Deck 27: The Woman with an Intrapartum Complication

Question 1

Birth for the nulliparous woman with a fetus in a breech presentation is usually by

A) cesarean delivery.
B) vaginal delivery.
C) forceps-assisted delivery.
D) vacuum extraction.

Answer 1

cesarean delivery.

Question 2

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.

Answer 2

stimulate fetal surfactant production.

Question 3

A woman who had two previous cesarean births is in active labor,when she suddenly complains of pain between her scapulae.The nurse's priority action is to

A) reposition the woman with her hips slightly elevated.
B) observe for abnormally high uterine resting tone.
C) decrease the rate of nonadditive intravenous fluid.
D) notify the provider promptly and prepare the woman for surgery.

Answer 3

notify the provider promptly and prepare the woman for surgery.

Question 4

What factor found in maternal history should alert the nurse to the potential for a prolapsed umbilical cord?

A) Oligohydramnios
B) Pregnancy at 38 weeks of gestation
C) Presenting part at station -3
D) Meconium-stained amniotic fluid

Question 5

Why is adequate hydration important when uterine activity occurs before pregnancy is at term?

A) Fluid and electrolyte imbalance can interfere with the activity of the uterine pacemakers.
B) Dehydration may contribute to uterine irritability for some women.
C) Dehydration decreases circulating blood volume, which leads to uterine ischemia.
D) Fluid needs are increased because of increased metabolic activity occurring during contractions.

Question 6

A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours.When the magnesium sulfate is discontinued,which oral drug will probably be prescribed for continuation of the tocolytic effect?

A) Ritodrine
B) Terbutaline
C) Calcium gluconate
D) Pitocin

Question 7

An important independent nursing action to promote normal progress in labor is

A) assessing the fetus.
B) encouraging urination about every 1 to 2 hours.
C) allowing the woman to stay in her preferred position.
D) regulating intravenous fluids.

Question 8

Which factor is most likely to result in fetal hypoxia during a dysfunctional labor?

A) Incomplete uterine relaxation
B) Maternal fatigue and exhaustion
C) Maternal sedation with narcotics
D) Administration of tocolytic drugs

Question 9

After a birth complicated by a shoulder dystocia,what action by the nurse is most appropriate?

A) Give supplemental oxygen with a small face mask.
B) Encourage the parents to hold the infant.
C) Palpate the infant's clavicles.
D) Perform a complete newborn assessment.

Question 10

Which technique is least effective for the woman with persistent occiput posterior position?

A) Lie supine and relax.
B) Sit or kneel, leaning forward with support.
C) Rock the pelvis back and forth while on hands and knees.
D) Squat.

Question 11

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 12

Which action should be initiated to limit hypovolemic shock when uterine inversion occurs?

A) Administer oxygen at 31 L/min by nasal cannula.
B) Administer an oxytocin by intravenous push.
C) Monitor fetal heart rate every 5 minutes.
D) Increase the intravenous infusion rate.

Question 13

The fetus in a breech presentation is often born by cesarean delivery because

A) the buttocks are much larger than the head.
B) postpartum hemorrhage is more likely if the woman delivers vaginally.
C) internal rotation cannot occur if the fetus is breech.
D) compression of the umbilical cord is more likely.

Question 14

In planning for home care of a woman with preterm labor,the nurse needs to address which 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 15

Which actions by the nurse may prevent infections in the labor and delivery area?

A) Vaginal examinations every hour while the woman is in active labor
B) Use of clean techniques for all procedures
C) Cleaning secretions from the vaginal area by using back-to-front motion
D) Keeping underpads and linens as dry as possible

Question 16

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) Secondary arrest
D) Protracted descent

Question 17

Which patient situation presents the greatest risk for the occurrence of hypotonic dysfunction during labor?

