Deck 8: Nursing Care of Women with Complications During Labor and Birth

Question 1

When a labor dysfunction due to decreased uterine muscle tone occurs in a patient who is dilated to 5 cm with membranes intact,the nurse informs the patient that the physician most likely will:

A) perform an amniotomy.
B) initiate tocolytic drugs.
C) order a sedative for the patient.
D) plan to do an emergency cesarean section.

Answer 1

perform an amniotomy.

Question 2

A pulsating structure is felt during a vaginal examination of a woman in labor.To prevent compression of a prolapsed cord,the nurse would position the woman:

A) on her right side with knees flexed.
B) on her left side with a pillow placed between her legs.
C) on her back with her head lower than the rest of her body.
D) supine with her legs elevated and bent at the knee.

Answer 2

on her back with her head lower than the rest of her body.

Question 3

A student nurse questions the instructor as to what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient.The best response is that the fundus of a patient with a cesarean section is:

A) not assessed until the second postoperative day.
B) assessed by "walking" fingers from side of uterus to the midline.
C) assessed only if large clots appear in lochia.
D) only once every shift.

Answer 3

assessed by "walking" fingers from side of uterus to the midline.

Question 4

A woman 2 weeks past her expected delivery date who is receiving an oxytocin infusion to induce labor begins to have contractions every 90 seconds.The nurse's initial action should be to:

A) stop the oxytocin infusion.
B) continue the infusion and report the findings to the physician.
C) turn her on her left side and reassess the contractions.
D) administer oxygen by mask.

Question 5

The nurse is administering terbutaline (Brethine)to a pregnant woman to prevent preterm labor.The nurse would assess for which adverse effect?

A) Maternal tachycardia
B) Maternal hypertension
C) Fetal bradycardia
D) Fetal hypokalemia

Question 6

When a woman is admitted to the labor and delivery unit,she tells the nurse that she is anxious about delivery,the welfare of her infant,and how quickly she will recover.The nurse is aware that anxiety can affect labor by:

A) decreasing a woman's pain sensitivity.
B) reducing blood flow to the uterus.
C) increasing the ability to tolerate pain.
D) enhancing maternal pushing through greater muscle tension.

Question 7

Several hours after delivery the nurse finds a woman crying.The woman says repeatedly,"My baby is beautiful,but I was planning on a vaginal delivery.Instead I needed an emergency C-section." The most appropriate nursing diagnosis is:

A) anxiety related to the development of postpartum complications.
B) ineffective individual coping related to unfamiliarity with procedures.
C) risk for ineffective parenting related to emergency cesarean section.
D) grieving related to loss of expected birth experience.

Question 8

A woman is having a difficult labor because the fetus is presenting in the right occipital position (ROP).To encourage fetal rotation and pain relief the nurse would position the patient:

A) prone with legs supported and give her a back massage.
B) supine with legs bent at the knee.
C) standing with support.
D) sitting up and leaning forward on the over-bed table.

Question 9

During a strenuous labor,the woman asks for some pain remedy for the sudden pain between her scapulae that seems to occur with every breath she takes.The nurse should:

A) give the pain remedy.
B) notify the charge nurse immediately.
C) turn patient to her back and flex her knees.
D) suggest that the coach give her a back rub.

Question 10

A woman who is 24 weeks' pregnant is placed on an intravenous infusion of magnesium sulfate.The nurse should inform the patient that she might experience what side effect?

A) Nausea and vomiting
B) Headache
C) Warm flush
D) Urinary frequency

Question 11

The statement that indicates a woman understands activity limitations for the management of preterm labor is:

A) "After my shower in the morning, I do the laundry and straighten up the house, then I rest. "
B) "I pack a picnic basket and put it next to the sofa so I do not have to get up for food during the day. "
C) "I have a 2-year-old to care for, but I try to rest as much as I can. "
D) "I get really bored at home, so I go to the shopping mall for just a little while. "

Question 12

After several hours of labor,a nursing assessment reveals that a woman's cervix is 5 cm dilated but contractions are becoming shorter and less frequent.The nurse knows that this labor pattern is described as:

A) normal.
B) hypotonic.
C) hypertonic.
D) false.

Question 13

The frustrated patient in labor that has been affected by decreased uterine muscle tone complains,"My doctor won't induce my labor because of some silly score.He said I was a 4.What kind of magic number do I need?" The nurse is aware that prior to induction,the patient should have a Bishop score of at least:

A) 6.
B) 8.
C) 10.
D) 12.

