Chapter 33: Labor and Birth Complications My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 33: Labor and Birth Complications

Test Bank

MULTIPLE CHOICE

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

a.

Nursing assessments are different from those done in the hospital setting.

b.

Restricted activity and medications are necessary to prevent recurrence of preterm labor.

c.

Prolonged bed rest may cause negative physiologic effects.

d.

Home health care providers are necessary.

ANS: 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.

Nursing assessments differ somewhat from those performed in the acute care setting, but this is not the concern that needs to be addressed.

Restricted activity and medications may prevent preterm labor but not in all women. Additionally, the plan of care is individualized to meet the needs of each client.

Many women receive home health nurse visits, but care is individualized for each woman.

DIF: Cognitive Level: Analysis REF: 784

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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

a.

Assess deep tendon reflexes (DTRs).

b.

Assess for dyspnea and crackles.

c.

Assess for bradycardia.

d.

Assess for hypoglycemia.

ANS: B

Terbutaline is a beta2-adrenergic agonist that affects the mothers cardiopulmonary and metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea.

Assessing DTRs does not address the possible respiratory side effects of using terbutaline. It is important for the nurse to perform this assessment if the woman is on magnesium sulfate.

Terbutaline is a beta2-adrenergic agonist that affects the mothers cardiopulmonary and metabolic systems. Beta2-adrenergic agonist drugs cause tachycardia, not bradycardia.

Terbutaline is a beta2-adrenergic agonist that affects the mothers cardiopulmonary and metabolic systems. The metabolic effect leads to hyperglycemia, not hypoglycemia.

DIF: Cognitive Level: Analysis REF: 788

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

3. 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.

Deep tendon reflexes 2+ and no clonus

c.

Respiratory rate (RR) of 16 breaths/min

d.

Serum magnesium level of 10 mg/dl

ANS: 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.

Urine output of 160 ml in 4 hours is a normal finding.

Deep tendon reflexes of 2+ is a normal finding.

RR of 16 breaths/min is a normal finding.

DIF: Cognitive Level: Comprehension REF: 787

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

Antenatal glucocorticoids given as IM injections to the mother accelerate fetal lung maturity.

Propranolol (Inderal) is given to reduce the effects of ritodrine administration.

Betamethasone has no effect on uterine contractions.

Calcium gluconate is given to reverse the respiratory depressive effects of magnesium sulfate therapy.

DIF: Cognitive Level: Comprehension REF: 790

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

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.

With hypotonic uterine dysfunction, the woman initially makes normal progress into the active stage of labor and then the contractions become weak and inefficient or stop altogether.

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.

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: Application REF: 792

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

6. Obese women are at risk for several complications during pregnancy and birth. These include all except:

a.

Thromboembolism

b.

Cesarean birth

c.

Wound infection

d.

Breech presentation

ANS: D

A breech presentation is not a complication of pregnancy or birth for the obese client.

Venous thromboembolism is a known risk for obese women. The use of TED hose and sequential compression devices may help to decrease the chance for clot formation. Women should also be encouraged to ambulate as soon as possible.

In addition to having an increased risk for cesarean birth in general, obese women are also more likely to require emergency cesarean birth.

Many obese women have a pannus (large roll of abdominal fat) that overlies a lower transverse incision made just above the pubic area. The pannus causes the area to remain moist, which encourages the development of infection.

DIF: Cognitive Level: Analysis REF: 797

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

With a secondary arrest of the active phase, the progress of labor has stopped. This client has not had any anticipated cervical change, indicating an arrest of labor.

In the nulliparous woman, a prolonged latent phase typically lasts more than 20 hours.

A protracted active phase, the first or second stage of labor, is prolonged (slow dilation).

With protracted descent, the fetus fails to descend at an anticipated rate during the deceleration phase and second stage of labor.

DIF: Cognitive Level: Analysis REF: 793

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

8. In evaluating the effectiveness of an oxytocin induction, the nurse expects:

a.

Contractions lasting 40 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 milliunits/min of oxytocin are needed to achieve cervical dilation

ANS: A

The goal of induction of labor is to produce contractions that occur every 2 to 3 minutes and last 80 to 90 seconds.

The intensity of the contractions should be 40 to 90 mm Hg by IUPC.

Cervical dilation of 1 cm/hr in the active phase of labor is the goal in an oxytocin induction.

The dose is increased by 1 to 2 milliunits/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 milliunits/min.

DIF: Cognitive Level: Analysis REF: 804

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

9. Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. The nurse recognizes that this medication is 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

Preparations of prostaglandin E1 and E2 are effective when used before induction to ripen (soften and thin) the cervix.

Uteroplacental perfusion is not altered by the use of prostaglandins.

The insertion of prostaglandin gel has no effect on the level of amniotic fluid.

In some cases, women will spontaneously begin laboring after the administration of prostaglandins, thereby eliminating the need for oxytocin. It is not common for a woman to rupture her membranes as a result of prostaglandin use.

DIF: Cognitive Level: Application REF: 800

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

10. 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. What 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 the doctor says that it is okay.

d.

It depends on what kind of insurance coverage you have.

ANS: B

The clients preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client.

Care of a woman with preterm labor is multifactorial; the goal is to prevent delivery. In many cases, this may be achieved at home.

Care of the preterm client is multidisciplinary and multifactorial. Managed care may dictate earlier hospital discharges or a shift from hospital to home care.

Insurance coverage may be one factor in client care, but ultimately, client safety remains the most important factor.

DIF: Cognitive Level: Application REF: 784

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

11. A client is to have an amniotomy to induce labor. The nurse recognizes that the priority intervention after the amniotomy is to:

a.

Apply clean linens under the woman

b.

Take the clients vital signs

c.

Perform a vaginal examination

d.

Assess the fetal heart rate (FHR)

ANS: D

The FHR is assessed before and immediately after the amniotomy to detect any changes that might indicate cord compression or prolapse.

Providing comfort measures for the client is important, but it is not the priority immediately after an amniotomy.

The womans temperature should be checked every 2 hours after rupture of membranes, but this is not the priority at this time.

The woman would have had a vaginal examination during the procedure. Unless cord prolapse is suspected, a vaginal examination is not warranted. Additionally, FHR assessment provides clinical cues to a prolapsed cord.

DIF: Cognitive Level: Analysis REF: 803

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

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 lb

d.

In the United States early in this century, preterm birth accounted for 18% to 20% of all births

ANS: B

Before 20 weeks it is not viable (miscarriage); after 37 weeks, it can be considered term.

Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (before 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, or about 5.5 pounds.

In 2006, the preterm birth rate in the United States was 12.8%; however, the rate is increasing in frequency.

DIF: Cognitive Level: Knowledge REF: 779

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

Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor.

It is essential that nurses teach women how to detect the early symptoms of preterm labor.

Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor.

Waiting too long to see a health care provider could result in essential medications failing to be administered. Preterm labor is not necessarily long-term labor.

DIF: Cognitive Level: Comprehension REF: 783

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

14. 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.

The cause may be of maternal or fetal origin.

ANS: C

Unfortunately, there is no way to accurately predict CPD.

Although CPD is often related to excessive fetal size or macrosomia, the problem in many cases is malposition of the fetal presenting part rather than true CPD.

When CPD is present, the fetus cannot fit through the maternal pelvis to be born vaginally.

CPD may be related to either fetal origins such as macrosomia or malposition or maternal origins such as a too small or malformed pelvis.

DIF: Cognitive Level: Knowledge REF: 794

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

15. 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

Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers, 5 or higher for veterans.

Version is turning of the fetus to a better position by a physician for an easier or safer birth.

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.

Two thirds of cases of induced labor are elective and not done for medical reasons.

DIF: Cognitive Level: Comprehension REF: 800

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Diagnosis

16. 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

These are mechanical means of ripening the cervix.

Ripening the cervix, making it softer and thinner, increases the success rate of induced labor.

Prostaglandin E1 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 labor only when the cervix is already ripe.

DIF: Cognitive Level: Comprehension REF: 800

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

17. With regard to the process of augmentation of labor, a 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

Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily.

Augmentation uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods.

Forceps-assisted births are less common than in the past and not considered a method of augmentation.

A vacuum assist occurs during birth if the mother is too exhausted to push. Vacuum extraction is not considered an augmentation methodology.

DIF: Cognitive Level: Comprehension REF: 805

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

18. 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

ANS: A

The infections that increase the risk of preterm labor and birth are bacterial. They include cervical, urinary tract, periodontal, and other bacterial infections. It is therefore important for the client to participate in early, continual, and comprehensive prenatal care.

Recent evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene in order to prevent infection.

Cervical infections of a bacterial nature have been linked to preterm labor and birth.

The presence of urinary tract infections increases the risk of preterm labor and birth.

DIF: Cognitive Level: Knowledge REF: 781

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

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

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 fetal heart rate (FHR) and pattern

ANS: B, D, E

Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are indications of uterine hyperstimulation with oxytocin administration.

Uterine contractions that occur more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin induction. A uterine tone of less than 20 mm Hg is normal.

DIF: Cognitive Level: Analysis REF: 804

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

2. 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

Pulmonary edema, wound dehiscence, hemorrhage, urinary tract infections, and fetal injuries are possible complications and risks associated with cesarean births.

DIF: Cognitive Level: Comprehension REF: 810

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

3. The nurse is teaching a client with PPROM about self-care activities. Which activities should the nurse include in her teaching? Choose all that apply.

a.

Report a temperature higher than 40 C.

b.

It is safe to use a tampon to absorb the leaking amniotic fluid.

c.

Do not engage in sexual activity.

d.

It is safe to take frequent tub baths.

e.

It is acceptable to douche to cleanse the vagina of foul-smelling fluids.

ANS: C

Sexual activity should be avoided because it may induce preterm labor.

A temperature of more than 38 C should be reported. Tub baths should be avoided to prevent the risk of infection. To avoid the risk of infection, nothing should be inserted into the vagina. Furthermore, foul-smelling vaginal fluid should be reported because this may be a sign of infection.

DIF: Cognitive Level: Application REF: 791

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

COMPLETION

1. Nurses need to know that when any woman is admitted to the hospital and is __________ to __________ weeks pregnant, she should receive antenatal glucocorticoids unless she has chorioamnionitis. Because these drugs require a 24-hour period to become effective, timely administration is essential.

ANS:

24; 34

All women between 24 and 34 weeks of gestation who are at risk for preterm birth within 7 days should receive treatment with a single course of antenatal glucocorticoids.

DIF: Cognitive Level: Comprehension REF: 790

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. ____________________ is defined as long, difficult, or abnormal labor. It is caused by various conditions associated with the five factors affecting labor.

ANS:

Dystocia

It is estimated that dystocia occurs in approximately 8% to 11% of all births. Dystocia is the second most common indication for cesarean birth (after previous cesarean birth) and is responsible for approximately 60% of all cesarean deliveries in the United States.

DIF: Cognitive Level: Comprehension REF: 794

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

3. A nurse is caring for a client in the active phase of labor. The womans bag of waters spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless and cyanotic. Additionally, 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 clients with anaphylactic or septic shock. In both of these conditions, a foreign substance is introduced into the circulation.

DIF: Cognitive Level: Analysis REF: 820

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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