Deck 17: Labor and Birth Complications

Question 1

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

Answer 1

Serum magnesium level of 10 mg/dL

Question 2

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.

Answer 2

Prolonged bed rest may cause negative physiologic effects.

Question 3

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.

Answer 3

ripen the cervix in preparation for labor induction.

Question 4

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 5

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

A) contractions lasting 80 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 6

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

Question 7

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 patient develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given.

Question 8

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 9

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 10

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 11

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 12

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 13

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

A) 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) 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 14

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 15

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 16

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 17

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 lbs.
D) in the United States early in this century, preterm birth accounted for 18% to 20% of all births.

Question 18

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 19

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) Postterm gestation

Question 20

The nurse,caring for a patient whose labor is being augmented with oxytocin,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 patient's needing to void.
D) rupture of the patient's amniotic membranes.

Question 21

A maternal indication for the use of forceps is:

A) a wide pelvic outlet.
B) maternal exhaustion.
C) a history of rapid deliveries.
D) failure to progress past 0 station.

Question 22

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-lb 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 23

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 24

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 25

Induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus.The charge nurse in 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) postterm pregnancy.
E) fetal death.

Question 26

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 27

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 28

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.

Question 29

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 30

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 31

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