Exam 2 Maternity CH.32-36 Flashcards
meow
1
Q
In planning for home care of a woman with preterm labor, which concern should the nurse
need to address?
A
Prolonged bed rest may cause negative physiologic effects.
2
Q
Which nursing intervention is paramount when providing care to a client with preterm labor
who has received terbutaline?
A
Assess for dyspnea and crackles.
3
Q
In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which
finding alerts the nurse to possible side effects?
A
Serum magnesium level of 10 mg/dl
4
Q
A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM)
doses of betamethasone. What is the purpose of this pharmacologic intervention?
A
To stimulate fetal surfactant production
5
Q
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.
The woman is crying and wants an epidural. What is the likely status of this woman’s labor?
A
She is exhibiting hypertonic uterine dysfunction.
6
Q
A woman is having her first child. She has been in labor for 15 hours. A vaginal examination
performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced, and the
presenting part of the fetus 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
Secondary arrest
7
Q
Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the
primary purpose of prostaglandin administration?
A
To ripen the cervix in preparation for labor induction
8
Q
. 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 the nurse is most accurate
A
“When we can stabilize your preterm labor and arrange home health visits.”
9
Q
The obstetric provider has informed the nurse that she will be performing an amniotomy on the
client to induce labor. What is the nurse’s highest priority intervention after the amniotomy is
performed?
A
Assessing the fetal heart rate (FHR)
10
Q
The nurse who elects to work in the specialty of obstetric care must have the ability to
distinguish between preterm birth, preterm labor, and low birth weight. Which statement
regarding this terminology is correct?
A
Preterm labor is defined as cervical changes and uterine contractions occurring between 20
and 37 weeks of gestation.
11
Q
The nurse is performing an assessment on a client who thinks she may be experiencing
preterm labor. Which information is the most important for the nurse to understand and share
with the client?
A
Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive
cervical change.
12
Q
Which statement related to cephalopelvic disproportion (CPD) is the least accurate?
A
CPD can be accurately predicted.
13
Q
Which statement related to the induction of labor is most accurate?
A
Is rated for viability by a Bishop score
14
Q
A number of methods can be used for inducing labor. Which cervical ripening method falls
under the category of mechanical or physical?
A
Labor can sometimes be induced with balloon catheters or laminaria tents
15
Q
Which description most accurately describes the augmentation of labor?
A
Is part of the active management of labor that is instituted when the labor process is
unsatisfactory
16
Q
The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is
thought to be a major factor in many preterm labors. Which type of infection has not been linked
to preterm birth?
A
Viral
17
Q
The nurse is teaching a client with preterm premature rupture of membranes (PPROM)
regarding self-care activities. Which activities should the nurse include in her teaching?
A
Do not engage in sexual activity.
18
Q
A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing
preterm labor. Which finding indicates that preterm labor is occurring?
A
The cervix is effacing and dilated to 2 cm
19
Q
Which assessment is least likely to be associated with a breech presentation?
A
Post term gestation
20
Q
A pregnant woman’s amniotic membranes have ruptured. A prolapsed umbilical cord is
suspected. What intervention would be the nurse’s highest priority?
A
Placing the woman in the knee-chest position
21
Q
What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?
A
The most important function of tocolytic therapy is to provide the opportunity to administer
antenatal glucocorticoids.
22
Q
When would an internal version be indicated to manipulate the fetus into a vertex position?
A
Second twin from a transverse lie to a breech presentation during a vaginal birth
23
Q
A client at 39 weeks of gestation has been admitted for an external version. Which
intervention would the nurse anticipate the provider to order?
A
Tocolytic drug
24
Q
What is a maternal indication for the use of vacuum-assisted birth?
A
Maternal exhaustion
25
Which nursing intervention should be immediately performed after the forceps-assisted birth
of an infant?
Assessing the infant for signs of trauma
26
The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency
interventions. What clinical cues alert the nurse that the woman is experiencing uterine
hyperstimulation? (Select all that apply.)
b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency
d. Uterine tone >20 mm Hg
e. Increased uterine activity accompanied by a non reassuring FHR and pattern
27
What are the complications and risks associated with cesarean births? (Select all that apply.)
a. Pulmonary edema
b. Wound dehiscence
c. Hemorrhage
d. Urinary tract infections
e. Fetal injuries
28
Women who are obese are at risk for several complications during pregnancy and birth. Which
of these would the nurse anticipate with an obese client? (Select all that apply.)
a. Thromboembolism
b. Cesarean birth
c. Wound infection
e. Hypertension
29
The 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 clients for this procedure and therefore must be cognizant of the specific conditions
appropriate for labor induction. What are appropriate indications for induction? (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)
e. Fetal death
30
Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has
had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after
cesarean (VBAC). Which clients would beless likely to have a successful VBAC? (Select all that
apply.)
b. African-American race
c. Delivery at a rural hospital
e. Maternal obesity (BMI >30)
31
A perinatal nurse is caring for a woman in the immediate postbirth period. Assessment reveals
that the client is experiencing profuse bleeding. What is the most likely cause for this bleeding?
Uterine atony
32
What is the primary nursing responsibility when caring for a client who is experiencing an
obstetric hemorrhage associated with uterine atony?
Performing fundal massage
33
What is the most common reason for late postpartum hemorrhage (PPH)?
Subinvolution of the uterus
34
Which client is at greatest risk for early PPH?
Woman with severe preeclampsia on magnesium sulfate whose labor is being induced
35
The nurse suspects that her postpartum client is experiencing hemorrhagic shock. Which
observation indicates or would confirm this diagnosis?
Urinary output of at least 30 ml/hr
36
The most effective and least expensive treatment of puerperal infection is prevention. What is
the most important strategy for the nurse to adopt?
Strict aseptic technique, including hand washing, by all health care personnel
37
What is one of the initial signs and symptoms of puerperal infection in the postpartum client?
Temperature of 38° C (100.4° F) or higher on 2 successive days
38
Nurses need to understand the basic definitions and incidence data regarding PPH. Which
statement regarding this condition is most accurate?
Traditionally, PPH has been classified as early PPH or late PPH with respect to birth.
39
A woman who has recently given birth complains of pain and tenderness in her leg. On
physical examination, the nurse notices warmth and redness over an enlarged, hardened area.
Which condition should the nurse suspect, and how will it be confirmed?
Thrombophlebitis; using real-time and color Doppler ultrasound
40
Which classification of placental separation is not recognized as an abnormal adherence
pattern?
Placenta abruptio
41
Which condition is considered a medical emergency that requires immediate treatment?
Inversion of the uterus
42
Which is the initial treatment for the client with vWD who experiences a PPH?
Desmopressin
43
What would a steady trickle of bright red blood from the vagina in the presence of a firm
fundus suggest to the nurse?
Lacerations of the genital tract
44
If nonsurgical treatment for late PPH is ineffective, which surgical procedure would be
appropriate to correct the cause of this condition?
Dilation and curettage (D&C)
45
Which medications are used to manage PPH? (Select all that apply.)
a. Oxytocin
b. Methergine
d. Hemabate
46
Lacerations of the cervix, vagina, or perineum are also causes of PPH. Which factors influence
the causes and incidence of obstetric lacerations of the lower genital tract? (Select all that apply.)
a. Operative and precipitate births
c. Abnormal presentation of the fetus
d. Congenital abnormalities of the maternal soft tissue
e. Previous scarring from infection
47
An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute
with significant substernal retractions). The infant is given oxygen by continuous nasal positive
airway pressure (CPAP). What level of partial pressure of arterial oxygen (PaO2) indicates
hypoxia?
45 mm Hg
48
On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents
ask if they may hold their infant during his next gavage feeding. Considering that this newborn is
physiologically stable, what response should the nurse provide?
You may hold your baby during the feeding.”
49
A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant.
How does the nurse explain surfactant therapy to the parents?
Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon
dioxide.”
50
An infant is to receive gastrostomy feedings. Which intervention should the nurse institute to
prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory
compromise?
Slow, small, warm bolus feedings over 30 minutes
51
A premature infant never seems to sleep longer than an hour at a time. Each time a light is
turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries
until held. What is the correct nursing diagnosis beginning with “ineffective coping, related to”?
Environmental stress
52
Which clinical findings would alert the nurse that the neonate is expressing pain?
Cry face; eyes squeezed; increase in blood pressure
53
A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29
weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy
was uncomplicated until the premature rupture of membranes and preterm birth. The newborn’s
parents arrive for their first visit after the birth. The parents walk toward the bedside but remain
approximately 5 feet away from the bed. What is the nurse’s most appropriate action?
Go to the parents, introduce him or herself, and gently encourage them to meet their infant.
Explain the equipment first, and then focus on the newborn.
54
An infant is being discharged from the NICU after 70 days of hospitalization. The infant was
born at 30 weeks of gestation with several conditions associated with prematurity, including
RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring
surgical treatment. During discharge teaching, the infant’s mother asks the nurse if her baby will
meet developmental milestones on time, as did her son who was born at term. What is the
nurse’smost appropriate response?
