Question 1

A woman in preterm labour at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly.What is the purpose of this pharmacological treatment?

Accepted Answer

Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity.Indomethacin relaxes uterine smooth muscle by inhibiting prostaglandins,not betamethasone.Betamethasone has no effect on uterine contractions.Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulphate therapy.

Question 2

What should the nurse be aware of in the use of tocolytic therapy to suppress uterine activity?

Accepted Answer

Buying time for antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics.Once the pregnancy has reached 34 weeks,the risks of tocolytic therapy outweigh the benefits.There are important maternal contraindications to tocolytic therapy.Tocolytic-induced edema can be caused by IV fluids.

Question 3

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 labour?

Accepted Answer

Women who experience hypertonic uterine dysfunction often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress.These contractions usually occur in the latent stage (cervical dilation of less than 5 cm)and are usually uncoordinated.The contraction pattern seen in this woman signifies hypertonic uterine activity.Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the capacity of the bony pelvis,including the inlet,midpelvis,outlet,or any combination of these planes.

Question 4

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

Accepted Answer

The woman is assisted into a position (e.g. ,modified Sims position,Trendelenburg position,or the knee-chest position)in which gravity keeps the pressure of the presenting part off the cord.Although covering the cord in sterile gauze soaked in saline,preparing the woman for a Caesarean,and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord,the intervention of top priority would be positioning the mother to relieve cord compression.

Question 5

The nurse should know that which statement is accurate?

Accepted Answer

Preterm labour is described as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation;after 37 weeks the fetus can be considered term.Although these terms are used interchangeably,they have different meanings: preterm birth describes the length of gestation (37 weeks)regardless of weight;low birth weight describes weight only (2500 g or less)at the time of birth,whenever it occurs.Low birth weight is anything below 2500 g.In 2010,the overall preterm birth rate for Canada was 7.7%.

Question 6

In evaluating the effectiveness of nitroglycerin for the treatment of preterm labour,what finding would alert the nurse to possible adverse effects?

Accepted Answer

Blood pressure of 80/46 would alert the nurse to possible adverse effects because nitroglycerin can cause severe hypotension.Magnesium sulphate management is not required when a woman is taking nitroglycerin.Urine output of 160 mL in 4 hours and deep tendon reflexes 2+ with no clonus are normal findings.

Question 7

What finding should the nurse expect when evaluating the effectiveness of an oxytocin induction?

Accepted Answer

The goal of induction of labour would be to produce contractions that occur every 2 to 3 minutes and last 80 to 90 seconds.The intensity of the contractions should be strong upon palpation.Cervical dilation of 1 cm/hr in the active phase of labour would be the goal in an oxytocin induction.The dose is increased by 1 to 2 mU/min every 30 minutes until the desired contraction pattern is achieved.Oxytocin 80 mU/min is much too high of a dose.

Question 8

Which should the nurse be aware of with regard to induction of labour?

Accepted Answer

Induction of labour is likely to be more successful with a Bishop score of 7 or higher.Version is turning of the fetus to a better position by a physician for an easier or safer birth.A trial of labour is the observance of a woman and her fetus for several hours of active labour to assess the safety of vaginal birth.Induced labour is not always done for medical reasons.

Question 9

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labour.Her labour is being controlled with tocolytic medications.She asks when she might be able to go home.What is the basis for the nurse's response?

Accepted Answer

The patient's preterm labour is being controlled with tocolytics.Once she is stable,home care may be a viable option for this type of patient.Care of a woman with preterm labour is multifactorial;the goal is to prevent delivery.In many cases this may be achieved at home.The fern test is used to determine if discharge is amniotic fluid,and her discharge is not dependent on the outcome of the fern test.Even women with positive fern test results can be cared for at home.Basing the response on the approach that the health care provider will inform her when she can go home disregards her question and is not the most appropriate answer.The patient's preterm labour is controlled,so there should be no reference made to the birth of the baby in relation to the woman's discharge home.

Question 10

Prostaglandin E? gel has been ordered for a pregnant woman at 43 weeks of gestation.The nurse knows that this medication will be administered for which reason?

Accepted Answer

It is accurate to state that prostaglandin E? gel will be administered to ripen the cervix in preparation for labour induction.It is not administered to enhance uteroplacental perfusion in an aging placenta,increase amniotic fluid volume,or stimulate the amniotic membranes to rupture.

Question 11

A woman is having her first child.She has been in labour for 15 hours.Two hours ago,her vaginal examination revealed the cervix to be dilated to 6 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 labour pattern is associated with this description?

Accepted Answer

With an arrest of the active phase,the progress of labour has stopped.This patient has not had any anticipated cervical change,indicating an arrest of labour.In the nulliparous woman,a prolonged latent phase typically would last over 20 hours.A protracted active phase,the first or second stage of labour,would be prolonged (slow dilation: <1.2 cm/hr in a nullipara and <1.5 cm/hr in a multipara).With protracted descent,the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labour.

