Chapter 27: Intrapartum Complications

Chapter 27: Intrapartum Complications

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Which pelvic shape is most conducive to vaginal labor and birth?

a.	Android
b.	Gynecoid
c.	Platypelloid
d.	Anthropoid

 

 

ANS:  B

The gynecoid pelvis is round and cylinder-shaped, with a wide pubic arch. The prognosis for a vaginal birth is good. Only 30% of women have an android-shaped pelvis, which has a poor prognosis for vaginal birth. The anthropoid pelvis is a long narrow oval, with a narrow pubic arch. It is more favorable than the android or platypelloid pelvic shape. The platypelloid pelvis is flat, wide, short, and oval and has a very poor prognosis for vaginal birth.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   574

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Health Promotion and Maintenance

 

2. Which action by the nurse prevents infection in the labor and birth area?

a.	Using clean techniques for all procedures
b.	Keeping underpads and linens as dry as possible
c.	Cleaning secretions from the vaginal area by using a back to front motion
d.	Performing vaginal examinations every hour while the client is in active labor

 

 

ANS:  B

Bacterial growth prefers a moist, warm environment. Use an aseptic technique if membranes are not ruptured; use a sterile technique if membranes are ruptured. Vaginal drainage should be removed with a front to back motion to decrease fecal contamination. Vaginal examinations should be limited to decrease transmission of vaginal organisms into the uterine cavity.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   576

OBJ:   Nursing Process Step: Implementation

MSC:  Client Needs: Safe and Effective Care Environment

 

3. A pregnant client with premature rupture of membranes is at higher risk for postpartum infection. Which assessment data indicate a potential infection?

a.	Fetal heart rate, 150 beats/min
b.	Maternal temperature, 99° F
c.	Cloudy amniotic fluid, with strong odor
d.	Lowered maternal pulse and decreased respiratory rates

 

 

ANS:  C

Amniotic fluid should be clear and have a mild odor, if any. Fetal tachycardia of greater than 160 beats/min is often the first sign of intrauterine infection. A temperature of 100.4° F or higher is a classic symptom of infection. Vital signs should be assessed hourly to identify tachycardia or tachypnea, which often accompany temperature elevation.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   576

OBJ:   Nursing Process Step: Evaluation     MSC:  Client Needs: Physiologic Integrity

 

4. A client in labor at 34 weeks of gestation is hospitalized and treated with intravenous magnesium sulfate for 18 to 20 hours. When the magnesium sulfate is discontinued, which oral drug will be prescribed for at-home continuation of the tocolytic effect?

a.	Buccal oxytocin (Pitocin)
b.	Terbutaline sulfate (Brethine)
c.	Calcium gluconate (Calgonate)
d.	Magnesium sulfate

 

 

ANS:  B

The client receiving decreasing doses of magnesium sulfate is often switched to oral terbutaline to maintain tocolysis. Pitocin increases the strength of contractions and is used to augment or stimulate labor. Buccal Pitocin dosing is uncontrollable. Calcium gluconate reverses magnesium sulfate toxicity. The drug should be available for complications of magnesium sulfate therapy. Magnesium sulfate is usually given intravenously or intramuscularly. The patient must be hospitalized for magnesium therapy because of the serious side effects of this drug.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   585

OBJ:   Nursing Process Step: Planning        MSC:  Client Needs: Physiologic Integrity

 

5. A client with polyhydramnios was admitted to a labor-birth-recovery-postpartum (LDRP) suite. Her membranes rupture and the fluid is clear and odorless, but the fetal heart monitor indicates bradycardia and variable decelerations. Which action should be taken next?

a.	Perform Leopold maneuvers.
b.	Perform a vaginal examination.
c.	Apply warm saline soaks to the vagina.
d.	Place the client in a high Fowler position.

 

 

ANS:  B

A prolapsed cord may not be visible but may be palpated on vaginal examination. The priority is to relieve pressure on the umbilical cord. Leopold maneuvers are not an appropriate action at this time. Moist towels retard cooling and drying of the prolapsed cord, but it is hoped the fetus will be delivered before this occurs. The high Fowler position will increase cord compression and decrease fetal oxygenation.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   591

OBJ:   Nursing Process Step: Implementation

MSC:   Client Needs: Physiologic Integrity