Chapter 22 Labor and Birth at Risk

Chapter 22  Labor and Birth at Risk

Complete Chapter Questions And Answers
 

Sample Questions

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: Analysis REF: 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 β2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. Assessing DTRs would not address these concerns.
B
Terbutaline is a β2-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 β2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. β2-Adrenergic agonist drugs cause tachycardia, not bradycardia.
D
Terbutaline is a β2-adrenergic agonist that affects the cardiopulmonary and metabolic systems of the mother. The metabolic effect leads to hyperglycemia, not hypoglycemia.

DIF: Cognitive Level: Analysis REF: 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: Comprehension REF: 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: Comprehension REF: 687
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

5. A primigravida at 40 weeks of gestation is having uterine contractions every 1½ 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 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: Application REF: 690
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis