Chapter 23 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Chapter 23 Contemporary Maternal Newborn Nursing 7th Edition by Patricia W. Ladewig

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Chapter 23_LO01_Q01

The nurse is scheduling a client for an external cephalic version (ECV). Which finding in the client’s chart requires immediate intervention?

1. “Multip, first birth by cesarean.”
2. “Primip, frank breech ballotable.”
3. “Multip, 32 weeks, complete breech.”
4. “Primip, failed ECV last week.”

Correct Answer: 1

Rationale:

1. Any previous uterine scar is a contraindication to ECV. The scar could rupture, leading to both fetal and maternal morbidity and to mortality.
2. This client has no contraindication to ECV.
3. ECV is not attempted until 36 weeks. This client is too early in her pregnancy for ECV.
4. Although this client is less likely to have a successful ECV this week if it was unsuccessful last week, there is no contraindication to attempting the procedure.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Implementation

Learning Outcome: 23.1 Explain the methods, purpose, criteria, and contraindications of external version in determining nursing care management.

Chapter 23_LO02 _Q02

The nurse has received an order to rupture the membranes of a client artificially. Which finding in the client’s history would lead the nurse to question the order?

1. Group B strep negative yesterday
2. HbsAg negative at 28 weeks
3. HIV-positive X 3 years
4. History of genital herpes

Correct Answer: 3

Rationale:

1. Artificial rupture of the membranes increases the incidence of chorioamnionitis. Group B strep negative findings yesterday decrease the risk of infection. This client is appropriate for artificial rupture of membranes.
2. Artificial rupture of the membranes increases the incidence of perinatal transmission of hepatitis B. This client is negative for hepatitis B; therefore, this client is appropriate for artificial rupture of membranes.
3. Artificial rupture of the membranes increases the incidence of perinatal transmission of HIV, and should not be undertaken in HIV/AIDS–positive women.
4. A history of genital herpes does not indicate that the client is currently experiencing an outbreak. This client is appropriate for artificial rupture of membranes.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Assessment

Learning Outcome: 23.2 Describe the use of amniotomy and the nursing care management of woman and fetus.

Chapter 23_LO03 _Q03

Induction of labor is planned for a 31-year-old primip at 39 weeks due to insulin-dependent diabetes. What nursing action is most important?

1. Administer 100 mcg of misoprostol (Cytotec) vaginally every two hours.
2. Place dinoprostone (Prepidil) vaginal gel and ambulate client for one hour.
3. Begin Pitocin (oxytocin) four hours after 50 mcg misoprostol (Cytotec).
4. Prepare to induce labor after administering a tap water enema.

Correct Answer: 3

Rationale:

1. Misoprostol (Cytotec) is administered in 25mcg doses every 3–6 hours. 100 mcg every two hours is too much medication too frequently.
2. The client must remain recumbent for two hours after administration of dinoprostone (Prepidil) vaginal gel, during which time continuous monitoring is undertaken.
3. A minimum of four hours must elapse between the last dose of misoprostol (Cytotec) and beginning Pitocin administration; thus the timing of these two medications is appropriate.
4. Enemas are not routinely used in labor. This order is not expected.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Planning

Learning Outcome: 23.3 Explain the indications, contraindications, labor readiness, and methods in determining the nursing care management for women during labor induction.

Chapter 23_LO04_Q04

The nurse is teaching childbirth education classes. Teaching has been successful if the primiparous client states: “I can reduce the likelihood that I’ll tear or need an episiotomy if I:

1. “Push in a semi-sitting position.”
2. “Make sure I push long and hard.”
3. “Begin regular perineal massage.”
4. “Pull back on my legs when pushing.”

Correct Answer: 3

Rationale:

1. Semi-sitting or lithotomy position increases the likelihood of perineal lacerations.
2. Short pushes during the expulsion of the head decrease the likelihood of perineal lacerations.
3. Perineal massage has been shown to decrease the need for episiotomy in primiparous clients.
4. Pulling back on the legs while pushing tightens the perineal tissue, which in turn increases the likelihood of perineal lacerations.

Cognitive level: Application

Category of Client Need: Health Promotion and Maintenance

Nursing Process: Evaluation

Learning Outcome: 23.4 Describe the indications for amnioinfusion, and the nursing care of the woman during amnioinfusion.