NUR114CH22

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Author:
TomWruble
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186805
Filename:
NUR114CH22
Updated:
2013-03-17 12:27:32
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nur114f Labor Birth Risk
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Labor and Birth at Risk
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  1. Preterm labor consists of cervical changes and uterine contractions occurring between ___ and ___ weeks of pregnancy. Preterm birth is a birth occurring before the completion of ___ weeks of gestation.
    • 20 and 37
    • 37

    [22]
  2. Most infant deaths and the most serious morbidity occur in the ___% of preterm infants who are born before ___ weeks of gestation.
    • 16
    • 32
  3. The major risk factors for spontaneous preterm birth include a ___, ___, ___, and ___.
    • previous preterm birth
    • multiple gestations
    • bleeding after the first trimester of pregnancy
    • a low maternal body mass index

    [22]
  4. More than ___ of preterm births occur in women ___.
    • half
    • without obvious risk factors
  5. The cause of preterm labor is ___.
    unknown

    [22]
  6. Many health care providers recommend ___  for women at high risk of preterm birth.
    modified bed rest

    [22]
  7. ___ are used to delay birth long enough to institute interventions that reduce neonatal morbidity and mortality. The most commonly used tocolytic is ___. Others are: beta-adrenergic agonists, especially ___, a calcium channel blocker, and the NSAID ___.
    • Tocolytics
    • magnesium sulfate
    • Terbutaline
    • Nifedipine
    • Indocin

    [22]
  8. One of the most effective interventions for preterm labor is ___, which accelerates fetal lung maturity.
    antenatal glucocorticoid administration
  9. Premature rupture of membranes (PROM) is the spontaneous rupture of the amniotic sac and leakage of amniotic fluid before ___ at any gestational age. Preterm premature rupture of membranes (PPROM) is a rupture before ___ weeks of gestation.
    • the onset of labor
    • 37

    [22]
  10. The most common maternal complication of preterm PROM is ___, called ___.
    • infection of the amniotic cavity
    • chorioamnionitis

    [22]
  11. ___ —a long, difficult, or abnormal labor—occurs in ___ to ___% of all births.
    • Dystocia
    • 8% to 11%

    [22]
  12. Cervical ripening using chemical measures, such as administering ___, or mechanical measures, such as ___, can increase the success of labor induction.
    • prostaglandins
    • inserting a balloon catheter
  13. A laboring woman’s amniotic membranes have just ruptured. The immediate action of the nurse would be to: (and why?)

    A. Assess the fetal heart rate (FHR) pattern.
    B. Inspect the characteristics of the fluid.
    C. Assess maternal temperature.
    D. Perform a vaginal examination.
    A. Assess the fetal heart rate (FHR) pattern.

    Compression of the cord could occur after rupture leading to fetal hypoxia as reflected in an alteration in FHR pattern, characteristically variable decelerations. The same initial action should follow artificial rupture of the membranes (amniotomy).

    Performing a vaginal examination, inspecting the characteristics of the fluid, and assessing maternal temperature are all important and should be done after the FHR and pattern are assessed.

    [22]
    (this multiple choice question has been scrambled)
  14. T/F: Dysfunctional labor: women who are underweight are more at risk.
    False: Short women more than 30 pounds overweight are more at risk for dysfunctional labor.

    [22]
  15. T/F: Dysfunctional labor: women experiencing precipitous labor are about the only “dysfunctionals” not to be exhausted.
    True: Precipitous labor lasts less than 3 hours.

    [22]
  16. T/F: Dysfunctional labor: hypotonic uterine dysfunction is more common than hypertonic dysfunction.
    True: contractions becoming weaker, is more common

    [22]
  17. Abnormal labor patterns are more common in women ___ of age.
    under 20 years

    [22]
  18. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring?

    A. Estriol is not found in maternal saliva.
    B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes.
    C. Fetal fibronectin is present in vaginal secretions.
    D. The cervix is effacing and dilated to 2 cm.
    D. The cervix is effacing and dilated to 2 cm.

    Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor.

    [22]
    (this multiple choice question has been scrambled)
  19. ___ accompanied by ___ indicate ___ at any gestational age.
    • Changes in the cervix
    • regular contractions
    • labor
  20. T/F: Preterm labor is occurring if estriol is not found in maternal saliva.
    False: Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth.

    [22]
  21. T/F: Indicates that preterm labor is occurring: irregular, mild uterine contractions are occurring every 12 to 15 minutes
    False: Irregular, mild contractions that do not cause cervical change are not considered a threat.

    [22]
  22. T/F: Could indicate that preterm labor is occurring: fetal fibronectin is present in vaginal secretions.
    True: BUT the presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.

    [22]
  23. The nurse is caring for a woman whose labor is being augmented with oxytocin. The nurse recognizes that the oxytocin should be discontinued immediately if there is evidence of:
    A. Rupture of the woman’s amniotic membranes.
    B. The woman needing to void.
    C. Uterine contractions occurring every 8 to 10 minutes.
    D. A fetal heart rate (FHR) of 180 with absence of variability.
    D. A fetal heart rate (FHR) of 180 with absence of variability.

    [22]
    (this multiple choice question has been scrambled)
  24. T/F: Oxytocin should be discontinued immediately if there is evidence of uterine contractions occurring every 8 to 10 minutes
    False: The oxytocin should be discontinued if uterine hyperstimulation occurs, which is a series of single contractions lasting 2 minutes or more or a contraction frequency of five or more in 10 minutes.

    [22]
  25. T/F: Oxytocin should be discontinued immediately if there is rupture of the woman’s amniotic membranes.
    False: Unless a change occurs in the FHR pattern that is nonreassuring or the woman experiences uterine hyperstimulation, the oxytocin does not need to be discontinued. The physician should be notified that the woman’s membranes have ruptured.

    [22]
  26. With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that:

    A. The drugs can be given efficaciously up to the designated beginning of term at 37 weeks.
    B. There are no important maternal (as opposed to fetal) contraindications.
    C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids.
    D. If the patient develops pulmonary edema while on tocolytics, intravenous (IV) fluids should be given.
    C. Its most important function is to afford the opportunity to administer antenatal glucocorticoids. To accelerate fetal lung development might be the best reason to use tocolytics.

    [22]
    (this multiple choice question has been scrambled)
  27. T/F: Tocolytic therapy to suppress uterine activity can be given efficaciously up to 34 weeks.
    True: Once the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits.

    [22]
  28. The nurse providing care to a woman in labor should be aware that cesarean birth:

    A. Is performed primarily for the benefit of the fetus.
    B. Is declining in frequency in the twenty-first century in the United States.
    C. Is more likely to be done for the poor in public hospitals who do not get the nurse counseling that wealthier patients do.
    D. Can be either elected or refused by women as their absolute legal right.
    A. Is performed primarily for the benefit of the fetus.

    The most common indications for cesarean birth are danger to the fetus related to labor and birth complications.
    (this multiple choice question has been scrambled)
  29. T/F: Cesarean birth can be either elected or refused by women as their absolute legal right.
    Unclear: A woman’s right to elect cesarean surgery is in dispute, as is her right to refuse it if in doing so she endangers the fetus. Legal issues are not absolutely clear.
  30. For a woman at 42 weeks of gestation, which finding would require more assessment by the nurse?

    A. Cervix dilated 2 cm and 50% effaced
    B. One fetal movement noted in 1 hour of assessment by the mother
    C. Fetal heart rate of 116 beats/min
    D. Score of 8 on the biophysical profile
    B. One fetal movement noted in 1 hour of assessment by the mother

    Self-care in a postterm pregnancy should include performing daily fetal kick counts three times per day. The mother should feel four fetal movements per hour. If fewer than four movements have been felt by the mother, she should count for 1 more hour. Fewer than four movements in that hour warrants evaluation.
    (this multiple choice question has been scrambled)
  31. Fetal heart rate of ___ beats/min is a normal finding in a 42-week gestation
    116
  32. A cervix dilated to ___ and ___ effaced is a normal finding in a 42-week gestation.
    2 cm and 50%
  33. A score of ___ on the BPP is a normal finding in a 42-week gestation.
    8 - normal infant; low risk of chronic asphyzia

