Chapter 19

Question 1

In planning for home care of a woman with preterm labour, the nurse needs to address which 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 labour.
c.
Prolonged bed rest may cause tension because of confinement.
d.
Home health care providers will be necessary.

Answer 1

C

Question 2

The nurse providing care for a woman with preterm labour on nifedipine (Adalat) would include which intervention to identify adverse effects of the drug?
a.
Assessing deep tendon reflexes (DTRs)
b.
Assessing for hypotension
c.
Assessing for bradycardia
d.
Assessing for hypoglycemia

Answer 2

B

Question 3

In evaluating the effectiveness of nitroglycerin for the treatment of preterm labour, what finding would alert the nurse to possible adverse effects?
a.
Urine output of 160 mL in 4 hours
b.
Deep tendon reflexes 2+ and no clonus
c.
Blood pressure of 80/46
d.
Serum magnesium level of 10 mg/dL

Answer 3

C

Question 4

A woman in preterm labour at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. What is the purpose of this pharmacological treatment?
a.
It stimulates fetal surfactant production.
b.
It reduces maternal and fetal tachycardia associated with ritodrine administration.
c.
It suppresses uterine contractions.
d.
It maintains adequate maternal respiratory effort and ventilation during magnesium sulphate therapy.

Answer 4

A

Question 5

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labour. What finding indicates that preterm labour is occurring?
a.
Estriol is not found in maternal saliva.
b.
Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
c.
Fetal fibronectin is present in vaginal secretions.
d.
The cervix is effacing and dilated to 2 cm.

Answer 5

D

Question 6

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 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 labour?
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.

Answer 6

C

Question 7

What assessment is least likely to be associated with a breech presentation?
a.
Meconium-stained amniotic fluid
b.
Fetal heart tones heard at or above the maternal umbilicus
c.
Preterm labour and birth
d.
Postterm gestation

Answer 7

D

Question 8

A woman is having her first child. She has been in labour 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 labour pattern is associated with this description?
a.
Primary prolonged latent phase
b.
Protracted active phase
c.
Secondary arrest of active phase
d.
Protracted descent

Answer 8

C

Question 9

What finding should the nurse expect when evaluating the effectiveness of an oxytocin induction?
a.
Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart
b.
The intensity of contractions being at least 110 to 130 mm Hg
c.
Labour to progress at least 2 cm/hr dilation
d.
At least 80 mU/min of oxytocin will be needed to achieve cervical dilation.

Answer 9

A

Question 10

In planning for an expected Caesarean birth for a woman who has given birth by Caesarean previously and who has a fetus in the transverse presentation, the nurse would include what information?
a.
“Because this is a repeat procedure, you are at the lowest risk for complications.”
b.
“Even though this is your second Caesarean birth, you may wish to review the preoperative and postoperative procedures.”
c.
“Because this is your second Caesarean birth, you will recover faster.”
d.
“You will not need preoperative teaching because this is your second Caesarean birth.”

Answer 10

B

Question 11

For a woman at 42 weeks of gestation, which finding would require more assessment by the nurse?
a.
Fetal heart rate of 116 beats/min
b.
Cervix dilated 2 cm and 50% effaced
c.
Score of 8 on the biophysical profile
d.
One fetal movement noted in 1 hour of assessment by the mother

Answer 11

D

Question 12

A pregnant woman’s amniotic membranes rupture. Prolapsed cord is suspected. Which intervention would be the top priority?
a.
Place the woman in the knee–chest position.
b.
Cover the cord in sterile gauze soaked in saline.
c.
Prepare the woman for a Caesarean birth.
d.
Start oxygen by face mask.

Answer 12

A

Question 13

Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of gestation. The nurse knows that this medication will be administered for which of the following reasons?
a.
It will enhance uteroplacental perfusion in an aging placenta.
b.
It will increase amniotic fluid volume.
c.
It will ripen the cervix in preparation for labour induction.
d.
It will stimulate the amniotic membranes to rupture.

Answer 13

C

Question 14

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labour. Her labour 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 labour and arrange home health visits.”
c.
“Whenever the doctor says that it is okay.”
d.
“It depends on the results of the fern test.”

Answer 14

B

Question 15

While caring for a patient whose labour is being augmented with oxytocin, the nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of which of the following?
a.
Uterine contractions occurring every 8 to 10 minutes
b.
A fetal heart rate (FHR) of 180 with absence of variability
c.
The patient needing to void
d.
Rupture of the patient’s amniotic membranes

Answer 15

B

Question 16

The nurse should know that which of the following statements is accurate?
a.
The terms preterm birth and low birth weight can be used interchangeably.
b.
Preterm labour is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of pregnancy.
c.
Low birth weight is anything below 3500 g.
d.
Preterm birth accounts for 18 to 20% of all births.

Answer 16

B

Question 17

What should the nurse be aware of for the care management of preterm labour?
a.
Because all women must be considered at risk for preterm labour 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 labour.
c.
Because preterm labour is likely to be the start of an extended labour, a woman with symptoms can wait several hours before contacting the primary caregiver.
d.
The diagnosis of preterm labour is based on gestational age, uterine activity, and progressive cervical change.

Answer 17

D

Question 18

What should the nurse be aware of in the use of tocolytic therapy to suppress uterine activity?
a.
The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.
b.
There are no important maternal (as opposed to fetal) contraindications.
c.
Its most important function is to afford the opportunity to administer antenatal glucocorticoids.
d.
If the patient develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given.

Answer 18

C

Question 19

What should the nurse be aware of with regard to dysfunctional labour?
a.
Women who are underweight are more at risk.
b.
Women experiencing precipitous labour often express feelings of disbelief about their labour.
c.
Hypertonic uterine dysfunction is more common than hypotonic dysfunction.
d.
Abnormal labour patterns are most common in older women.

Answer 19

B

Question 20

The nurse knows that which of the following is the least common cause of dystocia?
a.
Midplane contracture of the pelvis
b.
Compromised bearing-down efforts as a result of pain medication
c.
Disproportion of the pelvis
d.
Low-lying placenta

Answer 20

C

Question 21

Which of the following should the nurse be aware of with regard to induction of labour?
a.
It can be achieved by external and internal version techniques.
b.
It is also known as a trial of labour (TOL).
c.
It is always done for medical reasons.
d.
It is rated for viability by a Bishop score.

Answer 21

D

Question 22

What should the nurse be aware of with regard to the process of inducing labour?
a.
Ripening the cervix usually results in a decreased success rate for induction.
b.
Labour sometimes can be induced with balloon catheters or laminaria tents.
c.
Oxytocin is less expensive than prostaglandins and more effective but has greater health risks.
d.
Amniotomy can be used to make the cervix more favourable for labour.

Answer 22

B

Question 23

What should the nurse be aware of with regard to the process of augmentation of labour?
a.
It is active management of labour instituted when the labour process is not satisfactory.
b.
It relies on more invasive methods when oxytocin and amniotomy have failed.
c.
It is a modern management term to cover up the negative connotations of forceps-assisted birth.
d.
It uses vacuum cups to actively assist with the birth of the baby.

Answer 23

A

Question 24

What should the nurse be aware of with regard to Caesarean birth when providing care to a woman in labour?
a.
Caesarean births are declining in frequency in the twenty-first century in Canada.
b.
A Caesarean birth is more likely to be done for convenience than for medical risk.
c.
A Caesarean is performed primarily for the benefit of the fetus.
d.
A Caesarean birth can be either elected or refused by women as their absolute legal right.

Answer 24

C

Question 25

With regard to the psychological complications and risks of forced Caesarean births, nurses should be aware of which of the following?
a.
Mothering success is hampered for the woman who has an unplanned Caesarean birth.
b.
Most women relate to their newborns as quickly and are as likely to breastfeed as those who went through vaginal birth.
c.
The psychological outcomes are the same as for women who go through scheduled Caesarean births.
d.
Some couples (and individuals) have sexual worries; the women worry about sexual attractiveness, and the men worry about hurting their partners.

Answer 25

D

Question 26

Which of the following infections is not thought to be a major factor in many preterm labours?
a.
Viral
b.
Periodontal
c.
Measles
d.
Common cold

Answer 26

A

Question 27

The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency interventions. What clinical cue would alert the nurse that the woman is experiencing uterine hyperstimulation?
a.
Uterine contractions lasting 2 minutes in frequency
b.
Uterine contractions lasting >60 seconds and occurring >3 minutes in frequency
c.
Uterine tone 15 mm Hg
d.
Uterine tone 10 mm Hg

Answer 27

B

Question 28

Which of the following may occur after 37 weeks of gestation when a fetus is in a transverse lie?
a.
Preterm birth
b.
Internal version
c.
Fetal distress
d.
External cephalic version

Answer 28

D