Chapter 20 Childbirth at Risk: Pre-Labor and Intrapartum Complications

Chapter 20   Childbirth at Risk: Pre-Labor and Intrapartum Complications

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for a client at 30 weeks’ gestation who is experiencing preterm premature rupture of membranes (PPROM). Which statement indicates that the client needs additional teaching?

1. “If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured.”
2. “If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again.”
3. “If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy.”
4. “If I have bleeding in the third trimester of my next pregnancy, I might rupture membranes again.”

Answer:  3

Explanation:  1. Multifetal gestation increases the risk for PPROM.

2. A UTI increases the risk for PPROM.
3. There is no evidence indicating that bed rest in a subsequent pregnancy decreases the risk for PPROM.
4. Second- and third-trimester bleeding increases the risk for PPROM.

Page Ref: 405

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion

Learning Outcome:  LO 20.1-Explain the possible causes, risk factors, and clinical therapy for premature rupture of the membranes or preterm labor in determining the hospital-based and community-based nursing management of the woman and her fetus/newborn.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

2) A clinical nurse coordinator is teaching a class of nursing students about surgical and postoperative care of the woman who undergoes cerclage. Which nursing student’s statement indicates the need for further clarification of the teaching?

1. “Sometimes cerclage can be performed on an outpatient basis.”
2. “If cerclage is performed emergently, the woman will usually be hospitalized for at least 5 days.”
3. “If the woman’s amniotic sac is bulging, the cerclage is contraindicated and the procedure cannot be performed.”
4. “After 37 weeks’ gestation, the woman’s cerclage may be cut in order to allow for vaginal delivery.”

Answer:  3

Explanation:  1. An uncomplicated elective cerclage may be done on an outpatient basis or the woman may be hospitalized and discharged after 24 to 48 hours. An emergency cerclage, however, requires hospitalization for 5 to 7 days or longer.

2. An uncomplicated elective cerclage may be done on an outpatient basis or the woman may be hospitalized and discharged after 24 to 48 hours. An emergency cerclage, however, requires hospitalization for 5 to 7 days or longer.
3. Decompression of a bulging amniotic sac is not a contraindication to cerclage; rather, the amniotic sac must be decompressed immediately before the procedure.
4. After 37 completed weeks’ gestation, the suture may be cut and vaginal birth permitted, or the suture may be left in place and a cesarean birth performed.

Page Ref: 418

Cognitive Level:  Evaluating

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential II: Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Education

Learning Outcome:  LO 20.3-Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her fetus.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

3) A 26-year-old woman who is pregnant with her first child is admitted to the obstetrics unit with a diagnosis of cervical insufficiency. Based upon the client’s diagnosis, how is she most likely to describe her symptoms?

1. “I’ve been having contractions every four hours.”
2. “My cervical pain has gotten much worse over the past two days.”
3. “I’m not having any pain, but my contractions are getting stronger.”
4. “I’m not having any pain and I don’t feel any contractions.”

Answer:  4

Explanation:  1. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.

2. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.
3. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.
4. Cervical insufficiency (formerly called incompetent cervix) is painless dilatation of the cervix without contractions due to a structural or functional defect of the cervix.

Page Ref: 417

Cognitive Level:  Evaluating

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 20.3-Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her fetus.

MNL LO:  Compare obstetric emergencies and their implications for nursing care.

 

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

1. 26 weeks’ gestation with placenta previa experiencing blood on toilet tissue after a bowel movement
2. 30 weeks’ gestation with placenta previa whose fetal monitor strip shows late decelerations
3. 35 weeks’ gestation with grade I abruptio placentae in labor who has a strong urge to push
4. 37 weeks’ gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Answer:  1

Explanation:  1. Bleeding with a placenta previa is a complication that can be life-threatening to both the mother and baby. This client is the highest priority.

2. Late decelerations are an abnormal finding, but put only the fetus at risk. This patient is not the highest priority.
3. Grade I abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This patient is not the highest priority.
4. Although pregnancy-induced hypertension puts a woman at risk for developing abruptio placentae, there is no indication that this patient is experiencing this complication. This patient is not the highest priority.

Page Ref: 410

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 20.2-Compare placenta previa and abruptio placentae, including implications for the mother and the fetus, as well as nursing care.

MNL LO:  Contrast the bleeding disorders of late pregnancy and their implications for nursing care.