Deck 32: Labor and Birth Complications

Question 1

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor.Which 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.

Answer 1

The cervix is effacing and dilated to 2 cm.

Question 2

A woman is having her first child.She has been in labor for 15 hours.A vaginal examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100% effaced,and the presenting part of the fetus was at station 0; however,another vaginal examination performed 5 minutes ago indicated no changes.What abnormal labor pattern is associated with this description?

A) Prolonged latent phase
B) Protracted active phase
C) Secondary arrest
D) Protracted descent

Answer 2

Secondary arrest

Question 3

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

Answer 3

Postterm gestation

Question 4

The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth,preterm labor,and low birth weight.Which statement regarding this terminology is correct?

A) 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 gestation.
C) Low birth weight is a newborn who weighs below 3.7 pounds.
D) Preterm birth rate in the United States continues to increase.

Question 5

The exact cause of preterm labor is unknown but believed to be multifactorial.Infection is thought to be a major factor in many preterm labors.Which type of infection has not been linked to preterm birth?

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

Question 6

Which statement related to the induction of labor is most accurate?

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

Question 7

The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor.Which information is the most important for the nurse to understand and share with the client?

A) Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor 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) Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

Question 8

Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline?

A) Assess deep tendon reflexes (DTRs).
B) Assess for dyspnea and crackles.
C) Assess for bradycardia.
D) Assess for hypoglycemia.

Question 9

Which description most accurately describes the augmentation of labor?

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 10

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

A) CPD can be related to either fetal size or fetal position.
B) The fetus cannot be born vaginally.
C) CPD can be accurately predicted.
D) Causes of CPD may have maternal or fetal origins.

Question 11

The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor.What is the nurse's highest priority intervention after the amniotomy is performed?

A) Applying clean linens under the woman
B) Taking the client's vital signs
C) Performing a vaginal examination
D) Assessing the fetal heart rate (FHR)

Question 12

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.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 your physician says that it is okay."
D) "It depends on what kind of insurance coverage you have."

Question 13

A number of methods can be used for inducing labor.Which cervical ripening method falls under the category of mechanical or physical?

A) Prostaglandins are used to soften and thin the cervix.
B) Labor can sometimes be induced with balloon catheters or laminaria tents.
C) Oxytocin is less expensive and more effective than prostaglandins but creates greater health risks.
D) Amniotomy can be used to make the cervix more favorable for labor.

Question 14

A primigravida at 40 weeks of gestation is having uterine contractions every 1½ to 2 minutes and states 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 precipitous labor.

Question 15

A pregnant woman's amniotic membranes have ruptured.A prolapsed umbilical cord is suspected.What intervention would be the nurse's highest 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 16

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

A) Nursing assessments are different from those performed in the hospital setting.
B) Restricted activity and medications are necessary to prevent a recurrence of preterm labor.
C) Prolonged bed rest may cause negative physiologic effects.
D) Home health care providers are necessary.

Question 17

Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation.What is the primary purpose of prostaglandin administration?

A) To enhance uteroplacental perfusion in an aging placenta
B) To increase amniotic fluid volume
C) To ripen the cervix in preparation for labor induction
D) To stimulate the amniotic membranes to rupture

Question 18

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

A) Urine output of 160 ml in 4 hours
B) DTRs 2+ and no clonus
C) Respiratory rate (RR) of 16 breaths per minute
D) Serum magnesium level of 10 mg/dl

Question 19

The nurse is teaching a client with preterm premature rupture of membranes (PPROM)regarding self-care activities.Which activities should the nurse include in her teaching?

A) Report a temperature higher than 40° C.
B) Tampons are safe to use to absorb the leaking amniotic fluid.
C) Do not engage in sexual activity.
D) Taking frequent tub baths is safe.

Question 20

A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM)doses of betamethasone.What is the purpose of this pharmacologic intervention?

A) To stimulate fetal surfactant production
B) To reduce maternal and fetal tachycardia associated with ritodrine administration
C) To suppress uterine contractions
D) To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy

Question 21

Which nursing intervention should be immediately performed after the forceps-assisted birth of an infant?

A) Assessing the infant for signs of trauma
B) Administering prophylactic antibiotic agents to the infant
C) Applying a cold pack to the infant's scalp
D) Measuring the circumference of the infant's head

Question 22

Indications for a primary cesarean birth are often nonrecurring.Therefore,a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC).Which clients would be less likely to have a successful VBAC?

A) Lengthy interpregnancy interval
B) African-American race
C) Delivery at a rural hospital
D) Estimated fetal weight <4000 g
E) Maternal obesity (BMI >30)

Question 23

What is the primary purpose for the use of tocolytic therapy to suppress uterine activity?

A) Drugs can be efficaciously administered up to the designated beginning of term at 37 weeks gestation.
B) Tocolytic therapy has no important maternal (as opposed to fetal) contraindications.
C) The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids.
D) If the client develops pulmonary edema while receiving tocolytic therapy, then intravenous (IV) fluids should be given.

Question 24

A client at 39 weeks of gestation has been admitted for an external version.Which intervention would the nurse anticipate the provider to order?

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

Question 25

The 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 clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction.What are appropriate indications for induction? (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

When would an internal version be indicated to manipulate the fetus into a vertex position?

A) Fetus from a breech to a cephalic presentation before labor begins
B) Fetus from a transverse lie to a longitudinal lie before a 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 a vaginal birth

Question 27

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

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 FHR and pattern

Question 28

What are the complications and risks associated with cesarean births?
(Select all that apply).

A) Pulmonary edema
B) Wound dehiscence
C) Hemorrhage
D) Urinary tract infections
E) Fetal injuries

Question 29

What is a maternal indication for the use of vacuum-assisted birth?

A) Wide pelvic outlet
B) Maternal exhaustion
C) History of rapid deliveries
D) Failure to progress past station 0

Question 30

Women who are obese are at risk for several complications during pregnancy and birth.Which of these would the nurse anticipate with an obese client?

A) Thromboembolism
B) Cesarean birth
C) Wound infection
D) Breech presentation
E) Hypertension