Deck 17: Labor and Birth Complications

Question 1

For a woman at 42 weeks of gestation,which finding would require further assessment by the nurse?

A)Fetal heart rate of 116 beats/min
B)Cervix dilated 2 cm and 50% effaced
C)Score of 8 on the biophysical profile
D)One fetal movement noted in 1 hour of assessment by the mother

Answer 1

One fetal movement noted in 1 hour of assessment by the mother

Question 2

As relates to the use of tocolytic therapy to suppress uterine activity,nurses should be aware that:

A)The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.
B)There are no important maternal (as opposed to fetal) contraindications.
C)Its most important function is to afford the opportunity to administer antenatal glucocorticoids.
D)If the client develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given.

Answer 2

Its most important function is to afford the opportunity to administer antenatal glucocorticoids.

Question 3

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug?

A)Assessing deep tendon reflexes (DTRs)
B)Assessing for chest discomfort and palpitations
C)Assessing for bradycardia
D)Assessing for hypoglycemia

Answer 3

Assessing for chest discomfort and palpitations

Question 4

Which assessment is least likely to be associated with a breech presentation?

A)Meconium-stained amniotic fluid
B)Fetal heart tones heard at or above the maternal umbilicus
C)Preterm labor and birth
D)Post-term gestation

Question 5

The least common cause of long,difficult,or abnormal labor (dystocia)is:

A)Midplane contracture of the pelvis.
B)Compromised bearing-down efforts as a result of pain medication.
C)Disproportion of the pelvis.
D)Low-lying placenta.

Question 6

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

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 7

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 8

In planning for an expected cesarean birth for a woman who has given birth by cesarean previously and who has a fetus in the transverse presentation,which information would the nurse include?

A)"Because this is a repeat procedure, you are at the lowest risk for complications."
B)"Even though this is your second cesarean birth, you may wish to review the preoperative and postoperative procedures."
C)"Because this is your second cesarean birth, you will recover faster."
D)"You will not need preoperative teaching because this is your second cesarean birth."

Question 9

A pregnant woman's amniotic membranes rupture.Prolapsed umbilical cord is suspected.What intervention would be the top priority?

A)Placing the woman in the knee-chest position
B)Covering the cord in sterile gauze soaked in saline
C)Preparing the woman for a cesarean birth
D)Starting oxygen by face mask

Question 10

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

A)The terms preterm birth and low birth weight can be used interchangeably.
B)Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.
C)Low birth weight is anything below 3.7 pounds.
D)In the United States early in this century, preterm birth accounted for 18% to 20% of all births.

Question 11

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 12

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)Arrest of active phase
D)Protracted descent

Question 13

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 14

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 would be able to go home.Which response by the nurse is most accurate?

A)"After the baby is born."
B)"When we can stabilize your preterm labor and arrange home health visits."
C)"Whenever the doctor says that it is okay."
D)"It depends on what kind of insurance coverage you have."

Question 15

In evaluating the effectiveness of oxytocin induction,the nurse would expect:

A)Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.
B)The intensity of contractions to be at least 110 to 130 mm Hg.
C)Labor to progress at least 2 cm/hr dilation.
D)At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.

Question 16

The nurse is caring for a client whose labor is being augmented with oxytocin.He or she recognizes that the oxytocin should be discontinued immediately if there is evidence of:

A)Uterine contractions occurring every 8 to 10 minutes.
B)A fetal heart rate (FHR) of 180 with absence of variability.
C)The client's needing to void.
D)Rupture of the client's amniotic membranes.

Question 17

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor,what finding would alert the nurse to possible side effects?

A)Urine output of 160 mL in 4 hours
B)Deep tendon reflexes 2+ and no clonus
C)Respiratory rate of 16 breaths/min
D)Serum magnesium level of 10 mg/dL

Question 18

With regard to dysfunctional labor,nurses should be aware that:

A)Women who are underweight are more at risk.
B)Women experiencing precipitous labor are about the only "dysfunctionals" not to be exhausted.
C)Hypertonic uterine dysfunction is more common than hypotonic dysfunction.
D)Abnormal labor patterns are most common in older women.

Question 19

Prepidil (prostaglandin gel)has been ordered for a pregnant woman at 43 weeks of gestation.The nurse recognizes that this medication will be administered to:

A)Enhance uteroplacental perfusion in an aging placenta.
B)Increase amniotic fluid volume.
C)Ripen the cervix in preparation for labor induction.
D)Stimulate the amniotic membranes to rupture.

Question 20

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor.What finding indicates that preterm labor is occurring?

