Safe Maternity Pediatric Nursing By Care Palmer Coats -Test Bank

Chapter 11: Nursing Care of the Woman With Complications During Labor and Birth

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse admits a patient at 32 weeks’ gestation with a history of cervical cerclage to rule out preterm labor. Which finding is inconsistent with the patient’s history?
1) Rupture of membranes
2) Signs of infection
3) Cervical dilation to 3 cm
4) Mild vaginal bleeding

____ 2. A 28-year-old woman is a primipara who is pregnant with triplets, is at 18 weeks’ gestation, and is receiving regular prenatal care. The nurse identifies a risk for preterm labor related to which factor?
1) The patient’s age
2) 18 weeks’ gestation
3) Multiple gestations
4) Previous obstetric history

____ 3. The nurse questions an order to administer a tocolytic drug for which patient?
1) The patient under age 18
2) The patient with a history of multiple gestations
3) The patient who is 2 cm dilated
4) The patient with acute vaginal bleeding

____ 4. The experienced nurse recognizes that a graduate nurse needs guidance in caring for a woman at 38 weeks’ gestation with premature rupture of membranes when the graduate nurse is seen preparing to do what?
1) Fetal monitoring
2) Vital signs
3) Provide support and education
4) Conduct a cervical examination

____ 5. A patient is approaching 42 weeks’ gestation and has been admitted for induction of labor. The patient tells the nurse she does not want an induction and prefers to wait for labor to begin naturally. Which is the nurse’s best response?
1) “Waiting for labor to begin naturally could result in the death of your baby.”
2) “The longer you wait, the bigger the baby gets and the harder delivery will be.”
3) “Complications for you and your baby increase after 42 weeks of gestation.”
4) “If you had controlled your weight gain during pregnancy, you might have gone into natural labor.”

____ 6. The nurse is caring for a woman who has been admitted with a diagnosis of polyhydramnios and recognizes which as the most likely cause?
1) Fetal kidney failure
2) Gastrointestinal blockage
3) Rupture of the membranes
4) Fetal demise

____ 7. A woman’s labor is not progressing, and the fetus is found to be in the breech position. Which of the seven Ps of labor is involved with this woman’s failure to progress?
1) Presentation
2) Passenger
3) Passage
4) Powers

____ 8. A laboring patient’s water breaks, and the umbilical cord protrudes from the vagina. The nurse immediately places the patient in the Trendelenburg position. Which of the seven Ps is most impacted?
1) Passage
2) Pain
3) Powers
4) Position

____ 9. The fetus of a laboring patient is found to be in a breech position, and the nurse prepares the patient for a Cesarean section. The patient asks, “Can’t I try to deliver vaginally?” Which is the nurse’s best response?
1) “If the fetus has CPD, it could result in serious complications for you and the baby.”
2) “A fetus in the breech position causes labor to progress more slowly.”
3) “We’ll have to talk to the delivering provider to see if that is even possible.”
4) “When the fetus is breech, a Cesarean section is the safest choice for you and the baby.”

____ 10. The nurse is caring for a woman with suspected macrosomia. Which assessment finding best indicates the ability to deliver vaginally?
1) Cervical dilation at 10 cm
2) Fetus at +3 station
3) 100% effacement
4) Fetus at +1 station

MULTIPLE CHOICE

1. ANS: 3
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Discuss the medical management and nursing care for the patient with an incompetent cervix.
Chapter page reference: 153
Heading: Care of the Woman With an Incompetent Cervix
Integrated processes: Clinical Problem-Solving Process
Client need: Physiological Adaptation
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Easy

Feedback
1 Rupture of membranes is possible following a cervical cerclage.
2 Infection is not inconsistent with the patient’s history.
3 Cervical cerclage should not allow for cervical dilation, so the finding that the patient is 3 cm dilated is inconsistent with the patient’s history unless the cervical cerclage has been removed.
4 Mild vaginal bleeding is not inconsistent with the patient’s history.

PTS: 1 CON: Pregnancy

2. ANS: 3
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Identify 10 risk factors associated with preterm labor.
Chapter page reference: 154
Heading: Care of the Woman at Risk of Preterm Labor
Integrated processes: Clinical Problem-Solving Process
Client need: Reduction of Risk Potential
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Moderate

Feedback
1 Age younger than 17 and older than 35 is a risk for preterm labor, but this patient is 28 years old, so this is not a factor.
2 Gestational progress is not a factor in identifying the risk for preterm labor.
3 A woman carrying multiple gestations is at risk for preterm labor because of overdistention of the uterus.
4 Because this woman is a primipara, she has no previous obstetrical history, so this is not a factor related to risk for preterm labor.

PTS: 1 CON: Pregnancy

3. ANS: 4
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Discuss nursing care and the common tocolytic medications used to manage preterm labor.
Chapter page reference: 156
Heading: Box 11-1 Contraindications for Use of Tocolytic Drugs
Integrated processes: Clinical Problem-Solving Process
Client need: Pharmacological Therapies
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult

Feedback
1 There is no contraindication to administering tocolytics to patients under age 18.
2 Multiple gestations often result in preterm labor, and tocolytics can be administered safely.
3 The patient who is 2 cm dilated may receive tocolytics safely to prevent further progression of labor.
4 Acute vaginal bleeding may be a sign of placental abruption, and the order for a tocolytic should be questioned until placental abruption has been ruled out.

PTS: 1 CON: Pregnancy

4. ANS: 4
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Identify the major complication of premature rupture of membranes.
Chapter page reference: 157
Heading: Care of the Woman With Premature Rupture of Membranes
Integrated processes: Teaching and Learning
Client need: Reduction of Risk Potential
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult

Feedback
1 Performing fetal monitoring is appropriate and does not indicate the graduate nurse needs guidance.
2 Collecting vital signs at least every 4 hours is appropriate and does not indicate the graduate nurse needs guidance.
3 Providing support and education to both the patient and her support person is appropriate nursing care and does not indicate the need for guidance.
4 Conducting a cervical examination is contraindicated in the woman with premature rupture of membranes because of the risk of introducing infection and does indicate the need for guidance.

PTS: 1 CON: Pregnancy

5. ANS: 3
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Define postterm pregnancy and the possible fetal consequences of postterm pregnancy.
Chapter page reference: 158
Heading: Care of the Woman With a Postterm Pregnancy
Integrated processes: Teaching and Learning
Client need: Health Promotion and Maintenance
Cognitive level: Application [Applying]
Concept: Pregnancy
Difficulty: Moderate

Feedback
1 Telling a pregnant woman that her baby could die will increase her anxiety significantly and cause unnecessary fear, so this is not the most appropriate response.
2 Although this statement is true, the woman may feel that it is safer for the baby to begin labor naturally and may not see this as a reason for induction.
3 This statement is true and indicates the importance of why induction should be started now; it also avoids unnecessarily frightening the mother-to-be with potential horrors that could occur.
4 There is no indication that this patient is obese; even if she is, it is never appropriate to place responsibility and guilt on the patient when there is no certainty that this statement is true.

PTS: 1 CON: Pregnancy

6. ANS: 2
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Differentiate between oligohydramnios and polyhydramnios and potential complications.
Chapter page reference: 158
Heading: Care of the Woman With Abnormal Amniotic Fluid Volume
Integrated processes: Caring
Client need: Physiological Adaptation
Cognitive level: Comprehension [Understanding]
Concept: Pregnancy
Difficulty: Easy

Feedback
1 Polyhydramnios is an abnormally high level of fluid and is not indicative of kidney failure in the fetus.
2 An inability to swallow or gastrointestinal blockage in the fetus is the most common cause of polyhydramnios.
3 Rupture of the membranes results in oligohydramnios, not polyhydramnios.
4 Fetal demise does not result in polyhydramnios.

PTS: 1 CON: Pregnancy

7. ANS: 1
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Describe the variations in the passage, passenger, powers, position, psyche, pain management, or patience that can contribute to complications in labor.
Chapter page reference: 159-161
Heading: Care of the Woman With Dysfunctional Labor
Integrated processes: Clinical Problem-Solving Process
Client need: Physiological Adaptation
Cognitive level: Comprehension [Understanding]
Concept: Pregnancy
Difficulty: Moderate

Feedback
1 Fetal presentation is the cause of failure to progress.
2 Macrosomia, or a large fetus, involves the passenger, but breech presentation is not the result of the passenger.
3 Passage indicates the path through which the fetus must pass during delivery and is not involved in this case.
4 Power refers to the ability of the uterus to contract strongly enough to expel the fetus, which is not involved in this case.

PTS: 1 CON: Pregnancy

8. ANS: 3
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Describe the variations in the passage, passenger, powers, position, psyche, pain management, or patience that can contribute to complications in labor.
Chapter page reference: 159-161
Heading: Care of the Woman With Dysfunctional Labor
Integrated processes: Clinical Problem-Solving Process
Client need: Physiological Adaptation
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult

Feedback
1 Placing the patient in the Trendelenburg position will not alter the passage for the fetus.
2 Placing the patient in the Trendelenburg position will not alter the pain experienced by the laboring woman.
3 The Trendelenburg position will alter the powers because the contractions are pushing the fetus against gravity and will require stronger power to move the fetus through the passage.
4 The fetal position is not likely to be altered by the Trendelenburg position.

PTS: 1 CON: Pregnancy

9. ANS: 4
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Discuss the risks of a breech vaginal delivery.
Chapter page reference: 159-161
Heading: Care of the Woman With Dysfunctional Labor
Integrated processes: Teaching and Learning
Client need: Physiological Adaptation
Cognitive level: Application [Applying]
Concept: Pregnancy
Difficulty: Moderate

Feedback
1 Although this statement is true, it is unlikely the woman will understand the meaning of CPD.
2 Although this statement is true, this is not the reason why a Cesarean section is necessary.
3 This statement makes it sound as if delivering vaginally is an option, which it is not; so this is not the nurse’s best response.
4 This statement explains the need for a Cesarean section without causing undue anxiety for the patient and may be followed by a more precise explanation.

PTS: 1 CON: Pregnancy

10. ANS: 2
Chapter number and title: 11: Nursing Care of the Woman With Complications During Labor and Birth
Chapter learning objective: Define macrosomia and describe nursing care for the patient and fetus.
Chapter page reference: 163
Heading: Care of the Woman and Fetus at Risk for Macrosomia
Integrated processes: Clinical Problem-Solving Process
Client need: Health Maintenance and Promotion
Cognitive level: Analysis [Analyzing]
Concept: Pregnancy
Difficulty: Difficult

Feedback
1 Cervical dilation to 10 cm is a positive finding, but it is not the best indicator of the ability to deliver vaginally because the fetal head can still be too large to pass through the pelvis.
2 If the fetal head is at +3 station, the largest part of the head has passed through the pelvis, and this indicates that vaginal delivery is possible.
3 A 100% effacement can occur before the fetal head passes through the pelvis, so it does not indicate the ability to deliver vaginally.
4 When the fetal head is at +1 station, it has not begun to pass through the pelvis; thus, it does not indicate the ability to deliver vaginally.

PTS: 1 CON: Pregnancy