Question 12

The nurse providing care for a woman with preterm labour on nifedipine (Adalat)would include which intervention to identify adverse effects of the drug?

Accepted Answer

Women administered nifedipine (Adalat)need to be assessed for hypotension,as it is common with this medication.Assessing DTRs would not address these concerns.Nifedipine (Adalat)may cause tachycardia,not bradycardia.Hypoglycemia and depression of DTRs are not common adverse effects of this drug.

Question 13

What should the nurse be aware of with regard to the process of inducing labour?

Accepted Answer

Laminaria tents are mechanical means of ripening the cervix.Ripening the cervix,making it softer and thinner,increases the success rate of induced labour.Prostaglandin E₂ is less expensive and more effective than oxytocin but carries a greater risk.Amniotomy is the artificial rupture of membranes,which is used to induce labour only when the cervix is already ripe.

Question 14

What should the nurse be aware of with regard to dysfunctional labour?

Accepted Answer

Precipitous labour lasts less than 3 hours,and women experiencing precipitous labour often express feelings of disbelief that their labour began so fast and progressed so quickly.Short women or women more than 15 kg overweight are more at risk for dysfunctional labour.Hypotonic uterine dysfunction,in which the contractions become weaker,is more common.Abnormal labour patterns are more common in women under 20 years of age.

Question 15

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

Accepted Answer

Cervical changes such as shortened endocervical length,effacement,and dilation are predictors of imminent preterm labour.Changes in the cervix accompanied by regular contractions indicate labour at any gestation.For preterm labour the time frame is between 20 and 37 weeks of gestation.Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation.Levels of salivary estriol have been shown to increase before preterm birth.Irregular,mild contractions that do not cause cervical change are not considered a threat.The presence of fetal fibronectin in vaginal secretions before 35 weeks of gestation could predict preterm labour,but it has only a 25% positive predictive value.Of more importance are other physiological clues of preterm labour,such as cervical changes.

Question 16

What should the nurse be aware of for the care management of preterm labour?

Accepted Answer

Gestational age of 20 to 37 weeks,uterine contractions,and a cervix that is 80% effaced or dilated 2 cm indicate preterm labour.It is essential that nurses teach women how to detect the early symptoms of preterm labour.Braxton Hicks contractions resemble preterm labour contractions,but they are not true labour.Waiting too long to see a health care provider could result in not administering essential medications.Preterm labour is not necessarily long-term labour.

Question 17

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

Accepted Answer

Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day.The mother should feel six fetal movements in 2 hours.Fewer than four movements in that hour warrants evaluation.Normal findings in a 42-week gestation include fetal heart rate of 116 beats/min,cervix dilated 20 cm and 50% effaced,and a score of 8 on the biophysical profile.

Question 18

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

Accepted Answer

Reviewing the preoperative and postoperative procedures is the most appropriate information to provide to the woman.It is not accurate to tell the woman she is at the lowest risk for complications.Both maternal and fetal risks are associated with every Caesarean birth.Recovery is not quicker with a second or subsequent Caesarean birth,each one is individual.Physiological and psychological recovery from a Caesarean birth is multifactorial and individual to each patient each time.Preoperative teaching should always be performed,regardless of whether the patient has already had this procedure.

Question 19

While caring for a patient whose labour is being augmented with oxytocin,the nurse recognizes that which finding would indicate that the oxytocin should be discontinued immediately?

Accepted Answer

This FHR is abnormal.The oxytocin should be discontinued immediately,and the physician should be notified.The goal of oxytocin administration is to have uterine contractions every 2 to 3 minutes,lasting 8 to 9 seconds;therefore,uterine contractions occurring every 8 to 10 minutes is not a reason to stop the infusion.The patient needing to void is not an indication to discontinue the oxytocin induction immediately or to call the physician.Unless a change occurs in the FHR pattern that is abnormal or the patient experiences uterine contractions closer than 2 minutes in frequency,the oxytocin does not need to be discontinued.The physician should be notified if the patient's membranes have ruptured.

Question 20

In planning for home care of a woman with preterm labour,the nurse needs to address which concern?

Accepted Answer

Bedrest is not a benign intervention,and there is no evidence in the literature to support the effectiveness of this intervention in reducing preterm birth rates.Nursing assessments will differ somewhat from those performed in the acute care setting,but this is not the concern that needs to be addressed.Restricted activity and medication may prevent preterm labour,but not in all women.In addition,the plan of care is individualized to meet the needs of each woman.Many women will receive home health nurse visits,but care is individualized for each woman.

Quiz 20: Labour and Birth at Risk