Chapter 22: Labor and Birth at Risk My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 22: Labor and Birth at Risk

Test Bank 

MULTIPLE CHOICE

1. In planning for home care of a woman with preterm labor, the nurse needs to address what concern?

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.

ANS: C

Feedback
A Nursing assessments will differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed.
B Restricted activity and medication may prevent preterm labor, but not in all women. In addition, the plan of care is individualized to meet the needs of each woman.
C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery.
D Many women will receive home health nurse visits, but care is individualized for each woman.

DIF:Cognitive Level: AnalysisREF:682

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

2. The nurse providing care for a woman with preterm labor on terbutaline would include which intervention to identify side effects of the drug?

a. Assessing deep tendon reflexes (DTRs)
b. Assessing for dyspnea and crackles
c. Assessing for bradycardia
d. Assessing for hypoglycemia

ANS: B

Feedback
A Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Assessing DTRs would not address these concerns.
B Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Signs of cardiopulmonary decompensation would include adventitious breath sounds and dyspnea.
C Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia.
D Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. The metabolic effect leads to hyperglycemia, not hypoglycemia.

DIF:Cognitive Level: AnalysisREF:685

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

3. 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

ANS: D

Feedback
A Urine output of 160 ml in 4 hours is a normal finding.
B Deep tendon reflexes of 2+ with no clonus is a normal finding.
C Respiratory rate of 16 breaths/min is a normal finding.
D The therapeutic range for magnesium sulfate management is 5 to 8 mg/dl. A serum magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress.

DIF:Cognitive Level: ComprehensionREF:685

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation

4. 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.

ANS: A

Feedback
A Antenatal glucocorticoids given as intramuscular injections to the mother stimulates fetal lung maturation.
B Inderal would be given to reduce the effects of ritodrine administration.
C Betamethasone has no effect on uterine contractions.
D Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

DIF:Cognitive Level: ComprehensionREF:687

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

5. A primigravida at 40 weeks of gestation is having uterine contractions every 1 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 womans 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.

ANS: C

Feedback
A With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor; then the contractions become weak and inefficient or stop altogether.
B The contraction pattern seen in this woman signifies hypertonic uterine activity. Typically uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45 seconds.
C Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, often are anxious first-time mothers who are having painful and frequent contractions that are ineffective at causing cervical dilation or effacement to progress.
D 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.

DIF:Cognitive Level: ApplicationREF:690

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

6. Which statement is most likely to be associated with a breech presentation?

a. Least common malpresentation
b. Descent is rapid
c. Diagnosis by ultrasound only
d. High rate of neuromuscular disorders

ANS: D

Feedback
A Breech is the most common malpresentation affecting 3% to 4% of all labors.
B Descent is often slow because the breech is not as good a dilating wedge as is the fetal head.
C Diagnosis is made by abdominal palpation and vaginal examination. It is confirmed by ultrasound.
D Fetuses with neuromuscular disorders have a higher rate of breech presentation perhaps because they are less capable of movement within the uterus.

DIF:Cognitive Level: AnalysisREF:693

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

7. 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. Secondary arrest
d. Protracted descent

ANS: C

Feedback
A In the nulliparous woman, a prolonged latent phase typically would last over 20 hours.
B A protracted active phase, the first or second stage of labor, would be prolonged (slow dilation).
C There is no change in dilation with secondary arrest.
D With protracted descent, the fetus would fail to descend at an anticipated rate during the deceleration phase and second stage of labor.

DIF:Cognitive Level: AnalysisREF:691

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Assessment, Diagnosis

8. 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.

ANS: A

Feedback
A The goal of induction of labor would be to produce contractions that occur every 2 to 3 minutes and last 80 to 90 seconds.
B The intensity of the contractions should be 40 to 90 mm Hg by intrauterine pressure catheter.
C Cervical dilation of 1 cm/hr in the active phase of labor would be the goal in an oxytocin induction.
D The dose is increased by 1 to 2 mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved. Doses are increased up to a maximum of 20 to 40 mU/min.

DIF:Cognitive Level: AnalysisREF:701

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

9. 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, the nurse would include what information?

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.

ANS: B

Feedback
A This statement is not accurate. Both maternal and fetal risks are associated with every cesarean section.
B This statement is the most appropriate.
C This statement is not accurate. Physiologic and psychologic recovery from a cesarean section is multifactorial and individual to each patient each time.
D Preoperative teaching should always be performed, regardless of whether the patient has already had this procedure.

DIF:Cognitive Level: ApplicationREF:708

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

10. A pregnant womans amniotic membranes have ruptured. Prolapsed 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

ANS: A

Feedback
A 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.
B Covering the cord in sterile gauze soaked in saline is an appropriate nursing intervention in the event of a prolapsed cord, but the intervention of top priority would be positioning the mother to relieve cord compression.
C Preparing the woman for cesarean birth is an appropriate nursing intervention in the event of a prolapsed cord, but the intervention of top priority would be positioning the mother to relieve cord compression.
D Starting oxygen by face mask is an appropriate nursing intervention in the event of a prolapsed cord, but the intervention of top priority would be positioning the mother to relieve cord compression.

DIF:Cognitive Level: ApplicationREF:718

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

11. 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.

ANS: C

Feedback
A This choice is not accurate. The goal of Prepidil is to ripen the cervix in preparation for labor induction.
B This choice is not accurate. The goal of Prepidil is to ripen the cervix in preparation for labor induction.
C This statement is accurate.
D This choice is not accurate. The goal of Prepidil is to ripen the cervix in preparation for labor induction.

DIF:Cognitive Level: ApplicationREF:699

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

12. 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.

ANS: B

Feedback
A 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.
B Before 20 weeks labor results in miscarriage, a nonviable fetus; after 37 weeks the fetus can be considered term.
C Low birth weight is anything below 2500 g, or about 5 pounds.
D In 2003 the preterm birth rate in the United States was 12.3%, but it is increasing in frequency.

DIF:Cognitive Level: KnowledgeREF:678

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

13. 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.

ANS: D

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

DIF:Cognitive Level: ComprehensionREF:681

OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Planning

14. 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.

ANS: D

Feedback
A Version is turning of the fetus to a better position by a physician for an easier or safer birth.
B A trial of labor is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth.
C Two thirds of cases of induced labor are elective and not done for medical reasons.
D Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers and 5 or higher for veterans.

DIF:Cognitive Level: ComprehensionREF:697

OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Diagnosis

15. With regard to the process of inducing labor, nurses should be aware 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.

ANS: B

Feedback
A Ripening the cervix, making it softer and thinner, increases the success rate of induced labor.
B These are mechanical means of ripening the cervix.
C Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk.
D Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.

DIF:Cognitive Level: ComprehensionREF:698

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

16. The least common risk factor for a long, difficult, or abnormal labor (dystocia) is:

a. Advanced maternal age.
b. Infertility difficulties.
c. Multiparity.
d. Short stature.

ANS: C

Feedback
A Advanced maternal age increases a womans risk for uterine dystocia.
B Infertility difficulties have been identified as contributing to the risk for dystocia.
C The woman experiencing dystocia is often an anxious first-time mother who is having painful and frequent contractions that are ineffective in causing cervical dilation or effacement to progress. Dystocia affects 8% to 11% of all births.
D Short stature has been cited as a risk factor for dystocia.

DIF:Cognitive Level: KnowledgeREF:690

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

17. 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.

ANS: A

Feedback
A Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily.
B Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods.
C Forceps-assisted births and vacuum-assisted births come at the end of labor and are not part of augmentation.
D Forceps-assisted births and vacuum-assisted births come at the end of labor and are not part of augmentation.

DIF:Cognitive Level: ComprehensionREF:702

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Complications and risks associated with cesarean births include (choose all that apply):

a. Pulmonary edema.
b. Wound dehiscence.
c. Hemorrhage.
d. Urinary tract infections.
e. Fetal injuries.

ANS: A, B, C, D, E

Feedback
Correct All of these are possible complications and risks associated with cesarean section.
Incorrect None.

DIF:Cognitive Level: ComprehensionREF:707

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation

COMPLETION

1. A nurse is caring for a patient in the active phase of labor. The womans bag of waters spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless and cyanotic. In addition, she becomes hypotensive and tachycardic. The nurse immediately suspects the presence of ___________________________________.

ANS:

An amniotic fluid embolism

Anaphylactoid syndrome of pregnancy (ASP) is more commonly known as amniotic fluid embolism. This is a rare but devastating complication of pregnancy. It is characterized by the sudden, acute onset of hypoxia, hypotension or cardiac arrest, and coagulopathy. ASP can occur during labor, birth, or within 30 minutes after birth. This clinical presentation is similar to that observed in patients with anaphylactic or septic shock. In both of these conditions, a foreign substance is introduced into the circulation.

DIF:Cognitive Level: AnalysisREF:719

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

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