A) A primigravida who is 17 years old
B) A 22-year-old multiparous woman with ruptured membranes
C) A multiparous woman at 39 weeks of gestation who is expecting twins
D) A primigravida woman who has requested no analgesia during her labor

Question 18

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

A) 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 19

A laboring patient in the latent phase is experiencing uncoordinated,irregular contractions of low intensity.How should the nurse respond to complaints of constant cramping pain?

A) "You are only 2 cm dilated, so you should rest and save your energy for when the contractions get stronger."
B) "You must breathe more slowly and deeply so there is greater oxygen supply for your uterus. That will decrease the pain."
C) "Let me take off the monitor belts and help you get into a more comfortable position."
D) "I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

Question 20

Which nursing action must be initiated first when evidence of prolapsed cord is found?

A) Notify the provider.
B) Apply a scalp electrode.
C) Prepare the mother for an emergency cesarean delivery.
D) Reposition the mother with her hips higher than her head.

Question 21

What are the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline? (Select all that apply.)

A) Fetal heart rate
B) Maternal heart rate
C) Intake and output
D) Maternal blood glucose
E) Maternal blood pressure
F) Odor of amniotic fluid

Question 22

A woman who is 32 weeks pregnant telephones the nurse at her obstetrician's office and complains of constant backache.She asks what pain reliever is safe for her to take.The best nursing response is

A) "Back pain is common at this time during pregnancy due to poor posture."
B) "Acetaminophen is acceptable during pregnancy; however, do not take aspirin."
C) "You should come into the office and let the doctor check you."
D) "Try a warm bath or using a heating pad."

Question 23

A student nurse is preparing to administer a dose of betamethasone.What action by the student warrants intervention by the registered nurse?

A) Starts a separate IV line to infuse the medication
B) Tells the woman her blood glucose will be monitored more often
C) Prepares an IM injection choosing a ´ needle
D) Listens to the woman's lungs prior to administering the medication

Question 24

The nurse should suspect uterine rupture if

A) fetal tachycardia occurs.
B) the woman becomes dyspneic.
C) contractions abruptly stop during labor.
D) labor progresses unusually quickly.

Question 25

The nursing faculty explains to students on the labor and delivery unit that late preterm and term births are very different.What distinguishes the late preterm birth from a term birth? (Select all that apply.)

A) Late preterm births are between 34 and 36 completed weeks of pregnancy.
B) There is no real difference in mortality between the two types of births.
C) Late preterm infants may appear to be full term at delivery.
D) A late preterm infant who appears full term is classified full term.
E) Late preterm infants need careful assessments of gestational age.

Question 26

The nursing student observes a laboring woman doing lunges to the left side and asks for an explanation of this activity.What response by the nurse is best?

A) It decreases the pain associated with back labor.
B) It promotes rotation of the fetal occiput to an anterior position.
C) It relieves the cramping associated with a prolonged labor.
D) It causes the pelvic inlet to open wider in preparation for birth.

Question 27

A woman reports a sudden gush of fluid from her vagina and is worried about premature rupture of her membranes.What other causes of this does the nurse assess for? (Select all that apply.)

A) Urinary incontinence
B) Leaking of amniotic fluid
C) Loss of mucous plug
D) An increase in vaginal discharge
E) Bloody show

Question 28

The causes of preterm labor are not fully understood although many factors have been associated with early labor.These include (Select all that apply.)

A) Singleton pregnancy
B) History of cone biopsy
C) Smoking
D) Short cervical length
E) Higher level of education

Question 29

The provider orders an infusion of magnesium sulfate to run at 4 g/hour.The pharmacy delivers a bag of 4 g magnesium sulfate in 250 mL.At what rate does the nurse set the pump? ___________________

Question 30

An hour after her membranes ruptured,a laboring woman has a temperature of 38.2° C (100.7° F).What action does the nurse perform first?

A) Provide cool, wet washcloths for the woman's forehead.
B) Assess and document the fetal heart rate.
C) Administer acetaminophen orally.
D) Encourage the woman to drink clear fluids.