Your baby will need to be corrected for prematurity.
55
A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure
dates. A nonstress test (NST) in the obstetrician’s office revealed a nonreactive tracing. On
artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse
caring for the infant after birth anticipate?
Meconium aspiration, hypoglycemia, and dry, cracked skin
56
During the assessment of a preterm infant, the nurse notices continued respiratory distress
even though oxygen and ventilation have been provided. In this situation, which condition
should the nurse suspect?
Hypovolemia and/or shock
57
In appraising the growth and development potential of a preterm infant, the nurse should be
cognizant of the information that is best described in which statement?
Correct for milestones, such as motor competencies and vocalizations, until the child is
approximately 2 years of age.
58
A nurse practicing in the perinatal setting should promote kangaroo care regardless of an
infant’s gestational age. Which statement regarding this intervention is most appropriate?
Kangaroo care helps infants interact directly with their parents and enhances their
temperature regulation.
59
For clinical purposes, the most accurate definition of preterm and postterm infants is defined
as what?
Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation; no
matter the size for gestational age at birth
60
With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn
to a different facility, which information is essential to provide to the parents?
Parents of high-risk infants need special support and detailed contact information.
61
By understanding the four mechanisms of heat transfer (convection, conduction, radiation,
and evaporation), the nurse can create an environment for the infant that prevents temperature
instability. Which significant symptoms will the infant display when experiencing cold stress?
Mottled skin with acrocyanosis
62
When evaluating the preterm infant, the nurse understands that compared with the term infant,
what information is important for the nurse to understand?
Greater surface area in proportion to weight
63
When providing an infant with a gavage feeding, which infant assessment should be
documented each time?
Response to the feeding
64
An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse
weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the
prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse
oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is
the nurse’s most appropriate action at this time?
Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing
oxygen, and notifying a physician
65
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa.
The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition?
Abdominal distention, temperature instability, and grossly bloody stools
66
In caring for the preterm infant, what complication is thought to be a result of high arterial
blood oxygen level?
ROP
67
Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses,
followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing?
Breathing in a respiratory pattern common to premature infants
68
With regard to infants who are SGA and intrauterine growth restriction (IUGR), the nurse
should be aware of which information?
Infants with asymmetric IUGR have the potential for normal growth and development.
69
NEC is an acute inflammatory disease of the gastrointestinal mucosa that can progress to
perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal
disease. Care is supportive; however, known interventions may decrease the risk of NEC. Which
intervention has the greatest effect on lowering the risk of NEC?
Breastfeeding
70
Because of the premature infant’s decreased immune functioning, what nursing diagnosis
should the nurse include in a plan of care for a premature infant?
Risk for infection
71
What is the most important nursing action in preventing neonatal infection?
Good handwashing
72
Which risk factors are associated with NEC? (Select all that apply.)
a. Polycythemia
b. Anemia
c. Congenital heart disease
73
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm
infantsbecause they have many needs similar to those of preterm infants. Because they are more
stable than early-preterm infants, they may receive care that is similar to that of a full-term baby.
These infants are at increased risk for which conditions? (Select all that apply.)
a. Problems with thermoregulation
b. Cardiac distress
c. Hyperbilirubinemia
74
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the
infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurse’s first priority?
Frequently monitor blood glucose levels, and closely observe the infant for signs of
hypoglycemia.
75
. A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal
cord was found at delivery. After birth, the infant is noted to have petechiae over the face and
upper back. Which information regarding petechiae is most accurate and should be provided to
the parents?
Are benign if they disappear within 48 hours of birth
76
What information regarding a fractured clavicle is most important for the nurse to take into
consideration when planning the infant’s care?
No special treatment is necessary.
77
Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing?
Respiratory distress syndrome
78
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A
cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is
180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7
at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is
the most likely cause of this newborn’s distress?
Sepsis
79
What is the most important nursing action in preventing neonatal infection?
Good handwashing
80
A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After
birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The
infant also is microcephalic. Based on her infant’s physical findings, this woman should be
questioned about her use of which substance during pregnancy?
Alcohol
81
For an infant experiencing symptoms of drug withdrawal, which intervention should be
included in the plan of care?
Snugly swaddling the infant and tightly holding the baby
82
Human immunodeficiency virus (HIV) may be transmitted perinatally or during the
postpartum period. Which statement regarding the method of transmission is most accurate?
Through the ingestion of breast milk from an infected mother
83
Which substance, when abused during pregnancy, is the most significant cause of cognitive
impairment and dysfunction in the infant?
Alcohol
84
During a prenatal examination, a woman reports having two cats at home. The nurse informs
her that she should not be cleaning the litter box while she is pregnant. The client questions the
nurse as to why. What is the nurse’s most appropriate response?
“Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you
and have severe effects on your unborn child.”
85
A primigravida has just delivered a healthy infant girl. The nurse is about to administer
erythromycin ointment in the infant’s eyes when the mother asks, “What is that medicine for?”
How should the nurse respond?
“Erythromycin is prophylactically given to prevent a gonorrheal infection.”
86
The nurse should be cognizant of which condition related to skeletal injuries sustained by a
neonate during labor or childbirth?
Unless a blood vessel is involved, linear skull fractures heal without special treatment.
87
The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted
delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the
care of this neonate?
In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only
through laboratory tests.
88
Near the end of the first week of life, an infant who has not been treated for any infection
develops a copper-colored maculopapular rash on the palms and around the mouth and anus. The
newborn is displaying signs and symptoms of which condition?
Congenital syphilis
89
What bacterial infection is definitely decreasing because of effective drug treatment?
Group B streptococci (GBS) infection
90
Providing care for the neonate born to a mother who abuses substances can present a
challenge for the health care team. Nursing care for this infant requires a multisystem approach.
What is the first step in the provision of care for the infant?
Neonatal abstinence syndrome (NAS) scoring
91
An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant
appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the
result of what condition?
Hypoglycemia
92
Which information regarding to injuries to the infant’s plexus during labor and birth
is most accurate?
If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6
months.
93
A number of common drugs of abuse may cross into the breast milk of a mother who is
currently using these substances, which may result in behavioral effects in the newborn. Which
substances are contraindicated if the mother elects to breastfeed her infant? (Select all that
apply.)
a. Cocaine
b. Marijuana
c. Nicotine
94
To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the
newborn population must be aware of the physiologic characteristics related to these conditions.
What is the most common cause of pathologic hyperbilirubinemia?
Hemolytic disorders
95
Which infant is most likely to express Rh incompatibility?
Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh
factor
96
What is the highest priority nursing intervention for an infant born with myelomeningocele?
Protect the sac from injury.
97
Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic
hernia?
Impaired gas exchange
98
What is the clinical finding most likely to be exhibited in an infant diagnosed with
erythroblastosis fetalis?
Immature red blood cells
99
Which statement regarding congenital anomalies of the cardiovascular and respiratory systems
is correct?
Cardiac disease may demonstrate signs and symptoms of respiratory illness.
100
When attempting to screen and educate parents regarding the treatment of developmental
dysplasia of the hip (DDH), which intervention should the nurse perform?
Carefully monitor infants for DDH at follow-up visits.
101
The nurse is assigned a home care visit of a 5-day-old infant for the treatment of jaundice. A
thorough assessment is completed, and a health history is obtained. Which sign or symptom
indicates that the infant may be displaying the initial phase of encephalopathy?
Hypotonia, lethargy, and poor suck
102
Most congenital anomalies of the CNS result from defects in the closure of the neural tube
during fetal development. Which factor has the greatest impact on this process?
Maternal folic acid deficiency
103
The condition, hypospadias, encompasses a wide range of penile abnormalities. Which
information should the nurse provide to the anxious parents of an affected newborn?
Mild cases involve a single surgical procedure.
104
The nurse is instructing a family how to care for their infant in a Pavlik harness to treat DDH.
What information should be included in the teaching?
Return to the clinic every 1 to 2 weeks.
105
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be
corrected, how should the nurse respond?
Frequent, serial casting is tried first.
106
Which statement regarding hemolytic diseases of the newborn is most accurate?
The indirect Coombs’ test is performed on the mother before birth; the direct Coombs’ test
is performed on the cord blood after birth.
107
Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate
resulting from the failure of the primary palate to fuse. Multiple genetic and, to a lesser extent,
environmental factors may lead to the development of a cleft lip or palate. Which factors are
included? (Select all that apply.)
a. Alcohol consumption
c. Use of some anticonvulsant medications
d. Maternal cigarette smoking
108
The most widespread use of postnatal testing for genetic disease is the routine screening of
newborns for inborn errors of metabolism (IEM). Which conditions are considered metabolic
disorders? (Select all that apply.)
a. Phenylketonuria (PKU)
b. Galactosemia
c. Hemoglobinopathy
109
The nurse is caring for an infant with DDH. Which clinical manifestations should the nurse
expect to observe? (Select all that apply.)
a. Positive Ortolani click
b. Unequal gluteal folds
