Chapter 20: Labour and Birth at Risk
MULTIPLE CHOICE
1. In planning for home care of a woman with preterm labour, the nurse needs to address which
concern?
a. Nursing assessments will be different from
those done in the hospital setting.
b. Restricted activity and medications will be
necessary to prevent recurrence of preterm
labour.
c. Prolonged bedrest is not supported in the
literature as an effective intervention.
d. Home health care providers will be
necessary.
ANS: C
Bedrest is not a benign intervention, and there is no evidence in the literature to support the
effectiveness of this intervention in reducing preterm birth rates. Nursing assessments will
differ somewhat from those performed in the acute care setting, but this is not the concern
that needs to be addressed. Restricted activity and medication may prevent preterm labour,
but not in all women. In addition, the plan of care is individualized to meet the needs of each
woman. Many women will receive home health nurse visits, but care is individualized for each
woman.
DIF: Cognitive Level: Analysis REF: p. 516
OBJ: Nursing Process: Planning
2. The nurse providing care for a woman with preterm labour on nifedipine (Adalat) would include
which intervention to identify adverse effects of the drug?
a. Assessing deep tendon reflexes (DTRs)
b. Assessing for hypotension
c. Assessing for bradycardia
d. Assessing for hypoglycemia
ANS: B
, d. Serum magnesium level of 0.80
mmol/L
Women administered nifedipine (Adalat) need to be assessed for hypotension, as it is common
with this medication. Assessing DTRs would not address these concerns. Nifedipine (Adalat)
may cause tachycardia, not bradycardia. Hypoglycemia and depression of DTRs are not
common adverse effects of this drug.
DIF: Cognitive Level: Analysis REF: p. 517 |Medication Guide OBJ:
Nursing Process: Assessment
3. In evaluating the effectiveness of nitroglycerin for the treatment of preterm labour, what
finding would alert the nurse to possible adverse effects?
a. Urine output of 160 mL in 4 hours
b. Deep tendon reflexes 2+ and no clonus
c. Blood pressure of 80/46
ANS: C
Blood pressure of 80/46 would alert the nurse to possible adverse effects because nitroglycerin
can cause severe hypotension. Magnesium sulphate management is not required when a
woman is taking nitroglycerin. Urine output of 160 mL in 4 hours and deep tendon reflexes 2+
with no clonus are normal findings.
DIF: Cognitive Level: Comprehension REF: pp. 517-518 |Medication Guide
OBJ: Nursing Process: Evaluation
4. A woman in preterm labour at 30 weeks of gestation receives two 12-mg doses of
betamethasone intramuscularly. What is the purpose of this pharmacological treatment?
a. It stimulates fetal surfactant production.
b. It relaxes uterine smooth muscle by
inhibiting prostaglandins.
c. It suppresses uterine contractions.
d. It maintains adequate maternal
respiratory effort and ventilation during
magnesium sulphate therapy.
ANS: A
Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung
maturity. Indomethacin relaxes uterine smooth muscle by inhibiting prostaglandins, not
betamethasone. Betamethasone has no effect on uterine contractions. Calcium gluconate
would be given to reverse the respiratory depressive effects of magnesium sulphate therapy.
, DIF: Cognitive Level: Comprehension REF: p. 517 | p. 519 |Medication Guide
OBJ: Nursing Process: Planning
5. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing
preterm labour. What finding indicates that preterm labour 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.
MULTIPLE CHOICE
1. In planning for home care of a woman with preterm labour, the nurse needs to address which
concern?
a. Nursing assessments will be different from
those done in the hospital setting.
b. Restricted activity and medications will be
necessary to prevent recurrence of preterm
labour.
c. Prolonged bedrest is not supported in the
literature as an effective intervention.
d. Home health care providers will be
necessary.
ANS: C
Bedrest is not a benign intervention, and there is no evidence in the literature to support the
effectiveness of this intervention in reducing preterm birth rates. Nursing assessments will
differ somewhat from those performed in the acute care setting, but this is not the concern
that needs to be addressed. Restricted activity and medication may prevent preterm labour,
but not in all women. In addition, the plan of care is individualized to meet the needs of each
woman. Many women will receive home health nurse visits, but care is individualized for each
woman.
DIF: Cognitive Level: Analysis REF: p. 516
OBJ: Nursing Process: Planning
2. The nurse providing care for a woman with preterm labour on nifedipine (Adalat) would include
which intervention to identify adverse effects of the drug?
a. Assessing deep tendon reflexes (DTRs)
b. Assessing for hypotension
c. Assessing for bradycardia
d. Assessing for hypoglycemia
ANS: B
, d. Serum magnesium level of 0.80
mmol/L
Women administered nifedipine (Adalat) need to be assessed for hypotension, as it is common
with this medication. Assessing DTRs would not address these concerns. Nifedipine (Adalat)
may cause tachycardia, not bradycardia. Hypoglycemia and depression of DTRs are not
common adverse effects of this drug.
DIF: Cognitive Level: Analysis REF: p. 517 |Medication Guide OBJ:
Nursing Process: Assessment
3. In evaluating the effectiveness of nitroglycerin for the treatment of preterm labour, what
finding would alert the nurse to possible adverse effects?
a. Urine output of 160 mL in 4 hours
b. Deep tendon reflexes 2+ and no clonus
c. Blood pressure of 80/46
ANS: C
Blood pressure of 80/46 would alert the nurse to possible adverse effects because nitroglycerin
can cause severe hypotension. Magnesium sulphate management is not required when a
woman is taking nitroglycerin. Urine output of 160 mL in 4 hours and deep tendon reflexes 2+
with no clonus are normal findings.
DIF: Cognitive Level: Comprehension REF: pp. 517-518 |Medication Guide
OBJ: Nursing Process: Evaluation
4. A woman in preterm labour at 30 weeks of gestation receives two 12-mg doses of
betamethasone intramuscularly. What is the purpose of this pharmacological treatment?
a. It stimulates fetal surfactant production.
b. It relaxes uterine smooth muscle by
inhibiting prostaglandins.
c. It suppresses uterine contractions.
d. It maintains adequate maternal
respiratory effort and ventilation during
magnesium sulphate therapy.
ANS: A
Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung
maturity. Indomethacin relaxes uterine smooth muscle by inhibiting prostaglandins, not
betamethasone. Betamethasone has no effect on uterine contractions. Calcium gluconate
would be given to reverse the respiratory depressive effects of magnesium sulphate therapy.
, DIF: Cognitive Level: Comprehension REF: p. 517 | p. 519 |Medication Guide
OBJ: Nursing Process: Planning
5. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing
preterm labour. What finding indicates that preterm labour 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.
