1. Ritodrine and other beta- 6.
The physician decides to artificially A complication of diabetes that occurs when
adrenergic agonists may cause
what symptoms?
-tachycardia, hypotension,
bronchial dilation, increased
plasma volume, increased CO,
arrhythmias, MI, reduced urine
output, restlessness, headache,
n/v
2.During a childbirth education class, a
nurse-educator discusses pain control
techniques used during labor and delivery.
Which technique most effectively helps a
client cope with the pain of uterine
contractions?
a. controlled breathing
b. distraction
c. cutaneous stimulation
d. hypnosis
-c. cutaneous stimulation - used by the
client or coach (effleurage) creates
organized, controlled sensory input that
reduces local irritability. The client
concentrates on the sensation of light
fingertip stroking on the abdomen or back,
rather than the pain of the contraction, to
help counteract the perception of pain.
Controlled breathing is mainly used to
enhance relaxation, but is less effective than
cutaneous stimulation.
3. A ct with moderate PIH is a poor
candidate for regional anesthesia during
labor and delivery. If she were to get this
form of anesthesia, she might experience:
a. hypotension
b. hypertension
c. seizures
d. renal toxicity
PIH, uteroplacental perfusion may be
inadequate and gas exchange may be poor.
Regional anesthesia increaes the risk of
hypotension resulting from sympathetic
blockade, possibly cuasing fetal and
maternal hypoxia.
4. A client is admitted to the labor and
delivery department in preterm labor. To
help manage preterm labor, the nurse would
expect to administer:
a. ritodrine (Yutopar)
b. bromocriptine (Parlodel)
c. magnesium sulfate
d. betamethasone (Celestone)
A. Ritodrine - reduces frequency and intensity of
uterine contractions by stimulating B2 receptors
in the uterine smooth muscle. It is the drug of
choice when trying to inhibit labor.
Bromocriptine is used to inhibit lactation in the
postpartum period. Mag sulfate is an
anticonvulsant and treats PIH HTN.
Betamethasone is used to stimulate fetal
pulmonary surfactant.
5. The physician prescries
etiodcaine (duranest) to a client in active
labor. Why does she prescribe this over
other local anesthetic agents?
Etidocaine is least likely to cross the
placenta.
rupture the membranes. Following this
procedure, the nurse checks the fetal heart
tones for which of the following reasons?
a. to determine fetal well-being
b. to assess for prolapsed cord
c. to assess fetal position
d. to prepare for an imminent delivery
-B. To assess for prolapsed cord. After
amniotomy, the nurse should assure that the
cord isn't prolapsed and that the baby
tolerated the procedure well. The most
effective way to do is to check the fetal heart
rate.
7. When assessing a pregnant client with a
hx of cardiac dysfunction, the nurse
discovers that the client has been taking
propranolol (Inderal) to tx HTN.
During labor, the nurse should stay alert for
which adverse effect of this drug?
-Uterine Hypertonus and Preterm Labor
8. When assessing the fetal heart rate
tracing, the nruse assesses the FHR at 170
bpm.
This rate is considered fetal tachycadia if
what occurs?
-Tachycardia is defined as a FHR greater
than 160 bpm for more than 10 minutes
8. A client is to have an epidural block to
relieve labor pain. The nurse anticipates that
the anesthesiologist will inject the
anesthetic agent into the:
-area between the dura mater and the
ligamentum flavum in the lumbar region of
the spinal column
9. What condition would place the client at
risk for disseminated intravascular
coagulation? (DIC)
a. intrauterine fetal death
b. placenta accreta
c. dysfunctional labor
d. premature rupture of the membranes
A. Intrauterine fetal death, abruptio
placentae, septic shock, and amniotic fluid
embolism may trigger normal clotting
mechanisms; if clotting factors are depleted,
DIC may occur.
10. What is the tx for diabetic ketoacidosis?
Goal: to correct the high blood glucose level
by giving more insulin.
Goal: to replace fluids/electrolytes lost
through excessive urination and vomiting.
10. What are the s/s of diabetic
ketoacidosis?
Fatigue
Frequent urination or thirst for a day or
more
Fruity breath (breath odor)
Mental stupor that may progress to coma
Muscle stiffness or aching
Nausea and vomiting
Rapid breathing
Shortness of breath
11. What is diabetic ketoacidosis?
(glucose) is not available as a fuel source by
the body and fat is used instead.
Byproducts of fat breakdown, called
ketones, build up in the body.
12. When should oxytocin be discontinued?
when contractions occur less than 2
minutes apart or last longer than 90 seconds
13. Late in the 1st stage of labor, a client
receives a spinal block to relieve discomfort.
A short time later, her husband tells the
nurse that his wife feels dizzy and is
complaining of numbess around her lips.
What do the client's symptoms suggest?
-anesthesia overdose - dizziness, circumoral
numbness, and slurred speech indicate this
14. A 32 y.o. multipara is admitted to the
birthing room after her initial examination
reveals her vervix to be at 8 cm., completely
effaced, and at 0 station. What phase of
labor is she in?
-transitional phase
transition is 8-10 cm
active is 4-7 cm
latent is 0-3 cm
15. The physician orders I.V. administration
of oxytocin. Why must the nurse monitor the
client's fluid intake and output closely
during oxytocin administration?
a. oxytocin causes water intoxication
b. oxytocin causes excessive thirst
c. oxytocin is toxic to the kidneys
d. oxytocin has a diuretic effect
-he nurse should monistor I/Os b/c
prolonged oxytocin infusion make cause
severe water intoxication, leading to
seizures, coma, and death
excess thirst results fromt he work of labor
and limited oral fluid intake, not oxytocin
oxytocin has no diuretic effects. It
actuallyhas antidiuretic effects
16. If a nurse notes that the amniotic fluid is
port-wine-colored, what would that indicate?
-abruptio placentae
17. What are the cardinal movements of
labor?
fetal descent, flexion, internal rotation,
extension, external rotation, and expulsion
movements of the fetus during labor and
delivery
18.In the 1st stage of labor, a client with a
full-term pregnancy has an electronic fetal
monitor (EFM) in place. Which EFM pattern
suggests adequate uteroplacental-fetal
perfusion?
a. persistent fetal bradycardia
b. variable decelerations
c. average variability
d. late decelerations
-c. average variability - 6 to 10 bpm
accurately predicts adequate uteroplacental-
fetal perfusion.
Persistant bradycardia may indicate
hypoxia, arrhythmias, or umbilical cord
compression. Variable decelerations
suggest umbilical cord compression. Late
decelerations may reflect decreased blood
flow and oxygen to the intervillous spaces
during contractions.
19. The nurse is caring for a client who is in
labor. The physician still isn't present. After
the baby's head is delivered, which nursing
intervention would be most appropriate?
-checking for the umbilical cord around the
baby's neck
If it is, it should be gently lifted over the
baby's head.
20. The gonorrhea culture is positive in a
pregnant mom. What is the significance
of this finding?
a. may cause neural tube defect in fetus
b. may cause an eye infection in the neonate
c. may cause acute liver changes in the
fetus
d. may cause anemia in neonate
-b. gonorrhea in the cervix may cause
neonatal eye infection during delivery
21. The cervix is not completely dilated and
the client has a strong urge to push. The
nurse-midwife tells her not to push yet.
What is the rationale for this instruction?
a. early pushing may cause edema and
impede fetal descent
b. the nurse-midwife isn't ready to assist her
c. the fetus hasn't rotated into the proper
position
d. pushing at this time may cause rupture of
the membranes
-A. Pushing bfore the cervix is completely
dilated may cause edema and tissue
damage and may impede fetal descent.
22. A client is in the second stage of labor.
during this stage, how frequently should the
nurse assess her uterine contractions?
a. every 5 minutes
b. every 15 minutes
c. every 30 minutes
d. every 60 minutes
-b. every 15 minutes
23.A client in labor receives epidural
anesthesia. The nurse should assess
carefully for which adverse reaction to the
anesthetic agent?
a. hypotensive crisis
b. fetal tachycardia
c. renal toxicity
d. increased beat-to-beat variability in the
FHR
a. hypotensive crisis - may occur after
epidural anesthesia administration as the
anesthetic agent spreads through the spinal
canal, blocking sympathetic innervations.
Other s/s of hypotensive crisis with epidural
anesthesia include fetal BRADYCARDIA &
DECREASED beat-to-beat variability in FHR.
URINE RETENTION, not toxicity, may occur
during postpartum period.
24. Which of the following is the most
serious adverse affect associated with
oxytocin administration during labor?
a. tetanic contractions
b. elevated blood pressure
c. early decelerations of FHR
d. water intoxication
-a. tetanic contractions - are most serious
adverse effect associated with oxytocin.
When tetanic contractions occur, the fetus is
at high risk for hypoxia and the mother is at
risk for uterine rupture.
The client may be at risk for pulmonary
edema if large amounts of oxytocin were
given. This drug can increase BP too. BUT,
pulmonary edema and HTN aren't the most
serious adverse effects. Early decelerations
of FHR aren't associated with oxytocin.
25. When administering mag sulfate to a
client with preeclampsia, the nurse
understands that this drug is given to do
which of the following?
a. prevent seizures
b. reduce blood pressure
c. slow the process of labor
d. increase diuresis
-a. prevent seizures - the chemical makeup
of magnesium is like calcium and will act
like calcium in the body. The magnesium will
block seizure activity in a hyperstimulated
neurologic system by interfering with signal
transmission at the neural musculature
junction.
Reducing blood pressure, slowing labor,
and increased diuresis are secondary
affects of magnesium.
26. Why is magnesium sulfate used in
treating preterm labor?
-When a woman experiences preterm labor,
sometimes she is given magnesium sulfate,
which is thought to relax the muscles of the
uterus
Sometimes, a woman will then be put on a
different preterm labor drug like terbutaline
or nifedipine and sent home. Some women
who far from term and whose condition is
precarious may be kept on mag sulfate for
longer periods of time - sometimes weeks
and months.
27. What are some of the complications of
magnesium sulfate(sometimes occurring
with magnesium overdose)?
Note: Make sure kidneys are fully
functioning. (By Blood Test) Severe pre-
eclampsia sometimes can cause a woman's
kidneys to fail, increase risk of a
magnesium sulfate overdose. A blood test
can check the level of magnesium in your
body.
-Cardiac arrest
Pulmonary edema
Chest pain
Cardiac conduction defects
Low blood pressure
Low calcium
Increased urinary calcium
Visual disturbances
Decreased bone density
Respiratory depression
Muscular hyperexcitability
28. What are some of the most common side
effects of magnesium sulfate
-Flushing
Nausea
Vomiting
Palpitations
Headache
General muscle weakness
Lethargy
Constipation
29. Why is magnesium sulfate used for pre-
eclampsia and eclampsia?
-to prevent severe pre-eclampsia from
becoming eclampsia
30.Pre-eclampsia can evolve into HELLP.
What are the symptoms of HELLP?
-hemolysis (H)
elevated liver enzymes (EL)
low platelet count (LP)
31. Pre-eclamsia can evolve into eclampsia
with what fatal symptom?
-Seizures
32. Pre-eclampsia can become severe
pre-eclampsia with what symptoms?
-very high HTN
visual disturbances
failing kidneys
elevated liver enzymes.
33. Pre-eclampsia (aka toxemia and PIH)
consists of what symptoms?
-HTN
proteinuria
edema
34. Initial client assessment information
includes:
BP - 160/110 mmHg, Pulse - 88 bpm, RR - 22
bpm, reflexes +3/+4 w/ 2 beat clonus. Urine
specimen reveals +3 negative sugar, &
ketones.
Based on these findings, the nurse would
expect the client to have which complaints?
a. headache, blurred vision, facial and
extremity swelling
b. abdominal pain, urinary frequency, and
pedal edema
c. diaphoresis, nystagmus, and dizziness
d. lethargy, chest pain, and SOB
-a. headache, blurred vision, and facial and
extremity swelling
ct. is showing signs of preeclampsia
35. A pregnant client asks the nurse whether
she can take castor oil for her constipation.
How should a nurse respond?
-"No, it can initiate premature uterine
contractions."
36. At 15 weeks' gestations, a client is
scheduled for a serum alpha-fetoprotein
(AFP) test. Which maternal hx finding best
explains the need for this test?
a. family hx of spina bifida in a sister
b. family hx of down's syndrome on father's
side
c. hx of gestational diabetes during a
previous pregnancy
d. hx of spotting during the 1st month of the
current pregnancy
-A. An abnormally high AFP level in the
client's serum or amniotic fluid suggests a
neural tube defect such as spina bifida. A
family hx of such defects increase the risk
of carrying a fetus with a nerual tube defect.
Althrough a low AFP level has been
correlated with Down's, it isn't the most
accurate indicator. No known correlations
exists b/t g. diabetes or early vaginal
spotting and a certain AFP level at 15 to 20
weeks' gestation.
37. A client with pregnancy-induced
hypertension (PIH) receives magnesium
sulfate, 4 g in 50% solution I.V. over 20
minutes. What is the purpose of
administering magnesium sulfate to this
client.
a. to lower blood pressure
b. to prevent seizures
c. to inhibit labor
d. to block dopamine receptors
Beta adrenergic blockers and centrally
acting blockers are used ot lower blood
pressure
-B. Mag sulfate is given to prevent and
control seizures in clients with PIG. Mag
sulfate has no effect on labor or dopamine
receptors.