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

Question 1

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

A) Report any increase in fetal activity.
B) Notify her obstetrician if she has 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.

Answer 1

Notify her obstetrician if she has a temperature above 37.8° C (100° F).

Question 2

A pulsating structure is felt during a vaginal examination of a woman in labor.How would the nurse position the woman to prevent compression of a prolapsed cord?

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

What nursing assessment should be reported immediately after an amniotomy?

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.

Answer 3

Amniotic fluid is watery and pale green.

Question 4

A labor dysfunction due to decreased uterine muscle tone occurs in a patient who is dilated to 5 cm with membranes intact.What action by the physician will the nurse anticipate?

A) Perform an amniotomy.
B) Initiate tocolytic drugs.
C) Order a sedative for the patient.
D) Plan to do an emergency cesarean section.

Question 5

A new mother is distressed and tearful about the elevated dome over her infant's posterior fontanelle.The nurse responds,"This condition will resolve itself in a few days." What is the cause?

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 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.How can anxiety affect labor?

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

Question 7

A woman who is 33 weeks pregnant is admitted to the obstetric unit because her membranes ruptured spontaneously.What complication should the nurse closely assess for with this patient?

A) Chorioamnionitis
B) Hemorrhage
C) Hypotension
D) Amniotic fluid embolism

Question 8

Which statement indicates a woman understands activity limitations for the management of preterm labor?

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 9

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.What is this labor pattern considered?

A) Normal
B) Hypotonic
C) Hypertonic
D) False

Question 10

A woman is having a difficult labor because the fetus is presenting in the right occipital position (ROP).What position will the nurse promote to encourage fetal rotation and pain relief?

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 11

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

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

Question 12

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 13

A student nurse questions the instructor regarding what alteration should be made for the assessment of the fundus of a new postoperative cesarean section patient.What is the best response?

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

Question 14

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.What is the best nursing action?

A) Give the pain remedy.
B) Notify the charge nurse immediately.
C) Turn the patient to her back and flex her knees.
D) Suggest that the coach give her a back rub.

Question 15

A woman 2 weeks past her expected delivery date is receiving an oxytocin infusion to induce labor and begins to have contractions every 90 seconds.What is the nurse's initial action?

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 16

What nursing care should be provided to a woman with a third-degree laceration immediately after delivery?

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

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 18

A frustrated patient in labor has been affected by decreased uterine muscle tone and reports,"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?" What is the lowest Bishop score the patient should have prior to induction?

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

Question 19

An infant is delivered with the use of forceps.What should the nurse assess for in the newborn?

A) Loss of hair from contact with forceps
B) Sacral hematoma
C) Facial asymmetry
D) Shoulder dislocation

Question 20

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." What is the most appropriate nursing diagnosis?

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 21

What are the rationales for labor induction?

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

Question 22

_____________________________ is a lower-than-normal amount of amniotic fluid.

Question 23

The nurse arrives at the start of a shift on the labor unit to find a census of four patients in active labor.Which laboring patient should the nurse attend to first?

A) 18-year-old primigravida with a fetal breech presentation
B) 25-year-old multigravida with history of previous cesarean section
C) 35-year-old multigravida with history of precipitate birth
D) 16-year-old primigravida with a twin pregnancy

Question 24

What sign(s)of infection should the nurse assess for after an amniotomy?

A) Oral temperature of 37° C (99.8° F)
B) Increase of fetal heart rate (FHR) from 160 to 174 beats/minute
C) Flecks of vernix in the amniotic fluid
D) Low back pain
E) Edematous labia

Question 25

What does the nurse explain is used to soften the cervix with a "cervical ripening" agent?

A) Prostaglandin gel insertion
B) Intravenous oxytocin
C) Warm saline douches
D) Nipple stimulation

Question 26

Which interventions could a nurse apply to help stimulate contractions?

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 27

How might the nurse instruct the patient to stimulate her nipples in an attempt to increase the quality of uterine contractions?

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 her hands down on her breasts.

Question 28

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

Question 29

After 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 30

The nurse is caring for a patient diagnosed with hypotonic labor dysfunction.What will the nurse expect when caring for this patient?

A) Elevated uterine resting tone
B) Painful and poorly coordinated contractions
C) Implementation of fluid restriction
D) Use of frequent position changes

Question 31

What complications of overstimulation of uterine contractions may occur?

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

Question 32

A woman is 37 weeks pregnant and questioning the nurse about possible induction of labor at term.What conditions would contraindicate labor induction?

A) Maternal gynecoid pelvis
B) Placenta previa
C) Horizontal cesarean incision
D) Prolapsed cord
E) Gestational diabetes

Question 33

The nurse is caring for a patient who is threatening preterm labor and has been given glucocorticoids.What is the purpose of glucocorticoid administration?

A) Prevent infection.
B) Increase fetal lung maturity.
C) Increase blood flow from placenta.
D) Relax the cervix.

Question 34

A woman is preparing for administration of a cervical ripening agent.What nursing actions will the nurse anticipate implementing?

A) Insert IV.
B) Record a baseline fetal heart rate.
C) Explain procedure to patient.
D) Instruct patient to ambulate immediately afterward.
E) Ensure a tocolytic is available.