Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 23 Childbirth at Risk: Prelabor Onset Complications

1. 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?
2. Gestational diabetes
3. Placenta previa
4. Abruptio placentae
5. Placenta accreta

Page Ref: 565

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N 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. | N L N 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.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is caring for a client at 30 weeks' gestation who is experiencing preterm premature rupture of membranes (P P R O M). Which statement indicates that the client needs additional teaching?
2. "If I were having a singleton pregnancy instead of twins, my membranes would probably not have ruptured."
3. "If I develop a urinary tract infection in my next pregnancy, I might rupture membranes early again."
4. "If I want to become pregnant again, I will have to plan on being on bed rest for the whole pregnancy."
5. "If I have amniocentesis, I might rupture the membranes again."

Page Ref: 562

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 2 Identify the causes and risk factors for premature rupture of membranes.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A client was admitted to the labor area at 5 c m with ruptured membranes about 14 hours ago. What assessment data would be most beneficial for the nurse to collect?
2. Blood pressure
3. Temperature
4. Pulse
5. Respiration

Page Ref: 561

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Identify the causes and risk factors for premature rupture of membranes.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse admits into the labor area a client who is in preterm labor. What assessment finding would constitute a diagnosis of preterm labor?
2. Cervical effacement of 30% or more
3. Cervical change of 0.5 c m per hour
4. 2 contractions in 30 minutes
5. 8 contractions in 1 hour

Page Ref: 556

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Analyze the implications and maternal and fetal risks of preterm labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. During the nursing assessment of a woman with ruptured membranes, the nurse suspects a prolapsed umbilical cord. What would the nurse's priority action be?
2. To help the fetal head descend faster
3. To use gravity and manipulation to relieve compression on the cord
4. To facilitate dilation of the cervix with prostaglandin gel
5. To prevent head compression

Page Ref: 576

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Identify the causes and risk factors for premature rupture of membranes.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A client is admitted to the birth setting in early labor. She is 3 c m dilated, -2 station, with intact membranes, and F H R of 150 b p m. Her membranes rupture spontaneously, and the F H R drops to 90 b p m with variable decelerations. What would the nurse's initial response be?
2. Perform a vaginal exam
3. Notify the physician
4. Place the client in a left lateral position
5. Administer oxygen at 2 L per nasal cannula

Page Ref: 579, 581

Cognitive Level: Analyzing

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 2 Identify the causes and risk factors for premature rupture of membranes.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse has received end-of-shift reports in the high-risk maternity unit. Which client should the nurse see first?
2. The client at 26 weeks' gestation with placenta previa experiencing blood on toilet tissue after a bowel movement
3. The client at 30 weeks' gestation with placenta previa whose fetal monitor strip shows late decelerations
4. The client at 35 weeks' gestation with grade I abruptio placentae in labor who has a strong urge to push
5. The client at 37 weeks' gestation with pregnancy-induced hypertension whose membranes ruptured spontaneously

Page Ref: 570

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A client in her second trimester is complaining of spotting. Causes for spotting in the second trimester are diagnosed primarily through the use of which of the following?
2. A non-stress test
3. A vibroacoustic stimulation test
4. An ultrasound
5. A contraction stress test

Page Ref: 568

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 3 Describe the clinical therapy for premature rupture of membranes and preterm labor in determining hospital-based and community-based nursing management of the woman and her fetus-newborn.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is performing a comprehensive assessment on a client admitted to the birthing unit with abruptio placentae. Which finding(s) contribute(s) to this condition?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. History of domestic violence
2. Presence of uterine fibroids
3. Alcohol consumption during pregnancy
4. Hypertension
5. Gestational diabetes mellitus

Page Ref: 565

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Discuss the differences between developmental and degenerative placental problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is planning an in-service educational program to talk about disseminated intravascular coagulation (D I C). The nurse should identify which conditions as risk factors for developing D I C?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Diabetes mellitus
2. Abruptio placentae
3. Fetal demise
4. Multiparity
5. Preterm labor

Page Ref: 567

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The client at 30 weeks' gestation is admitted with painless late vaginal bleeding. The nurse understands that expectant management includes which of the following?
2. Limiting vaginal exams to only one per 24-hour period.
3. Evaluating the fetal heart rate with an internal monitor.
4. Monitoring for blood loss, pain, and uterine contractibility.
5. Assessing blood pressure every 2 hours.

Page Ref: 569

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A client is admitted to the labor and delivery unit in active labor. What nursing diagnoses might apply to the client with suspected abruptio placentae?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fluid Volume, Deficient, related to hypovolemia secondary to excessive blood loss
2. Tissue Perfusion: Peripheral, Ineffective, related to blood loss secondary to uterine atony following birth
3. Anxiety related to concern for own personal status and the baby's safety
4. Knowledge, Deficient related to lack of information about inherited genetic defects
5. Alteration in Respiratory Function related to blood loss

Page Ref: 568

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. What is the most significant cause of neonatal morbidity and mortality?
2. A) Amenorrhea
3. B) Posttraumatic stress disorder
4. C) Prematurity
5. D) Endometriosis

Page Ref: 563

Cognitive Level: Remembering

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 1 Analyze the implications and maternal and fetal risks of preterm labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. What is the most significant maternal risk factor for preterm birth?
2. Previous preterm birth
3. Smoking
4. Stress
5. Substance abuse

Page Ref: 555

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Analyze the implications and maternal and fetal risks of preterm labor.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A client admitted to the birthing unit with placenta previa asks the nurse, "What is the cause of my condition?" Which statement should be included in the nurse's response?
2. "The placenta is improperly implanted in the lower uterus."
3. "The placenta has separated prematurely."
4. "The placenta has grown too large."
5. "The placenta has prolapsed and is being compressed."

Page Ref: 568

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Discuss the differences between developmental and degenerative placental problems.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is performing an assessment on a client in the birthing unit who has acquired cervical insufficiency. Which other finding(s) may contribute to the client's condition?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Inflammation
2. Infection
3. Cervical trauma
4. Cone biopsy
5. H P V positivity

Page Ref: 576

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Identify the causes and risk factors of cervical insufficiency.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse on the birthing unit is collecting the obstetric history of a client at risk for cervical insufficiency. Which findings increase the client's risk for this condition?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Multiple gestations
2. Previous preterm births
3. Progressively earlier births with each subsequent pregnancy
4. Cervical manipulation
5. Prolonged labors

Page Ref: 573

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Identify the causes and risk factors of cervical insufficiency.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The home health nurse is visiting a client at 18 weeks who is pregnant with twins. Which nursing action is most important?
2. Teach the client about foods that are good sources of protein.
3. Assess the client's blood pressure in her upper right arm.
4. Determine whether the pregnancy is the result of infertility treatment.
5. Collect a cervicovaginal fetal fibronectin (fF N) specimen.

Page Ref: 578

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Analyze the maternal and fetal-newborn implications and clinical therapy in determining community-based and hospital-based nursing care of the woman with a multiple gestation.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. When counseling a newly pregnant client at 8 weeks' gestation with twins, the nurse teaches the woman about the need for increased caloric intake. What would the nurse tell the woman that the minimum recommended intake should be?
2. 2500 k c a l and 120 grams protein
3. 3000 k c a l and 150 grams protein
4. 4000 k c a l and 135 grams protein
5. 5000 k c a l and 190 grams protein

Page Ref: 578

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Analyze the maternal and fetal-newborn implications and clinical therapy in determining community-based and hospital-based nursing care of the woman with a multiple gestation.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. Intervention to reduce preterm birth can be divided into primary prevention and secondary prevention. What does secondary prevention include?
2. Diagnosis and treatment of infections
3. Cervical cerclage
4. Progesterone administration
5. Antibiotic treatment and tocolysis

Page Ref: 559

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅳ. 1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 3 Describe the clinical therapy for premature rupture of membranes and preterm labor in determining hospital-based and community-based nursing management of the woman and her fetus-newborn.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The client is carrying monochorionic-monoamniotic twins. The nurse teaches the client what this is, and the implications of this finding. The nurse knows that teaching is successful when the client states which of the following?
2. "My babies came from two eggs."
3. "About two thirds of twins have this amniotic sac formation."
4. "My use of a fertility drug led to this issue."
5. "My babies have a lower chance of surviving to term than fraternal twins do."

Page Ref: 575

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 8 Analyze the maternal and fetal-newborn implications and clinical therapy in determining community-based and hospital-based nursing care of the woman with a multiple gestation.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse on the birthing unit is caring for a client who has an amputated cervix and is about to undergo a cerclage procedure. Which type of cerclage procedure should the nurse anticipate?
2. Abdominal cerclage
3. Rescue cerclage
4. Emergency cerclage
5. Elective cerclage

Page Ref: 574

Cognitive Level: Analyzing

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 7 Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her unborn fetus.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. Slowly removing some amniotic fluid is a treatment for hydramnios. What consequence can occur with the withdrawal of fluid?
2. Preterm labor
3. Prolapsed cord
4. Preeclampsia
5. Placenta previa

Page Ref: 579

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Describe the identification of the woman with hydramnios and the maternal and fetal-neonatal implications.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is admitting a client who was diagnosed with hydramnios. The client asks why she has developed this condition. The nurse should explain that hydramnios is sometimes associated with 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. Rh sensitization
2. Postmaturity syndrome
3. Renal malformation or dysfunction
4. Maternal diabetes
5. Large-for-gestational-age infants

Page Ref: 579

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 9 Describe the identification of the woman with hydramnios and the maternal and fetal-neonatal implications.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is admitting a client with possible hydramnios. When is hydramnios most likely suspected?
2. Hydramnios is most likely suspected when there is less amniotic fluid than normal for gestation.
3. Hydramnios is most likely suspected when the fundal height increases disproportionately to the gestation.
4. Hydramnios is most likely suspected when the woman has a twin gestation.
5. Hydramnios is most likely suspected when the quadruple screen comes back positive.

Page Ref: 579

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 11 Compare the clinical therapy and nursing management of the woman with hydramnios and the woman with oligohydramnios.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. If oligohydramnios occurs in the first part of pregnancy, the nurse knows that there is a danger of which of the following?
2. Major congenital anomalies
3. Fetal adhesions
4. Maternal diabetes
5. Rh sensitization

Page Ref: 579

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅳ. 1. Demonstrate skills in using patient care technologies, information systems, and communication devices that support safe nursing practice. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Describe the identification of the woman with oligohydramnios and the maternal and fetal-neonatal implications.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. When caring for a laboring client with oligohydramnios, what should the nurse be aware of?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Increased risk of cord compression
2. Decreased variability
3. Labor progress is often more rapid than average
4. Presence of periodic decelerations
5. During gestation, fetal skin and skeletal abnormalities can occur

Page Ref: 579

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Describe the identification of the woman with oligohydramnios and the maternal and fetal-neonatal implications.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse knows that a baby born to a mother who had oligohydramnios could show signs of which of the following?
2. Respiratory difficulty
3. Hypertension
4. Heart murmur
5. Decreased temperature

Page Ref: 579

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 11 Compare the clinical therapy and nursing management of the woman with hydramnios and the woman with oligohydramnios.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The client at 38 weeks' gestation has been diagnosed with oligohydramnios. Which statement indicates that teaching about the condition has been effective?
2. "My gestational diabetes might have caused this problem to develop."
3. "When I go into labor, I should come to the hospital right away."
4. "This problem was diagnosed with blood and urine tests."
5. "Women with this condition usually do not have a cesarean birth."

Page Ref: 579

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N 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. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 11 Compare the clinical therapy and nursing management of the woman with hydramnios and the woman with oligohydramnios.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A patient in preterm labor is prescribed magnesium sulfate 6 grams intravenous infusion now, followed by 5 grams per hour. The pharmacy prepares an infusion of 500 m L lactated Ringer's solution with 100 grams of magnesium sulfate. If the patient receives the loading dose and 3 hours of the medication, how many total m L of the infusion did the patient receive?

Page Ref: 559

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 3 Describe the clinical therapy for premature rupture of membranes and preterm labor in determining hospital-based and community-based nursing management of the woman and her fetus-newborn.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A pregnant patient is diagnosed with premature separation of the placenta. The nurse provides the patient with the following diagram. What amount of placenta separation is this patient experiencing?

1. Central
2. Marginal
3. Complete
4. Anticipated

Page Ref: 566

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. The nurse is preparing teaching material for a pregnant patient with the following type of placenta previa. What information should the nurse provide the patient about this health problem?

1. Internal o s is partially covered by the placenta
2. Internal o s is covered completely by the placenta
3. Edge of the placenta is at the margin of the internal o s
4. Placenta is implanted in the lower segment but does not reach the o s

Page Ref: 569

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Compare placenta previa and abruptio placentae, including implications for the mother and fetus and their nursing care.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A pregnant patient is scheduled to have the procedure depicted in the diagram performed. What should the nurse explain is the purpose for this procedure?

1. Correct marginal placenta previa
2. Prevent preterm cervical dilatation and pregnancy loss
3. Reduce the risk of developing central abruptio placentae
4. Assist the fetus to rotate into the appropriate position for delivery

Page Ref: 573

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Describe the clinical therapies and appropriate nursing interventions for the mother with cervical insufficiency and her unborn fetus.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.

1. A patient pregnant with twins late in the 3rd trimester has an ultrasound that shows the position of the fetuses as follows. What should the nurse expect will be planned for this patient?

1. Cesarean birth
2. Vaginal delivery
3. Spinal block during labor
4. Continuous lumbar epidural

Page Ref: 577

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N 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. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 8 Analyze the maternal and fetal-newborn implications and clinical therapy in determining community-based and hospital-based nursing care of the woman with a multiple gestation.

M N L L O: Demonstrate use of the nursing process in the care of the woman with prelabor onset complications.