Deck 26: Childbirth at Risk: Prelabor Complications

Question 1

The nurse educator is describing the different kinds of abruptio placentae to a group of students, explaining that in a complete abruptio placentae:

A) Separation begins at the periphery of the placenta.
B) The placenta separates centrally, and there can be concealed bleeding.
C) There is massive vaginal bleeding in the presence of almost total separation.
D) Blood passes between the fetal membranes and the uterine wall, and escapes vaginally.

Answer 1

There is massive vaginal bleeding in the presence of almost total separation.

Question 2

The nurse is admitting a patient for a cerclage procedure. The patient asks for information about the procedure. What is the nurse's most accurate response?

A) A stitch is placed in the cervix to prevent a spontaneous abortion or premature birth.
B) The procedure is done during the third trimester.
C) Cerclage is always placed after the cervix has dilated and effaced.
D) A stitch is placed at the very tip of the cervix.

Answer 2

A stitch is placed in the cervix to prevent a spontaneous abortion or premature birth.

Question 3

The labor nurse is caring for a patient at 38 weeks' gestation who has been diagnosed with symptomatic placenta previa. Which physician order should the nurse question?

A) Begin oxytocin drip rate at 0.5 milliunits/min.
B) Assess fetal heart rate every 10 minutes.
C) Weigh all vaginal pads.
D) Assess hematocrit and hemoglobin.

Answer 3

Begin oxytocin drip rate at 0.5 milliunits/min.

Question 4

The nurse is planning an in-service educational program to talk about disseminating intravascular coagulation (DIC). The nurse should include which of the following as risk factors for developing DIC? () Standard Text:

A) Diabetes mellitus
B) Abruptio placentae
C) Prolonged retention of a fetus after demise
D) Multiparity
E) Preterm labor

Question 5

The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC?

A) Diabetes mellitus
B) Abruptio placentae
C) Prolonged retention of a fetus after demise
D) Multiparity
E) Preterm labor

Question 6

A multigravida patient is admitted to the labor and delivery unit in active labor. Nursing diagnoses that might apply to the patient with suspected abruptio placentae include:

A) Fluid Volume, risk for deficit related to hypovolemia.
B) Tissue Perfusion, risk for altered related to blood loss.
C) Anxiety related to concern for own safety.
D) Knowledge Deficit related to lack of information about inherited genetic defects.
E) Alteration in Respiratory Function related to blood loss.

Question 7

During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. The nurse's priority action is to:

A) Help the fetal head descend faster.
B) Use gravity and manipulation to relieve compression on the cord.
C) Facilitate dilation of the cervix with prostaglandin gel.
D) Prevent head compression.

Question 8

The patient at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes:

A) Limiting vaginal exams to only one per 24-hour period.
B) Evaluating the fetal heart rate with an internal monitor.
C) Monitoring for blood loss, pain, and uterine contractibility.
D) Assessing blood pressure every 2 hours.

Question 9

The client is admitted to Labor and Delivery with a history of ruptured membranes for two hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. This client is at risk for:

A) Gestational diabetes.
B) Placenta previa.
C) Abruptio placentae.
D) Placenta accrete.

Question 10

A pregnant patient is admitted to the emergency department with bleeding. The nurse realizes that the patient might have placenta previa. Which signs would be suggestive of placenta previa?

A) Bright red vaginal bleeding
B) Sudden onset of vaginal bleeding
C) Firm and stony hard uterus
D) Increase in size of abdomen

Question 11

A patient at 32 weeks' gestation is admitted with painless vaginal bleeding. Placenta previa has been confirmed by ultrasound. What should be included in the nursing plan?

A) No vaginal exams
B) Encouraging activity
C) No intravenous access until labor begins
D) Evaluating fetal heart rate with an external monitor
E) Monitoring blood loss, pain, and uterine contractility

Question 12

The nurse is caring for a patient at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the patient needs additional teaching? "If I:

A) "Were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."
B) "Develop a urinary tract infection in my next pregnancy, I might rupture membranes early again."
C) "Want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."
D) "Have bleeding in the third trimester of my next pregnancy, I might rupture membranes again."

Question 13

A patient is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. This patient is at risk for:

A) Gestational diabetes.
B) Placenta previa.
C) Abruptio placentae.
D) Placenta accreta.

Question 14

A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, -2 station, with intact membranes and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. The initial response from the nurse would be to:

A) Perform a vaginal exam.
B) Notify the physician.
C) Place the patient in a left lateral position.
D) Administer oxygen at 2 L per nasal cannula.

Question 15

A patient in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of:

A) A nonstress test.
B) A vibroacoustic stimulation test
C) An ultrasound.
D) A contraction stress test.

Question 16

The nurse admits into the labor area a patient who is in preterm labor. The assessment finding that would constitute a diagnosis of preterm labor is:

A) Cervical effacement of 30% or more.
B) Cervical change of 0.5 cm per hour.
C) Two contractions in 30 minutes.
D) Eight contractions in 1 hour.

Question 17

A patient was admitted to the labor area at 5 cm with ruptured membranes about 14 hours ago. The assessment data that would be most beneficial is:

A) Blood pressure.
B) Temperature.
C) Pulse.
D) Respiration.

Question 18

The nurse has received end-of-shift reports in the high-risk maternity unit. Which patient should the nurse see first?

A) The patient at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement
B) The patient at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations
C) The patient at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push
D) The patient at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Question 19

The nurse has admitted a woman with cervical insufficiency. The nurse is aware that causes of this condition include:

A) Congenital factors.
B) Intercourse during pregnancy.
C) Infection.
D) Increased uterine volume.
E) Past cervical surgeries.

