cardiopulmonary and metabolic
systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and
dyspnea. An assessment for dyspnea and crackles is important for thenurse to perform if
thewoman is taking magnesium sulfate. Assessing DTRs does not address thepossible respiratory
side effects of using terbutaline. Since terbutaline is a beta2-adrenergic agonist, it can lead to
hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs cause tachycardia, not
bradycardia
In evaluating theeffectiveness of magnesium sulfate for thetreatment of preterm labor,
which finding alerts thenurse to possible side effects?
a. Urine output of 160 ml in 4 hours
b. DTRs 2+ and no clonus
c. Respiratory rate (RR) of 16 breaths per minute
d. Serum magnesium level of 10 mg/dl
D - Thetherapeutic range for magnesium sulfate management is 4 to 7.5 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, DTRs of 2+, and a RR of 16 breaths
per minute are all normal findings.
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular
(IM) doses of betamethasone. What is thepurpose of this pharmacologic intervention?
a. To stimulate fetal surfactant production
b. To reduce maternal and fetal tachycardia associated with ritodrine administration
c. To suppress uterine contractions
d. To maintain adequate maternal respiratory effort and ventilation during magnesium
sulfate therapy
A - Antenatal glucocorticoids administered as IM injections to themother accelerate fetal lung
maturity. Propranolol (Inderal) is given to reduce theeffects of ritodrine administration.
A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes
and states that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours.
Thewoman is crying and wants an epidural. What is thelikely status of this womans 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 precipitous labor.
C - Thecontraction pattern observed 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. Women
who experience hypertonic uterine dysfunction, or primary dysfunctional labor, are often 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,
thewoman initially makes normal progress into theactive stage of labor; then thecontractions
become weak and inefficient or stop altogether. Precipitous labor is one that lasts less than 3
hours from theonset of contractions until time of birth
A woman is having her first child. She has been in labor for 15 hours. A vaginal
examination performed 2 hours earlier revealed thecervix to be dilated to 5 cm and 100%
effaced, and thepresenting part of thefetus was at station 0; however, another vaginal examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is
associated with this description?
a. Prolonged latent phase
b. Protracted active phase
c. Secondary arrest
d. Protracted descen
C - With a secondary arrest of theactive phase, theprogress of labor has stopped. This client has not
had any anticipated cervical change, indicating an arrest of labor. In thenulliparous woman, a
prolonged latent phase typically lasts longer than 20 hours. A protracted active phase, thefirst or
second stage of labor, is prolonged (slow dilation). With a protracted descent, thefetus fails to
descend at an anticipated rate during thedeceleration phase and second stage of labor
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What
is theprimary purpose of prostaglandin administration?
a. To enhance uteroplacental perfusion in an aging placenta
b. To increase amniotic fluid volume
c. To ripen thecervix in preparation for labor induction
d. To stimulate theamniotic membranes to rupture
C - Preparations of prostaglandin E1 and E2 are effective when used before labor induction to ripen
(i.e., soften and thin) thecervix. Uteroplacental perfusion is not altered by theuse of
prostaglandins. Theinsertion of prostaglandin gel has no effect on thelevel of amniotic fluid. In
some cases, women will spontaneously begin laboring after theadministration of prostaglandins,
thereby eliminating theneed for oxytocin. It is not common for a womans membranes to rupture
as a result of prostaglandin use.
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 might be able to go
home. Which response by thenurse is mostaccurate?
a. After thebaby is born.
b. When we can stabilize your preterm labor and arrange home health visits.
c. Whenever your physician says that it is okay.
d. It depends on what kind of insurance coverage you have.
B - This clients 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 client with preterm labor is multidisciplinary
and multifactorial; thegoal is to prevent delivery. In many cases, this goal may be achieved at
home. Managed care may dictate an earlier hospital discharge or a shift from hospital to home
care. Insurance coverage may be one factor in client care, but ultimately, client safety remains
themost important factor
Theobstetric provider has informed thenurse that she will be performing an amniotomy
on theclient to induce labor. What is thenurses highest priority intervention after theamniotomy
is performed?
a. Applying clean linens under thewoman
b. Taking theclients vital signs
c. Performing a vaginal examination
d. Assessing thefetal heart rate (FHR)
D - TheFHR is assessed before and immediately after theamniotomy to detect any changes that
might indicate cord compression or prolapse. Providing comfort measures, such as clean linens,
for theclient is important but not thepriority immediately after an amniotomy. Thewomans
temperature should be checked every 2 hours after therupture of membranes but not thepriority
immediately after an amniotomy. Thewoman would have had a vaginal examination during
theprocedure. Unless cord prolapse is suspected, another vaginal examination is not warranted.
Additionally, FHR assessment provides clinical cues to a prolapsed cord.
Thenurse who elects to work in thespecialty of obstetric care must have theability to
distinguish between preterm birth, preterm labor, and low birth weight. Which statement
regarding this terminology is correct?
a. 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 gestation.
c. Low birth weight is a newborn who weighs below 3.7 pounds.
d. Preterm birth rate in theUnited States continues to increase.
B - Before 20 weeks of gestation, thefetus is not viable (miscarriage); after 37 weeks, thefetus can be
considered term. Although these terms are used interchangeably, they have different meanings:
preterm birth describes thelength of gestation (before 37 weeks), regardless of thenewborns
weight; low birth weight describes only theinfants weight at thetime of birth (2500 g or less),
whenever it occurs. Low birth weight is anything below 2500 g or approximately pounds. In
2011, thepreterm birth rate in theUnited States was 11.7 %; it has dropped every year since 2008
Thenurse is performing an assessment on a client who thinks she may be experiencing
preterm labor. Which information is themost important for thenurse to understand and share with
theclient?
a. Because all women must be considered at risk for preterm labor and prediction is so
variable, teaching pregnant women thesymptoms of preterm labor probably causes more harm
through false alarms.
b. Braxton Hicks contractions often signal theonset of preterm labor.
c. Because preterm labor is likely to be thestart of an extended labor, a woman with
symptoms can wait several hours before contacting theprimary caregiver.
d. 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
theearly symptoms of preterm labor.
Which statement related to cephalopelvic disproportion (CPD) is theleast accurate?
a. CPD can be related to either fetal size or fetal position.
b. Thefetus cannot be born vaginally.
c. CPD can be accurately predicted.
d. Causes of CPD may have maternal or fetal origins.
C - Unfortunately, accurately predicting CPD is not possible. Although CPD is often related to
excessive fetal size (macrosomia), malposition of thefetal presenting part is theproblem in many
cases, not true CPD. When CPD is present, thefetus cannot fit through thematernal pelvis to be
born vaginally. CPD may be related to either fetal origins such as macrosomia or malposition or
maternal origins such as a too small or malformed pelvis
Which statement related to theinduction of labor is most accurate?
a. Can be achieved by external and internal version techniques
b. Is also known as a trial of labor (TOL)
c. Is almost always performed 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 or 5 or higher for veterans. Version is theturning of thefetus to a better position by a
physician for an easier or safer birth. A TOL is theobservance of a woman and her fetus for
several hours of active labor to assess thesafety of vaginal birth. Two thirds of cases of induced
labor are elective and not done for medical reasons.
A number of methods can be used for inducing labor. Which cervical ripening method
falls under thecategory of mechanical or physical?
a. Prostaglandins are used to soften and thin thecervix.
b. Labor can sometimes be induced with balloon catheters or laminaria tents.
c. Oxytocin is less expensive and more effective than prostaglandins but creates greater
health risks.
d. Amniotomy can be used to make thecervix more favorable for labor.
B - Balloon catheters or laminaria tents are mechanical means of ripening thecervix. Ripening
thecervix, making it softer and thinner, increases thesuccess rate of induced labor. Prostaglandin
E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is
theartificial rupture of membranes, which is used to induce labor only when thecervix is already
ripe
Which description most accurately describes theaugmentation of labor?
a. Is part of theactive management of labor that is instituted when thelabor process is
unsatisfactory
b. Relies on more invasive methods when oxytocin and amniotomy have failed
c. Is a modern management term to cover up thenegative connotations of forceps- assisted
birth
d. Uses vacuum cups
A - Augmentation is part of theactive 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 more gentle, noninvasive methods. Forceps-assisted births are
less common than in thepast and not considered a method of augmentation. A vacuum-assisted
delivery occurs during childbirth if themother is too exhausted to push. Vacuum extraction is not
considered an augmentation methodology
