Deck 27: The Woman With an Intrapartum Complication

Question 1

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.

Answer 1

Dehydration may contribute to uterine irritability for some women.

Question 2

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."

Answer 2

"I have notified the doctor that you are having a lot of discomfort. Let me rub your back and see if that helps."

Question 3

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 oxytocic drug by intravenous push.
C) Monitor fetal heart rate every 5 minutes.
D) Restore circulating blood volume by increasing the intravenous infusion rate.

Answer 3

Restore circulating blood volume by increasing the intravenous infusion rate.

Question 4

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 5

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 6

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 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) Limiting contact with the woman's partner
D) Regulating intravenous fluids

Question 8

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 9

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

A) Notify the physician.
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 10

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 at-home continuation of the tocolytic effect?

A) Ritodrine
B) Terbutaline
C) Calcium gluconate
D) Magnesium sulfate

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 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 13

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

Question 14

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 15

After a birth complicated by a shoulder dystocia,the infant's Apgar scores were 7 at 1 minute and 9 at 5 minutes.The infant is now crying vigorously.The nurse in the birthing room should

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

Question 16

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 17

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 physician promptly and prepare the woman for surgery.

Question 18

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 19

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 20

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 21

A nurse is caring for a patient in the active phase of labor.The woman's BOW spontaneously ruptures.Suddenly the woman complains of dyspnea and appears restless and cyanotic.Additionally,she becomes hypotensive and tachycardic.The nurse immediately suspects the presence of a(n)_____________.

Question 22

Infant mortality for late preterm infants (34 to 36 weeks)is three times the rate of mortality for term infants.Is this statement true or false?

Question 23

Rupture of the amniotic sac before the onset of true labor,regardless of length of gestation is called premature rupture of membranes (PROM).The first priority for the nurse is to determine whether membranes are truly ruptured.Other explanations for this increase in fluid discharge include all except

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

Question 24

What is the priority nursing assessments for a woman receiving tocolytic therapy with terbutaline?

A) Fetal heart rate, maternal pulse, and blood pressure
B) Maternal temperature and odor of amniotic fluid
C) Intake and output
D) Maternal blood glucose

Question 25

Nurses need to know that when any woman is admitted to the hospital and is _____ to _____ weeks pregnant,she should receive antenatal glucocorticoids unless she has chorioamnionitis.Because these drugs require a 24-hour period to become effective,timely administration is essential.

Question 26

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

Question 27

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 28

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 because you tend to stand with a sway back."
B) "Acetaminophen is acceptable during pregnancy; however, you should not take aspirin."
C) "You should come into the office and let the doctor check you."
D) "Avoid medication because you are pregnant. Try soaking in a warm bath or using a heating pad on low before taking any medication."

Question 29

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 30

The nurse has been caring for a primiparous patient who is suspected of carrying a macrosomic infant.Pushing appears to have been effective so far; however,as soon as the head is born,it retracts against the perineum much like a turtle's head drawing into its shell.In evaluating the labor progress so far,the nurse is aware that this is normal with large infants and extra pushing efforts by the mother may be necessary.Is this statement true or false?