Question 20

The nurse is presenting a class on preterm labor, its causes, and treatments to a group of newly pregnant couples. Which statements are true regarding preterm labor? Note: Credit will be given only of all correct choices and no incorrect choices are selected. Standard Text:

A) Antepartum hemorrhage can cause preterm labor.
B) Trauma can cause preterm labor.
C) Infection can cause preterm labor.
D) Magnesium sulfate is a drug used to stop contractions.
E) Sedatives and narcotics may be given to stop labor.

Question 21

A multiple-gestation pregnancy at 20 weeks is considered normal on ultrasound. At what interval would you have the patient return for serial ultrasounds?

A) Every 2 weeks
B) Every 3-4 weeks
C) Every 5 weeks
D) Every 6-8 weeks

Question 22

A multiple-gestation patient has just had her first biophysical profile (BPP) of 8 at 33 weeks' gestation. When would she return for the next BPP?

A) In 1-2 weeks
B) In 3-4 weeks
C) In 5-6 weeks
D) In 7-8 weeks

Question 23

The nurse is presenting a class for nursing students on multiple-gestation pregnancy. Which statements about multiple-gestation pregnancies are accurate?

A) Hypertension is a major maternal complication.
B) There is an increased incidence of fetal anomalies.
C) Twins have an increase in long-term disabilities compared with singletons.
D) Uterine dysfunction is not a problem with multiple-gestation pregnancies.
E) Pulmonary embolism is more common with multiple-gestation pregnancies.

Question 24

The nurse knows that a baby born to a mother who had oligohydramnios could show signs of:

A) Respiratory difficulty.
B) Hypertension.
C) Heart murmur.
D) Decreased temperature.

Question 25

A woman with a multiple-fetus pregnancy asks, "What are the chances of having an uncomplicated pregnancy?" The nurse's best response is that:

A) The perinatal mortality rate for monoamniotic siblings is 50%.
B) Twins are less likely to have complications than are singleton births.
C) Primiparous women pregnant with twins are less likely to develop complications.
D) Spontaneous abortion is more common with twins.

Question 26

Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with too rapid a withdrawal of fluid?

A) Preterm labor
B) Placental abruption
C) Preeclampsia
D) Placenta previa

Question 27

The nurse is admitting a patient with possible hydramnios. Hydramnios most likely would be suspected when:

A) There is less amniotic fluid than normal for gestation.
B) The fundal height increases disproportionately to the gestation.
C) The woman has a twin gestation.
D) The quadruple screen comes back positive.

Question 28

The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with: () Standard Text:

A) Chest pain, dyspnea, tachycardia, and hypotension.
B) Postmaturity syndrome.
C) Renal malformation or dysfunction.
D) Maternal diabetes.
E) Large for gestational age infants.

Question 29

When counseling a newly pregnant gravida 1 at 8 weeks' twin gestation, the nurse teaches the woman about the need for increased caloric intake. The nurse would tell the woman that the minimum recommended intake should be:

A) 2500 kcal and 120 grams protein.
B) 3000 kcal and 150 grams protein.
C) 4000 kcal and 135 grams protein.
D) 5000 kcal and 190 grams protein.

Question 30

The home health nurse is admitting a patient at 18 weeks who is pregnant with twins. Which nursing action is most important?

A) Teach the patient about foods that are good sources of protein.
B) Assess the patient's blood pressure in her upper right arm.
C) Determine whether the pregnancy is the result of infertility treatment.
D) Collect a cervicovaginal fetal fibronectin (fFN) specimen.

Question 31

When caring for a laboring patient with oligohydramnios, the nurse should be aware that:

A) There is an increased risk of cord compression.
B) Respiratory support personnel should be standing by at the birth.
C) Labor progress is often more rapid than average.
D) Early decelerations are more likely.
E) During gestation, fetal skin and skeletal abnormalities can occur.

Question 32

The nurse is caring for a patient with hydramnios. The nurse will watch for:

A) Possible intrauterine growth restriction.
B) Newborn congenital anomalies.
C) Newborn postmaturity and renal malformations.
D) Maternal prolonged labor.

Question 33

The patient at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective?

A) "My gestational diabetes might have caused this problem to develop."
B) "When I go into labor, I should come to the hospital right away."
C) "This problem is common, and will likely occur with my next pregnancy."
D) "Women with this condition usually go into labor after their due date."

Question 34

The patient is carrying monochorionic-monoamniotic twins. The nurse teaches the patient what this is, and the implications of this finding. The nurse knows that teaching is successful when the patient states:

A) "My babies came from two eggs."
B) "About two thirds of twins have this amniotic sac formation."
C) "My use of a fertility drug led to this issue."
D) "My babies have a lower chance of surviving to term than fraternal twins do."

Question 35

The nurse is admitting a patient who was diagnosed with hydramnios. The patient asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with:

A) Chest pain, dyspnea, tachycardia, and hypotension.
B) Postmaturity syndrome.
C) Renal malformation or dysfunction.
D) Maternal diabetes.
E) Large-for-gestational-age infants.

Question 36

The nurse is planning care for a patient with hydramnios. For which interventions might the nurse need to prepare the patient?

A) Artificial rupture of the membranes
B) Amnioinfusion
C) Amniocentesis
D) Administration of prostaglandin synthesis inhibitor
E) Administration of indomethacin