Chapter 24 Childbirth at Risk: Prelabor and Intrapartum Complications

Chapter 24   Childbirth at Risk: Prelabor and Intrapartum Complications

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

1) The nurse has admitted a woman with cervical insufficiency. The nurse is aware that causes of this condition include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Congenital factors
2. Intercourse during pregnancy
3. Infection
4. Increased uterine volume
5. Past cervical surgeries

Answer:  1, 3, 4, 5

Explanation:  1. Congenitally incompetent cervix may be found in women exposed to diethylstilbestrol (DES) or those with a bicornuate uterus.

3. Infection or trauma can cause acquired cervical incompetence.
4. Cervical insufficiency can occur in multiple-gestation pregnancies.
5. Previous elective abortion or cervical manipulation can lead to cervical insufficiency.

Page Ref: 586

Cognitive Level:  Understanding

Client Need/Sub:  Safe and Effective Care Environment: Management of Care

Standards:  QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  6 Identify the causes and risk factors of cervical insufficiency.

MNL LO:  3.4.2 Implement nursing care for a pregnant woman diagnosed with premature labor.

2) The nurse is admitting a client for a cerclage procedure. The client asks for information about the procedure. What is the nurse’s most accurate response?

1. “A stitch is placed in the cervix to prevent a spontaneous abortion or premature birth.”
2. “The procedure is done during the third trimester.”
3. “Cerclage is always placed after the cervix has dilated and effaced.”
4. “An uncomplicated elective cerclage may is done on inpatient basis.”

Answer:  1

Explanation:  1. This is the correct description of cerclage.

Page Ref: 587

Cognitive Level:  Understanding

Client Need/Sub:  Health Promotion and Maintenance: Safety and Infection Control

Standards:  QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Teaching and Learning

Learning Outcome:  6 Identify the causes and risk factors of cervical insufficiency.

MNL LO:  3.4.1 Discuss the pathophysiology and risk factors associated with premature labor.

3) A client is admitted to the labor and delivery unit with a history of ruptured membranes for 2 hours. This is her sixth delivery; she is 40 years old, and smells of alcohol and cigarettes. What is this client at risk for?

1. Gestational diabetes
2. Placenta previa
3. Abruptio placentae
4. Placenta accreta

Answer:  3

Explanation:  3. Abruptio placentae is more frequent in pregnancies complicated by smoking, premature rupture of membranes, multiple gestation, advanced maternal age, cocaine use, chorioamnionitis, and hypertension.

Page Ref: 579

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus, and their nursing care.

MNL LO:  3.4.1 Discuss the pathophysiology and risk factors associated with premature labor.

4) 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 aminocentesis, I might rupture the membranes again.”

Answer:  3

Explanation:  3. There is no evidence that bed rest in a subsequent pregnancy decreases the risk for PPROM.

Page Ref: 575

Cognitive Level:  Applying

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome:  2 Identify the causes and risk factors for premature rupture of membranes.

MNL LO:  3.4.1 Discuss the pathophysiology and risk factors associated with premature labor.

5) A client was admitted to the labor area at 5 cm with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect?

1. Blood pressure
2. Temperature
3. Pulse
4. Respiration

Answer:  2

Explanation:  2. Rupture of membranes places the mother at risk for infection. The temperature is the primary and often the first indication of a problem.

Page Ref: 575, 576

Cognitive Level:  Understanding

Client Need/Sub:  Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  2 Identify the causes and risk factors for premature rupture of membranes.

MNL LO:  3.4.1 Discuss the pathophysiology and risk factors associated with premature labor.