A)Estriol is not found in maternal saliva.
B)Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
C)Fetal fibronectin is present in vaginal secretions.
D)The cervix is effacing and dilated to 2 cm.

Question 21

A maternal indication for the use of vacuum extraction is:

A)A wide pelvic outlet.
B)Maternal exhaustion.
C)A history of rapid deliveries.
D)Failure to progress past 0 station.

Question 22

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

A)Placental abruption.
B)Wound dehiscence.
C)Hemorrhage.
D)Urinary tract infections.
E)Fetal injuries.

Question 23

Immediately after the forceps-assisted birth of an infant,the nurse should:

A)Assess the infant for signs of trauma.
B)Give the infant prophylactic antibiotics.
C)Apply a cold pack to the infant's scalp.
D)Measure the circumference of the infant's head.

Question 24

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.

A)Viral
B)Periodontal
C)Cervical
D)Urinary tract

Question 25

The priority nursing care associated with an oxytocin (Pitocin)infusion is:

A)Measuring urinary output.
B)Increasing infusion rate every 30 minutes.
C)Monitoring uterine response.
D)Evaluating cervical dilation.

Question 26

To provide safe care for the woman,the nurse understands that which condition is a contraindication for an amniotomy?

A)Dilation less than 3 cm
B)Cephalic presentation
C)-2 station
D)Right occiput posterior position

Question 27

The nurse providing care to a woman in labor should understand that cesarean birth:

A)Is declining in frequency in the twenty-first century in the United States.
B)Is more likely to be performed for poor women in public hospitals who do not receive the nurse counseling as do wealthier clients.
C)Is performed primarily for the benefit of the fetus.
D)Can be either elected or refused by women as their absolute legal right.

Question 28

Surgical,medical,or mechanical methods may be used for labor induction.Which technique is considered a mechanical method of induction?

A)Amniotomy
B)Intravenous Pitocin
C)Transcervical catheter
D)Vaginal insertion of prostaglandins

Question 29

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

A)Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency
B)Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency
C)Uterine tone <20 mm Hg
D)Uterine tone >20 mm Hg
E)Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR) and pattern

Question 30

Nurses should be aware that the induction of labor:

A)Can be achieved by external and internal version techniques.
B)Is also known as a trial of labor (TOL).
C)Is almost always done for medical reasons.
D)Is rated for viability by a Bishop score.

Question 31

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus.The charge nurse on the labor and delivery unit is often asked to schedule patients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction.These include (Select all that apply):

A)Rupture of membranes at or near term.
B)Convenience of the woman or her physician.
C)Chorioamnionitis (inflammation of the amniotic sac).
D)Post-term pregnancy.
E)Fetal death.

Question 32

Before the physician performs an external version,the nurse should expect an order for a:

A)Tocolytic drug.
B)Contraction stress test (CST).
C)Local anesthetic.
D)Foley catheter.

Question 33

While caring for the patient who requires an induction of labor,the nurse should be cognizant that:

A)Ripening the cervix usually results in a decreased success rate for induction.
B)Labor sometimes can be induced with balloon catheters or laminaria tents.
C)Oxytocin is less expensive than prostaglandins and more effective but creates greater health risks.
D)Amniotomy can be used to make the cervix more favorable for labor.

Question 34

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

A)Is part of the active management of labor that is instituted when the labor process is unsatisfactory.
B)Relies on more invasive methods when oxytocin and amniotomy have failed.
C)Is a modern management term to cover up the negative connotations of forceps-assisted birth.
D)Uses vacuum cups.

Question 35

Which patient status is an acceptable indication for serial oxytocin induction of labor?

A)Past 42 weeks' gestation
B)Multiple fetuses
C)Polyhydramnios
D)History of long labors

Question 36

The priority nursing intervention after an amniotomy should be to:

A)Assess the color of the amniotic fluid.
B)Change the patient's gown.
C)Estimate the amount of amniotic fluid.
D)Assess the fetal heart rate.

Question 37

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is:

A)A gravida 3 who has had two low-segment transverse cesarean births.
B)A gravida 2 who had a low-segment vertical incision for delivery of a 10-pound infant.
C)A gravida 5 who had two vaginal births and two cesarean births.
D)A gravida 4 who has had all cesarean births.

Question 38

The standard of care for obstetrics dictates that an internal version may be used to manipulate the:

A)Fetus from a breech to a cephalic presentation before labor begins.
B)Fetus from a transverse lie to a longitudinal lie before cesarean birth.
C)Second twin from an oblique lie to a transverse lie before labor begins.
D)Second twin from a transverse lie to a breech presentation during vaginal birth.