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Chapter 32: Labor and Birth Complications

Lowdermilk: Maternity & Womens Health Care, 11th Edition

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.

DIF: Cognitive Level: Analyze REF: p. 777 TOP: Nursing Process:


Planning
MSC: Client Needs: Health Promotion and Maintenance

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 mothers 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.
DIF: Cognitive Level: Analyze REF: pp. 767-768
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.

DIF: Cognitive Level: Apply REF: p. 767 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.

DIF: Cognitive Level: Understand REF: p. 769 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 womans 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.
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.

DIF: Cognitive Level: Apply REF: p. 773 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.

DIF: Cognitive Level: Analyze REF: p. 774


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 prostaglandin administration?
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
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 womans membranes to rupture as a result of prostaglandin use.

DIF: Cognitive Level: Apply REF: p. 779 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.
ANS: B
This clients preterm labor is being controlled with tocolytics. Once she is stable, home
care may be a viable option for this type of client. Care of a client with preterm labor is
multidisciplinary and multifactorial; the goal is to prevent delivery. In many cases, this
goal may be achieved at home. Managed care may dictate an earlier hospital discharge or
a shift from hospital to home care. Insurance coverage may be one factor in client care,
but ultimately, client safety remains the most important factor.

DIF: Cognitive Level: Apply REF: p. 765 TOP: Nursing Process:


Planning
MSC: Client Needs: Health Promotion and Maintenance

9. The obstetric provider has informed the nurse that she will be performing
an amniotomy on the client to induce labor. What is the nurses highest priority
intervention after the amniotomy is performed?
a. Applying clean linens under the woman
b. Taking the clients vital signs
c. Performing a vaginal examination
d. Assessing the fetal heart rate (FHR)
ANS: D
The FHR is assessed before and immediately after the amniotomy to detect any changes
that might indicate cord compression or prolapse. Providing comfort measures, such as
clean linens, for the client is important but not the priority immediately after an
amniotomy. The womans temperature should be checked every 2 hours after the rupture
of membranes but not the priority immediately after an amniotomy. The woman would
have had a vaginal examination during the procedure. Unless cord prolapse is suspected,
another vaginal examination is not warranted. Additionally, FHR assessment provides
clinical cues to a prolapsed cord.

DIF: Cognitive Level: Analyze REF: p. 783


TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

10. The nurse who elects to work in the specialty of obstetric care must have
the ability to distinguish between preterm birth, preterm labor, and low birth weight.
Which statement regarding this terminology is correct?
a. Terms preterm birth and low birth weight
can be used interchangeably.
b. Preterm labor is defined as cervical
changes and uterine contractions
occurring between 20 and 37 weeks of
gestation.
c. Low birth weight is a newborn who
weighs below 3.7 pounds.
d. Preterm birth rate in the United States
continues to increase.
ANS: B
Before 20 weeks of gestation, the fetus is not viable (miscarriage); after 37 weeks, the
fetus can be considered term. Although these terms are used interchangeably, they have
different meanings: preterm birth describes the length of gestation (before 37 weeks),
regardless of the newborns weight; low birth weight describes only the infants weight at
the time of birth (2500 g or less), whenever it occurs. Low birth weight is anything below
2500 g or approximately pounds. In 2011, the preterm birth rate in the United States was
11.7 %; it has dropped every year since 2008.

DIF: Cognitive Level: Understand REF: p. 759


TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and
Maintenance

11. The nurse is performing an assessment on a client who thinks she may be
experiencing preterm labor. Which information is the most important for the nurse to
understand and share with the client?
a. Because all women must be considered at
risk for preterm labor and prediction is so
variable, teaching pregnant women the
symptoms of preterm labor probably
causes more harm through false alarms.
b. Braxton Hicks contractions often signal
the onset of preterm labor.
c. Because preterm labor is likely to be the
start of an extended labor, a woman with
symptoms can wait several hours before
contacting the primary caregiver.
d. Diagnosis of preterm labor is based on
gestational age, uterine activity, and
progressive cervical change.
ANS: D
Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced
or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to
detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm
labor contractions, but they are not true labor. Waiting too long to see a health care
provider could result in essential medications failing to be administered. Preterm labor is
not necessarily long-term labor.

DIF: Cognitive Level: Understand REF: p. 759 TOP: Nursing Process:


Planning
MSC: Client Needs: Safe and Effective Care Environment

12. Which statement related to cephalopelvic disproportion (CPD) is the least


accurate?
a. CPD can be related to either fetal size or
fetal position.
b. The fetus cannot be born vaginally.
c. CPD can be accurately predicted.
d. Causes of CPD may have maternal or fetal
origins.
ANS: C
Unfortunately, accurately predicting CPD is not possible. Although CPD is often related
to excessive fetal size (macrosomia), malposition of the fetal presenting part is the
problem in many cases, not true CPD. When CPD is present, the fetus cannot fit through
the maternal pelvis to be born vaginally. CPD may be related to either fetal origins such
as macrosomia or malposition or maternal origins such as a too small or malformed
pelvis.

DIF: Cognitive Level: Understand REF: p. 775 TOP: Nursing Process:


Planning
MSC: Client Needs: Health Promotion and Maintenance
13. Which statement related to the induction of labor is most accurate?
a. Can be achieved by external and internal
version techniques
b. Is also known as a trial of labor (TOL)
c. Is almost always performed for medical
reasons
d. Is rated for viability by a Bishop score
ANS: D
Induction of labor is likely to be more successful with a Bishop score of 9 or higher for
first-time mothers or 5 or higher for veterans. Version is the turning of the fetus to a better
position by a physician for an easier or safer birth. A TOL is the observance of a woman
and her fetus for several hours of active labor to assess the safety of vaginal birth. Two
thirds of cases of induced labor are elective and not done for medical reasons.

DIF: Cognitive Level: Understand REF: p. 780 TOP: Nursing Process:


Diagnosis
MSC: Client Needs: Safe and Effective Care Environment

14. A number of methods can be used for inducing labor. Which cervical
ripening method falls under the category of mechanical or physical?
a. Prostaglandins are used to soften and thin
the cervix.
b. Labor can sometimes be induced with
balloon catheters or laminaria tents.
c. Oxytocin is less expensive and more
effective than prostaglandins but creates
greater health risks.
d. Amniotomy can be used to make the
cervix more favorable for labor.
ANS: B
Balloon catheters or laminaria tents are mechanical means of ripening the cervix.
Ripening the cervix, making it softer and thinner, increases the success rate of induced
labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a
greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce
labor only when the cervix is already ripe.

DIF: Cognitive Level: Apply REF: p. 781 TOP: Nursing Process:


Planning
MSC: Client Needs: Health Promotion and Maintenance

15. Which description most accurately describes the augmentation of labor?


a. Is part of the active management of labor
that is instituted when the labor process is
unsatisfactory
b. Relies on more invasive methods when
oxytocin and amniotomy have failed
c. Is a modern management term to cover up
the negative connotations of forceps-
assisted birth
a. Is part of the active management of labor
that is instituted when the labor process is
unsatisfactory
b. Relies on more invasive methods when
oxytocin and amniotomy have failed
c. Is a modern management term to cover up
the negative connotations of forceps-
assisted birth
d. Uses vacuum cups
ANS: A
Augmentation is part of the active management of labor that stimulates uterine
contractions after labor has started but is not progressing satisfactorily. Augmentation
uses amniotomy and oxytocin infusion, as well as some more gentle, noninvasive
methods. Forceps-assisted births are less common than in the past and not considered a
method of augmentation. A vacuum-assisted delivery occurs during childbirth if the
mother is too exhausted to push. Vacuum extraction is not considered an augmentation
methodology.

DIF: Cognitive Level: Understand REF: pp. 785-786 TOP: Nursing Process:
Planning
MSC: Client Needs: Health Promotion and Maintenance

16. The exact cause of preterm labor is unknown but believed to be


multifactorial. Infection is thought to be a major factor in many preterm labors. Which
type of infection has not been linked to preterm birth?
a. Viral
b. Periodontal
c. Cervical
d. Urinary tract
ANS: A
Infections that increase the risk of preterm labor and birth are bacterial and include
cervical, urinary tract, periodontal, and other bacterial infections. Therefore, early,
continual, and comprehensive participation by the client in her prenatal care is important.
Recent evidence has shown a link between periodontal infections and preterm labor.
Researchers recommend regular dental care before and during pregnancy, oral assessment
as a routine part of prenatal care, and scrupulous oral hygiene to prevent periodontal
infections.

DIF: Cognitive Level: Remember REF: p. 760


TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. The nurse is teaching a client with preterm premature rupture of


membranes (PPROM) regarding self-care activities. Which activities should the nurse
include in her teaching?
a. Report a temperature higher than 40 C.
b. Tampons are safe to use to absorb the
leaking amniotic fluid.
c. Do not engage in sexual activity.
d. Taking frequent tub baths is safe.
a. Report a temperature higher than 40 C.
b. Tampons are safe to use to absorb the
leaking amniotic fluid.
c. Do not engage in sexual activity.
d. Taking frequent tub baths is safe.
ANS: C
Sexual activity should be avoided because it may induce preterm labor. A temperature
higher than 38 C should be reported. To prevent the risk of infection, tub baths should be
avoided and nothing should be inserted into the vagina. Further, foul-smelling vaginal
fluid, which may be a sign of infection, should be reported.

DIF: Cognitive Level: Apply REF: p. 762


TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and
Maintenance

18. A woman at 26 weeks of gestation is being assessed to determine whether


she is experiencing preterm labor. Which 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.
ANS: D
Cervical changes such as shortened endocervical length, effacement, and dilation are
predictors of imminent preterm labor. Changes in the cervix accompanied by regular
contractions indicate labor at any gestation. 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. Irregular, mild contractions that do not cause
cervical change are not considered a threat. 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.

DIF: Cognitive Level: Apply REF: p. 759


TOP: Nursing Process: Assessment | Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

19. Which assessment is least likely to be associated with a breech


presentation?
a. Meconium-stained amniotic fluid
b. Fetal heart tones heard at or above the
maternal umbilicus
c. Preterm labor and birth
d. Postterm gestation
ANS: D
Postterm gestation is not likely to occur with a breech presentation. The presence of
meconium in a breech presentation may be a result of pressure on the fetal wall as it
traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the
mother are a typical finding in a breech presentation because the fetal back would be
located in the upper abdominal area. Breech presentations often occur in preterm births.

DIF: Cognitive Level: Analyze REF: pp. 775-776


TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and
Maintenance

20. A pregnant womans amniotic membranes have ruptured. A prolapsed


umbilical cord is suspected. What intervention would be the nurses highest priority?
a. Placing the woman in the knee-chest
position
b. Covering the cord in sterile gauze soaked
in saline
c. Preparing the woman for a cesarean birth
d. Starting oxygen by face mask
ANS: A
The woman is assisted into a modified Sims position, Trendelenburg position, or the
knee-chest position in which gravity keeps the pressure of the presenting part off the
cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for
a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the
event of a prolapsed cord, the intervention of top priority would be positioning the
mother to relieve cord compression.

DIF: Cognitive Level: Apply REF: p. 797


TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. What is the primary purpose for the use of tocolytic therapy to suppress
uterine activity?
a. Drugs can be efficaciously administered
up to the designated beginning of term at
37 weeks gestation.
b. Tocolytic therapy has no important
maternal (as opposed to fetal)
contraindications.
c. The most important function of tocolytic
therapy is to provide the opportunity to
administer antenatal glucocorticoids.
d. If the client develops pulmonary edema
while receiving tocolytic therapy, then
intravenous (IV) fluids should be given.
ANS: C
Buying time for antenatal glucocorticoids to accelerate fetal lung development may be
the best reason to use tocolytic therapy. Once the pregnancy has reached 34 weeks,
however, the risks of tocolytic therapy outweigh the benefits. Important maternal
contraindications to tocolytic therapy exist. Tocolytic-induced edema can be caused by IV
fluids.

DIF: Cognitive Level: Comprehend REF: p. 766 TOP: Nursing Process:


Planning
MSC: Client Needs: Physiologic Integrity

22. When would an internal version be indicated to manipulate the fetus into a
vertex position?
a. Fetus from a breech to a cephalic
presentation before labor begins
b. Fetus from a transverse lie to a
longitudinal lie before a cesarean birth
c. Second twin from an oblique lie to a
transverse lie before labor begins
d. Second twin from a transverse lie to a
breech presentation during a vaginal birth
ANS: D
Internal version is used only during a vaginal birth to manipulate the second twin into a
presentation that allows it to be vaginally born. For internal version to occur, the cervix
needs to be completely dilated.

DIF: Cognitive Level: Remember REF: p. 779


TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

23. A client at 39 weeks of gestation has been admitted for an external


version. Which intervention would the nurse anticipate the provider to order?
a. Tocolytic drug
b. Contraction stress test (CST)
c. Local anesthetic
d. Foley catheter
ANS: A
A tocolytic drug will relax the uterus before and during the version, thus making
manipulation easier. CST is used to determine the fetal response to stress. A local
anesthetic is not used with external version. Although the bladder should be emptied,
catheterization is not necessary.

DIF: Cognitive Level: Apply REF: p. 779 TOP: Nursing Process:


Planning
MSC: Client Needs: Physiologic Integrity

24. What is a maternal indication for the use of vacuum-assisted birth?


a. Wide pelvic outlet
b. Maternal exhaustion
c. History of rapid deliveries
d. Failure to progress past station 0
ANS: B
A mother who is exhausted may be unable to assist with the expulsion of the fetus. The
client with a wide pelvic outlet will likely not require vacuum extraction. With a rapid
delivery, vacuum extraction is not necessary. A station of 0 is too high for a vacuum-
assisted birth.

DIF: Cognitive Level: Understand REF: p. 786


TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

25. Which nursing intervention should be immediately performed after the


forceps-assisted birth of an infant?
a. Assessing the infant for signs of trauma
b. Administering prophylactic antibiotic
agents to the infant
c. Applying a cold pack to the infants scalp
d. Measuring the circumference of the
infants head
ANS: A
The infant should be assessed for bruising or abrasions at the site of application, facial
palsy, and subdural hematoma. Prophylactic antibiotics are not necessary with a forceps
delivery. A cold pack would place the infant at risk for cold stress and is contraindicated.
Measuring the circumference of the head is part of the initial nursing assessment.

