Chapter 23: Childbirth at Risk- Prelabor Onset Complications

A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for?

A. Gestational diabetes

B. Placenta previa

C. Abruptio placentae

D. Placenta accreta

C. Abruptio placentae

Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension.

The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (P P R O M). Which statement indicates that the client needs additional teaching?

A. "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."

B. "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again."

C. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."

D. "If I have amniocentesis, I might rupture the membranes again."

C. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."

A client was admitted to the labor area at 5 c m with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect?

A. Blood pressure

B. Temperature

C. Pulse

D. Respiration

B. Temperature

Rupture of membranes places the mother at risk for infection. The temperature is the primary and often the first indication of a problem.

The nurse admits into the labor area a client who is in preterm labor. What assessment finding would constitute a diagnosis of preterm labor?

A. Cervical effacement of 30% or more

B. Cervical change of 0.5 c m per hour

C. 2 contractions in 30 minutes

D. 8 contractions in 1 hour

8 contractions in 1 hour

During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. What would the nurse's priority action be?

A. To help the fetal head descend faster

B. To use gravity and manipulation to relieve compression on the cord

C. To facilitate dilation of the cervix with prostaglandin gel

D. To prevent head compression

B. To use gravity and manipulation to relieve compression on the cord

The top priority is to relieve compression on the umbilical cord to allow blood flow to reach the fetus. It is because some obstetric maneuvers to relieve cord compression are complicated that cesarean birth is sometimes necessary

A client is admitted to the birth setting in early labor. She is 3 c m dilated, -2 station, with intact membranes, and F H R of 150 b p m. Her membranes rupture spontaneously, and the F H R drops to 90 b p m with variable decelerations. What would the nurse's initial response be?

A. Perform a vaginal exam

B. Notify the physician

C. Place the client in a left lateral position

D. Administer oxygen at 2 L per nasal cannula

A. Perform a vaginal exam

Prolapsed umbilical cord can occur when the membranes rupture. The fetus is more likely to experience variable decelerations because the amniotic fluid is insufficient to keep pressure off the umbilical cord.

The nurse has received end-of-shift reports in the high-risk maternity unit. Which client should the nurse see first?

A. The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement

B. The client at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations

C. The client at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push

D. The client at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

A. The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement

Assessment of the woman with placenta previa must be ongoing to prevent or treat complications that are potentially lethal to the mother and fetus. Painless, bright red vaginal bleeding is the best diagnostic sign of placenta previa. This client is the highest priority.

A client in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of which of the following?

A. A non-stress test

B. A vibroacoustic stimulation test

C. An ultrasound

D. A contraction stress test

C. An ultrasound

The nurse is performing a comprehensive assessment on a client admitted to the birthing unit with abruptio placentae. Which finding(s) contribute(s) to this condition? Select all that apply.

A. History of domestic violence

B. Presence of uterine fibroids

C. Alcohol consumption during pregnancy

D. Hypertension

E. Gestational diabetes mellitus

A. History of domestic violence

B. Presence of uterine fibroids

C. Alcohol consumption during pregnancy

D. Hypertension

The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (DIC). The nurse should identify which conditions as risk factors for developing DIC? Select all that apply.

A. Diabetes mellitus

B. Abruptio placentae

C. Fetal demise

D. Multiparity

E. Preterm labor

B. Abruptio placentae

C. Fetal demise

The client at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes which of the following?

A. Limiting vaginal exams to only one per 24-hour period.

B. Evaluating the fetal heart rate with an internal monitor.

C. Monitoring for blood loss, pain, and uterine contractibility.

D. Assessing blood pressure every 2 hours.

C. Monitoring for blood loss, pain, and uterine contractibility.

A client is admitted to the labor and delivery unit in active labor. What nursing diagnoses might apply to the client with suspected abruptio placentae? Select all that apply.

A. Fluid Volume, Deficient, related to hypovolemia secondary to excessive blood loss

B. Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth

C. Anxiety related to concern for own personal status and the baby's safety

D. Knowledge, Deficient related to lack of information about inherited genetic defects

E. Alteration in Respiratory Function related to blood loss

A. Fluid Volume, Deficient, related to hypovolemia secondary to excessive blood loss

B. Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth

C. Anxiety related to concern for own personal status and the baby's safety

What is the most significant cause of neonatal morbidity and mortality?

A) Amenorrhea

B) Posttraumatic stress disorder

C) Prematurity

D) Endometriosis

C) Prematurity

What is the most significant maternal risk factor for preterm birth?

A. Previous preterm birth

B. Smoking

C. Stress

D. Substance abuse

A. Previous preterm birth

A client admitted to the birthing unit with placenta previa asks the nurse, "What is the cause of my condition?" Which statement should be included in the nurse's response?

A. "The placenta is improperly implanted in the lower uterus."

B. "The placenta has separated prematurely."

C. "The placenta has grown too large."

D. "The placenta has prolapsed and is being compressed."

A. "The placenta is improperly implanted in the lower uterus."

The nurse is performing an assessment on a client in the birthing unit who has acquired cervical insufficiency. Which other finding(s) may contribute to the client's condition? Select all that apply.

A. Inflammation

B. Infection

C. Cervical trauma

D. Cone biopsy

E. HPV positivity

A. Inflammation

B. Infection

C. Cervical trauma

D. Cone biopsy

The nurse on the birthing unit is collecting the obstetric history of a client at risk for cervical insufficiency. Which findings increase the client's risk for this condition? Select all that apply.