    Performed via real-time ultrasound.
  34. ___ is defined as long, difficult, or abnormal labor. It is caused by various conditions associated with the five factors affecting labor.
    Dystocia
  35. antenatal glucocorticoids
    Medications administered to the mother for the purpose of accelerating fetal lung maturity when an increased risk exists for preterm birth between24 and 34 weeks of gestation
  36. cephalopelvic disproportion (CPD)
    Condition in which the infant's head is of such a shape, size, or position that it cannot pass through the mother's pelvis, or the maternal pelvis is too small, abnormally shaped, or deformed to allow the passage of a fetus of average size
  37. dysfunctional labor
    Abnormal uterine contractions that prevent normal progress cervical dilation, effacement, or descent
  38. dystocia
    Prolonged, painful, or otherwise difficult labor caused by various conditions associated with the five factors affecting labor:

    • powers
    • passage
    • passenger
    • maternal position
    • maternal emotions
  39. oxytocin
    Hormone produced by the posterior pituitary gland that stimulates uterine contractions and the release of milk in the mammary glands (let-down reflex); synthetic oxytocin is a medication that mimics the uterine stimulating action of oxytocin
  40. precipitous labor
    Rapid or sudden labor lasting less than 3 hours from the onset of uterine contractions to complete birth of the fetus
  41. premature rupture of membranes(PROM)
    Rupture of the amniotic sac and leakage of amniotic fluid before the onset labor at any gestational age
  42. prolapse of the umbilical cord
    Protrusion of the umbilical cord in advance of the presenting part
  43. shoulder dystocia
    Condition in which the head is born but the anterior shoulder cannot pass under the pubic arch
  44. tocolytics
    Medications used to suppress uterine activity and relax the uterus in cases of hyperstimulation or preterm labor
  45. Late preterm
    75% of preterm (before 37 weeks) are 34-36 weeks.


    The greatest morbidity and mortality occur with the 16% born before 32 weeks.
  46. T/F: Preterm birth is a more dangerous health condition that LBW.
    True: immature body systems
  47. EBP - Recurrent preterm birth can be prevented in some women  by
    administering prophylactic progesterone supplimentation
  48. Risk Factors for Spontaneous Preterm Birth
    • Genital tract infection
    • Non-Caucasian race
    • Multifetal gestation
    • Second-trimester bleeding
    • Low prepregnancy weight
    • History of previous spontaneous birth
  49. Signs and Symptoms of Preterm Labor
    • DISCOMFORT
    • Lower abdominal cramping similar to gas pains;may be accompanied by diarrhea
    • Dull, intermittent low back pain (below the waist)
    • Painful, menstrual-like cramps
    • Suprapubic pain or pressure
    • Pelvic pressure or heaviness
    • Urinary frequency

    • VAGINAL DISCHARGE
    • Change in character and amount of usual discharge:
    • thicker (mucoid) or thinner (watery); bloody, brown,or colorless; increased amount; odor
    • Rupture of amniotic membranes
  50. EBP - Preterm Early Recongnition Interventions
    • Transfer mom to hosp w/ NICU
    • Antibiotics against group B Stret infections
    • Antenatal corticosteroids to reduce resp distress syndrome, and other issues
  51. Bishop Score
  52. PPROM/PROM
    • Chorioamnitis is what may occur, temp taken generally q2hours, conservative management is usually daily fetal assessments. NST's, BPP, the longer the infant can stay in the better it will be.
    • Corticosteroids usually given IM two doses24 hours apart to help the infants lungs mature.
  53. EBP - For preterm risk, activity restriction and limited work may be OK but ___ is has no evidence to support it and it does have plenty of risks.
    Bed Rest

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