You are on page 1of 13

Perry: Maternal Child Nursing Care, 4th Edition

Chapter 19: Labor and Birth at Risk


Test Bank
MULTIPLE CHOICE
1. In planning for home care of a woman with preterm labor, the nurse needs to address
what 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 labor.
c. Prolonged bed rest may cause negative physiologic effects.
d. Home health care providers will be 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 will differ somewhat from those performed in
the acute care setting, but this is not the concern that needs to be addressed. Restricted
activity and medication may prevent preterm labor, but not in all women. In addition, the
plan of care is individualized to meet the needs of each woman. Many women will
receive home health nurse visits, but care is individualized for each woman.
PTS: 1
DIF: Cognitive Level: Analysis
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 492

2. The nurse providing care for a woman with preterm labor on terbutaline would include
which intervention to identify side effects of the drug?
a. Assessing deep tendon reflexes (DTRs)
b. Assessing for dyspnea and crackles
c. Assessing for bradycardia
d. Assessing for hypoglycemia
ANS: B
Terbutaline is a 2-adrenergic agonist that affects the cardiopulmonary and metabolic
systems of the mother. Signs of cardiopulmonary decompensation would include
adventitious breath sounds and dyspnea. Assessing DTRs would not address these
concerns. 2-Adrenergic agonist drugs cause tachycardia, not bradycardia. The metabolic
effect leads to hyperglycemia, not hypoglycemia.
PTS: 1
DIF: Cognitive Level: Analysis
REF: 494, 495
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-2

3. In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor,
what finding would alert the nurse to possible side effects?
a. Urine output of 160 ml in 4 hours
b. Deep tendon reflexes 2+ and no clonus
c. Respiratory rate of 16 breaths/min
d. Serum magnesium level of 10 mg/dl
ANS: D
The therapeutic range for magnesium sulfate management is 5 to 8 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, deep tendon
reflexes 2+ with no clonus, and respiratory rate of 16 breaths/min are normal findings.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 495
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation
4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of
betamethasone intramuscularly. The purpose of this pharmacologic treatment is to:
a. Stimulate fetal surfactant production.
b. Reduce maternal and fetal tachycardia associated with ritodrine administration.
c. Suppress uterine contractions.
d. Maintain adequate maternal respiratory effort and ventilation during magnesium
sulfate therapy.
ANS: A
Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal
lung maturity. Inderal would be given to reduce the effects of ritodrine administration.
Betamethasone has no effect on uterine contractions. Calcium gluconate would be given
to reverse the respiratory depressive effects of magnesium sulfate therapy.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 496
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
5. A woman at 26 weeks of gestation is being assessed to determine whether she is
experiencing preterm labor. What finding indicates that preterm labor 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.
ANS: D

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-3

Cervical changes such as shortened endocervical length, effacement, and dilation are
predictors of imminent preterm labor. Changes in the cervix accompanied by regular
contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the
fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been
shown to increase before preterm birth. Irregular, mild contractions that do not cause
cervical change are not considered a threat. The presence of fetal fibronectin in vaginal
secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has
only a 20% to 40% positive predictive value. Of more importance are other physiologic
clues of preterm labor such as cervical changes.
PTS: 1
DIF: Cognitive Level: Application
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment, Planning

REF: 491

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 womans 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 pelvic dystocia.
ANS: C
Women who experience hypertonic uterine dysfunction, or primary dysfunctional labor,
often are 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. The
contraction pattern seen 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.
Pelvic dystocia can occur whenever contractures of the pelvic diameters reduce the
capacity of the bony pelvis, including the inlet, midpelvis, outlet, or any combination of
these planes.
PTS: 1
DIF: Cognitive Level: Application
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Diagnosis

REF: 498

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 labor and birth
d. Postterm gestation
ANS: D

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-4

Postterm gestation is not likely to be seen with a breech presentation. The presence of
meconium in a breech presentation may result from pressure on the fetal wall as it
traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the
mother are a typical finding in a breech presentation because the fetal back would be
located in the upper abdominal area. Breech presentations often occur in preterm births.
PTS: 1
DIF: Cognitive Level: Analysis
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

REF: 500

8. A woman is having her first child. She has been in labor 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 labor pattern is associated with this
description?
a. Prolonged latent phase
c. Arrest of active phase
b. Protracted active phase
d. Protracted descent
ANS: C
With an arrest of the active phase, the progress of labor has stopped. This client has not
had any anticipated cervical change, indicating an arrest of labor. In the nulliparous
woman a prolonged latent phase typically would last over 20 hours. A protracted active
phase, the first or second stage of labor, would be prolonged (slow dilation). With
protracted descent, the fetus would fail to descend at an anticipated rate during the
deceleration phase and second stage of labor.
PTS: 1
DIF: Cognitive Level: Analysis
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment, Diagnosis

REF: 502

9. In evaluating the effectiveness of oxytocin induction, the nurse would expect:


a. Contractions lasting 40 to 90 seconds, 2 to 3 minutes apart.
b. The intensity of contractions to be at least 110 to 130 mm Hg.
c. Labor to progress at least 2 cm/hr dilation.
d. At least 30 mU/min of oxytocin will be needed to achieve cervical dilation.
ANS: A
The goal of induction of labor would be to produce contractions that occur every 2 to 3
minutes and last 60 to 90 seconds. The intensity of the contractions should be 40 to 90
mm Hg by intrauterine pressure catheter. Cervical dilation of 1 cm/hr in the active phase
of labor would be the goal in an oxytocin induction. The dose is increased by 1 to 2
mU/min at intervals of 30 to 60 minutes until the desired contraction pattern is achieved.
Doses are increased up to a maximum of 20 to 40 mU/min.
PTS: 1
DIF: Cognitive Level: Analysis
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 499

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-5

10. In planning for an expected cesarean birth for a woman who has given birth by cesarean
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 cesarean birth, you may wish to review the
preoperative and postoperative procedures.
c. Because this is your second cesarean birth, you will recover faster.
d. You will not need preoperative teaching because this is your second cesarean
birth.
ANS: B
Even though this is your second cesarean birth, you may wish to review the preoperative
and postoperative procedures is the most appropriate statement. It is not accurate to state
that the woman is at the lowest risk for complications. Both maternal and fetal risks are
associated with every cesarean section. Because this is your second cesarean birth, you
will recover faster is not an accurate statement. Physiologic and psychologic recovery
from a cesarean section is multifactorial and individual to each client each time.
Preoperative teaching should always be performed, regardless of whether the client has
already had this procedure.
PTS: 1
DIF: Cognitive Level: Application
REF: 514, 515, 516, 517
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning
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
ANS: D
Self-care in a postterm pregnancy should include performing daily fetal kick counts three
times per day. The mother should feel four fetal movements per hour. If fewer than four
movements have been felt by the mother, she should count for 1 more hour. Fewer than
four movements in that hour warrants evaluation. Normal findings in a 42-week gestation
include fetal heart rate of 116 beats/min, cervix dilated 20 cm and 50% effaced, and a
score of 8 on the biophysical profile.
PTS: 1
DIF: Cognitive Level: Application
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

REF: 497, 519

12. A pregnant womans amniotic membranes rupture. Prolapsed cord is suspected. What
intervention would be the top priority?
a. Placing the woman in the knee-chest position

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-6

b. Covering the cord in sterile gauze soaked in saline


c. Preparing the woman for a cesarean birth
d. Starting oxygen by face mask
ANS: A
The woman is assisted into a position (e.g., modified Sims position, Trendelenburg
position, or the knee-chest position) in which gravity keeps the pressure of the presenting
part off the cord. Though covering the cord in sterile gauze soaked saline, preparing the
woman for a cesarean, and starting oxygen by face mark are appropriate nursing
interventions in the event of a prolapsed cord, the intervention of top priority would be
positioning the mother to relieve cord compression.
PTS: 1
DIF: Cognitive Level: Application
REF: 520, 521
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation
13. Prepidil (prostaglandin gel) has been ordered for a pregnant woman at 43 weeks of
gestation. The nurse recognizes that this medication will be administered to:
a. Enhance uteroplacental perfusion in an aging placenta.
b. Increase amniotic fluid volume.
c. Ripen the cervix in preparation for labor induction.
d. Stimulate the amniotic membranes to rupture.
ANS: C
It is accurate to state that Prepidil will be administered to ripen the cervix in preparation
for labor induction. It is not administered to enhance uteroplacental perfusion in an aging
placenta, increase amniotic fluid volume, or stimulate the amniotic membranes to rupture.
PTS: 1
DIF: Cognitive Level: Application
REF: 507
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
14. A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her
labor 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 labor and arrange home health visits.
c. Whenever the doctor says that it is okay.
d. It depends on what kind of insurance coverage you have.
ANS: B
The clients preterm labor is being controlled with tocolytics. Once she is stable, home
care may be a viable option for this type of client. Care of a woman with preterm labor is
multifactorial; the goal is to prevent delivery. In many cases this may be achieved at
home. Care of the preterm client is multidisciplinary and multifactorial. Managed care
may dictate earlier hospital discharges or a shift from hospital to home care. Insurance
coverage may be one factor in the care of clients, but ultimately client safety remains the
most important factor.
PTS:

DIF:

Cognitive Level: Application

REF: 494

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-7

OBJ: Client Needs: Health Promotion and Maintenance


TOP: Nursing Process: Planning
15. The nurse is caring for a client whose labor is being augmented with oxytocin. He or she
recognizes that the oxytocin should be discontinued immediately if there is evidence of:
a. Uterine contractions occurring every 8 to 10 minutes.
b. A fetal heart rate (FHR) of 180 with absence of variability.
c. The client needing to void.
d. Rupture of the clients amniotic membranes.
ANS: B
This FHR is nonreassuring. The oxytocin should be discontinued immediately, and the
physician should be notified. The oxytocin should be discontinued if uterine
hyperstimulation occurs. Uterine contractions that are occurring every 8 to 10 minutes do
not qualify as hyperstimulation. The client needing to void is not an indication to
discontinue the oxytocin induction immediately or to call the physician. Unless a change
occurs in the FHR pattern that is nonreassuring or the client experiences uterine
hyperstimulation, the oxytocin does not need to be discontinued. The physician should be
notified that the clients membranes have ruptured.
PTS: 1
DIF: Cognitive Level: Evaluation
REF: 507, 508
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
16. Nurses should know some basic definitions concerning preterm birth, preterm labor, and
low birth weight. For instance:
a. The terms preterm birth and low birth weight can be used interchangeably.
b. Preterm labor is defined as cervical changes and uterine contractions occurring
between 20 and 37 weeks of pregnancy.
c. Low birth weight is anything below 3.7 pounds.
d. In the United States early in this century, preterm birth accounted for 18% to 20%
of all births.
ANS: B
Before 20 weeks it is not viable (miscarriage); after 37 weeks it can be considered term.
Although these terms are used interchangeably, they have different meanings: preterm
birth describes the length of gestation (37 weeks) regardless of weight; low birth weight
describes weight only (2500 g or less) at the time of birth, whenever it occurs. Low birth
weight is anything below 2500 g, or about 5.5 pounds. In 2003 the preterm birth rate in
the United States was 12.3%, but it is increasing in frequency.
PTS: 1
DIF: Cognitive Level: Knowledge
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Assessment

REF: 486

17. With regard to the care management of preterm labor, nurses should be aware that:
a. Because all women must be considered at risk for preterm labor and prediction is
so hit-and-miss, teaching pregnant women the symptoms probably causes more

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-8

harm through false alarms.


b. Braxton Hicks contractions often signal the onset of preterm labor.
c. Because preterm labor is likely to be the start of an extended labor, a woman with
symptoms can wait several hours before contacting the primary caregiver.
d. The diagnosis of preterm labor is based on gestational age, uterine activity, and
progressive cervical change.
ANS: D
Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced
or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to
detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm
labor contractions, but they are not true labor. Waiting too long to see a health care
provider could result in not administering essential medications. Preterm labor is not
necessarily long-term labor.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Safe and Effective Care Environment
TOP: Nursing Process: Planning

