Chapter 22 Contemporary Maternal Newborn Nursing 8th Edition

Chapter 22  Contemporary Maternal Newborn Nursing 8th Edition

Complete Chapter Questions And Answers
 

Sample Questions

Question 1
Type: MCSA
A patient who sustained a difficult, lengthy labor and delivery is conversing with the nurse. Suddenly, the patient complains of chest pain and appears dyspneic. She is cyanotic and tachycardic, and her blood pressure has decreased to 78/36. What condition should the nurse suspect is developing?
1. Placenta accreta
2. Infection
3. Hypertensive crisis
4. Amniotic fluid embolus
Correct Answer: 4
Rationale 1: Placenta accreta occurs when the chorionic villi attach directly to the uterine myometrium. The major complications of placenta accreta include maternal hemorrhage and failure of the placenta to separate following birth of the infant. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis.
Rationale 2: This patient’s symptoms have a severe, sudden onset that is consistent with amniotic fluid embolus. Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis.
Rationale 3: The patient is hypotensive and is demonstrating signs and symptoms that are consistent with amniotic fluid embolus, including chest pain, dyspnea, tachycardia, hypotension and cyanosis.
Rationale 4: Signs and symptoms of amniotic fluid embolus include chest pain, dyspnea, tachycardia, hypotension, and cyanosis. The condition may progress to hemorrhage, shock, and death.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: LO07 – Summarize the identification, maternal and fetal-neonatal implications, clinical therapy, and nursing care management of the woman with an amniotic fluid embolus.

Question 2
Type: MCSA
A 20-year-old woman who is pregnant with her first child has been laboring for 14 hours with very minimal progress. Cervical dilatation and effacement are slow, and the nurse is unable to verify engagement of the presenting fetal part. What condition should the nurse suspect may be affecting the patient’s labor?
1. Cephalopelvic disproportion (CPD)
2. Prolapsed cord
3. Placenta accreta
4. Occiput anterior (OA) fetal position
Correct Answer: 1
Rationale 1: The nurse should suspect CPD when labor is prolonged, cervical dilatation and effacement are slow, and engagement of the presenting part is delayed.
Rationale 2: A prolapsed cord is an umbilical cord that precedes the fetal presenting part. Fetal bradycardia is a critical indicator of prolapsed cord. This patient is demsontrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
Rationale 3: Placenta accreta, in which the chorionic villi attach directly to the uterine myometrium, is associated with maternal hemorrhage and failed placental separation after birth. This patient is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
Rationale 4: The occiput anterior (OA) fetal position is amenable to delivery and would not represent a barrier to labor. This patient is demonstrating prolonged labor, slow cervical dilatation and effacement, and delayed engagement of the presenting fetal part, which are consistent with cephalopelvic disproportion (CPD).
Global Rationale:

Cognitive Level: Analyzing
Client Need: Physiological Integrity
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO03 – Relate the various types of fetal malposition and malpresentation, risks, and clinical therapy to the nursing care management of each.

Question 3
Type: MCSA
The nurse is making patient assignments for the next shift. Which patient is most likely to experience a complicated labor pattern?
1. 34-year-old gravida 6 at 39 weeks’ gestation with twins
2. 22-year-old gravida 1 at 23 weeks’ gestation with ruptured membranes
3. 30-year-old gravida 3 at 41 weeks’ gestation and estimated fetal weight 7 pounds, 8 ounces
4. 43-year-old gravida 2 at 37 weeks’ gestation with hypertension
Correct Answer: 1
Rationale 1: Twins at term will cause overdistention of the uterus, putting the patient at risk for development of a hypotonic labor pattern. Her high parity also increases the risk for a hypotonic labor pattern.
Rationale 2: Although this patient is high-risk, especially for infection, neonatal lung immaturity, and respiratory distress syndrome, this patient has no risk factors for an abnormal labor pattern.
Rationale 3: This patient has an average-sized fetus and no risk factors for either hypertonic or hypotonic labor pattern development.
Rationale 4: Hypertension does not impact labor pattern; this patient has no risk factors for either hypertonic or hypotonic labor pattern development.
Global Rationale:

Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 – Compare tachysystolic and hypotonic labor patterns, including risks, clinical therapy, and nursing care management.

Question 4
Type: MCSA
Two hours ago, the 39-weeks’-gestation patient was 3 cm dilated, 40% effaced, and +1 station. Frequency of contractions was every five minutes with duration 40 seconds and intensity 50 mmHg. The current assessment is 4 cm dilated, 40% effaced, and +1 station. Frequency of contractions is now every three minutes with 40–50 seconds’ duration with intensity of 40 mmHg. The priority intervention would be:
1. Begin oxytocin after assessing for CPD.
2. Give Terbutaline to stop the preterm labor.
3. Start oxygen at 8 L/min.
4. Have anesthesia give the patient an epidural.
Correct Answer: 1
Rationale 1: The patient is having hypertonic contractions. The presence of CPD can prolong labor, so it is important to rule this out. Oxytocin (Pitocin) can create a more productive labor pattern by strengthening the contractions.
Rationale 2: Terbutaline would not be recommended. The contraction pattern is incoordinate, but they need to be enhanced, not stopped.
Rationale 3: Oxygen will not hurt, but it is not the priority.
Rationale 4: An epidural will not change the incoordinate contraction pattern.
Global Rationale:

Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Client Need Sub:
Nursing/Integrated Concepts: Nursing Process: Assessment
Learning Outcome: LO01 – Compare tachysystolic and hypotonic labor patterns, including risks, clinical therapy, and nursing care management.