Deck 19: Labor and Birth at Risk

Question 1

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. What intervention would be the top priority?

A)Placing the woman in the knee-chest position
B)Covering the cord in sterile gauze soaked in saline
C)Preparing the woman for a cesarean birth
D)Starting oxygen by face mask

Answer 1

Placing the woman in the knee-chest position

Question 2

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,the nurse would include what information?

A)"Because this is a repeat procedure,you are at the lowest risk for complications."
B)"Even though this is your second cesarean birth,you may wish to review the preoperative and postoperative procedures."
C)"Because this is your second cesarean birth,you will recover faster."
D)"You will not need preoperative teaching because this is your second cesarean birth."

Answer 2

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

Question 3

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. What response by the nurse is most accurate?

A)"After the baby is born."
B)"When we can stabilize your preterm labor and arrange home health visits."
C)"Whenever the doctor says that it is okay."
D)"It depends on what kind of insurance coverage you have."

Answer 3

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

Question 4

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

A)Urine output of 160 ml in 4 hours
B)Deep tendon reflexes 2+ and no clonus
C)Respiratory rate of 16 breaths/min
D)Serum magnesium level of 10 mg/dl

Question 5

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

A)Contractions lasting 40 to 90 seconds,2 to 3 minutes apart.
B)The intensity of contractions to be at least 110 to 130 mm Hg.
C)Labor to progress at least 2 cm/hr dilation.
D)At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

Question 6

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?

A)Prolonged latent phase
B)Protracted active phase
C)Arrest of active phase
D)Protracted descent

Question 7

The nurse providing care for a woman with preterm labor on terbutaline would include which intervention to identify side effects of the drug?

A)Assessing deep tendon reflexes (DTRs)
B)Assessing for dyspnea and crackles
C)Assessing for bradycardia
D)Assessing for hypoglycemia

Question 8

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:

A)Enhance uteroplacental perfusion in an aging placenta.
B)Increase amniotic fluid volume.
C)Ripen the cervix in preparation for labor induction.
D)Stimulate the amniotic membranes to rupture.

Question 9

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?

A)Estriol is not found in maternal saliva.
B)Irregular,mild uterine contractions are occurring every 12 to 15 minutes.
C)Fetal fibronectin is present in vaginal secretions.
D)The cervix is effacing and dilated to 2 cm.

Question 10

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:

A)Stimulate fetal surfactant production.
B)Reduce maternal and fetal tachycardia associated with ritodrine administration.
C)Suppress uterine contractions.
D)Maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

Question 11

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

A)Fetal heart rate of 116 beats/min
B)Cervix dilated 2 cm and 50% effaced
C)Score of 8 on the biophysical profile
D)One fetal movement noted in 1 hour of assessment by the mother

Question 12

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 woman's 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 pelvic dystocia.

Question 13

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

A)The 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 pregnancy.
C)Low birth weight is anything below 3.7 pounds.
D)In the United States early in this century,preterm birth accounted for 18% to 20% of all births.

Question 14

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

A)Midplane contracture of the pelvis.
B)Compromised bearing-down efforts as a result of pain medication.
C)Disproportion of the pelvis.
D)Low-lying placenta.

Question 15

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

A)Because all women must be considered at risk for preterm labor and prediction is so hit-and-miss,teaching pregnant women the symptoms probably causes more harm through false alarms.
B)Braxton Hicks contractions often signal the onset of preterm labor.
C)Because preterm labor is likely to be the start of an extended labor,a woman with symptoms can wait several hours before contacting the primary caregiver.
D)The diagnosis of preterm labor is based on gestational age,uterine activity,and progressive cervical change.

Question 16

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:

A)Uterine contractions occurring every 8 to 10 minutes.
B)A fetal heart rate (FHR) of 180 with absence of variability.
C)The client needing to void.
D)Rupture of the client's amniotic membranes.

Question 17

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

A)Meconium-stained amniotic fluid
B)Fetal heart tones heard at or above the maternal umbilicus
C)Preterm labor and birth
D)Postterm gestation

Question 18

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

A)The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.
B)There are no important maternal (as opposed to fetal) contraindications.
C)Its most important function is to afford the opportunity to administer antenatal glucocorticoids.
D)If the client develops pulmonary edema while on tocolytics,intravenous (IV) fluids should be given.

Question 19

In planning for home care of a woman with preterm labor,the nurse needs to address what concern?

A)Nursing assessments will be different from those done in the hospital setting.
B)Restricted activity and medications will be necessary to prevent recurrence of preterm labor.
C)Prolonged bed rest may cause negative physiologic effects.
D)Home health care providers will be necessary.

Question 20

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

A)Women who are underweight are more at risk.
B)Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted.
C)Hypertonic uterine dysfunction is more common than hypotonic dysfunction.
D)Abnormal labor patterns are most common in older women.

Question 21

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:

A)Viral
B)Periodontal
C)Cervical
D)Urinary tract

Question 22

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

A)Is part of the active management of labor that is instituted when the labor process is unsatisfactory.
B)Relies on more invasive methods when oxytocin and amniotomy have failed.
C)Is a modern management term to cover up the negative connotations of forceps-assisted birth.
D)Uses vacuum cups.

Question 23

Approximately 50% of all women who give birth prematurely have no identifiable risk factors,and about 50% of preterm births could not be prevented.

Question 24

A nurse is caring for a client in the active phase of labor. The woman's bag of waters spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless and cyanotic. In addition,she becomes hypotensive and tachycardic. The nurse immediately suspects the presence of:__________________________________.

Question 25

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? Choose all that apply.

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

Question 26

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

A)Pulmonary edema.
B)Wound dehiscence.
C)Hemorrhage.
D)Urinary tract infections.
E)Fetal injuries.
F)None of the above

Question 27

With regard to the process of inducing labor,nurses should be aware that:

A)Ripening the cervix usually results in a decreased success rate for induction.
B)Labor sometimes can be induced with balloon catheters or laminaria tents.
C)Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks.
D)Amniotomy can be used to make the cervix more favorable for labor.

Question 28

With regard to the psychologic complications and risks of forced cesarean births,nurses should be aware that:

A)A family's worries about extra cost are unfounded;vaginal birth and unscheduled cesarean births cost about the same.
B)Most women relate to their newborns as quickly and are as likely to breastfeed as those who went through vaginal birth.
C)The psychologic outcomes are the same as for women who go through scheduled cesarean births.
D)Some couples (and individuals) have sexual worries;the women worry about sexual attractiveness,and the men worry about hurting their partners.

Question 29

____________________ is defined as long,difficult,or abnormal labor. It is caused by various conditions associated with the five factors affecting labor.

Question 30

Nurses should be aware that the induction of labor:

A)Can be achieved by external and internal version techniques.
B)Is also known as a trial of labor (TOL).
C)Is almost always done for medical reasons.
D)Is rated for viability by a Bishop score.

Question 31

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

A)Is declining in frequency in the twenty-first century in the United States.
B)Is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier clients do.
C)Is performed primarily for the benefit of the fetus.
D)Can be either elected or refused by women as their absolute legal right.