Chapter 32: Labor and Birth at Risk
MULTIPLE CHOICE
1. In planning for home care of a woman with preterm labor, which concern should the nurse
need to address?
a. Nursing assessments are different from those performed in the hospital setting.
b. Restricted activity and medications are necessary to prevent a recurrence of
preterm labor.
c. Prolonged bed rest may cause negative physiologic effects.
d. Home health care providers are necessary.
ANS: C
Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle
wasting, weakness, bone demineralization, decreased cardiac output, risk for
thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged
postpartum recovery. Nursing assessments differ somewhat from those performed in the
acute care setting, but this concern does not need to be addressed. Restricted activity and
medications may prevent preterm labor but not in all women. In addition, the plan of care is
individualized to meet the needs of each client. Many women receive home health nurse
visits, but care is individualized for each woman.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Planning
MSC: Client Needs: HealtN
hUPrRoS
mI ioG
otN nTanBd.MCaO
inM
tenance
2. Which nursing intervention is paramount when providing care to a client with preterm labor
who has received terbutaline?
a. Assess deep tendon reflexes (DTRs).
b. Assess for dyspnea and crackles.
c. Assess for bradycardia.
d. Assess for hypoglycemia.
ANS: B
Terbutaline is a beta2-adrenergic agonist that affects the mother’s cardiopulmonary and
metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath
sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to
perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the
possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic
agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs
cause tachycardia, not bradycardia.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
3. In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor,
which finding alerts the nurse to possible side effects?
a. Urine output of 160 ml in 4 hours
, b. DTRs 2+ and no clonus
c. Respiratory rate (RR) of 16 breaths per minute
d. Serum magnesium level of 10 mg/dl
ANS: D
The therapeutic range for magnesium sulfate management is 4 to 7.5 mg/dl. A serum
magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity,
including oliguria and respiratory distress. Urine output of 160 ml in 4 hours, DTRs of 2+,
and a RR of 16 breaths per minute are all normal findings.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity
4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM)
doses of betamethasone. What is the purpose of this pharmacologic intervention?
a. To stimulate fetal surfactant production
b. To reduce maternal and fetal tachycardia associated with ritodrine administration
c. To suppress uterine contractions
d. To maintain adequate maternal respiratory effort and ventilation during
magnesium sulfate therapy
ANS: A
Antenatal glucocorticoids administered as IM injections to the mother accelerate fetal lung
maturity. Propranolol (Inderal) is given to reduce the effects of ritodrine administration.
Betamethasone has no effect on uterine contractions. Calcium gluconate is given to reverse
the respiratory depressive effects of magnesium sulfate therapy.
PTS: 1
N R I G B.C M
DIF: UCoS gnitN
ive T
Level: O
Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
5. A primigravida at 40 weeks of gestation is having uterine contractions every to 2
minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed
in 3 hours. The woman is crying and wants an epidural. What is the likely status of this
woman’s labor?
a. She is exhibiting hypotonic uterine dysfunction.
b. She is experiencing a normal latent stage.
c. She is exhibiting hypertonic uterine dysfunction.
d. She is experiencing precipitous labor.
ANS: C
The contraction pattern observed in this woman signifies hypertonic uterine activity.
Typically, uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45
seconds. Women who experience hypertonic uterine dysfunction, or primary dysfunctional
labor, are often anxious first-time mothers who are having painful and frequent contractions
that are ineffective at causing cervical dilation or effacement to progress. With hypotonic
uterine dysfunction, the woman initially makes normal progress into the active stage of
labor; then the contractions become weak and inefficient or stop altogether. Precipitous
labor is one that lasts less than 3 hours from the onset of contractions until time of birth.
PTS: 1 DIF: Cognitive Level: Apply
, TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
6. A woman is having her first child. She has been in labor for 15 hours. A vaginal
examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100%
effaced, and the presenting part of the fetus was at station 0; however, another vaginal
examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is
associated with this description?
a. Prolonged latent phase
b. Protracted active phase
c. Secondary arrest
d. Protracted descent
ANS: C
With a secondary arrest of the active phase, the progress of labor has stopped. This client
has not had any anticipated cervical change, indicating an arrest of labor. In the nulliparous
woman, a prolonged latent phase typically lasts longer than 20 hours. A protracted active
phase, the first or second stage of labor, is prolonged (slow dilation). With a protracted
descent, the fetus fails to descend at an anticipated rate during the deceleration phase and
second stage of labor.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
7. Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is
the primary purpose of prosNtaUgR
laS
ndIinNaGdT
mB
in.
isC
tratiM
on?
a. To enhance uteroplacental perfusion in an aging placenta
b. To increase amniotic fluid volume
c. To ripen the cervix in preparation for labor induction
d. To stimulate the amniotic membranes to rupture
ANS: C
Preparations of prostaglandin E1 and E2 are effective when used before labor induction to
ripen (i.e., soften and thin) the cervix. Uteroplacental perfusion is not altered by the use of
prostaglandins. The insertion of prostaglandin gel has no effect on the level of amniotic
fluid. In some cases, women will spontaneously begin laboring after the administration of
prostaglandins, thereby eliminating the need for oxytocin. It is not common for a woman’s
membranes to rupture as a result of prostaglandin use.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
8. A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her
labor is being controlled with tocolytic medications. She asks when she might be able to go
home. Which response by the nurse is most accurate?
a. “After the baby is born.”
b. “When we can stabilize your preterm labor and arrange home health visits.”
c. “Whenever your physician says that it is okay.”
d. “It depends on what kind of insurance coverage you have.”
MULTIPLE CHOICE
1. In planning for home care of a woman with preterm labor, which concern should the nurse
need to address?
a. Nursing assessments are different from those performed in the hospital setting.
b. Restricted activity and medications are necessary to prevent a recurrence of
preterm labor.
c. Prolonged bed rest may cause negative physiologic effects.
d. Home health care providers are necessary.
ANS: C
Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle
wasting, weakness, bone demineralization, decreased cardiac output, risk for
thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged
postpartum recovery. Nursing assessments differ somewhat from those performed in the
acute care setting, but this concern does not need to be addressed. Restricted activity and
medications may prevent preterm labor but not in all women. In addition, the plan of care is
individualized to meet the needs of each client. Many women receive home health nurse
visits, but care is individualized for each woman.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Planning
MSC: Client Needs: HealtN
hUPrRoS
mI ioG
otN nTanBd.MCaO
inM
tenance
2. Which nursing intervention is paramount when providing care to a client with preterm labor
who has received terbutaline?
a. Assess deep tendon reflexes (DTRs).
b. Assess for dyspnea and crackles.
c. Assess for bradycardia.
d. Assess for hypoglycemia.
ANS: B
Terbutaline is a beta2-adrenergic agonist that affects the mother’s cardiopulmonary and
metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath
sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to
perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the
possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic
agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs
cause tachycardia, not bradycardia.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
3. In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor,
which finding alerts the nurse to possible side effects?
a. Urine output of 160 ml in 4 hours
, b. DTRs 2+ and no clonus
c. Respiratory rate (RR) of 16 breaths per minute
d. Serum magnesium level of 10 mg/dl
ANS: D
The therapeutic range for magnesium sulfate management is 4 to 7.5 mg/dl. A serum
magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity,
including oliguria and respiratory distress. Urine output of 160 ml in 4 hours, DTRs of 2+,
and a RR of 16 breaths per minute are all normal findings.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity
4. A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM)
doses of betamethasone. What is the purpose of this pharmacologic intervention?
a. To stimulate fetal surfactant production
b. To reduce maternal and fetal tachycardia associated with ritodrine administration
c. To suppress uterine contractions
d. To maintain adequate maternal respiratory effort and ventilation during
magnesium sulfate therapy
ANS: A
Antenatal glucocorticoids administered as IM injections to the mother accelerate fetal lung
maturity. Propranolol (Inderal) is given to reduce the effects of ritodrine administration.
Betamethasone has no effect on uterine contractions. Calcium gluconate is given to reverse
the respiratory depressive effects of magnesium sulfate therapy.
PTS: 1
N R I G B.C M
DIF: UCoS gnitN
ive T
Level: O
Understand
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
5. A primigravida at 40 weeks of gestation is having uterine contractions every to 2
minutes and states that they are very painful. Her cervix is dilated 2 cm and has not changed
in 3 hours. The woman is crying and wants an epidural. What is the likely status of this
woman’s labor?
a. She is exhibiting hypotonic uterine dysfunction.
b. She is experiencing a normal latent stage.
c. She is exhibiting hypertonic uterine dysfunction.
d. She is experiencing precipitous labor.
ANS: C
The contraction pattern observed in this woman signifies hypertonic uterine activity.
Typically, uterine activity in this phase occurs at 4- to 5-minute intervals lasting 30 to 45
seconds. Women who experience hypertonic uterine dysfunction, or primary dysfunctional
labor, are often anxious first-time mothers who are having painful and frequent contractions
that are ineffective at causing cervical dilation or effacement to progress. With hypotonic
uterine dysfunction, the woman initially makes normal progress into the active stage of
labor; then the contractions become weak and inefficient or stop altogether. Precipitous
labor is one that lasts less than 3 hours from the onset of contractions until time of birth.
PTS: 1 DIF: Cognitive Level: Apply
, TOP: Nursing Process: Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
6. A woman is having her first child. She has been in labor for 15 hours. A vaginal
examination performed 2 hours earlier revealed the cervix to be dilated to 5 cm and 100%
effaced, and the presenting part of the fetus was at station 0; however, another vaginal
examination performed 5 minutes ago indicated no changes. What abnormal labor pattern is
associated with this description?
a. Prolonged latent phase
b. Protracted active phase
c. Secondary arrest
d. Protracted descent
ANS: C
With a secondary arrest of the active phase, the progress of labor has stopped. This client
has not had any anticipated cervical change, indicating an arrest of labor. In the nulliparous
woman, a prolonged latent phase typically lasts longer than 20 hours. A protracted active
phase, the first or second stage of labor, is prolonged (slow dilation). With a protracted
descent, the fetus fails to descend at an anticipated rate during the deceleration phase and
second stage of labor.
PTS: 1 DIF: Cognitive Level: Analyze
TOP: Nursing Process: Assessment
MSC: Client Needs: Health Promotion and Maintenance
7. Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is
the primary purpose of prosNtaUgR
laS
ndIinNaGdT
mB
in.
isC
tratiM
on?
a. To enhance uteroplacental perfusion in an aging placenta
b. To increase amniotic fluid volume
c. To ripen the cervix in preparation for labor induction
d. To stimulate the amniotic membranes to rupture
ANS: C
Preparations of prostaglandin E1 and E2 are effective when used before labor induction to
ripen (i.e., soften and thin) the cervix. Uteroplacental perfusion is not altered by the use of
prostaglandins. The insertion of prostaglandin gel has no effect on the level of amniotic
fluid. In some cases, women will spontaneously begin laboring after the administration of
prostaglandins, thereby eliminating the need for oxytocin. It is not common for a woman’s
membranes to rupture as a result of prostaglandin use.
PTS: 1 DIF: Cognitive Level: Apply
TOP: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity
8. A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her
labor is being controlled with tocolytic medications. She asks when she might be able to go
home. Which response by the nurse is most accurate?
a. “After the baby is born.”
b. “When we can stabilize your preterm labor and arrange home health visits.”
c. “Whenever your physician says that it is okay.”
d. “It depends on what kind of insurance coverage you have.”
