Question 1

Nurses should be aware that the induction of labor:

Accepted Answer

Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers,5 or higher for veterans.Version is turning of the fetus to a better position by a physician for an easier or safer birth.A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth.Two thirds of cases of induced labor are elective and not done for medical reasons.

Question 2

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions.What clinical cues alert the nurse that the woman is experiencing uterine hyperstimulation? Choose all that apply.

Accepted Answer

Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds,a uterine tone of over 20 mm Hg,and a nonreassuring FHR and pattern are indications of uterine hyperstimulation with oxytocin administration.Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction.A uterine tone of less than 20 mm Hg is normal.

Question 3

Obese women are at risk for several complications during pregnancy and birth.These include all except:

Accepted Answer

A breech presentation is not a complication of pregnancy or birth for the obese client.Venous thromboembolism is a known risk for obese women.The use of TED hose and sequential compression devices may help to decrease the chance for clot formation.Women should also be encouraged to ambulate as soon as possible.In addition to having an increased risk for cesarean birth in general,obese women are also more likely to require emergency cesarean birth.Many obese women have a pannus (large roll of abdominal fat)that overlies a lower transverse incision made just above the pubic area.The pannus causes the area to remain moist,which encourages the development of infection.

Question 4

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

Accepted Answer

Pulmonary edema,wound dehiscence,hemorrhage,urinary tract infections,and fetal injuries are possible complications and risks associated with cesarean births.

Question 5

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?

Accepted Answer

With a secondary arrest of the active phase,the progress of labor has stopped.This client has not had any anticipated cervical change,indicating an arrest of labor.In the nulliparous woman,a prolonged latent phase typically lasts more than 20 hours.A protracted active phase,the first or second stage of labor,is prolonged (slow dilation).With protracted descent,the fetus fails to descend at an anticipated rate during the deceleration phase and second stage of labor.

Question 6

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

Accepted Answer

Terbutaline is a beta₂-adrenergic agonist that affects the mother's cardiopulmonary and metabolic systems.Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea.Assessing DTRs does not address the possible respiratory side effects of using terbutaline.It is important for the nurse to perform this assessment if the woman is on magnesium sulfate.Terbutaline is a beta₂-adrenergic agonist that affects the mother's cardiopulmonary and metabolic systems.Beta₂-adrenergic agonist drugs cause tachycardia,not bradycardia.Terbutaline is a beta₂-adrenergic agonist that affects the mother's cardiopulmonary and metabolic systems.The metabolic effect leads to hyperglycemia,not hypoglycemia.

Question 7

A primigravida at 40 weeks of gestation is having uterine contractions every 1 1/2 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?

Accepted Answer

Women who experience hypertonic uterine dysfunction,or primary dysfunctional labor,often are 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,the woman initially makes normal progress into the active stage of labor and then the contractions become weak and inefficient or stop altogether.The contraction pattern seen 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.Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis,including the inlet,midpelvis,outlet,or any combination of these planes.

Question 8

Which statement related to cephalopelvic disproportion (CPD)is the least accurate?

Accepted Answer

Unfortunately,there is no way to accurately predict CPD.Although CPD is often related to excessive fetal size or macrosomia,the problem in many cases is malposition of the fetal presenting part rather than true CPD.When CPD is present,the fetus cannot fit through the maternal 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.

Question 9

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

Accepted Answer

These are mechanical means of ripening the cervix.Ripening the cervix,making it softer and thinner,increases the success rate of induced labor.Prostaglandin E₁ is less expensive and more effective than oxytocin but carries a greater risk.Amniotomy is the artificial rupture of membranes,which is used to induce labor only when the cervix is already ripe.

Question 10

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:

Accepted Answer

The infections that increase the risk of preterm labor and birth are bacterial.They include cervical,urinary tract,periodontal,and other bacterial infections.It is therefore important for the client to participate in early,continual,and comprehensive prenatal care.Recent evidence has shown a link between periodontal infections and preterm labor.Researchers recommend regular dental care before and during pregnancy,oral assessment as a routine part of prenatal care,and scrupulous oral hygiene in order to prevent infection.Cervical infections of a bacterial nature have been linked to preterm labor and birth.The presence of urinary tract infections increases the risk of preterm labor and birth.