A. Multiple gestations

B. Previous preterm births

C. Progressively earlier births with each subsequent pregnancy

D. Cervical manipulation

E. Prolonged labors

A. Multiple gestations

B. Previous preterm births

C. Progressively earlier births with each subsequent pregnancy

D. Cervical manipulation

The home health nurse is visiting a client at 18 weeks who is pregnant with twins. Which nursing action is most important?

A. Teach the client about foods that are good sources of protein.

B. Assess the client's blood pressure in her upper right arm.

C. Determine whether the pregnancy is the result of infertility treatment.

D. Collect a cervicovaginal fetal fibronectin (fF N) specimen

A. Teach the client about foods that are good sources of protein

When counseling a newly pregnant client at 8 weeks' gestation with twins, the nurse teaches the woman about the need for increased caloric intake. What would the nurse tell the woman that the minimum recommended intake should be?

A. 2500 k c a l and 120 grams protein

B. 3000 k c a l and 150 grams protein

C. 4000 k c a l and 135 grams protein

D. 5000 k c a l and 190 grams protein

C. 4000 kcal and 135 grams protein

Intervention to reduce preterm birth can be divided into primary prevention and secondary prevention. What does secondary prevention include?

A. Diagnosis and treatment of infections

B. Cervical cerclage

C. Progesterone administration

D. Antibiotic treatment and tocolysis

D. Antibiotic treatment and tocolysis

The client is carrying monochorionic-monoamniotic twins. The nurse teaches the client what this is, and the implications of this finding. The nurse knows that teaching is successful when the client states which of the following?

A. "My babies came from two eggs."

B. "About two thirds of twins have this amniotic sac formation."

C. "My use of a fertility drug led to this issue."

D. "My babies have a lower chance of surviving to term than fraternal twins do."

D. "My babies have a lower chance of surviving to term than fraternal twins do."

The nurse on the birthing unit is caring for a client who has an amputated cervix and is about to undergo a cerclage procedure. Which type of cerclage procedure should the nurse anticipate?

A.Abdominal cerclage

B. Rescue cerclage

C. Emergency cerclage

D. Elective cerclage

A.Abdominal cerclage

Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with the withdrawal of fluid?

A. Preterm labor

B. Prolapsed cord

C. Preeclampsia

D. Placenta previa

B. Prolapsed cord

A needle or a fetal scalp electrode is used to make a small puncture in the amniotic sac. There is a risk that the force of the fluid could make a larger hole in the amniotic sac, thus increasing the risk of a prolapsed cord.

The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with which of the following? Select all that apply.

A. Rh sensitization

B. Postmaturity syndrome

C. Renal malformation or dysfunction

D. Maternal diabetes

E. Large-for-gestational-age infants

A. Rh sensitization

D. Maternal diabetes

The nurse is admitting a client with possible hydramnios. When is hydramnios most likely suspected?

A. Hydramnios is most likely suspected when there is less amniotic fluid than normal for gestation.

B. Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation.

C. Hydramnios is most likely suspected when the woman has a twin gestation.

D. Hydramnios is most likely suspected when the quadruple screen comes back positive.

B. Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation.

If oligohydramnios occurs in the first part of pregnancy, the nurse knows that there is a danger of which of the following?

A. Major congenital anomalies

B. Fetal adhesions

C. Maternal diabetes

D. Rh sensitization

B. Fetal adhesions

When caring for a laboring client with oligohydramnios, what should the nurse be aware of? Select all that apply.

A. Increased risk of cord compression

B. Decreased variability

C. Labor progress is often more rapid than average

D. Presence of periodic decelerations

E. During gestation, fetal skin and skeletal abnormalities can occur

A. Increased risk of cord compression

B. Decreased variability

D. Presence of periodic decelerations

E. During gestation, fetal skin and skeletal abnormalities can occur

The nurse knows that a baby born to a mother who had oligohydramnios could show signs of which of the following?

A. Respiratory difficulty

B. Hypertension

C. Heart murmur

D. Decreased temperature

A. Respiratory difficulty

The client at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective?

A. "My gestational diabetes might have caused this problem to develop."

B. "When I go into labor, I should come to the hospital right away."

C. "This problem was diagnosed with blood and urine tests."

D. "Women with this condition usually do not have a cesarean birth."

B. "When I go into labor, I should come to the hospital right away."

The incidence of cord compression and resulting fetal distress is high when there is an inadequate amount of amniotic fluid. The client with oligohydramnios should come to the hospital in early labor.

A patient in preterm labor is prescribed magnesium sulfate 6 grams intravenous infusion now, followed by 5 grams per hour. The pharmacy prepares an infusion of 500 m L lactated Ringer's solution with 100 grams of magnesium sulfate. If the patient receives the loading dose and 3 hours of the medication, how many total m L of the infusion did the patient receive?

105mL

The solution is 100 grams/500 m L or 1 gram in every 5 m L of solution. If the loading dose is 6 grams, then the patient received 6 grams × 5 m L =30 m L. For each hourly dose of 5 grams, the patient received 5 grams × 5 m L = 25 m L. Since the patient received the dose of 5 grams for 3 hours, then the patient received 25 m L × 3 = 75 m L. With the loading dose of 30 m L plus the three hours of infusion equaling 75 m L, the patient received 105 m L of the infusion.