REF: 491

18. With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be
aware that:
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 client develops pulmonary edema while on tocolytics, intravenous (IV)
fluids should be given.
ANS: C
Buying time for antenatal glucocorticoids to accelerate fetal lung development might be
the best reason to use tocolytics. Once the pregnancy has reached 34 weeks, the risks of
tocolytic therapy outweigh the benefits. There are important maternal contraindications to
tocolytic therapy. Tocolytic-induced edema can be caused by IV fluids.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 493
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning
19. With regard to dysfunctional labor, nurses should be aware that:
a. Women who are underweight are more at risk.
b. Women experiencing precipitous labor are about the only dysfunctionals not to
be exhausted.
c. Hypertonic uterine dysfunction is more common than hypotonic dysfunction.
d. Abnormal labor patterns are most common in older women.
ANS: B

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-9

Precipitous labor lasts less than 3 hours. Short women more than 30 pounds overweight
are more at risk for dysfunctional labor. Hypotonic uterine dysfunction, in which the
contractions become weaker, is more common. Abnormal labor patterns are more
common in women under 20 years of age.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 502

20. The least common cause of long, difficult, or abnormal labor (dystocia) is:
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.
ANS: C
The least common cause of dystocia is disproportion of the pelvis.
PTS: 1
DIF: Cognitive Level: Knowledge
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 498

21. Nurses should be aware that the induction of labor:


a. Can be achieved by external and internal version techniques.
b. Is also known as a trial of labor (TOL).
c. Is almost always done for medical reasons.
d. Is rated for viability by a Bishop score.
ANS: D
Induction of labor is likely to be more successful with a Bishop score of 9 or higher for
first-time mothers and 5 or higher for veterans. Version is turning of the fetus to a better
position by a physician for an easier or safer birth. A trial of labor is the observance of a
woman and her fetus for several hours of active labor to assess the safety of vaginal birth.
Two thirds of cases of induced labor are elective and not done for medical reasons.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Safe and Effective Care Environment
TOP: Nursing Process: Diagnosis

REF: 504, 505

22. With regard to the process of inducing labor, nurses should be aware that:
a. Ripening the cervix usually results in a decreased success rate for induction.
b. Labor sometimes can be induced with balloon catheters or laminaria tents.
c. Oxytocin is less expensive than prostaglandins and more effective but creates
greater health risks.
d. Amniotomy can be used to make the cervix more favorable for labor.
ANS: B

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-10

Using balloon catheters or laminaria tents are mechanical means of ripening the cervix.
Ripening the cervix, making it softer and thinner, increases the success rate of induced
labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a
greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce
labor only when the cervix is already ripe.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 505

23. With regard to the process of augmentation of labor, the nurse should be aware that it:
a. Is part of the active management of labor that is instituted when the labor process
is unsatisfactory.
b. Relies on more invasive methods when oxytocin and amniotomy have failed.
c. Is a modern management term to cover up the negative connotations of forcepsassisted birth.
d. Uses vacuum cups.
ANS: A
Augmentation is part of the active management of labor that stimulates uterine
contractions after labor has started but is not progressing satisfactorily. Augmentation
uses amniotomy and oxytocin infusion, as well as some gentler, noninvasive methods.
Forceps-assisted births and vacuum-assisted births come at the end of labor and are not
part of augmentation.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 508

24. The nurse providing care to a woman in labor should be aware that cesarean birth:
a. Is declining in frequency in the twenty-first century in the United States.
b. Is more likely to be done for the poor in public hospitals who do not get the nurse
counseling that wealthier clients do.
c. Is performed primarily for the benefit of the fetus.
d. Can be either elected or refused by women as their absolute legal right.
ANS: C
The most common indications for cesarean birth are danger to the fetus related to labor
and birth complications. Cesarean births are increasing in the United States in this
century. Wealthier women who have health insurance and who give birth in a private
hospital are more likely to experience cesarean birth. A womans right to elect cesarean
surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus.
Legal issues are not absolutely clear.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 511, 512
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-11

25. With regard to the psychologic complications and risks of forced cesarean births, nurses
should be aware that:
a. A familys worries about extra cost are unfounded; vaginal birth and unscheduled
cesarean births cost about the same.
b. Most women relate to their newborns as quickly and are as likely to breastfeed as
those who went through vaginal birth.
c. The psychologic outcomes are the same as for women who go through scheduled
cesarean births.
d. Some couples (and individuals) have sexual worries; the women worry about
sexual attractiveness, and the men worry about hurting their partners.
ANS: D
The sexual worries may be exaggerated, but couples still have them. Fears about extra
costs do have a foundation. Cesarean birth and aftercare are more expensive.
Often women who deliver by cesarean section experience a delay in their ability to
interact with their newborns, and they are less likely to breastfeed. The psychologic
outcomes of unplanned cesarean birth are usually more pronounced and negative than
those associated with scheduled procedures.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Psychosocial Integrity
TOP: Nursing Process: Planning

REF: 514

26. The exact cause of preterm labor is unknown and believed to be multifactorial. Infection
is thought to be a major factor in many preterm labors. Select the type of infection that
has not been linked to preterm births:
a. Viral
c. Cervical
b. Periodontal
d. Urinary tract
ANS: A
The infections that increase the risk of preterm labor and birth are all bacterial in nature.
They include cervical, urinary tract, periodontal, and other bacterial infections. Therefore
it is important for the client to participate in early, continual, and comprehensive prenatal
care. Recent evidence has shown a link between periodontal infections and preterm labor.
Researchers recommend regular dental care before and during pregnancy, oral
assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent
infection. Cervical infections of a bacterial nature have been linked to preterm labor and
birth. The presence of urinary tract infections increases the risk of preterm labor and
birth.
PTS: 1
DIF: Cognitive Level: Knowledge
REF: 488
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
MULTIPLE RESPONSE

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-12

1. The nurse recognizes that uterine hyperstimulation with oxytocin requires emergency
interventions. What clinical cues would alert the nurse that the woman is experiencing
uterine hyperstimulation? Choose all that apply.
a. Uterine contractions lasting <90 seconds and occurring >2 minutes in frequency
b. Uterine contractions lasting >90 seconds and occurring <2 minutes in frequency
c. Uterine tone <20 mm Hg
d. Uterine tone >20 mm Hg
e. Increased uterine activity accompanied by a nonreassuring fetal heart rate (FHR)
and pattern
ANS: B, D, E
Uterine contractions that occur less than 2 minutes apart and last more than 90 seconds, a
uterine tone of over 20 mm Hg, and a nonreassuring FHR and pattern are all indications
of uterine hyperstimulation with oxytocin administration. Uterine contractions that occur
more than 2 minutes apart and last less than 90 seconds are the expected goal of oxytocin
induction. A uterine tone of less than 20 mm Hg is normal.
PTS: 1
DIF: Cognitive Level: Analysis
REF: 510
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Implementation
2. Complications and risks associated with cesarean births include (choose all that apply):
a. Pulmonary edema.
b. Wound dehiscence.
c. Hemorrhage.
d. Urinary tract infections.
e. Fetal injuries.
ANS: A, B, C, D, E
All of these are possible complications and risks associated with cesarean section.
PTS: 1
DIF: Cognitive Level: Comprehension REF: 513
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation
COMPLETION
1. ____________________ is defined as long, difficult, or abnormal labor. It is caused by
various conditions associated with the five factors affecting labor.
ANS: Dystocia
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Evaluation

REF: 497

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank

19-13

2. A nurse is caring for a client in the active phase of labor. The womans bag of waters
spontaneously ruptures. Suddenly the woman complains of dyspnea and appears restless
and cyanotic. In addition, she becomes hypotensive and tachycardic. The nurse
immediately suspects the presence of:__________________________________.
ANS: An amniotic fluid embolism
PTS: 1
DIF: Cognitive Level: Analysis
REF: 523
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment
TRUE/FALSE
1. Approximately 50% of all women who give birth prematurely have no identifiable risk
factors, and about 50% of preterm births could not be prevented.
ANS: T
No risk screening system has resulted in lowering of the preterm birth rate in the United
States. About 25% of preterm births are intentional for health reasons, and about 25%
happen because of spontaneous rupture of the membranes.
PTS: 1
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Health Promotion and Maintenance
TOP: Nursing Process: Planning

REF: 487, 488

Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.