1
Q
What is the definition of preterm labor in terms of gestational weeks?
A
It is defined as uterine contractions and cervical changes that occur between 20 and 36 weeks and 6 days of gestation.
2
Q
Preterm labor occurring at less than 32 weeks of gestation is categorized as _____ preterm.
A
very
3
Q
What range of gestational weeks defines moderately preterm labor?
A
32 to 34 weeks of gestation.
4
Q
What range of gestational weeks defines late preterm labor?
A
34 to 36 weeks of gestation.
5
Q
List three types of infections that are considered risk factors for preterm labor.
A
Infections of the urinary tract or vagina, HIV, active herpes infection, or intrauterine infection.
6
Q
Besides infection, what is a significant historical risk factor for preterm labor?
A
A previous preterm birth.
7
Q
What type of pregnancy is a known risk factor for preterm labor?
A
Multifetal pregnancy.
8
Q
Name two maternal lifestyle choices that are risk factors for preterm labor.
A
Smoking and substance use.
9
Q
What are two socioeconomic or psychosocial risk factors for preterm labor?
A
Violence or abuse and lack of prenatal care.
10
Q
A client with uterine abnormalities or a _____ prepregnancy weight is at higher risk for preterm labor.
A
low
11
Q
What is an expected finding related to uterine activity in a client with preterm labor?
A
Uterine contractions.
12
Q
Describe the type of discomfort in the pelvis a client in preterm labor might report.
A
Pressure in the pelvis and menstrual-like cramping.
13
Q
A persistent low _____ is an expected finding in preterm labor.
A
backache
14
Q
What gastrointestinal symptoms can be an expected finding of preterm labor?
A
Gastrointestinal cramping, sometimes with diarrhea.
15
Q
What change in vaginal discharge is a physical assessment finding in preterm labor?
A
An increase, change, odor or blood in vaginal discharge.
16
Q
What defines regular uterine contractions as a physical finding in preterm labor?
A
A frequency of every 10 minutes or greater, lasting for 1 hour or longer.
17
Q
What protein, found in vaginal secretions between 24 and 34 weeks, can indicate inflammation and an increased risk for preterm labor?
A
Fetal fibronectin (FFN).
18
Q
What is the best way to determine the risk for preterm labor using diagnostic procedures?
A
Combining fetal fibronectin (FFN) testing with cervical measurements.
19
Q
What measurement of endocervical length via ultrasound indicates a low risk of preterm labor?
A
A cervical length greater than 30 mm.
20
Q
Why are cervical cultures obtained during assessment for preterm labor?
A
To check for the presence of infectious organisms, which guides antibiotic prescription.
21
Q
What is the primary goal of managing a client who is in preterm labor?
A
Stopping uterine contractions.
22
Q
What resting position is encouraged for a client in preterm labor to increase uterine blood flow?
A
The left lateral position.
23
Q
Why is ensuring hydration a key nursing intervention for preterm labor?
A
Dehydration can cause the pituitary to release oxytocin, which stimulates uterine contractions.
24
Q
What vital sign changes may indicate an intrauterine infection in a client with preterm labor?
A
Elevated temperature and tachycardia.
25
What is the significance of fetal tachycardia (FHR > 160/min) in the context of preterm labor?
It can indicate infection.
26
What is the classification of Nifedipine when used for preterm labor?
A calcium channel blocker.
27
How does Nifedipine work to suppress preterm labor contractions?
It inhibits calcium from entering smooth muscles.
28
Common side effects of Nifedipine, such as headache, flushing, and dizziness, are usually related to what condition?
Orthostatic hypotension.
29
Nifedipine should not be administered concurrently with what other tocolytic medication?
Magnesium sulfate.
30
What is the classification of Magnesium Sulfate when used as a tocolytic?
A central nervous system depressant.
31
Besides inhibiting uterine contractions, what is another therapeutic benefit of magnesium sulfate if birth is anticipated before 32 weeks?
It reduces the severity and risk of fetal neuroprotection in surviving infants.
32
List three contraindications for tocolysis with magnesium sulfate.
Active vaginal bleeding, intrauterine infection, gestation greater than 34 weeks, or acute fetal distress.
33
What are the signs of pulmonary edema that would require immediate discontinuation of tocolytic therapy?
Chest pain, shortness of breath, respiratory distress, wheezing, crackles, and a productive cough with blood-tinged sputum.
34
A client on magnesium sulfate exhibits a loss of deep tendon reflexes. What is the immediate nursing action?
Discontinue the magnesium sulfate infusion, as this is a sign of toxicity.
35
What is the minimum acceptable urinary output for a client receiving magnesium sulfate?
Less than 30 mL/hr or 100 mL/4 hr indicates toxicity.
36
What is the minimum acceptable respiratory rate for a client receiving magnesium sulfate?
A respiratory rate less than 12/min is a sign of toxicity.
37
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate or calcium chloride.
38
What is the classification of Terbutaline when used for preterm labor?
A beta-adrenergic agonist.
39
Terbutaline should not be administered to a client with a history of cardiac disease, preeclampsia, or _____.
hyperthyroidism
40
At what maternal heart rate should the provider be notified when a client is on Terbutaline?
A heart rate greater than 130/min.
41
What is the standard dosage and route for Terbutaline administration in preterm labor?
0.25 mg subcutaneously every 4 hours, for up to 24 hours.
42
What is the classification of Betamethasone when used in preterm labor?
A glucocorticoid.
43
What is the therapeutic action of Betamethasone in a fetus between 24 and 34 weeks gestation?
It enhances fetal lung maturity and surfactant production.
44
What is the standard administration schedule for Betamethasone?
Two injections of 12 mg IM, administered 24 hours apart.
45
For maximum effectiveness, Betamethasone should be administered at least _____ before delivery.
24 hours
46
What potential maternal side effect should a nurse monitor for after administering Betamethasone?
Maternal hyperglycemia.
47
What is Prelabor Rupture of Membranes (PROM)?
The spontaneous rupture of amniotic membranes prior to the onset of true labor.
48
What is Preterm Prelabor Rupture of Membranes (pPROM)?
The prelabor spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation.
49
A key risk factor for pPROM is a shortening of the _____.
cervix
50
What is a characteristic report from a client experiencing rupture of membranes?
A gush or leakage of clear fluid from the vagina.
51
An abrupt FHR variable or prolonged deceleration after rupture of membranes may indicate what complication?
A prolapsed umbilical cord.
52
A positive nitrazine paper test will turn what color, indicating the presence of amniotic fluid?
Blue, indicating a pH of 6.5 to 7.5.
53
What is the most common complication of preterm PROM?
Infection, particularly intrauterine infection.
54
Name two mechanical complications associated with pPROM.
Placental abruption, umbilical cord compression, or prolapse.
55
What is the purpose of administering Ampicillin to a client with pPROM?
It is an antibiotic used to treat infection, commonly intrauterine infection.
56
What should a client with pPROM be educated to monitor for and report regarding vaginal discharge?
Any foul-smelling vaginal discharge.
57
Clients with pPROM should be instructed to avoid tub baths and refrain from inserting _____ into the vagina.
anything
58
At what temperature should a client with pPROM, who is monitoring at home, report to their provider?
A temperature greater than 38° C (100° F).
59
The presence of Fetal Fibronectin (FFN) between 24 weeks and 34 weeks, 6 days can indicate _____, which increases the risk for preterm labor.
inflammation
60
What is the rationale for limiting vaginal exams in a client with prelabor rupture of membranes?
To decrease the risk of introducing infection.
61
A client receiving Magnesium Sulfate should be educated to notify the nurse if they experience _____, headache, nausea, vomiting, or difficulty breathing.
blurred vision
62
What is the definition of preterm labor according to the source material?
Preterm labor is defined as uterine contractions and cervical changes that occur between 20 and 36 weeks and 6 days of gestation.
63
Preterm labor occurring at less than 32 weeks of gestation is categorized as _____ preterm.
very
64
What gestational age range defines moderately preterm labor?
Moderately preterm labor occurs between 32 to 34 weeks of gestation.
65
A client is in labor at 35 weeks of gestation. This is categorized as what type of preterm labor?
This is categorized as late preterm labor (34 to 36 weeks of gestation).
66
Which type of infection is listed as a risk factor for preterm labor?
Infections of the urinary tract or vagina, HIV, active herpes, or intrauterine infection are risk factors.
67
Name three maternal history or pregnancy-related risk factors for preterm labor.
Previous preterm birth, multifetal pregnancy, and uterine abnormalities are three key risk factors.
68
List three lifestyle or social risk factors for preterm labor.
Smoking, substance use, violence or abuse, and lack of prenatal care are listed risk factors.
69
What are two maternal physical characteristics that are risk factors for preterm labor?
Low prepregnancy weight and advanced maternal age are risk factors for preterm labor.
70
A client in preterm labor might report what type of back discomfort?
The client might report a persistent low backache.
71
What gastrointestinal symptoms can be an expected finding in preterm labor?
Gastrointestinal cramping, sometimes accompanied by diarrhea, can be a finding.
72
A physical assessment finding in preterm labor may include a change in cervical _____.
dilation
73
What criteria define regular uterine contractions as a physical finding in preterm labor?
Regular uterine contractions with a frequency of every 10 minutes or greater, lasting for 1 hour or longer.
74
The presence of which protein in vaginal secretions between 24 and 34 weeks, 6 days can indicate an increased risk for preterm labor?
The presence of fetal fibronectin (FFN) can indicate inflammation and increased risk.
75
What is the best way to determine the risk for preterm labor using diagnostic procedures?
Fetal fibronectin (FFN) testing combined with cervical measurements is the best way to determine risk.
76
A cervical length greater than what measurement, obtained via ultrasound, indicates a low risk of preterm labor?
A cervical length greater than 30 mm indicates a low risk of preterm labor.
77
What is the primary goal of managing a client who is in preterm labor?
The primary goal is focusing on stopping uterine contractions.
78
What is the recommended resting position for a client in preterm labor to increase uterine blood flow?
The client should be encouraged to rest in the left lateral position.
79
Why is it important for a client in preterm labor to maintain hydration?
Preventing dehydration prevents the pituitary gland from releasing oxytocin, which stimulates uterine contractions.
80
A prolonged increase in the fetal heart rate (FHR) greater than 160/min, known as fetal tachycardia, can indicate what complication associated with preterm labor?
Fetal tachycardia can indicate an infection.
81
What is the classification of Nifedipine when used for preterm labor?
Nifedipine is a calcium channel blocker used to suppress contractions.
82
By what mechanism does Nifedipine suppress uterine contractions?
It suppresses contractions by inhibiting calcium from entering smooth muscles.
83
A nurse should monitor a client taking Nifedipine for headache, flushing, and dizziness, which are related to what adverse effect?
These symptoms are usually related to orthostatic hypotension.
84
Nifedipine should not be administered concurrently with which other tocolytic medication?
Nifedipine should not be administered concurrently with magnesium sulfate.
85
What is the therapeutic intent of administering magnesium sulfate to a client in preterm labor?
It is a tocolytic that relaxes smooth muscles to inhibit uterine contractions.
86
Besides being a tocolytic, magnesium sulfate provides fetal _____ if birth is anticipated before 32 weeks' gestation.
neuroprotection
87
List three contraindications for tocolysis with magnesium sulfate.
Active vaginal bleeding, intrauterine infection, gestation greater than 34 weeks, and acute fetal distress are contraindications.
88
A client receiving magnesium sulfate develops chest pain, shortness of breath, and a productive cough with blood-tinged sputum. The nurse should suspect what complication?
The nurse should suspect pulmonary edema and discontinue the infusion immediately.
89
What are the signs of magnesium sulfate toxicity that require discontinuing the medication?
Loss of deep tendon reflexes, urinary output <30 mL/hr, respirations <12/min, pulmonary edema, severe hypotension, or chest pain.
90
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate or calcium chloride is the antidote.
91
What is the classification of Terbutaline when used for preterm labor?
Terbutaline is a beta-adrenergic agonist used as a tocolytic.
92
A nurse should notify the provider if a client receiving Terbutaline has a heart rate greater than _____/min.
130
93
A nurse should notify the provider if a client receiving Terbutaline has a blood pressure less than _____ mm Hg.
90/60
94
What is the standard subcutaneous dose and frequency for Terbutaline administration for preterm labor?
The standard dose is 0.25 mg subcutaneously every 4 hours, for up to 24 hours.
95
What is the therapeutic action of Betamethasone when administered for anticipated preterm birth?
It enhances fetal lung maturity and surfactant production.
96
Betamethasone is effective for fetuses between what gestational ages?
It is effective for fetuses between 24 to 34 weeks gestation.
97
How long does it take for Betamethasone to become effective after administration begins?
It requires 24 hours to be effective.
98
What is the administration protocol for Betamethasone (dose and frequency)?
Betamethasone is administered as two 12 mg IM injections, 24 hours apart.
99
What potential maternal side effect should a nurse monitor for after administering Betamethasone?
The nurse should monitor for maternal hyperglycemia.
100
What is the definition of prelabor rupture of membranes (PROM)?
PROM is the spontaneous rupture of the amniotic membranes prior to the onset of true labor.
101
What is the definition of preterm prelabor rupture of membranes (pPROM)?
pPROM is the prelabor spontaneous rupture of membranes after 20 weeks and prior to 37 weeks of gestation.
102
List three risk factors for preterm prelabor rupture of membranes (pPROM).
Infection, prior preterm birth, shortening of the cervix, second/third trimester bleeding, low BMI, and tobacco/substance use are risk factors.
103
What is the primary expected finding reported by a client experiencing PROM or pPROM?
The client reports a gush or leakage of clear fluid from the vagina.
104
An abrupt FHR variable or prolonged deceleration after rupture of membranes may indicate what emergency complication?
This may indicate a prolapsed umbilical cord.
105
What result on a nitrazine paper test indicates rupture of membranes?
A positive test is indicated by the paper turning blue, which corresponds to a pH of 6.5 to 7.5.
106
A nurse should notify the provider if a client with pPROM has a temperature greater than _____ °C (_____ °F).
38° C (100° F)
107
For a client with pPROM, what is the purpose of obtaining vaginal/rectal cultures?
The cultures are obtained to test for streptococcus beta-hemolytic.
108
What class of medication is typically prescribed as a 7-day course for a client with pPROM?
A 7-day course of broad-spectrum antibiotics is anticipated.
109
What is the classification and therapeutic intent of Ampicillin when used for pPROM?
Ampicillin is an antibiotic used to treat infection, particularly intrauterine infection.
110
What is the most common complication of preterm PROM?
Infection, specifically intrauterine infection, is the most common complication.
111
Besides infection, name two other potential complications of preterm PROM.
Placental abruption, umbilical cord compression or prolapse, fetal pulmonary hypoplasia, and death are other complications.
112
What specific hygiene instruction should be given to a client with pPROM to prevent infection?
The client should be taught to wipe the perineal area from front to back after voiding and fecal elimination.
113
A client with pPROM should be educated to refrain from inserting anything into the vagina, abstain from intercourse, and avoid _____.
tub baths
114
How often should a client with pPROM who is being managed at home take their temperature?
The client should take their temperature every 4 hours when awake.
115
What client education regarding fetal well-being should be provided for conservative management of pPROM?
The client should be taught to perform daily fetal kick counts and report uterine contractions.
116
What two conditions, besides fetal distress, are contraindications for tocolysis with magnesium sulfate?
Active vaginal bleeding and intrauterine infection are contraindications for its use.
117
Which medication for preterm labor is contraindicated for a client with myasthenia gravis?
Magnesium sulfate should not be given to clients who have myasthenia gravis.
118
Which tocolytic medication is contraindicated in clients with a history of cardiac disease, pregestational diabetes, or severe preeclampsia?
Terbutaline is contraindicated in these conditions.
119
An endocervical length measurement is obtained via ____ to assess the risk of preterm labor.
ultrasound
120
When managing preterm labor, what activities should the client be encouraged to engage in during modified bed rest?
The client should be encouraged to engage in activities that can be completed in bed or on the couch.
121
What is the definition of preterm labor in terms of gestational age?
It is defined as uterine contractions and cervical changes that occur between 20 and 36 weeks and 6 days of gestation.
122
Preterm labor occurring at less than 32 weeks of gestation is categorized as _____ preterm.
very
123
Preterm labor occurring between 32 and 34 weeks of gestation is categorized as _____ preterm.
moderately
124
Preterm labor occurring between 34 to 36 weeks of gestation is categorized as _____ preterm.
late
125
What is a key infectious risk factor for preterm labor?
Infections of the urinary tract, vagina, HIV, active herpes, or intrauterine infection.
126
Name three non-infectious risk factors for preterm labor.
Previous preterm birth, multifetal pregnancy, smoking, substance use, violence, lack of prenatal care, uterine abnormalities, low prepregnancy weight, or advanced maternal age.
127
What are four expected findings a client might report when experiencing preterm labor?
Uterine contractions, pressure in the pelvis, menstrual-like cramping, persistent low backache, GI cramping, urinary frequency, or vaginal discharge.
128
What physical assessment finding related to vaginal discharge can indicate preterm labor?
An increase, change, odor, or blood in vaginal discharge.
129
A pattern of regular uterine contractions with a frequency of every ____ min or greater, lasting for ____ hr or longer, is a physical finding of preterm labor.
10; 1
130
What is fetal fibronectin (FFN)?
A protein whose presence in vaginal secretions between 24 weeks and 34 weeks, 6 days can indicate inflammation and an increased risk for preterm labor.
131
What is the best way to determine the risk for preterm labor using diagnostic procedures?
Combining Fetal Fibronectin (FFN) testing with cervical measurements.
132
How is endocervical length measured, and why is it a predictor for preterm labor?
It is measured with an ultrasound; cervical shortening can occur before uterine contractions, acting as a predictor.
133
A cervical length greater than what measurement indicates a low risk of preterm labor?
30 mm
134
What is the primary goal of management for a client in preterm labor?
To stop uterine contractions.
135
What type of activity restriction is typically prescribed for a client in preterm labor?
Modified bed rest with bathroom privileges.
136
In which position should a client in preterm labor be encouraged to rest, and why?
In the left lateral position to increase blood flow to the uterus and decrease uterine activity.
137
Why is it crucial to ensure hydration for a client in preterm labor?
Dehydration can stimulate the pituitary gland to release oxytocin, which stimulates uterine contractions.
138
What combination of vital signs in a pregnant client can indicate an intrauterine infection?
An elevated temperature and tachycardia.
139
What finding on a fetal heart rate monitor can indicate an infection and is frequently associated with preterm labor?
Fetal tachycardia, a prolonged FHR greater than 160/min.
140
What is the classification and therapeutic intent of Nifedipine in treating preterm labor?
It is a calcium channel blocker used to suppress contractions by inhibiting calcium from entering smooth muscles.
141
A nurse monitoring a client on Nifedipine should watch for headache, flushing, dizziness, and nausea, which are related to what side effect?
Orthostatic hypotension.
142
Nifedipine should not be administered concurrently with which other tocolytic medication?
Magnesium sulfate.
143
What is the classification and therapeutic intent of magnesium sulfate as a tocolytic?
It is a central nervous system depressant that relaxes smooth muscles to inhibit uterine contractions.
144
For what secondary purpose is magnesium sulfate administered when birth is anticipated before 32 weeks' gestation?
For fetal neuroprotection, reducing the severity and risk of neurologic issues in surviving infants.
145
List three contraindications for tocolysis with magnesium sulfate.
Active vaginal bleeding, intrauterine infection, gestation greater than 34 weeks, or acute fetal distress.
146
What are the signs of pulmonary edema for which a nurse should immediately discontinue magnesium sulfate therapy?
Chest pain, shortness of breath, respiratory distress, audible wheezing and crackles, and a productive cough with blood-tinged sputum.
147
What are four signs of magnesium sulfate toxicity that require discontinuing the infusion?
Loss of deep tendon reflexes, urinary output <30 mL/hr, respirations <12/min, pulmonary edema, severe hypotension, or chest pain.
148
What is the antidote for magnesium sulfate toxicity?
Calcium gluconate or calcium chloride.
149
What is the classification and therapeutic intent of Terbutaline for preterm labor?
It is a beta-adrenergic agonist used as a tocolytic to relax smooth muscles and inhibit uterine activity.
150
At what maternal heart rate should a nurse notify the provider for a client receiving Terbutaline?
A heart rate greater than 130/min.
151
What is the standard subcutaneous dose and frequency for Terbutaline administration?
0.25 mg subcutaneously every 4 hours, for up to 24 hours.
152
What is the classification and therapeutic intent of Betamethasone in the context of preterm labor?
A glucocorticoid used to enhance fetal lung maturity and surfactant production.
153
Between what gestational weeks is Betamethasone effective for fetal lung maturity?
Between 24 to 34 weeks gestation.
154
What is the standard administration schedule for Betamethasone?
Two injections of 12 mg IM, administered 24 hours apart.
155
How long must Betamethasone be administered before delivery to be effective?
At least 24 hours.
156
What potential maternal side effect should be monitored after Betamethasone administration?
Maternal hyperglycemia.
157
Define Prelabor Rupture of Membranes (PROM).
The spontaneous rupture of amniotic membranes prior to the onset of true labor at any gestational age.
158
Define Preterm Prelabor Rupture of Membranes (pPROM).
The prelabor spontaneous rupture of membranes after 20 weeks of gestation and prior to 37 weeks of gestation.
159
Besides infection and prior preterm birth, name two other risk factors for pPROM.
Shortening of the cervix, second/third trimester bleeding, pulmonary/connective tissue disorders, low BMI, copper/ascorbic acid deficiencies, or tobacco/substance use.
160
What is the classic finding reported by a client experiencing rupture of membranes?
A gush or leakage of clear fluid from the vagina.
161
When assessing a client with ruptured membranes, what is a critical potential complication involving the umbilical cord to assess for?
A prolapsed umbilical cord.
162
What changes in the Fetal Heart Rate (FHR) can indicate a prolapsed umbilical cord?
Abrupt FHR variable or prolonged decelerations.
163
A positive nitrazine paper test will turn what color, indicating what pH range?
The paper will turn blue, indicating a pH of 6.5 to 7.5.
164
In a client with pPROM, vaginal exams should be _____.
limited
165
For a client with pPROM, a nurse should notify the provider if the client's temperature is greater than ____.
$38^{\circ}$ C ($100^{\circ}$ F).
166
What is the purpose of administering Ampicillin to a client with pPROM?
It is an antibiotic used to treat infection, particularly intrauterine infection.
167
What is the most common complication of preterm PROM?
Infection, particularly intrauterine infection.
168
Name two complications of pPROM other than infection.
Placental abruption, umbilical cord compression or prolapse, fetal pulmonary hypoplasia, or death.
169
What client education regarding hygiene is important to prevent infection after pPROM?
Wipe the perineal area from front to back after voiding and fecal elimination.
170
Clients with pPROM should be educated to abstain from intercourse and to avoid ____ baths.
tub
OB Proctor Exam ATI
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