Question 14

The initial vaginal examination of a woman admitted to the labor unit reveals that the cervix is dilated 9 cm.The panicked woman asks the nurse,"Please give me something." The most appropriate pain relief intervention for a woman in precipitate labor is to:

A) get an order for an intravenous narcotic.
B) notify the anesthesiologist for an epidural block.
C) stay and breathe with her during contractions.
D) tell her to bear with it because she is close to delivery.

Question 15

A new mother is distressed and tearful about the elevated dome over her infant's posterior fontanelle.The nurse's best response is,"This condition will resolve itself in a few days.It is caused by:

A) prolonged pressure against the partially dilated cervix. "
B) small leak of fluid through the posterior fontanelle. "
C) pressure of the forceps during delivery. "
D) the effect of the vacuum extractor. "

Question 16

The nursing care of a woman with a third-degree laceration immediately after delivery would include:

A) warm compresses to the perineum.
B) cold pack to the perineum.
C) warm sitz bath.
D) elevation of hips to prevent edema.

Question 17

The nurse would assess an infant delivered with the use of forceps for:

A) loss of hair from contact with forceps.
B) sacral hematoma.
C) facial asymmetry.
D) shoulder dislocation.

Question 18

Following an amniotomy,the nursing assessment that should be reported immediately is:

A) fetal heart rate is regular at 154 beats/min.
B) amniotic fluid is clear with flecks of vernix.
C) amniotic fluid is watery and pale green.
D) maternal temperature is 37. 8° C.

Question 19

A pregnant woman's membranes ruptured prematurely at 34 weeks.She will be discharged to her home for the next few weeks.The nurse planning discharge instructions would teach the woman to:

A) report any increase in fetal activity.
B) notify her obstetrician for a temperature above 37. 8° C (100° F).
C) massage her breasts to promote uterine relaxation.
D) rest in a side-lying Trendelenburg position with hips elevated.

Question 20

A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously.She must be closely observed for signs of:

A) chorioamnionitis.
B) hemorrhage.
C) hypotension.
D) amniotic fluid embolism.

Question 21

The nurse explains that a "cervical ripening" softens the cervix with the use of:

A) prostaglandin gel insertion.
B) intravenous oxytocin.
C) warm saline douches.
D) nipple stimulation.

Question 22

Which intervention(s)could a nurse apply to help stimulate contractions? Select all that apply.

A) Encouraging the patient to sit upright
B) Assisting the patient to ambulate
C) Stimulating the nipples
D) Offering emotional support
E) Allowing the patient to vent frustration

Question 23

What is(are)the rationales for labor induction? Select all that apply.

A) Placenta previa
B) Prolapse of cord
C) High station of fetus
D) Maternal diabetes
E) Placental insufficiency

Question 24

After an amniotomy,the nurse should be alert for what sign(s)of infection? Select all that apply.

A) Oral temperature of 37° C (99. 8° F)
B) Increase of fetal heart rate from 160 to 174 beats/minute
C) Flecks of vernix in the amniotic fluid
D) Low back pain
E) Edematous labia

Question 25

The nurse explains to the patient who is threatening preterm labor that glucocorticoids are given prior to delivery in order to:

A) prevent infection.
B) increase fetal lung maturity.
C) increase blood flow from placenta.
D) relax the cervix.

Question 26

To increase the quality of uterine contractions,the nurse instructs the patient to do what to stimulate her nipples? Select all that apply.

A) Place a warm, moist washcloth over the breast.
B) Brush the nipples with a dry washcloth.
C) Gently pull on the nipples.
D) Apply suction to the nipples with a breast pump.
E) Press the palms of hands down on her breasts.

Question 27

Following an amniotomy,the umbilical cord becomes compressed.The nurse prepares the patient for an instillation of a bolus of warm sterile saline into the uterus,which is called ____________________.

Question 28

What complication(s)of overstimulation of uterine contractions may occur? Select all that apply.

A) Water intoxication
B) Impaired placental exchange of oxygen and nutrients
C) Increased blood pressure
D) Convulsions
E) Uterine rupture

Question 29

The nurse explains to a patient that a minimum score of _____ on the Bishop scale is predictive of successful labor induction.

Question 30

A(n)_______________ is a narrow cone inserted into the cervix to "ripen" the cervix to increase uterine contractions.