Chapter 14: Caring for the Woman Experiencing Complications During Labor and Birth

Chapter 14: Caring for the Woman Experiencing Complications During Labor and Birth

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The perinatal nurse explains to a nursing student that the most appropriate patient for an amnioinfusion is a woman who has a fetal heart rate tracing that exhibits which pattern?

A.	Absent variability
B.	Early decelerations
C.	Late decelerations
D.	Variable decelerations

 

 

ANS:  D

Pregnancy outcome in patients experiencing variable fetal heart rate decelerations caused by cord compression is improved through the use of amnioinfusion, which is the instillation of normal saline or lactated Ringer’s solution into the uterine cavity.

 

Cognitive Level: Comprehension/Understanding

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Teaching/Learning

Difficulty: Easy

 

PTS:   1

 

2. The perinatal nurse notes a rapid decrease in the fetal heart rate (FHR) that does not recover immediately following an amniotomy. What action should the nurse perform first?

A.	Administer oxygen at 100%.
B.	Assess the maternal temperature.
C.	Perform a vaginal examination.
D.	Recheck the FHR in 30 minutes.

 

 

ANS:  C

The nurse needs to assess the fetal heart rate immediately before and after the artificial rupture of the membranes. Changes such as transient fetal tachycardia may occur and are common. However, other fetal heart rate patterns, such as bradycardia and variable decelerations, may be indicative of cord compression or prolapse. The nurse should perform a vaginal examination to assess for cord prolapse. Administering oxygen may or may not be needed. Maternal temperature is assessed every 2 hours after artificial rupture of membranes but is not related to this situation. The nurse should not wait 30 minutes prior to doing anything.

 

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Safe and Effective Care Environment: Management of Care

Integrated Process: Nursing Process: Assessment

Difficulty: Moderate

 

PTS:   1

 

3. The perinatal nurse has administered a dose of dinoprostone (Cervidil) to a woman prior to a labor induction with oxytocin (Pitocin). The nurse then notices that the admission database is incomplete. What conditions should the nurse quickly question the patient about?

A.	Asthma
B.	Gallbladder disease
C.	IV drug use
D.	Penicillin allergy

 

 

ANS:  A

Dinoprostone is a prostaglandin E2 preparation for cervical ripening. It should be used cautiously in women with a history of asthma, glaucoma, and renal, hepatic, or cardiovascular disorders. Once the missing information is noticed, the nurse should assess for contraindications to using the medication, then for conditions that make it riskier. The other conditions are not related.

 

Cognitive Level: Analysis/Analyzing

Content Area: Pediatrics/Maternity

Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Integrated Process: Nursing Process: Assessment

Difficulty: Difficult

 

PTS:   1

 

4. During the postpartum assessment, the perinatal nurse notes that a patient who has just experienced a forceps-assisted birth now has a large amount of bright red vaginal bleeding. Her uterine fundus is firm. The most appropriate action by the nurse is to collaborate with the health-care provider in which activity?

A.	Bladder assessment and catheterization
B.	Preparing the woman for a hysterectomy
C.	Uterine massage and oxytocin infusion
D.	Vaginal assessment and repair

 

 

ANS:  D

A forceps-assisted birth is one in which a steel instrument with two curved blades is used to facilitate the birth of the infant’s head. Perineal trauma is one of the major complications associated with the use of forceps. Because hemorrhage (bright red bleeding) may result from cervical lacerations and vaginal tearing, the woman requires close observation during the postpartum period. If this occurs, the care provider should be notified regarding a potential vaginal repair. The other actions are not warranted.

 

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process: Implementation

Difficulty: Moderate

 

PTS:   1

 

5. The perinatal nurse is caring for a patient with preeclampsia. What intervention does the nurse include on this patient’s care plan?

A.	Administer magnesium sulfate per agency policy.
B.	Assess the patient’s blood pressure every 6 hours.
C.	Encourage the patient to rest on her back.
D.	Notify the physician of urine output greater than 30 mL/hr.

 

 

ANS:  A

The nurse is the manager of care for the woman with preeclampsia during the intrapartal period. Careful assessments are critical. The nurse administers medications as ordered and should adhere to hospital protocol for a magnesium sulfate infusion. Vital signs should be assessed more often than every 6 hours. The patient should be encouraged to maintain a left side-lying position. A urine output of greater than 30 mL/hour is normal.

 

Cognitive Level: Application/Applying

Content Area: Pediatrics/Maternity

Patient Needs: Health Promotion and Maintenance

Integrated Process: Nursing Process: Implementation

Difficulty: Moderate

 

PTS:   1