Chapter 32 Labor and Birth Complications

Chapter 32  Labor and Birth Complications

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. In planning for home care of a woman with preterm labor, which concern should the nurse need to address?
a.
Nursing assessments are different from those performed in the hospital setting.
b.
Restricted activity and medications are necessary to prevent a 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 concern does not need to be addressed. Restricted activity and medications may prevent preterm labor but not in all women. In addition, 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: Analyze REF: p. 777 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

2. Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline?
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 mother’s cardiopulmonary and metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs cause tachycardia, not bradycardia.

DIF: Cognitive Level: Analyze REF: pp. 767-768
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

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.
DTRs 2+ and no clonus
c.
Respiratory rate (RR) of 16 breaths per minute
d.
Serum magnesium level of 10 mg/dl

ANS: D
The therapeutic range for magnesium sulfate management is 4 to 7.5 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, DTRs of 2+, and a RR of 16 breaths per minute are all normal findings.

DIF: Cognitive Level: Apply REF: p. 767 TOP: Nursing Process: Evaluation
MSC: Client Needs: Physiologic Integrity

4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention?
a.
To stimulate fetal surfactant production
b.
To reduce maternal and fetal tachycardia associated with ritodrine administration
c.
To suppress uterine contractions
d.
To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy

ANS: A
Antenatal glucocorticoids administered 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: Understand REF: p. 769 TOP: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

5. A primigravida at 40 weeks of gestation is having uterine contractions every to 2 minutes and states 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 precipitous labor.

ANS: C
The contraction pattern observed 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. Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor, are often 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; then the contractions become weak and inefficient or stop altogether. Precipitous labor is one that lasts less than 3 hours from the onset of contractions until time of birth.

DIF: Cognitive Level: Apply REF: p. 773 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance