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1. A client in preterm labor (32 weeks) who is dilated to 5cm has been given magnesium sulfate and the contractions have stopped. If the labor can be delayed for the next 2 days, which of the following medication does the nurse expect that will be prescribed?
- Fentanyl (Sublimaze).
- Sufentanil (Sufenta).
- Betamethasone (Celestone).
- Butorphanol tartrate (Stadol).
2. Which drug is used to manage preterm labor by causing smooth muscle relaxation?
3. The nurse in charge is reviewing a patient’s prenatal history. Which finding indicates a genetic risk factor?
- The patient is 25 years old
- The patient has a child with cystic fibrosis
- The patient was exposed to rubella at 36 weeks’ gestation
- The patient has a history of preterm labor at 32 weeks’ gestation
4. The physician ordered Betamethasone to a pregnant woman at 34 weeks of gestation with sign of preterm labor. The nurse expects that the drug will:
- Treat infection.
- Suppress labor contraction.
- Stimulate the production of surfactant.
- Reduce the risk of hypertension.
- Daily enemas
- Increased fiber intake
- Decreased fluid intake
6. When taking an obstetrical history on a pregnant client who states, “I had a son born at 38 weeks gestation, a daughter born at 30 weeks gestation and I lost a baby at about 8 weeks,” the nurse should record her obstetrical history as which of the following?
- G2 T2 P0 A0 L2
- G3 T1 P1 A0 L2
- G3 T2 P0 A0 L2
- G4 T1 P1 A1 L2
7. To prevent preterm labor from progressing, drugs are usually prescribed to halt the labor. The drugs commonly given are:
- Magnesium sulfate and terbutaline
- Prostaglandin and oxytocin
- Progesterone and estrogen
- Dexamethasone and prostaglandin
8. Which of the following best describes preterm labor?
- Labor that begins after 20 weeks gestation and before 37 weeks gestation
- Labor that begins after 15 weeks gestation and before 37 weeks gestation
- Labor that begins after 24 weeks gestation and before 28 weeks gestation
- Labor that begins after 28 weeks gestation and before 40 weeks gestation
9. A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:
- Magnesium sulfate
- Calcium gluconate
- Dinoprostone (Prostin E.)
- Bromocrystine (Pardel)
10. A client in the 28th week of gestation comes to the emergency department because she thinks that she’s in labor. To confirm the diagnosis of PRETERM LABOR, the nurse would expect the physical examinations to reveal:
- Client’s needs category: Physiological integrity
- Client’s need subcategory: Physiological adaptation
- Cognitive level: Knowledge
- irregular uterine contractions with no cervical dilation
- painful contractions with cervical dilation
- regular uterine dilation with cervical dilation
- regular uterine contractions without cervical dilation
Answer & Rationale
1. C. Glucocorticoids such as betamethasone and dexamethasone are being used to increase the production of surfactant to aid in fetal lung maturation. It is being given to patients who are in preterm labor at 28-32 weeks of gestation if the labor can be stopped for 2 days.
- Option A, B, and D are opioid analgesic.
2.C. Ritodrine is used to arrest uterine contractions in preterm labor. Oxytocin is used to stimulate labor.
3. B. Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. Maternal age is not a risk factor until age 35, when the incidence of chromosomal defects increases. Maternal exposure to rubella during the first trimester may cause congenital defects. Although a history or preterm labor may place the patient at risk for preterm labor, it does not correlate with genetic defects.
4. C. Betamethasone, a form of cortisone, acts on the fetal lungs to produce surfactant.
5. C . During the third trimester, the enlarging uterus places pressure on the intestines. This coupled with the effect of hormones on smooth muscle relaxation causes decreased intestinal motility (peristalsis). Increasing fiber in the diet will help fecal matter pass more quickly through the intestinal tract, thus decreasing the amount of water that is absorbed. As a result, stool is softer and easier to pass. Enemas could precipitate preterm labor and/or electrolyte loss and should be avoided. Laxatives may cause preterm labor by stimulating peristalsis and may interfere with the absorption of nutrients. Use for more than 1 week can also lead to laxative dependency. Liquid in the diet helps provide a semisolid, soft consistency to the stool. Eight to ten glasses of fluid per day are essential to maintain hydration and promote stool evacuation.
6. D. The client has been pregnant four times, including current pregnancy (G). Birth at 38 weeks’ gestation is considered full term (T), while birth form 20 weeks to 38 weeks is considered preterm (P). A spontaneous abortion occurred at 8 weeks (A). She has two living children (L).
7. A. Magnesium sulfate acts as a CNS depressant as well as a smooth muscle relaxant. Terbutaline is a drug that inhibits the uterine smooth muscles from contracting. On the other hand, oxytocin and prostaglandin stimulates contraction of smooth muscles.
8. A. Preterm labor is best described as labor that begins after 20 weeks’ gestation and before 37 weeks’ gestation. The other time periods are inaccurate.
9. C. The client with a missed abortion will have induction of labor. Prostin E. is a form of prostaglandin used to soften the cervix. Magnesium sulfate is used for preterm labor and preeclampsia, calcium gluconate is the antidote for magnesium sulfate, and Pardel is a dopamine receptor stimulant used to treat Parkinson’s disease; therefore, answers A, B, and D are incorrect. Pardel was used at one time to dry breast milk.
10. C. Regular uterine contractions (every 10 minutes or more) along with cervical dilation before 36 weeks’ gestation or rupture of fluids indicates preterm labor.