Question 11

Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation.The nurse recognizes that this medication is administered to:

Accepted Answer

Preparations of prostaglandin E₁ and E₂ are effective when used before induction to "ripen" (soften and thin)the cervix.Uteroplacental perfusion is not altered by the use of prostaglandins.The insertion of prostaglandin gel has no effect on the level of amniotic fluid.In some cases,women will spontaneously begin laboring after the administration of prostaglandins,thereby eliminating the need for oxytocin.It is not common for a woman to rupture her membranes as a result of prostaglandin use.

Question 12

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

Accepted Answer

Before 20 weeks it is not viable (miscarriage);after 37 weeks,it can be considered term.Although these terms are used interchangeably,they have different meanings: preterm birth describes the length of gestation (before 37 weeks)regardless of weight;low birth weight describes weight only (2500 g or less)at the time of birth,whenever it occurs.Low birth weight is anything below 2500 g,or about 5.5 pounds.In 2006,the preterm birth rate in the United States was 12.8%;however,the rate is increasing in frequency.

Question 13

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

Accepted Answer

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 the early symptoms of preterm labor.Braxton Hicks contractions resemble preterm labor contractions,but they are not true labor.Waiting too long to see a health care provider could result in essential medications failing to be administered.Preterm labor is not necessarily long-term labor.

Question 14

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor,which finding alerts the nurse to possible side effects?

Accepted Answer

The therapeutic range for magnesium sulfate management is 5 to 8 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 is a normal finding.Deep tendon reflexes of 2+ is a normal finding.RR of 16 breaths/min is a normal finding.

Question 15

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?

Accepted Answer

The client's 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 woman with preterm labor is multifactorial;the goal is to prevent delivery.In many cases,this may be achieved at home.Care of the preterm client is multidisciplinary and multifactorial.Managed care may dictate earlier hospital discharges or a shift from hospital to home care.Insurance coverage may be one factor in client care,but ultimately,client safety remains the most important factor.

Question 16

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

Accepted Answer

Augmentation is part of the active 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 gentler,noninvasive methods.Forceps-assisted births are less common than in the past and not considered a method of augmentation.A vacuum assist occurs during birth if the mother is too exhausted to push.Vacuum extraction is not considered an augmentation methodology.

Question 17

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:

Accepted Answer

Antenatal glucocorticoids given as IM injections to the mother accelerate fetal lung maturity.Propranolol (Inderal)is given to reduce the effects of ritodrine administration.Betamethasone has no effect on uterine contractions.Calcium gluconate is given to reverse the respiratory depressive effects of magnesium sulfate therapy.

Question 18

A client is to have an amniotomy to induce labor.The nurse recognizes that the priority intervention after the amniotomy is to:

Accepted Answer

The FHR is assessed before and immediately after the amniotomy to detect any changes that might indicate cord compression or prolapse.Providing comfort measures for the client is important,but it is not the priority immediately after an amniotomy.The woman's temperature should be checked every 2 hours after rupture of membranes,but this is not the priority at this time.The woman would have had a vaginal examination during the procedure.Unless cord prolapse is suspected,a vaginal examination is not warranted.Additionally,FHR assessment provides clinical cues to a prolapsed cord.

Question 19

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

Accepted Answer

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 the acute care setting,but this is not the concern that needs to be addressed.Restricted activity and medications may prevent preterm labor but not in all women.Additionally,the plan of care is individualized to meet the needs of each client.Many women receive home health nurse visits,but care is individualized for each woman.

Question 20

In evaluating the effectiveness of an oxytocin induction,the nurse expects:

Accepted Answer

The goal of induction of labor is to produce contractions that occur every 2 to 3 minutes and last 80 to 90 seconds.The intensity of the contractions should be 40 to 90 mm Hg by IUPC.Cervical dilation of 1 cm/hr in the active phase of labor is the goal in an oxytocin induction.The dose is increased by 1 to 2 milliunits/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved.Doses are increased up to a maximum of 20 to 40 milliunits/min.

Quiz 33: Labor and Birth Complications