Chapter 21 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Chapter 21 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 21_LO01_Q01

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? “If I:

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

Correct Answer: 3

Rationale:

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

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 21.1 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 care management of the woman and her fetus-newborn.

Chapter 21_LO01_Q02

During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. The nurse’s priority action is to:

1. Help the fetal head descend faster.
2. Use gravity and manipulation to relieve compression on the cord.
3. Facilitate dilation of the cervix with prostaglandin gel.
4. Prevent head compression.

Answer: 2

Rationale:

1. The fetal head’s descending would put further pressure on the umbilical, and reduce blood flow and oxygenation to the fetus.
2. The number one priority is to relieve compression on the umbilical cord to allow blood flow to reach the fetus. A C-section is imminent.
3. Further dilatation of the cervix, or descent of the head, is unnecessary in light of the impending C-section.

4.Head compression is not a concern in the case of prolapsed of the umbilical cord.  The cord is what will be compressed.

Cognitive Level:  Analysis

Category of Client Need: Physiological Integrity: Reduction of Risk Potential

Nursing Process: Implementation

Learning Outcome: 21.1 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 care management of the woman and her fetus-newborn.

Chapter 21_LO01_Q03

A primigravida is admitted to the birth setting in early labor. She is 3 cm dilated, −2 station, with intact membranes and FHR of 150 bpm. Her membranes rupture spontaneously, and the FHR drops to 90 bpm with variable decelerations. The initial response from the nurse would be to:

1. Perform a vaginal exam.
2. Notify the physician.
3. Place the client in a left lateral position.
4. Administer oxygen at 2L per nasal cannula.

Answer: 1

Rationale:

1. A drop in fetal heart rate accompanied by variable decelerations is consistent with a prolapsed cord, and a vaginal exam is the best way to confirm.
2. The vaginal exam should be done before notification of the physician.
3. Positioning will not relieve the decreased heart rate if the cord is compromised.
4. Oxygen will not relieve the decreased heart rate if the cord is compromised.

Cognitive Level:  Analysis

Category of Client Need: Physiological Integrity: Reduction of Risk Potential

Nursing Process: Implementation

Learning Outcome: 21.1 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 care management of the woman and her fetus-newborn.

Chapter 21_LO02 _Q04

The nurse has received 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

Correct Answer: 1

Rationale:

1. Bleeding with a placenta previa is a complication that can be life-threatening to both mother and baby. This client is the highest priority.
2. Late decelerations are an abnormal finding, but put only the fetus at risk. This client is not the highest priority.
3. Grade I abruptio placentae creates slight vaginal bleeding. The urge to push indicates that delivery is near. This client 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 client is experiencing this complication. This client is not the highest priority.

Cognitive level: Analysis

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 21.2 Compare placenta previa and abruptio placentae, including implications for the mother and fetus, and nursing care.