DIF: Cognitive Level: Apply REF: p. 788


TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

MULTIPLE RESPONSE

1. The nurse recognizes that uterine hyperstimulation with oxytocin requires


emergency interventions. What clinical cues alert the nurse that the woman is
experiencing uterine hyperstimulation? (Select all that apply.)
a. Uterine contractions lasting <90 seconds
and occurring >2 minutes in frequency
b. Uterine contractions lasting >90 seconds
and occurring <2 minutes in frequency
c. Uterine tone <20 mm Hg
d. Uterine tone >20 mm Hg
e. Increased uterine activity accompanied by
a nonreassuring FHR and pattern
ANS: B, D, E
Uterine contractions that occur less frequently than 2 minutes apart and last longer than
90 seconds, a uterine tone over 20 mm Hg, and a nonreassuring FHR and pattern are
indications of uterine hyperstimulation with oxytocin administration. Uterine contractions
that occur more frequently than 2 minutes apart and last less than 90 seconds are the
expected goal of oxytocin induction. A uterine tone less than 20 mm Hg is normal.

DIF: Cognitive Level: Analyze REF: p. 785


TOP: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. What are the complications and risks associated with cesarean births?
(Select all that apply.)
a. Pulmonary edema
b. Wound dehiscence
c. Hemorrhage
d. Urinary tract infections
e. Fetal injuries
ANS: A, B, C, D, E
Pulmonary edema, wound dehiscence, hemorrhage, urinary tract infections, and fetal
injuries are possible complications and risks associated with cesarean births.

DIF: Cognitive Level: Understand REF: p. 790 TOP: Nursing Process:


Evaluation
MSC: Client Needs: Physiologic Integrity

3. Women who are obese are at risk for several complications during
pregnancy and birth. Which of these would the nurse anticipate with an obese client?
(Select all that apply.)
a. Thromboembolism
b. Cesarean birth
c. Wound infection
d. Breech presentation
e. Hypertension
ANS: A, B, C, E
A breech presentation is not a complication of pregnancy or birth for the client who is
obese. Venous thromboembolism is a known risk for obese women. Therefore, the use of
thromboembolism-deterrent (TED) hose and sequential compression devices may help
decrease the chance for clot formation. Women should also be encouraged to ambulate as
soon as possible. In addition to having an increased risk for complications with a
cesarean birth, in general, obese women are also more likely to require an emergency
cesarean birth. Many obese women have a pannus (i.e., large roll of abdominal fat) that
overlies a lower transverse incision made just above the pubic area. The pannus causes
the area to remain moist, which encourages the development of infection. Obese women
are more likely to begin pregnancy with comorbidities such as hypertension and type 2
diabetes.

DIF: Cognitive Level: Analyze REF: p. 778


TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and
Maintenance

4. The induction of labor is considered an acceptable obstetric procedure if it


is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit
is often asked to schedule clients for this procedure and therefore must be cognizant of
the specific conditions appropriate for labor induction. What are appropriate indications
for induction? (Select all that apply?)
a. Rupture of membranes at or near term
b. Convenience of the woman or her
physician
c. Chorioamnionitis (inflammation of the
amniotic sac)
d. Postterm pregnancy
e. Fetal death
ANS: A, C, D, E
The conditions listed are all acceptable indications for induction. Other conditions
include intrauterine growth restriction (IUGR), maternal-fetal blood incompatibility,
hypertension, and placental abruption. Elective inductions for the convenience of the
woman or her provider are not recommended; however, they have become commonplace.
Factors such as rapid labors and living a long distance from a health care facility may be
valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks
of completed gestation.

DIF: Cognitive Level: Apply REF: p. 790 TOP: Nursing Process:


Planning
MSC: Client Needs: Physiologic Integrity

5. Indications for a primary cesarean birth are often nonrecurring. Therefore,


a woman who has had a cesarean birth with a low transverse scar may be a candidate for
vaginal birth after cesarean (VBAC). Which clients would be less likely to have a
successful VBAC? (Select all that apply.)
a. Lengthy interpregnancy interval
b. African-American race
c. Delivery at a rural hospital
d. Estimated fetal weight <4000 g
e. Maternal obesity (BMI >30)
ANS: B, C, E
Indications for a low success rate for a VBAC delivery include a short interpregnancy
interval, non-Caucasian race, gestational age longer than 40 weeks, maternal obesity,
preeclampsia, fetal weight greater than 4000 g, and delivery at a rural or private hospital.

DIF: Cognitive Level: Understand REF: p. 794


TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity