Chapter 23 Childbirth at Risk Prelabor Onset Complications
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.
1
,Copyright 2016 Pearson Education, Inc.
2) The nurse is admitting a client for a cerclage procedure. The client asks for
information about the procedure. What is the nurses 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.
2
Copyright 2016 Pearson Education, Inc.
3
Copyright 2016 Pearson Education, Inc.
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.
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.
1
,Copyright 2016 Pearson Education, Inc.
2) The nurse is admitting a client for a cerclage procedure. The client asks for
information about the procedure. What is the nurses 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.
2
Copyright 2016 Pearson Education, Inc.
3
Copyright 2016 Pearson Education, Inc.
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.
