Chapter 27 The Woman with an Intrapartum Complication

Chapter 27  The Woman with an Intrapartum Complication

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. Which actions by the nurse may prevent infections in the labor and delivery area?

a. Vaginal examinations every hour while the woman is in active labor
b. Use of clean techniques for all procedures
c. Cleaning secretions from the vaginal area by using back-to-front motion
d. Keeping underpads and linens as dry as possible

ANS: D
Bacterial growth prefers a moist, warm environment. Vaginal examinations should be
limited to decrease transmission of vaginal organisms into the uterine cavity. Use an aseptic
technique if membranes are not ruptured; use a sterile technique if membranes are ruptured.
Vaginal drainage should be removed with a front-to-back motion to decrease fecal
contamination.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 579 OBJ: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment

2. A woman in labor at 34 weeks of gestation is hospitalized and treated with intravenous

magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which
oral drug will probably be prescribed for continuation of the tocolytic effect?
a. Ritodrine
b. Terbutaline
c. Calcium gluconate
d. Pitocin

ANS: B
The woman receiving decreasing doses of magnesium sulfate is often switched to oral
terbutaline to maintain tocolysis for 48 hours. The terbutaline will probably be discontinued
prior to discharge. Ritodrine is the only drug approved by the FDA for tocolysis; however, it
is rarely used because of significant side effects. Calcium gluconate reverses magnesium
sulfate toxicity. The drug should be available for complications of magnesium sulfate
therapy. Pitocin is used to augment labor, not stop it.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 588 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

3. Which technique is least effective for the woman with persistent occiput posterior position?

a. Lie supine and relax.
b. Sit or kneel, leaning forward with support.
c. Rock the pelvis back and forth while on hands and knees.
d. Squat.

ANS: A

Lying supine increases the discomfort of “back labor.” A sitting or kneeling position may
help the fetal head to rotate to occiput anterior. Rocking the pelvis encourages rotation from
occiput posterior to occiput anterior. Squatting aids both rotation and fetal descent.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 575 OBJ: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

4. Birth for the nulliparous woman with a fetus in a breech presentation is usually by

a. cesarean delivery.
b. vaginal delivery.
c. forceps-assisted delivery.
d. vacuum extraction.

ANS: A
Delivery for the nulliparous woman with a fetus in breech presentation is almost always
cesarean section. The greatest fetal risk in the vaginal delivery of breech presentation is that
the head (largest part of the fetus) is the last to be delivered. The delivery of the rest of the
baby must be quick so that the infant can breathe.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 576 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

5. Which patient situation presents the greatest risk for the occurrence of hypotonic

dysfunction during labor?
a. A primigravida who is 17 years old
b. A 22-year-old multiparous woman with ruptured membranes
c. A multiparous woman at 39 weeks of gestation who is expecting twins
d. A primigravida woman who has requested no analgesia during her labor

ANS: C
Overdistention of the uterus in a multiple pregnancy is associated with hypotonic
dysfunction because the stretched uterine muscle contracts poorly. A young primigravida
usually will have good muscle tone in the uterus. This prevents hypotonic dysfunction.
There is no indication that this woman’s uterus is overdistended, which is the main cause of
hypotonic dysfunction. A primigravida usually will have good uterine muscle tone, and
there is no indication of an overdistended uterus.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 578 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity