Preterm Labor Practice Exam

EXPLANATION

✔Correct answer:

The patient has a child with cystic fibrosis. Cystic fibrosis (CF) is a genetic disorder that is inherited in an autosomal recessive pattern, meaning that both parents must carry a copy of the defective gene for a child to have the condition. Having a child with cystic fibrosis indicates that both the patient and her partner are carriers of the CF gene mutation. This finding is a significant genetic risk factor, as there is a 25% chance with each pregnancy that another child could inherit cystic fibrosis if both parents are carriers.

Cystic fibrosis is caused by mutations in the CFTR gene, leading to the production of thick, sticky mucus that can cause severe damage to the lungs and digestive system. Carriers of the gene usually do not show symptoms but have a 50% chance of passing the carrier status to their offspring. If both parents are carriers, there is a 25% chance of having an affected child, a 50% chance of having a carrier child, and a 25% chance of having a child with neither mutation.

Think of the CF gene mutation like a hidden trait in a family. Both parents carry a hidden 'blueprint' (mutation) for cystic fibrosis. When they have a child, there’s a random chance the child might get the blueprint from both parents, leading to the condition (cystic fibrosis). If only one parent passes the blueprint, the child becomes a carrier like the parents.

Nurse Emily should provide the patient with genetic counseling to discuss the risk of having another child with cystic fibrosis and the options available, such as genetic testing and prenatal screening. Supportive care and education about cystic fibrosis, including potential challenges and resources, should be offered.

• Refer the patient to a genetic counselor for a detailed risk assessment and discussion of reproductive options.
• Educate the patient about cystic fibrosis, including the inheritance pattern, potential complications, and available treatments.
• Discuss prenatal testing options such as chorionic villus sampling (CVS) or amniocentesis for early detection of cystic fibrosis in the fetus.
• Provide emotional support and resources, such as connecting with local cystic fibrosis support groups or networks.

✘Incorrect answer options:

The patient is 25 years old. Age 25 does not represent a genetic risk factor for the fetus. Advanced maternal age (35 years or older) is associated with an increased risk of chromosomal abnormalities like Down syndrome, but a patient being 25 years old is not considered a genetic risk factor.

The patient was exposed to rubella at 36 weeks’ gestation. Rubella exposure is a teratogenic risk, particularly in the first trimester, as it can lead to congenital rubella syndrome, which may cause severe birth defects. However, rubella exposure is not considered a genetic risk factor since it is an environmental influence rather than a hereditary condition.

The patient has a history of preterm labor at 32 weeks’ gestation. While a history of preterm labor is an important obstetric risk factor, it does not indicate a genetic risk. Preterm labor can be influenced by multiple factors, including infections, cervical insufficiency, or other maternal health conditions, but it is not inherently related to genetic disorders.

EXPLANATION

✔Correct answer:

Regular uterine contractions with cervical dilation. Preterm labor is defined as regular uterine contractions that lead to cervical changes (dilation and/or effacement) occurring between 20 and 37 weeks of gestation. To confirm a diagnosis of preterm labor, Nurse Grace would expect to find not only regular uterine contractions but also evidence of cervical dilation. The presence of cervical dilation in the context of regular contractions is a key indicator that labor is progressing, even if it is occurring prematurely.

During labor, uterine contractions occur regularly and cause the cervix to dilate and efface, allowing the fetus to pass through the birth canal. In preterm labor, this process begins too early, before 37 weeks of gestation, which can lead to premature birth if not managed appropriately. Cervical dilation in the presence of regular contractions indicates that the body is preparing for delivery, which is a critical concern in preterm labor because the fetus may not yet be fully developed.

Imagine preterm labor as a door that’s starting to open before the house is ready for guests. The regular contractions are like someone repeatedly knocking on the door, signaling that something is happening. The cervical dilation is when the door actually begins to open, indicating that labor is progressing. When both the knocking (contractions) and the door opening (dilation) occur together, it means the labor process is moving forward, even though it’s too early for the baby to arrive.

Nurse Grace should focus on confirming the diagnosis and initiating appropriate interventions to delay delivery if possible, such as administering tocolytics or corticosteroids to enhance fetal lung maturity. Continuous monitoring of uterine activity and fetal status is essential, along with providing emotional support to the patient and her family.

• Monitor the frequency, duration, and intensity of uterine contractions.
• Perform a sterile vaginal exam to assess the degree of cervical dilation and effacement.
• Prepare for possible interventions, such as the administration of tocolytics to inhibit further labor progression.
• Educate the patient about the signs of preterm labor and the importance of seeking immediate medical attention if symptoms occur.
• Provide emotional support and reassurance, explaining the steps being taken to manage preterm labor and protect the health of both mother and baby.

✘Incorrect answer options:

Irregular uterine contractions with no cervical dilation. Irregular uterine contractions without cervical dilation may be indicative of Braxton Hicks contractions, which are common in pregnancy but do not lead to labor. These do not confirm preterm labor because they are not associated with cervical changes.

Painful contractions with cervical dilation. While painful contractions with cervical dilation could indicate labor, pain is not a required criterion to diagnose labor. The key indicators are regular contractions and cervical changes, regardless of pain.

Regular uterine contractions without cervical dilation. Regular contractions alone are not sufficient to confirm labor. Cervical dilation is essential to diagnose labor, including preterm labor. Without cervical changes, the contractions may not be progressing toward delivery.

EXPLANATION

✔Correct answer:

Betamethasone (Celestone). Betamethasone is a corticosteroid that is commonly administered to pregnant women at risk of preterm labor, particularly between 24 and 34 weeks of gestation. The primary purpose of this medication is to accelerate fetal lung maturity and reduce the risk of respiratory distress syndrome (RDS) in the newborn if preterm birth occurs. Administering betamethasone can significantly improve neonatal outcomes by promoting the production of surfactant, a substance crucial for keeping the lungs inflated and functioning properly after birth.

In this scenario, delaying labor for at least 48 hours allows sufficient time for the betamethasone to be effective, thus enhancing the chances of a healthier outcome for the preterm infant.

Think of betamethasone like a quick-acting "shield" being prepared for a premature baby. Just as you would give a soldier time to put on armor before a battle, administering betamethasone gives the baby’s lungs time to strengthen and be better prepared for the "battle" of breathing outside the womb.

Nurse Olivia should monitor the client for any side effects of betamethasone and ensure that the timing of doses is optimal. She should also educate the client about the purpose of the medication and its benefits for the baby.

• Administer the betamethasone as prescribed, typically in two doses 24 hours apart.
• Monitor the mother for potential side effects, including hyperglycemia, especially if she has gestational diabetes.
• Provide emotional support to the mother, addressing any concerns she might have about preterm labor and the effects of the medication.
• Educate the mother on the importance of delaying delivery for 48 hours to maximize the effectiveness of the corticosteroid treatment.

✘Incorrect answer options:

Fentanyl (Sublimaze). Fentanyl is a potent opioid analgesic used for pain management. It is not indicated for promoting fetal lung maturity or managing preterm labor. Its use would be more relevant in controlling pain during labor or other procedures but not for the situation described.

Sufentanil (Sufenta). Sufentanil is another opioid analgesic, similar to fentanyl, used for pain control. Like fentanyl, it does not have a role in the management of preterm labor or in promoting fetal lung maturity.

Butorphanol tartrate (Stadol). Butorphanol is an opioid analgesic that may be used for pain relief during labor, but it is not used to manage preterm labor or to promote fetal lung maturity. It has no role in delaying labor or improving neonatal outcomes in the context of preterm birth.

EXPLANATION

✔Correct answer:

Ritodrine. Ritodrine is a beta-adrenergic agonist that was commonly used to manage preterm labor by promoting smooth muscle relaxation in the uterus. By activating beta-adrenergic receptors, ritodrine causes the uterine muscles to relax, which helps in delaying premature contractions and extending the duration of pregnancy. Though not as commonly used today due to side effects and the development of newer drugs, ritodrine was specifically designed as a tocolytic agent to prevent or slow down preterm labor.

In preterm labor, the uterus contracts prematurely, which can lead to early delivery. Tocolytic agents like ritodrine work by relaxing the uterine smooth muscle, thereby inhibiting contractions and potentially prolonging pregnancy. This can give the fetus more time to develop and reduce the risks associated with prematurity.

Think of the uterus as a balloon that is starting to deflate too soon (preterm contractions). Ritodrine acts like a clamp on the valve, slowing down the deflation process (contractions) so the balloon (pregnancy) stays inflated (continues) longer.

When administering ritodrine or other tocolytics, nurses must monitor the patient’s vital signs, especially heart rate and blood pressure, as these drugs can cause tachycardia, hypotension, and other cardiovascular effects. Fetal monitoring is also critical to ensure that the drug does not negatively impact the fetus.

• Monitor maternal heart rate, blood pressure, and respiratory status due to the cardiovascular effects of the drug.
• Assess fetal heart rate and contractions to evaluate the effectiveness of the tocolytic therapy.
• Educate the patient about potential side effects such as palpitations, tremors, and hyperglycemia.
• Provide emotional support to the patient and family, explaining the rationale for delaying preterm labor and the potential benefits for the fetus.
• Be prepared to manage potential side effects or complications, including the need for emergency interventions if maternal or fetal distress occurs.

✘Incorrect answer options:

Oxytocin. Oxytocin is a hormone that stimulates uterine contractions and is typically used to induce labor, not to delay it. It would not be appropriate to use oxytocin in a patient in preterm labor if the goal is to prolong pregnancy.

Prostaglandin. Prostaglandins are used to ripen the cervix and induce labor. Like oxytocin, they would promote labor rather than inhibit it. Therefore, they are not used to manage preterm labor.

Estrogen. Estrogen plays a role in the reproductive cycle and helps prepare the body for labor, but it is not used as a tocolytic agent to prevent or delay labor. Its function is more related to the development of secondary sexual characteristics and regulation of the menstrual cycle.

EXPLANATION

✔Correct answer:

G4 P2. The correct way to document the obstetrical history using the gravida and para notation is G4 P2.

• Gravida (G): The number of times a woman has been pregnant, regardless of the outcome, including the current pregnancy. In this case, the client had three previous pregnancies (a son born at 38 weeks, a daughter born at 30 weeks, and a miscarriage at around 8 weeks) and is currently pregnant. Therefore, the client is Gravida 4 (G4).
• Para (P): The number of pregnancies that have reached 20 weeks of gestation or more, regardless of whether the infant was born alive or stillborn. The client had two pregnancies that reached this milestone (the son at 38 weeks and the daughter at 30 weeks), so she is Para 2 (P2).

Thus, Nurse Kelly should record the history as G4 P2.

Think of "G" as counting the number of attempts (pregnancies), and "P" as counting the number of completions where a project reached a significant milestone (20 weeks of gestation). The woman has had four attempts (G4) and two completions (P2).

Properly documenting obstetrical history is essential for risk assessment and care planning during the current pregnancy. Understanding the client’s history allows healthcare providers to monitor and manage potential complications, particularly in cases with a history of preterm birth or miscarriage.

• Accurately document the client’s obstetrical history to ensure comprehensive care and appropriate monitoring during the current pregnancy.
• Provide the client with information about signs of preterm labor, given the history of a preterm birth at 30 weeks.
• Offer supportive resources, especially considering the emotional aspects of a previous miscarriage.

✘Incorrect answer options:

G4 P3. This notation would indicate four pregnancies and three that reached 20 weeks or more. While the gravida count is correct (G4), only two pregnancies reached 20 weeks, so the para count should be P2, not P3.

G3 P2 .This option suggests three pregnancies, which is incorrect because the client is currently pregnant, making it her fourth pregnancy. Although the para count is correct (P2), the gravida should be G4, not G3.

G3 P3. This notation is incorrect as it suggests the client has had three pregnancies that reached 20 weeks or more. The correct counts are G4 for pregnancies and P2 for those reaching 20 weeks.

EXPLANATION

✔Correct answer:

Magnesium sulfate and terbutaline. Magnesium sulfate and terbutaline are medications commonly used to prevent or delay preterm labor by relaxing the uterine muscles and preventing contractions.

• Magnesium sulfate acts as a tocolytic agent by inhibiting uterine contractions, primarily through calcium antagonism, which reduces the availability of calcium ions necessary for muscle contraction. It is also used for neuroprotection of the fetus in cases of imminent preterm birth.
• Terbutaline is a beta-adrenergic agonist that works by stimulating beta-2 receptors in the uterus, leading to smooth muscle relaxation and suppression of uterine contractions.

These medications are often administered when a patient is showing signs of preterm labor, with the goal of delaying delivery long enough to allow for further fetal development or for corticosteroids like betamethasone to enhance fetal lung maturity.

Imagine the uterus as a machine that’s starting to work too soon. Magnesium sulfate and terbutaline act like switches that slow down or stop the machine from operating, giving more time for the baby to develop before birth.

When administering these medications, Nurse Riley should monitor the patient’s vital signs and watch for any side effects. Magnesium sulfate can cause respiratory depression and hypotension, so close monitoring is essential. Terbutaline can cause tachycardia and palpitations, so cardiac monitoring may be necessary.

• Monitor maternal vital signs, particularly respiratory rate and blood pressure when administering magnesium sulfate.
• Assess the patient for signs of magnesium toxicity, such as loss of deep tendon reflexes, respiratory depression, and reduced urine output.
• Monitor fetal heart rate for signs of distress, which could indicate an adverse reaction to the medication.
• Educate the patient about the purpose of the medications and possible side effects, ensuring informed consent is obtained before administration.

✘Incorrect answer options:

Prostaglandin and oxytocin. Both prostaglandin and oxytocin are used to induce labor, not to prevent it. Prostaglandins help ripen the cervix, and oxytocin stimulates uterine contractions. These would exacerbate labor rather than prevent it, making them inappropriate for managing preterm labor.

Progesterone and estrogen. Progesterone is sometimes used in early pregnancy to help maintain a pregnancy and prevent preterm labor, but it is not a primary intervention in active preterm labor. Estrogen is not typically used to prevent preterm labor. The combination of these hormones does not play a role in immediate preterm labor management.

Dexamethasone and prostaglandin. Dexamethasone is a corticosteroid used to enhance fetal lung maturity in cases of preterm labor but does not prevent contractions. Prostaglandins, as mentioned, are used to induce labor, not to prevent it, so this combination would not be appropriate for delaying preterm labor.

EXPLANATION

✔Correct answer:

Labor that starts after 20 weeks of gestation and before 37 weeks of gestation. Preterm labor is defined as the onset of labor between 20 weeks and 37 weeks of gestation. Labor that occurs within this timeframe is considered preterm, and it involves regular uterine contractions leading to cervical changes (effacement and dilation) before 37 completed weeks of gestation. Preterm labor is a significant concern because it can result in premature birth, which is associated with a higher risk of neonatal morbidity and mortality due to the incomplete development of organs, particularly the lungs.

The exact cause of preterm labor is often multifactorial, involving factors such as infection, uterine overdistension, placental issues, or maternal stress. The key point is that preterm labor can lead to premature delivery, which places the neonate at risk for complications like respiratory distress syndrome, intraventricular hemorrhage, and other developmental issues.

Imagine a cake baking in the oven: full-term labor is like taking the cake out at the perfect time, when it's fully baked at 40 weeks. Preterm labor, however, is like opening the oven and taking the cake out too soon, between 20 and 37 weeks, when it's still undercooked. The cake (baby) may not be ready, leading to challenges that need extra care to ensure it develops fully outside the oven.

Nurse Emma should emphasize the importance of recognizing early signs of preterm labor, such as frequent contractions, lower back pain, or changes in vaginal discharge, and encourage immediate medical evaluation if these symptoms occur. Preventive measures, such as adequate hydration, avoiding overexertion, and managing stress, should also be discussed.

• Educate expectant mothers on the signs and symptoms of preterm labor, including the frequency and duration of contractions.
• Stress the importance of regular prenatal visits to monitor for risk factors associated with preterm labor.
• Encourage the prompt reporting of any symptoms suggestive of preterm labor, such as pelvic pressure or lower back pain.
• Discuss lifestyle modifications that may reduce the risk of preterm labor, including proper nutrition, hydration, and avoiding smoking or substance use.

✘Incorrect answer options:

Labor that starts after 15 weeks of gestation and before 37 weeks of gestation. This option incorrectly suggests that preterm labor can begin as early as 15 weeks of gestation. However, labor before 20 weeks is typically classified as a miscarriage or spontaneous abortion, not preterm labor.

Labor that starts after 24 weeks of gestation and before 28 weeks of gestation. This timeframe is too narrow and does not encompass the full range for preterm labor, which starts after 20 weeks and before 37 weeks. Labor within this specific range (24 to 28 weeks) would indeed be preterm, but it doesn't cover the entire definition of preterm labor.

Labor that starts after 28 weeks of gestation and before 40 weeks of gestation. While this timeframe partially overlaps with the definition of preterm labor, it excludes the period between 20 and 28 weeks, which is still considered preterm. Also, labor at 40 weeks is considered full-term, not preterm.

EXPLANATION

✔Correct answer:

Increase her intake of dietary fiber. Constipation is a common issue during pregnancy, especially in the third trimester, due to hormonal changes that relax the smooth muscles of the digestive tract, and the pressure exerted by the growing uterus on the intestines. Nurse Ellen’s recommendation to increase dietary fiber is appropriate because fiber helps to bulk up the stool and promotes regular bowel movements. Foods rich in fiber, such as fruits, vegetables, whole grains, and legumes, can help alleviate constipation by increasing stool weight and decreasing transit time through the intestines.

Progesterone levels are elevated during pregnancy, which causes relaxation of the gastrointestinal tract, leading to slower movement of food through the intestines (decreased peristalsis). Additionally, the growing uterus puts pressure on the intestines, further contributing to constipation. Adequate fiber intake helps by increasing the water content and bulk of the stool, making it easier to pass.

Think of the intestines as a highway. When traffic is slow, it’s like constipation. Fiber acts like more lanes on the highway, allowing traffic (stool) to move more smoothly and quickly, reducing the chances of a traffic jam (constipation).

Nurse Ellen should also encourage the client to increase fluid intake, as water helps fiber work more effectively, and to engage in regular physical activity to further promote bowel movements. It is important to educate the client about the risks associated with excessive use of enemas or laxatives during pregnancy, as they can lead to dehydration, electrolyte imbalance, and, in some cases, stimulate uterine contractions.

• Advise the client to consume at least 25-30 grams of fiber per day from a variety of foods.
• Encourage an increase in water intake to at least 8-10 glasses per day to help soften the stool.
• Recommend regular moderate physical activity, such as walking, to stimulate intestinal motility.
• Educate the client on avoiding excessive use of laxatives and enemas, which could cause complications during pregnancy.
• Discuss alternative methods for managing constipation, such as consuming prunes or prune juice, which are natural laxatives.

✘Incorrect answer options:

Use enemas daily. Regular use of enemas is not recommended during pregnancy because they can cause irritation of the rectum, electrolyte imbalances, and potentially stimulate uterine contractions, leading to preterm labor.

Take laxatives regularly. Frequent use of laxatives, particularly stimulant laxatives, is not advisable during pregnancy because they can lead to dehydration, electrolyte imbalance, and dependency, which may exacerbate constipation over time. Some laxatives can also cause uterine contractions, posing a risk for preterm labor.

Reduce her fluid consumption. Decreasing fluid intake would likely worsen constipation. Adequate hydration is crucial for preventing constipation, as water helps to soften the stool and promote regular bowel movements. Pregnant women should be encouraged to drink plenty of fluids, especially water.

EXPLANATION

✔Correct answer:

Dinoprostone (Prostin E.). Dinoprostone is a prostaglandin E2 analog that is used to induce labor by softening and dilating the cervix and stimulating uterine contractions. In the case of a missed abortion at 29 weeks gestation, where the fetus has died but the body has not yet expelled it, the goal is to induce labor to deliver the fetus. Dinoprostone is commonly used for this purpose because it effectively promotes cervical ripening and uterine contractions, facilitating the delivery process.

A missed abortion refers to a situation where the fetus has died in utero but has not been expelled by the body. At 29 weeks, this situation requires medical intervention to induce labor and avoid complications such as infection or disseminated intravascular coagulation (DIC). Dinoprostone helps to initiate this process by preparing the cervix and promoting contractions, leading to the delivery of the fetus.

Think of the cervix as a doorway that needs to be opened for the baby to pass through. Dinoprostone acts like a key that unlocks and widens this doorway, allowing labor to start and the fetus to be delivered.

When administering Dinoprostone, Nurse Taylor should monitor the patient for signs of effective cervical ripening and uterine activity, as well as potential side effects such as uterine hyperstimulation. Continuous fetal monitoring is not necessary in this case due to the absence of a viable fetus, but maternal vital signs and comfort should be closely observed.

• Monitor uterine contractions and cervical dilation to assess the effectiveness of Dinoprostone.
• Observe the patient for signs of uterine hyperstimulation or other adverse effects, such as nausea or vomiting.
• Provide emotional support and counseling, as this is a highly distressing situation for the patient and family.
• Prepare the patient for potential outcomes, including the possibility of needing additional interventions if labor does not progress as expected.

✘Incorrect answer options:

Magnesium sulfate. Magnesium sulfate is used primarily as a tocolytic to prevent preterm labor and to manage severe preeclampsia or eclampsia. It would not be appropriate for inducing labor in the case of a missed abortion.

Calcium gluconate. Calcium gluconate is the antidote for magnesium sulfate toxicity and is not used to induce labor or manage missed abortion. It is irrelevant in this context.

Bromocriptine (Parlodel). Bromocriptine is a dopamine agonist used to inhibit lactation or treat conditions such as hyperprolactinemia. It does not play a role in managing a missed abortion or in inducing labor.

EXPLANATION

✔Correct answer:

Encourage the production of surfactant in the fetus. Betamethasone is a corticosteroid that is administered to pregnant women at risk of preterm labor, typically between 24 and 34 weeks of gestation, to enhance fetal lung maturity. The primary action of Betamethasone in this context is to stimulate the production of surfactant, a substance that reduces surface tension in the lungs, thereby helping to prevent respiratory distress syndrome (RDS) in preterm infants. Surfactant is crucial for keeping the air sacs in the lungs open and facilitating effective breathing after birth.

In preterm infants, the lungs are often not fully developed, particularly in the production of surfactant, which can lead to respiratory complications. Betamethasone helps accelerate the maturation of the fetal lungs, increasing surfactant production and improving lung function. This reduces the risk of RDS, a common and serious complication in premature babies that can lead to hypoxia and other related health issues.

Imagine the lungs of a preterm baby as balloons that are difficult to inflate because they're sticky inside. Surfactant works like a lubricant that makes it easier for the balloons (lungs) to expand. Betamethasone helps the baby's body produce more of this lubricant before birth, making breathing easier after delivery.

When administering Betamethasone, Nurse Harper should monitor both the mother and fetus for any potential side effects. Betamethasone is typically given in two doses, 24 hours apart, and it is essential to ensure timely administration to maximize its benefits. The nurse should also provide education to the patient regarding the purpose of the medication and its role in enhancing fetal lung maturity.

• Monitor maternal blood glucose levels, especially in diabetic patients, as corticosteroids can elevate blood sugar.
• Educate the patient about the importance of completing the full course of Betamethasone to ensure optimal fetal lung development.
• Observe for any signs of maternal infection, as corticosteroids can suppress the immune response, potentially masking symptoms.
• Coordinate with the healthcare team to schedule follow-up assessments and fetal monitoring to evaluate the effectiveness of the therapy.
• Provide reassurance to the patient regarding the benefits of the medication in reducing the risk of respiratory complications in the newborn.

✘Incorrect answer options:

Address any underlying infection. Betamethasone is not an antibiotic or an antiviral medication, so it does not address infections. While infection can be a cause of preterm labor, Betamethasone’s primary role is to enhance fetal lung maturity, not to treat infections.

Inhibit uterine contractions. Betamethasone is not a tocolytic agent, which are the drugs used to inhibit uterine contractions in preterm labor. Tocolytics such as magnesium sulfate or nifedipine are used to delay labor, but Betamethasone is used specifically to accelerate fetal lung development.

Lower the potential for hypertension. Betamethasone is not used to manage or lower hypertension. In fact, corticosteroids can sometimes increase blood pressure as a side effect. Management of hypertension in pregnancy is typically handled with antihypertensive medications, not corticosteroids like Betamethasone.