Maternity NCLEX RN

Postpartum Psychosis

(0.1-0.2%) Onset 2 weeks postpartum. Hallucinations, delusions, impulsivity, hyperactivity, confusion, delirium, often associated w/ bipolar disorder. Requires emergent psychiatric hospitalization + pharmacologic intervention

Postpartum depression

(8-15%) onset 4-6 weeks postpartum & up to 12 months. Extreme sadness, irritability, emotional outbursts, severe mood swings, postpartum anxiety. Psychotherapy + pharmacologic intervention

S/s of cold stress in neonate (7)

"In cold stress, metabolism increases causing greater demand for O2, glucose & release of norepinephrine." 1)decreased temp 2)altered mental status (irritability/lethargY) 3)bradycardia 4)tachypnea early --> apnea + hypoxia 5)hypotonia 6)weak cry and/or suck 7)Hypoglycemia, high gastric residuals, emesis

Objective (probable) signs of pregnancy

-Uterine/cervical changes (Goodell sign, Chadwick sign, Hegar sign, uterine enlargement) -Braxton hicks contractions -Ballottement -Fetal outline palpation -Uterine & funic souffle -Skin pigmentation changes (Chloasma, linea nigra, areola darkening) -Striae gravidarum -Positive pregnancy tests

tx of necrotizing enterocolitis

1. Feeding must be D/C for *bowel rest* 2. *IV fluids* must be started immediately 3. *NGT * must be placed for *bowel decompression * 4. If medical mgt does not lead to resolution, then *surgery* is indicated to remove the affected bowel

Temperature above ____ F in 24 hr postpartum mothers requires further evaluation.

100.4 (38)

An acceleration of the fetal HR of at least __/min above the baseline lasting for at least ___ seconds is a reassuring finding.

15, 15

Sex of the fetus can be identified around ___ weeks gestation

16

Nagele's rule

1st day of last period + 7 days - 3 months (gives you date and then add a year)

The umblical cord stump begins to shrivel and turn black in __-__ days after the clamp is taken off around 24 hrs. It usually seperates spontaneously around __-__ weeks after birth.

2-3; 1-2

Preterm is a baby delivered between ___-___ weeks gestation

20-37

Uterine resting tone of ___ mm Hg or less is considered acceptable. Contraction intensity should not exceed ___ mm Hg. Contraction frequency should be __-__ every 10 mins. Duration should not exceed __ seconds.

20; 90; 2-5; 90

Average total weight gain for a normal weight woman is ___-___ lbs

25-35

Tdap Vaccine (Tetanus, Diphtheria, Pertussis) is given to pregnant women b/t ___ and ___ weeks gestation as it provides the newborn w/ passive immunity against pertussis (whooping cough).

27-36 weeks

The Moro reflex is present until age __-___ months.

3-6

The WBC count is normally elevated during the first 24 hrs postpartum, up to ________/mm3.

30,000

Ovulation may occur as early as ___ weeks after birth and before resumption of menses.

4

Newborns of HIV mothers should receive __-__ weeks of ART (antiretroviral therapy) & not breastfeed; as well as maternal antiretroviral therapy during pregnancy.

4-6

A therapeutic magnesium level of __-__ mEq/L is necessary to prevent seizures in a preeclamptic pt.

4-7

Pregnancy lasts

40 weeks (9 months) or 280 days

Pregnant women and those attempting to conceive need a minimum _____mcg of folic acid (Folate) daily.

400

Postdate or post term is a pregnancy that goes beyond ___ weeks of gestation

42

Shoulder dystocia lasting ≥ ___ minutes is correlated with almost certain fetal asphyxia.

5

Postpartum hemorrhage (PPH) is usually defined as maternal blood loss of >____ mL after a vaginal birth or >_____mL after a cesarean birth.

500, 1000

Uterine tachysystole occurs when contractions are too frequent (>___ in 10 minutes), which may cause inadequate fetal oxygenation, _______ or ______.

5; placental abruption, uterine rupture

Secondary or delayed postpartum hemorrhage can occur anywhere from >24 hrs postpartum to ___ < weeks postpartum from uterine subinvolution, retained placental fragments or uterine infection.

6

Moderate variability is good and is fluctuation in baseline fetal HR b/t __-___/min

6-25

Newborns who are large for gestational age have a birth weight that is >___th percentile.

90

The nurse reviews the chart of a client who gave birth 4 hours ago. Which contributing factor indicates that the client has an increased risk of postpartum hemorrhage? A)Infant birth weight of 9 lb 2 oz (4139 g) B)Labor and birth without pain medication C)Labor that lasted 8 hours D)Third stage of labor lasting 20 mins

A

The nurse is monitoring a client who is in active labor w/ a cervical dilation of 6 cm. Which uterine assessment finding requires an intervention by the nurse? A)Contraction duration of 95 seconds B)Contraction frequency of every 3 mins C)Contraction intensity at 45 mm Hg D)Uterine resting tone of 10 mm Hg

A Uterine contractions should not exceed 90 secs or occur less than 2 mins apart.

The nurse is caring for a 2 week old client who has tetralogy of Fallot. Which assessment finding is a priority to report to the HCP? A)Hemoglobin level of 24.9 g/dL B)Murmur noted on heart auscultation C)Newborn becomes fatigued during feeding D)Newborn has gained 0.6 lb since birth

A A cyanotic cardiac defect causing chronic hypoxemia d/t decreased pulmonary blood flow & circulation of poorly oxygenated blood. To compensate for hypoxia, erythropoietin production increases to produce additional oxygen-carrying RBCs. Increased RBCs result in increased circulatory viscosity or polycythemia (Hgb >22 g/dL or Hct >65%). Polycythemia increases the risk for blood clotting. A loud, systolic ejection murmur is characteristic of TOF. Poor weight gain & fatigue during feeding are findings associated w/ TOF.

Trisomy 18 (Edwards Syndrome)

A life threatening chromosomal abnormality that affects multiple organ systems. Many die in utero, within first week or year of life.

Nulligravida

A woman who has never been pregnant

Multipara

A women who has completed two or more pregnancies to 20 or more weeks of gestation

Multigravida

A women who has had two or more pregnancies

Nullipara

A women who has not completed a pregnancy with a fetus(es) whom have reached 20 weeks of gestation

Gravida

A women who is pregnant

Primigravida

A women who is pregnant for the first time

A nurse on the antepartum unit is caring for a client at 30 weeks gestation who was admitted with reports of vaginal bleeding. A diagnosis of placenta previa was confirmed by ultrasound. What should the nurse tell the client to anticipate? (select all that apply) A)Additional ultrasound around 36 weeks gestation B)Clearance for sexual activity if bleeding stops C)Discharge home if bleeding stops and fetal status is reassuring D)Scheduled c-section before onset of labor E)Weekly vaginal examinations to assess for cervical change

A, C, D A c-section birth is planned for 36 weeks gestation

Which assessment findings would the nurse most likely expect to find in a male infant born at 28 weeks gestation? (Select all that apply) A)Abundant lanugo on shoulders & back B)Deep creases & peeling skin on soles of feet C)Flat areolae w/o palpable breast buds D)Smooth, pink skin w/ visible veins E)Testes completely descended into the scrotum

A, C, D Lanugo (fine, downy hair) is found on preterm newborns & disappears around 36 weeks. Pink skin w/ visible veins as skin is thin & transparent d/t lack of SQ fat.

A nurse is caring for a postpartum client who is breastfeeding and has been diagnosed w/ mastitis of the right breast. Which of the following instructions should the nurse include in client teaching? (select all that apply) A)Apply warm compresses to breast B)Discontinue breastfeeding until symptoms resolve C)Increase oral fluid intake D)Take ibuprofen as needed for pain E)Wear a tight-fitting bra as much as possible

A, C, D Requires antibiotic tx (dicloxacillin, cephalexin), continue breastfeeding w/ proper technique, warm/cool compresses & massage breast, nutrition/hydration, analgesics, wash hands before/after feeding. UNDERWIRE OR TIGHT BRAS are not recommended (soft supportive bras) b/c milk flow is impeded, which worsens engorgement

A nurse is preparing to administer an oxytocin IV infusion to a client for labor induction. The nurse recognizes that an oxytocin infusion may increase the client's risk for which of the following? (Select all that apply) A)Abnormal or indeterminate fetal HR patterns B)Delayed breast milk production C)Placenta previa D)Postpartum hemorrhage E)Uterine tachysystole

A, D, E Oxytocin (Pitocin) stimulates contraction of uterine smooth muscle; it is used to induce or augment labor & to prevent postpartum hemorrhage (PPH). Oxytocin administration increases the risk of abnormal fetal HR pattern, emergency c-section birth, uterine tachysystole, placental abruption & uterine rupture. Prolonged administration increases the risk of water intoxication & PPH.

A client who is being evaluated for suspected ectopic pregnancy reports sudden-onset, severe, right lower abdominal pain and dizziness. Which additional assessment findings will the nurse anticipate if the client is experiencing a ruptured ectopic pregnancy? (select all that apply) A)Blood pressure 582/64 mmHg B)Crackles on auscultation C)Distended jugular veins D)Pulse 120/min E)Shoulder pain

A, D, E Ruptured ectopic pregnancy manifests as: unilateral abdominal pain, hypotension, mild-moderate vaginal bleeding, missed menses, referred shoulder pain (from free intraperitoneal blood pooling). Can lead to hypovolemic shock (tachycardia, hypotension). Peritoneal signs: tenderness, rigidity, low grad fever. B & C indicate volume overload instead of hypovolemia suspected w/ ectopic rupture.

The nurse is performing telephone triage w/ a client at 38 weeks gestation who thinks she may be in labor. Which questions would help the nurse to determine whether the client is in labor? (select all that apply) A)Do you feel like the contractions are getting stronger? B)Does anything you do make the pain better? C)Have you lost your mucous plug? D)How frequent are the contractions? E)Where do you feel the contraction pain most?

ALL BUT C C is not sign of true labor but in days preceding

Miscarriage (spontaneous abortion)

Abortion that occurs, naturally

Which actions should the L & D nurse perform when caring for a pt. who has decided to relinquish her newborn to an adoptive parent? (select all that apply) A)Avoid discussing the adoption details until after the birth B)Encourage the birth mother to hold the newborn C)Notify other staff who may interact w/ the client of the adoption plan D)Offer the birth mother a chance to say goodbye to the newborn E)Use phrases that illustrate adoption as a decision of love, not abandonment

All except A The nurse should encourage birth mother to creat memories to facilitate grieving - holding newborn, taking pictures & naming the newborn & chance to say goodbye. Avoiding discussing adoption is not correct. Acknowledging the adoption plan early encourages the pt. to express emotions & be involved in decision-making.

Subjective (presumptive) signs of pregnancy

Amenorrhea; nausea and vomiting; excessive fatigue; urinary frequency; breast tenderness; quickening.

Anencephaly

Severe neural tube defect resulting in little to no brain tissue or skull formation in utero. Many are stillborn and others are still not compatible w/ life. Administering o2 & drying/bundling baby at birth for comfort measures.

HELLP Syndrome

Severe preeclampsia plus hemolysis, elevated liver enzymes, and low platelets. Treatment is prompt delivery

Caput succedaneum

mnemonic = CS = crosses suture Edema of the soft tissue of the scalp d/t prolonged pressure of the presenting part against the cervix during labor, resolves in a few days.

Postpartum blues (baby blues)

common (40-80%) & milder form of depression 2-3 days postpartum w/ emotional lability, sadness, anxiety & difficulty sleeping lasting about 2 weeks w/o tx. CLIENTS ABILITY TO FUNCTION IS NOT AFFECTED.

The clinic nurse is collecting data on a pregnant client in the first trimester. Which finding is most concerning & warrants priority intervention? A)Client has not been taking prenatal vitamins B)Client is taking lisinopril to control HTN C)Client reports a whitish vaginal discharge D)Client reports mild cramping pain in the lower abdomen

B Angiotensin-converting enzyme (ACE) inhibitors (enalapril, lisinopril, ramipril) and angiotensin II receptor blockers (losartan, valsartan, telmisartan) are teratogenic and should be avoided in those planning to become pregnant. Prenatals important but not priority. Other are common discomforts.

Antepartum lasts from _____ to ______.

conception to onset of labor

A pregnant client comes to the L & D unit stating, "My water just broke at home." On assessment of the client's perineal area, the nurse visualizes a loop of umbilical cord protruding from the vagina. Which nursing intervention would be appropriate? A)Apply subrapubic pressure B)Assist the client to the knee-chest position C)Perform Leopold manuevers D)Perform the McRoberts manuever

B A client w/ a prolapsed umbilical cord should be placed in knee-chest or Trendelenburg position to relieve pressure on the cord until emergency birth is possible. A & D are for shoulder dystocia. C is for palpating to identify fetal presentation.

______ is the most common cause of early postpartum hemorrhage (occurring < or = 24 hours after birth).

Uterine atony (boggy uterus)

Within thirty seconds after birth, an unresponsive and limp newborn is placed on the warmer in the "sniffing" position. The nurse clears the airway, dries & stimulates the newborn. At 1 minute of life, the newborn has shallow, gasping respirations with a HR of 62/min. What action should the nurse take? A)Administer epinephrine B)Begin positive pressure ventilation C)Continue stimulating the newborn D)Start chest compressions

B Neonatal resuscitation interventions are initiated at 30 second intervals after birth. 1. warm/stimulate & clear airway 2. If HR <100, gasping or apnea --> Positive pressure ventilation (PPV) w/ SpO2 & consider cardiac monitor 3. If HR <60 --> intubate, chest compressions, PPV w/ 100% o2 & cardiac monitor 4. If still no improvement, continue compressions/ventilation & also give IV epinephrine

Fetal effects of congenital rubella syndrome

congenital cataracts, deafness, heart defects (patent ductus arteriosis) and cerebral palsy

An infant is born with a cleft palate. Which actions will promote oral intake until the defect can be repaired? (Select All That Apply) A)Angle bottle up and toward cleft B)Burping the infant often C)Feeding in an upright position D)Feeding slowly over 45 minutes or more E)Using a specialty bottle or nipple

B, C, E A child w/ a cleft palate is at risk for aspiration & inadequate B/C of their inability to create suction. Actions to promote intake & reduce aspiration risk include feeding in an upright position, pointing the nipples away from cleft, feeding over no more than 20-30 minutes, using special nipples or bottles, and feeding every 3-4 hours. The infant should be burped at regular intervals to reduce gastric distension.

A nurse is participating in an obstetrical emergency simulation in which the health care provider announces shoulder dystocia. Which of the following interventions should the assisting nurse implement? (Select all that apply) A)Assist maternal pushing efforts by applying fundal pressure during each contraction B)Document the time the fetal head was born C)Flex the client's legs back against the abdomen and apply downwards pressure above the symphysis pubis D)Prepare for a forceps-assisted birth E)Request additional assistance from other nurses immediately

B, C, E McRoberts Manuever: legs flexed onto abdomen causes rotation of pelvis, alignment of sacrum & opening of birth canal Suprapubic pressure to fetal anterior shoulder. Nurse should document time of head, verbalize time passed & request additional help. FUNDAL PRESSURE & USE OF FORCEPS/VACUUM are contraindicated b/c may further wedge the fetal shoulder into maternal symphysis pubis.

Preeclampsia involves ______ increases and ______.

BP; proteinuria

Tx. for postpartum endometritis (2)

Broad spectrum antibiotics!! IV clindamycin PLUS IV gentamicin Subsequent interventions: antipyretics, IV fluids & possibly uterotonics for uterine subinvolution.

A client with poorly controlled diabetes mellitus gives birth to a newborn at term gestation. When caring for the 2 hour old newborn, which clinical finding requires the nurse to intervene? A)Cyanosis of hands & feet B)Heart rate of 165/min while crying C)Jitteriness D)Respirations of 60/min

C A common symptom of newborn hypoglycemia is jitteriness. Newborns w/ mothers who have diabetes mellitus are at increased risk for hypoglycemia, esp. in the first several hours after birth. Newborn hypoglycemia (<40-45mg/dL)requires immediate intervention to prevent neurologic damage.

A client in active labor who received an epidural 20 minutes ago reports feeling nauseated and lightheaded. Which action should the nurse perform first? A)Administer IV ondansetron B)Apply oxygen via face mask C)Obtain BP D)Perform vaginal exam

C Epidural blocks can inhibit the sympathetic nervous system, causing peripheral vasodilation leading to HTN (nausea, lightheadedness). Assess BP and then intervene: IV fluids or vasopressors (phenylephrine/ephedrine), left lateral positioning (to alleviate pressure on vena cava), o2.

A client who is 8 weeks pregnant reports morning sickness. What is the most appropriate response by the nurse? A)Advise the client to consume hot vs. cold foods B)Instruct pt. to drink 2 glasses of water w/ each meal C)Suggest the pt. consume high-protein snacks on awakening D)Tell pt. that morning sickness should pass in a few weeks

C Morning sickness: nausea w/ or w/out vomiting is common during first trimester. Interventions: drinking fluids (preferably clear, cold, carbonated beverages) b/t meals (30 mins before or after), eating small meals during day (high in protein or carbs & low in fat), having high protein snack before bedtime & on awakening, consuming food/drinks w/ ginger, consuming foods high in Vitamin B6 (nuts, seeds, legumes)

A client who gave birth vaginally with epidural anesthesia still has limited movement and strength of the right leg and reports no urge to urinate at 2 hours postpartum. The nurse palpates the client's fundus 2 cm above the umbilicus and to the right. What should the nurse do next? a)assist the client to the bathroom in a wheelchair B)Encourage the client to drink plenty of fluids C)Perform in-and-out catheterization D)Reassess for bladder distension hourly

C The pt. cannot ambulate to void or void in bedpan. Expected to void within 6-8 hrs after delivery OR removal of indwelling catheter. Reassessing in an hour may increase the risk of postpartum hemorrhage, as a full bladder can cause uterine atony.

Which pt. in a prenatal clinic should the nurse assess first? A)Client at 11 weeks gestation w/ backache & pelvic pressure B)Client at 16 weeks gestation w earaches & sinus congestion C)Client at 27 weeks gestation w/ headache & facial edema D)Client at 37 weeks gestation w/ white vaginal discharge & urinary frequency

C The pt. is exhibiting s/s of preeclampsia (headache, visual disturbances & facial swelling) so should be assessed first. Other options are common discomforts during pregnancy.

The nurse is caring for a client at 21 weeks gestation w/ reports of occasional, bothersome heartburn (pyrosis). Which of the following lifestyle changes should the nurse recommend (select all that apply)? A)Avoid intake of dairy products B)Drink large amounts of fluid w/ meals C)Eat several small meals each day D)Eliminate fried, fatty foods E)Lie down on the left side after meals

C, D Pyrosis is common during pregancy b/c of the increase of progesterone hormone (resulting in esophageal sphincter relaxation) & uterine enlargement that displaces the stomach. Lifestyle changes: HOB up during/after meals, small frequent meals, avoid tight fitting clothing, eliminate dietary triggers (caffeine, fatty foods, citrus, chocolate, spicy foods, tomatoes, carbonated drinks, peppermint). The client should cluster small amounts vs. large amts. of fluid between meals.

Spina Bifida

Congenital neural tube defect that occurs when spinal vertebrae do not close during fetal development, potentially allowing spinal cord contents to protrude through the opening. A tuft of hair, hemangioma, nevus or dimple at the base of the spine may indicate the mildest form, spina bifida occulta. Other neuro disturbances (bowel/bladder incontinence, sensory loss) may accompany.

When triaging 4 pregnant clients in the obstetric clinic, the nurse should alert the health care provider to see which client first? A)First-trimester client reporting frequent nausea & vomiting B)Second-trimester client with dysuria and urinary frequency C)Second-trimester client with obesity reporting decrease in fetal movement D)Third trimester client w/ R Upper quadrant pain & nausea

D RUQ or epigastric pain can be an indicator of HELLP syndrome. N & V in first trimester is normal. Option B should be evaluated for dysuria but nor priority. Maternal perception of fetal movement can be altered by obesity, maternal position, fetal sleep cycle, fetal position, anterior placenta, amniotic fluid volume (increased or decreased). The cause of decreased fetal movement should be evaluated but not priority.

Postpartum urinary retention risk factors

DECREASED BLADDER SENSATION d/t 1)Primiparity 2)Regional anesthesia 3)Operative vaginal delivery (or prolonged delivery) 4)perineal trauma/injury 5)Cesarean delivery

GP acronym

Gravidity and parity

GTPAL

Gravidity, term, preterm, abortions, living children *term and preterm births includes nonliving children birthed (stillbirth or death after birth) Term birth is 37 weeks or after. Preterm are 20-36 weeks.

The nurse reviews lab results for a pregnant client at 32 weeks gestation. What is the nurses best action based on these results? (Hgb 11.4 g/dl, Hct 34%, RBC 5.3 x 10^6/mm^3, WBC 14,000/mm^3, platelets 230,000/mm^3) A)Complete the pt. assessment & documentation B)draw another sample for repeat CBC C)prepare for transfusion of packed rbcs D)request a prescription for iron supplementation

HEMODILUTION during pregnancy b/c of increase in blood volume. Blood transfusion only in severe anemia (<7.0 g/dl). NORMAL VALUES: Hgb >11 g/dL, HCT > 33%, RBCS 5-6.25 x 10^6/mm3, WBC 5,000-15,000/mm^3, Platelets 150,000-4000,000/mm^3.

Preeclampsia is characterized by ____ and ____ after the 20th gestational week.

HTN & proteinuria

erythema toxicum neonatorum

Firm, white or yellow papules or pustules surrounded by erythema; closely resembles flea bites. Idiopathically appears in the first few days after birth & resolves within 5-7 days.

S/s of endometrial infection

FOUL ODOR LOCHIA!! Fever Tachycardia Uterine pain/tenderness

Jaundice first appears on the ____ and spreads to the rest of the body. Jaundice within the first 24 hours is pathological, usually r/t problems of the _____. Jaundice after 24 hours is referred to as physiological jaundice & is r/t increased amount of unconjugated ______ in the system.

Face; liver; bilirubin

Positive (diagnostic) signs of pregnancy

Fetal Heartbeat w/ doppler Fetal Movement (felt or observed by an examiner) Visualization of Fetus (ultrasound)

congenital dermal melanocytosis (aka Mongolian spots)

Flat, bluish-gray, discolored areas on the lower back and/or buttocks (benign). Fade over the first 1-2 years of life. MEASURE & DOCUMENT

Normal Lab Values during 3rd trimester (H & H, RBCs, WBCs, Platelets)

Hgb >11g/dL Hct >33% RBCs 5-6.25 x 10^6/mm^3 WBCS 5,000-15,000/mm3 Platelets: 150,000-400,000/mm^3

Syphilis treatment

IM Penicillin G benzathine

Newborn resuscitation

Infant on back w/ neck slightly extended to promote adequate ventilation (aka neutral or sniffing position). The nurse may place a blanket/towel under the newborns shoulders to elevate the chest 3/4-1 inch.

Rectal bleeding in neonates may be a s/s of...

Meckel's diverticulum - a remnant of the umbilical cord that should have disintegrated at 8 weeks in utero became an out pouch in the small intestine

Syphilis serologic tests (2)

Nontreponemal (RPR, VDRL) and then Treponemal (FTA-ABS)

Gravidity

Number of pregnancies a woman has had (including current one)

The nurse is admitting a client at 41 weeks gestation for induction of labor d/t oligohydramnios. Considering the pts. indication for induction, what should the nurse anticipate? A)Additional neonatal personnel present for birth B)Intermittent fetal monitoring during labor C)Need for forceps-assisted vaginal birth D)Need for uterotonic drugs for postpartum hemorrhage

Oligohydramnios (low amniotic fluid volume) can be bc of kidney anomalies or fluid leaking through vagina w/ undiagnosed ruptured membranes. Indicated by: small uterine size for gestational age, fetal outline easily palpated through maternal abdomen. Dx: ultrasound. Complications: pulmonary hypoplasia, umbilical cord compression. Additional neonatal personnel should be present for possible resuscitation and continuous fetal monitoring during labor for s/s of cord compression. Oligohydramnios is not associated w/ postpartum hemorrhage or operative vaginal birth (w/ forceps/vacuum).

Abnormalities in conception (4)

Oligohydramnios, polyhydramnios, placenta previa, and abruptio placentae

Elective abortion

Performed at the women's request

Why do infants need Vit K Im Injection at birth?

Prevent bleeding - Vit K does not cross placenta (b/c its fat soluble) & they do not have gut bacteria to synthesize Vit K until several days after birth. Vitamin K deficiency bleeding (VKDB) can occur up to 6 months in infant.

Induced abortion

Purposeful interruption of a pregnancy before 20 weeks of gestation

Magnesium toxicity tx

STOP magnesium therapy. Give IV calcium gluconate bolus.

A nurse is measuring a uterine fundal heigh for a pt. who is at 36 weeks gestation in supine position. The pt. suddenly reports dizziness & the nurse observes pallor & damp, cool skin. What should the nurse do first? A)Assess fetal HR & pattern B)Assess heart & lung sounds C)Notify the HCP immediately D)Reposition the pt. into a lateral position

Supine hypotensive syndrome (w/ maternal hypotension, reflex tachycardia) is usually seen in 3rd trimester when weight of uterine contents compress inferior vena cava. HCP is notified & fetal monitoring AFTER position change.

Parity

The number of pregnancies in which the fetus(es) have reached 20 weeks of gestation when they were born. This is not affected by twins or stillborn pregnancies

Oral Candidiasis (Thrush)

White patches on the oral mucosa, palate & tongue. Nonremovable & bleed when touched. Difficulty sucking or feeding d/t pain. Tx. w/ fungicide (nystatin) may hasten recovery.

Primipara

a women who has completed one pregnancy with a fetus(es) who reached 20 weeks of gestation

Opioids can be given during ____ birth but not with..

active; contraindications (imminent birth, opioid dependence) and NOT latent labor.

In LGA neonates, the nurse should prioritize assessment of ______ and ______.

birth injuries & hypoglycemia (<40-45 mg/dL)

The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of the following actions should the nurse take? (Select all that apply) A)Administer o2 via nonrebreather face mask B)Change maternal position to the left side C)D/c the oxytocin infusion D)Notify the HCP E)Perform a nitrazine test

all EXCEPT D Late decelerations are evidence of impaired fetal oxygenation. D/c the oxytocin infusion, changing maternal position, administer O2 and giving an IV fluid bolus are essential interventions. Nitrazine pH tests detect leaking amniotic fluid to determine rupture of membranes.

Infants of HIV mothers are tested for HIV at _____, _____ and ______. __ consecutive negatives at 1 month or older and 4 months or older.

birth, 1 month, 4 months; two

Necrotizing enterocolitis is caused when:

enteral feeding is initiated causing bacteria to enter the bowel where it proliferates d/t compromised gut immunity --> inflammation, ischemic necrosis of the intestine --> congested & gangrenous bowel w/ gas collections

Hard wire supportive bras & cold application is treatment of _____, while soft supportive bras & heat application is for tx. of _____.

breast engorgement; mastitis

Viability

capacity for the baby to live outside the uterus. No clear guidelines. Infants at 22-25 weeks are considered borderline viable

Mongolian spots are more common in newborns of ______.

darker skin tones (African American, Native American, Hispanic, Asian)

Signs of magnesium toxicity

decreased DTR is 1st sign; respiratory depression, decreased urine output hypotension, prolonged PR intervals

______ is used to determine worsening preeclampsia or magnesium sulfate toxicity.

deep tendon reflex

Once full dilation (10 cm) is reached in the second stage, pushing should be _____ to avoid cervical swelling and/or laceration.

delayed

_____ is the only cure for preeclampsia-eclampsia syndrome.

delivery

Amniotic fluid that is yellowish-green can indicate...

fetal passage of meconium in utero

_____ disease may also cause positve HCg pregnancy test.

gestational trophoblastic disease

The presence of only one umbilical artery & vein is associated with ____ or ____ malformation.

heart or kidney

Pregnant clients with HIV should receive recommended _______ vaccines.

inactivated

Reactive Nonstress Test (NST) indicates:

indicates that the fetus is well oxgenated

Code pink is for

infant or child abduction

Subjective self-reported signs of pregnancy may include:

leukorrhea, breast tenderness, urinary frequency, N & V, quickening, excessive fatigue, amenorrhea

Abortion

loss of pregnancy before the fetus is viable outside the uterus

Pregnant adolescent patients are at increased risk for:

low birth weight, preterm birth, preeclampsia, vulnerable to poverty/dangerous living conditions (physical/sexual abuse), exposure to teratogens (tobacco, alcohol drugs)

____ position is optimal for fetal rotation & birth.

occiput anterior

The _____ position is associated w/ intense "back labor" d/t increased pressure on maternal sacrum & may result in prolonged labor.

occiput posterior

Soaking a perineal pad in < or = ____ hour would indicate excessive bleeding that requires urgent intervention.

one

Sinusoidal fetal HR

pattern characterized by repetitive, wave-like fluctuations w/ absent variability and no response to contractions. Ominous finding requiring immediate intervention. Can be suggestive of severe fetal anemia potentially d/t fetomaternal hemorrhage (ex. abdominal trauma) or some fetal infections (parvovirus B19). Tx: intrauterine resuscitation & expedited birth.

IV narcotics should be administered to laboring women at the ___ of contractions to reduce the amount of narcotic that crosses the placental barrier & affects the fetus.

peak (b/c uteroplacental blood flow is decreased significantly during contraction peaks).

A history of __________ disease is a risk factor for ectopic pregnancy.

pelvic inflammatory

Therapeutic abortion

performed for maternal or fetal health reasons

Placenta accreta

placenta adheres to myometrium & attempted separation can result in life-threatening hemorrhage

If gravidity is the number of ______, then parity is the number of _____.

pregnancies; term births

Condylomata acuminata

soft non tender, pointed, fleshy papules that occur on the genitalia and are caused by the human papillomavirus (HPV). Tx: removal (ie. trichloracetic acid)

Vaginal exams of laboring client w/ ruptured membranes should be performed using _____ to decrease risk of infection.

sterile gloves

Placenta previa is dx. with ______.

ultrasound

Circumcision care (3)

1)Apply petroleum jelly to the glans penis at diaper changes (unless PlastiBell was used) for 3-7 days to prevent exposed glans from adhering to the diaper until the site heals. 2)Report bleeding that exceeds the size of a quarter OR no voiding within 6-8 hrs of circumcision 3)Clean w/ warm water only during diaper changes or at least twice daily

Rubin Theory Phases of Postpartum Adaptation to motherhood

1)Birth-24/48 hours; "Taking in" Pt. focus is self. Nursing focus: anticipating needs of pt. 2)2-10 days "Taking hold"; Pt. focus: learning to care for the infant. Nursing focus: Providing learning opportunities & positive reinforcement 3)>10 days; Letting go; Pt. focus: Adapting to new parenting role; Nursing focus: follow up

Urinary retention s/s

1)Bladder distention 2)displaced and/or boggy fundus

Proper breastfeeding & latch technique (5)

1)Breastfeed every 2-3 hours on average (8-12 times/day) & w/ hunger cues (sucking, rooting) 2)Position the newborn "tummy to tummy" w/ mouth in front of nipple and head in alignments w/ body 3)Ensure a proper latch (grasps both nipple & part of areola) 4)Feed for at least 15-20 mins/breast or until satisfaction 5)Alternate breasts

Maternal complications of operative vaginal delivery (3)

1)GI tract injury 2)urinary retention 3)hemorrhage

S/s of Eclampsia

1)HTN 2)Proteinuria 3)Severe headaches 4)Visual disturbances 5)Right upper quadrant or epigastric pain 6)3-4 mins of tonic-clonic seizure, usually self-limited

Newborns of mothers w/ diabetes mellitus are at increased risk for complications such as:

1)HYPOGLYCEMIA 2)hypocalcemia 3)hyperbilirubinemia 5)resp. distress syndrome

Birthing interventions for preterm labor before 34 weeks (5)

1)IM antenatal glucocorticoids (betamethasone or dexamethasone) to stimulate fetal lung maturation & promote lung surfactant development 2)Administer antibioitics (penicillin) to prevent Group B transmission 3)Mag sulfate IV if <32 weeks gestation 4)Tocolytics (nifedipine, indomethacin) to suppress uterine activity to allow antenatal glucocorticoids time to take effect 5)monitoring labs/cultures

Syphilis effect on pregnancy

1)Intrauterine fetal demise 2)Preterm labor 3)Fetal effects: Hepatic (hepatomegaly, jaundice), Hematologic (hemolytic anemia, decreased platelets), Musculoskeletal (long bone abnormalities), Failure to thrive

Symptoms of hypoglycemia in neonates (6)

1)JITTERINESS 2)irritability! 3)hypotonia! 4)apnea 5)lethargy 6)temp. instability

Umbilical Cord Care

1)Keep open to air for adequate drying 2)Do NOT apply antiseptics (alcohol, chlorhexidine) 3)Report s/s of infection

S/s of Down Syndrome in neonates (5)

1)Single transverse palmar crease 2)Small & low-set ears 3)Flat nose bridge 4)Protruding tongue 5)hypotonia

Contraindications to epidural anesthesia (3)

1)Uncorrected maternal hypotension 2)coagulopathies (ex: low platelets) 3)infection at site

Signs of uterine rupture (5)

1)abnormal FHR pattern (decelerations, decreased variability, bradycardia) 2)Loss of fetal station 3)constant abdominal pain 4)cessation of uterine contractions 5)maternal tachycardia

Tx. of breast engorgement

1)apply ice packs to both breasts for 15-20 mins q 3-4 hrs 2)Apply chilled, fresh cabbage leaves to both breasts. 3)Taking an anti-inflammatory analgesic (ibuprofen) 4)Maintaining firm breast support (SUPPORTIVE bra, breast binder) until milk flow is diminished

Risk factors of postpartum hemorrhage

1)grand multiparity (> or = 5 births) 2)intrauterine infection 3)prolonged labor 4)use of oxytocin during labor 5)coagulopathy

Fetal complications of operative vaginal delivery (5)

1)laceration 2)cepalohematoma 3)facial nerve palsy 4)intracranial hemorrhage 5)shoulder dystocia

Indications of Operative vaginal delivery (3)

1)protracted 2nd stage of labor 2)fetal HR abnormalities 3)maternal contraindications to pushing

Pregnant women on flights should walk q __-___ hrs to avoid prolonged sitting & thrombus formation.

1-2

Stages of Labor (4)

1: latent (0-5 cm dilation); Active (6-10 cm dilation) 2: 10 cm (complete) 3: birth of baby to expulsion of placenta 4: 1-4 hours after birth, maternal physiologic readjustment

Precipitous birth occurs when labor lasts <___ hours from contraction onset until birth.

3

Term is a baby born between __-__ weeks gestation

37-42

A client, gravida 4 para 3, at 38 weeks gestation arrives in the emergency department w/ strong contractions that began 1 hour ago. The client is diaphoretic, grunting & yelling loudly that she wants an epidural b/c she feels the need to push. What priority action should the nurse take? A)Apply gloves & assess perineal area B)Initiate large bore IV access C)Notify anesthesia provider of client's request for epidural D)Obtain fetal heart tones via Doppler

A If the pt. arrives at the hospital in 2nd stage labor (pushing), the nurse must rapidly assess whether birth is imminent by applying gloves & observing the perineum for bulging or crowning of the presenting fetal part.

A nurse is preparing to teach the parents of a newborn about newborn safety. Which instruction is appropriate for the nurse to include in the teaching plan? A)Dress the newborn in a wearable blanket, such as a sleep sack, during sleep if an extra layer is needed B)Layer the newborn w/ jackets and blankets before securing the car seat harness C)Place the newborn in the prone position while sleeping D)Place the newborn's car seat facing forward

A ALWAYS place infants in supine position NOT prone. No bulky jackets or blankets should be b/t the newborn & the harness b/c it reduces effectiveness during a crash. The newborn should be in rear-facing car seat in back seat.

A 37-weeks-pregnant woman comes to the emergency department with a fractured ankle. Which assessment finding is most concerning and requires the nurse to follow up? A)Fetal HR remains 206/min B)Fetus kicked 4 times in the past hour C)Mother reports feeling 2 contractions every hour D)Mothers hemoglobin is 11g/dL

A Fetal tachycardia >160 for >10 mins Fetal HR & movement are the most sensitive indicators of fetus health 4 movements/hr or 10 distinct fetal movements within 2 hours is a reassuring finding. For option C, these braxton hicks contractions are normal mid pregnancy - concern if continuous regular contractions. Option D - hgb drops in pregnancy

A primigravid client in early labor is admitted and reports intense back pain w/ contractions. The fetal position is determined to be right occiput posterior. Which action by the nurse would be the most helpful for alleviating the client's back pain during early labor? A)Applying counterpressure to the client's sacrum during contractions B)Encouraging the client to remain in bed during early labor C)Positioning the client on the left side w/ pillows for support D)Requesting that the nurse anesthetist administer epidural anesthesia

A Firm, continuous pressure applied w/ a closed fist, heel of the hand & other firm object (tennis ball, back massager). Client's should be encouraged to change positions frequently (q30-60 mins) to promote fetal rotation/descent. Epidural can limit client mobility & contribute to fetal malposition. C does not help pain.

The nurse is providing teaching to a prenatal client about the 1 hour glucose challenge test that will be performed at the next visit. Which client statement indicates a need for further teaching? A)Fasting is required before the 1 hr glucose challenge test B)One blood sample is obtained at the end of the test C)The test includes drinking a 50 g glucose solution D)The test's purpose is to screen for gestational diabetes, not diagnose it

A Gestational diabetes mellitus is d/t physiologic pregnancy changes (insulin resistance, rising BG levels). GDM screening occurs at 24-28 weeks gestation. If dx. nutrition counseling & pharmacological intervention if needed. The 1 hr glucose screening test can be at any time of day and does not require fasting; it is one blood draw an hour after ingestion. If results are <140 mg/dL GDM is unlikely and no further testing. If elevated, a 2 or 3 hr glucose tolerance test is used which require fasting and hourly blood samples.

The nurse is reviewing lab results for several prenatal clients. Which finding is most important to report to the HCP? A)Client at 24 weeks gestation w/ Hgb of 9 g/dL & hct of 29% B)Client at 26 weeks gestation whose 1 hr oral glucose challenge test result is 120 mg/dl C)Client at 36 weeks gestation w/ BP of 125/85 mmHG and trace protein detected on urine dipstick D)client at 37 weeks gestation w/ a WBC count of 13,000/mm3

A Hgb <11g/dL in 1st or 3rd trimester OR <10.5 in second trimester is considered low. S/s of anemia. Glucose test is abnormal if BG is > or = 130-140 mg/dL. Trace protein is likely d/t specimen contamination or recent illness but if > or = to 300mg/34 hrs of > or = 1+ on urine dipstick AND BP > or = to 140/190 mm Hg may indicate preeclampsia. During pregnancy it is normal for WBC count to increase.

The graduate nurse (GN) is caring for a laboring client w/ epidural anesthesia. After the pt. pushes for 3 hrs during the 2nd stage of labor, the HCP decides to use forceps to assist the client to deliver secondary to maternal exhaustion. Which action by the GN requires the nurse preceptor to intervene? A)Begins to apply fundal pressure when the HCP applies traction to forceps B)Drains the client's bladder using a catheter before the placement of forceps C)Notes the exact time the forceps are applied on a card for documentation in the birth record D)Palpates for contractions and notifies the HCP when they are present

A In an operative birth, forceps or a vacuum extractor are used to shorten the second (pushing) stage of labor. The nurse must: ensure the pts. bladder is empty, monitor contractions, document time forceps or vacuum applied. FUNDAL PRESSURE SHOULD NEVER BE APPLIED DURING BIRTH OR THIS PROCEDURE B/C UTERINE RUPTURE CAN OCCUR.

The nurse assesses a client at term gestation who reports having contractions for the last 2 hours. The pt. states "I'm not sure, but i think my water broke." The nurse performs a nitrazine pH test, which turns blue. When documenting the results of the test, which client statement is most concerning to the nurse? A)I did have sexual intercourse w/ my partner 1 hr before coming in today B)I have noticed constant wetness in my panties since i thought my water broke C)It is difficult for me to tell if my water broke or if i just peed myself a little bit D)With the last 3 pregnancies, my water never broke on its own

A Nitrazine pH test blue is positive for membrane rupture (yellow-green is negative). It differentiates b/t alkaline amniotic fluid & normal vaginal fluids/urine which is acidic. However, the presence of blood or SEMEN (alkaline) may result in false positive. A should alert the nurse for this possible false positive d/t semen.

A client at 20 weeks gestation states that she started consuming an increased amount of cornstarch about 3 weeks ago. Based on this assessment, the nurse should anticipate that the HCP will order which lab tests? A)Hgb & Hct B)Human chorionic gonadotropin level C)Serum folate level D)WBC count

A PICA is the constant craving for & consumption of nonfood/nonnutritive food. It may be accompanied by iron deficiency anemia so H & H is useful to screen for anemia. Common PICA substances include: Ice, cornstarch, chalk, clay, dirt & paper.

The nurse is caring for a client at 30 weeks gestation who is hospitalized for preeclampsia. After reviewing the client's chart & performing an initial assessment, the nurse notes several abnormal findings. Which finding should the nurse discuss w/ the HCP immediately? A)dark red vaginal bleeding B)edema of hands/feet C)elevated liver enymes D)urine output of 150 ml in 4 hrs

A Placental abruption is life threatening complication of preeclampsia (s/s: dark red vaginal bleeding, abdominal pain, rigid uterus, abnormal fetal HR patterns, uterine tachysystole). Option B: swelling is common in preeclampsia & should be reported but NOT emergency. Option C: elevated liver enzymes may indicate HEELLP syndrome b/c tx. is giving birth by induction of labor. Option D: urine ouput of <30 ml/hr may be early sign of kidney damage s/t preeclampsia so nurse should monitor I & O & report output but not emergent.

The nurse cares for a client who gave birth an hour ago to a 9 lb (4.1 kg) newborn. The client's lochia is heavy w/ large clots, and the fundus remains boggy after fundal massage and an oxytocin bolus. Which prescription from the health care provider should the nurse question? A)Administer 0.2 mg methylergonovine IM B)Administer 800 mcg misoprostol rectally C)Collect a H & H STAT D)Initiate second IV line w/ 18 gauge needle

A Postpartum hemorrhage d/t uterine atony may require uterotonic drug (AFTER FUNDAL MASSAGE & OXYTOCIN BOLUS) to reverse excessive bleeding. Methylergonovine is contraindicated in pts. with HTN (OR PREECLAMPSIA) d/t risk of seizure/stroke b/c of vasoconstriction. Misoprostol combats uterine atony by contracting the uterine muscle, rather than through vasoconstriction, making it a safe option for clients w/ HTN.

A nurse is caring for a client who had a vaginal birth 2 hours ago. The client has saturated a perineal pad in 20 mins. During assessment, the nurse notices the client has a boggy fundus that is deviated to the right and slightly above the umbilicus. Which intervention should the nurse perform first? A)Assist pt. to use the bedpan to void B)Begin oxytocin IV infusion at 124 milliunits/min C)Obtain a CBC D)Start o2 delivery at 10L/min via nonrebreather facemask

A Postpartum vaginal bleeding that saturates a perineal pad in <1 hour is excessive. The boggy fundus indicates uterine atony and the displacement indicates a distended bladder. Bladder distension prevents the uterus from contracting sufficiently to control bleeding. The client should be assisted to void to correct the bladder distension. After, the nurse should perform fundal massage. CBC is NOT the immediate priority. Oxytocin is a uterotonic initiated as infusion if initial attempts to control bleeding have failed.

A laboring client at 35 weeks gestation comes to the L & D unit with preterm rupture of membranes "about 18 hours ago." The client's group B Streptococcus status is unknown. What intervention is a priority for this client? A)Administration of prophylactic antibiotics B)Assessment of uterine contraction frequency C)Collection of a clean-catch urine specimen D)Vaginal examination to assess cervical dilation

A Pregnant clients are tested for GBS colonization at 35-37 weeks gestation & receive prophylactic antibiotics during labor if results are positive. Antibiotics are indicated when membranes have been ruptured ≥ 18 hours, maternal temp ≥ 100.4 F or gestation is <37 weeks. This is to prevent infection transmission to fetus and serious complications during birth.

A nurse is admitting a client at 42 weeks gestation to the labor and delivery unit for induction of labor. What is a predictor of a successful induction? A)Bishop score of 10 B)Firm and posterior cervix C)History of precipitous labor D)Reactive nonstress test

A The Bishop score is a system for the assessment and rating of cervical favorability and readiness for induction of labor. A score of ≥6-8 in nulliparous women is associated w/ successful induction and subsequent vaginal birth. The cervix is scored (0-3) on consistency, position, dilation, effacement & station. Option B: indicates a low Bishop score and low likelihood of successful labor induction Option C & D: not related to question

The nurse is performing the initial assessment of a newborn. Which finding should the nurse report to the HCP? A)A sudden jarring of the client's crib does not produce a Moro Reflex B)The client has swollen labia & a thin, white vaginal discharge C)The posterior fontanel is triangular & smaller than the anterior fontanel D)There are pearly, white pinpoint papules on the client's face & nose

A The Moro (startle) reflex is elicited in newborns by stimulating a falling sensation; the infant extends and raises the arms & then curls into fetal position. An absent Moro reflex may indicate brain or spinal cord underdevelopment or damage. Other findings are normal.

The nurse is providing education to several first-trimester pregnant clients. Which client requires priority anticipatory teaching? A)Client who gardens & eats homegrown vegetables B)Client who has gained 4 lbs from pre-pregnancy weight C)Client who has noticed thin, milky white discharge D)Client who practices yoga and swims in pool 3x a week

A Toxoplasmosis is a parasitic infection which may be acquired from exposure to infected cat feces, ingestion of undercooked meat or soil contaminated fruits/veggies. Pregnant pts. who contract it can transmit it to fetus. Serious fetal harm can occur (stillbirth, malformations, blindness, mental disability). Pregnant women should thoroughly wash all produce & take precautions gardening. For option B, a 1-4 lb weight gain is common in 1st trimester, and 1 lb/week thereafter. For option C, This discharge (called Leukorrhea) is normal during pregnancy d/t increased levels of estrogen & progesterone. If discharge changes color, becomes malodorous or causes itching/burning further investigation is needed. Only contact sports should be avoided.

The nurse is participating in an obstetrical emergency simulation in which a client is hemorrhaging after birth d/t uterine inversion. When describing interventions, which statement by the nurse indicates a need for further education? A)I will administer a rapid infusion of IV oxytocin before the inverted uterus is corrected B)I will establish a second IV line w/ an 18 gauge catheter C)I will initiate serial BP monitoring q3-5 mins D)I will notify anesthesia & OR staff of the client's condition immediately

A Uterine inversion is a postbirth complication in which the uterine fundus collapses into the uterine cavity, resulting in sudden hemorrhage & hypovolemic shock. Initially, a soft, uncontracted uterus is needed to correct the inversion (manual uterine replacement) & uterotonic administration (oxytocin) is delayed until after the uterus is replaced. If manual uterine replacement through the vagina is unsuccessful, emergency laparotomy (replacement via abdominal incision) may be necessary.

A client at 20 weeks gestation reports "running to the bathroom all the time," pain w/ urination & foul smelling urine. Which question is most important for the nurse to ask when assessing the client? A)Are you having any pain in your lower back or flank area B)Do you wipe from front to back after urinating C)Have you found that you urinate more frequently since becoming pregnant D)Have you had a UTI in the past?

A lower UTIs or cystitis s/s include frequency, dysuria, urgency, foul-smelling urine & sensation of bladder fullness. Pyelonephritis occurs if cystitis goes untreated & the infection ascends to the kidneys causing flank pain & fever. This can cause preterm labor risk so IV antibiotics are required. HELP CURRENT S/S

Pregancy Categories

A - Human & animal studies w/ no fetal risk; safe for use in pregnancy. B - Animal studies did not show fetal risk, no human studies done OR animal studies showed fetal risk, human studies showed no risk; likely safe to use. C - Fetal risk in animal studies w/o adequate human studies OR no adequate human or animal studies; use only if benefits outweigh risks D - Positive fetal risk in human studies or postmarketing surveillance; potential benefit may justify risk in severe circumstances X - Fetal risk in animal or human studies or postmarketing surveillance; potential benefits do not justify use in any circumstance

A client at 41 weeks gestation is admitted to the L & D unit for labor induction. The nurse is assisting the HCP w/ an amniotomy. What actions should the nurse anticipate? (select all that apply) A)Assessing the fetal HR before & after the procedure B)checking the pts. temp q 2 hrs C)Informing the client she will feel a sharp pain during the procedure D)Keeping the client in a supine position after the procedure E)Noting the characteristics of the amniotic fluid

A, B, D Amniotomy is the artificial rupture of membranes (AROM). Assess fetal HR b/c of risk of fetal bradycardia d/t prolapsed cord after AROM. Temp b/c of risk of infection increased after AROM. Nurse should assist pt. to an upright position after procedure. There may be pressure or discomfort but no pain.

A nurse is caring for a client at 30 weeks gestation who is admitted for preterm labor. Which of the following interventions should the nurse anticipate? (Select all that apply) A)Administering IM betamethasone B)Administering penicillin via IV piggyback C)Assisting w/ artifical ROM D)Initiating IV magnesium sulfate E)Obtaining fetal heart tones once per shift

A, B, D Not C b/c goal is to prolong labor & not E b/c they should be on continuous fetal monitoring w/ suspected PTL & if on magnesium sulfate. Penicillin is to prevent group B strept infection in newborn if birth occurs. Mag sulfate for infusion of fetal neuroprotection if at <32 weeks

A pt. at 38 weeks gestation is brought to the ED after a motor vehicle crash. She reports severe, continuous abdominal pain. The nurse notes frequent uterine contractions & mild, dark vaginal bleeding. What actions should the nurse take? (select all that apply) A)Anticipate emergent cesarean birth B)Apply continuous external fetal monitoring C)Assess routine vs q 4 hrs D)draw blood for type & crossmatch E)Initiate IV access w/ 22 gauge catheter

A, B, D s/s of placental abruption (also abdominal pain, hypertonic/tender uterus, tachysystole (frequent uterine CONTRACTIONS). Interventions: Continuous fetal monitoring, type & crossmatch for blood transfusions, emergent c-section in severe cases, LARGE bore IV access (16 or 18 guage)

The client is admitted to the L & D unit w/ a dx. of severe preeclampsia. IV magnesium sulfate is prescribed. Which nursing measures should the nurse include in the client's plan of care? (Select all that apply) A)assess DTR hourly B)Ensure availability of calcium gluconate C)Ensure bright lighting to prevent falls D)Have supplemental o2 at bedside E)Limit visitors to minimize stimulation

A, B, D, E NOT C b/c of CNS irritability lights should be lowered to decrease visual stimuli & risk for seizure

A nurse is evaluating the fetal monitoring strip of a laboring primigravida at 38 weeks gestation who is receiving an oxytocin infusion and has external fetal monitors and an intrauterine pressure catheter in place. Which of the following interventions should the nurse implement? (select all that apply) A)Administer supplemental oxygen by mask B)Initiate an IV bolus of 0.9% saline C)Prepare for amniofusion D)Reposition the client to supine E)Stop the oxytocin infusion

A, B, E LATE DECELERATIONS AS SEEN IN Q. Late decelerations are caused when fetal oxygenation is compromised (ex: uteroplacental insufficiency, uterine tachysystole, hypotension). INTERVENTIONS: 1)stop oxytocin 2)reposition side-lying (NOT supine b/c can obstruct blood flow to placenta) 3)O2 4)IV bolus of isotonic fluid

A client comes to the clinic indicating that a home pregnancy test was positive. The pts. LMP was September 7. Today is December 7. Which are true statements for this client? (Select all that apply) A)According to Naegele's rule, the expected date of delivery is June 14 B)Detection of the Fetal HR via Doppler is possible C)Fundal heigh should be 24 cm above the symphysis pubis D)The client should be feeling fetal movement E)Urinary frequency is a common symptom

A, B, E Pt. is 12 weeks pregnant. Fetal HR is detectable by Doppler at 10-12 weeks. Quickening (fetal movements) occur around 18-20 weeks in primigravidas & 14-16 in multigravidas

The nurse is monitoring a neonate 1 hour after spontaneous vaginal delivery. Which of the following are expected findings? (Select all that apply) A)Capillary glucose of 60 mg/dL B)Holosystolic murmur auscultated at 4th intercostal space C)Respirations of 56 bpm D)Single transverse crease across palm of the hand E)White papules on bridge of the nose

A, C, E Expected findings for a neonate at 1-3 hrs postpartum: RR 30-60; BG 40-100 & milia (white papules from plugged sebaceous glands on nose & chin) A single transverse palmar crease from is a sign of Down Syndrome (extra copy of chromosome 21).

A pregnant client at 30 weeks gestation comes to the prenatal clinic. Which vaccines may be administered safely at this prenatal visit? (select all the apply) A)Influenza injection B)Influenza nasal spray C)Measles, mumps, rubella D)Tetanus, diphtheria & pertussis E)Varicella

A, D Inactivated vaccines (ex: inactivated injectable influenza, tetanus, diptheria, pertussis) are safe during pregnancy. Live viruses are contraindicated 4 weeks prior to becoming pregnant & during (influenza nasal spray, MMR, varicella).

A nulliparous client asks about being in "real" labor. The nurse should teach that which signs are MOST indicative of true labor? (Select all that apply) A)Contractions that increase in frequency B)Contractions that lessen after resting C)Increased blood-tinged, mucoid vaginal discharge D)Pain in lower back that moves to lower abdomen E)Progressive cervical effacement & dilation

A, D, E A key indicator of true labor is the progressive effacement and dilation of the cervix. Contractions are regular & increase in frequency, duration & intensity. The pain may initially start in the lower back and radiate to the abdomen. Option B & C are not signs of true labor.

A client without prenatal care gives birth to a newborn at term gestation. The client denies opioid or other illicit drug use during pregnancy. When monitoring the newborn, which of the following signs would indicate neonatal abstinence syndrome to the nurse? (Select All That Apply) A)Irritability & restlessness B)Meconium ileus & floppy muscle tone C)Microcephaly & cleft palate D)Nasal congestion & frequent sneezing E)Poor feeding & loose stools

A, D, E AKA opioid withdrawal. Tx is opioid therapy (morphine, methadone). Clinical manifestations: Irritability, hypertonia & jittery movements, seizures (rare); Diarrhea, vomiting, feeding intolerance; Sweating, sneezing, pupillary dilation

The nurse is teaching the mother of a newborn about gastroesophageal reflux. What does the nurse suggest to help prevent reflux? (select all that apply) A)Burp during & after feeds B)Engage baby in active play after the feeding C)Feed baby in side-lying position D)Hold baby upright 20-30 mins after each feeding E)Offer smaller but more frequent feeds F)Place baby on tummy after feeding

A, D, E GER is common in infants <3 months. These infants should not be rocked or in active play for at least 30 mins after feeding. Placing them on the stomach creates abdominal pressure which can aggravate reflux. Infants should not be placed in a car seat after feedings as this can increase intra-abdominal pressure & cause reflux

A nurse is caring for a client following delivery of a stillborn infant. Which actions should the nurse take? (select all that apply) A)Ask the parents if they would like to help bathe the infant B)Discourage the parents from naming the infant C)Discourage the parents from naming the infant D)Encourage the parents & family members to hold the infant E)Offer to obtain handprints, footprints & photographs of the infant

A, D, E intrauterine fetal demise is aka stillbirth The nurse or primary HCP should call the designated organ procurement organization, according to facility protocol.

A client at 35 weeks gestation is admitted to the L & D unit for severe pre-eclampsia. She is started on IV magnesium sulfate for seizure prophylaxis. Which of the following signs indicate that the client has developed magnesium sulfate toxicity? (select all that apply) A)0/4 patellar reflex B)BP of 156/84 mmHg C)Client voiding 600 ml in 8 hrs D)Respirations of 10/min E)Serum magnesium level of 8.0 mEq/L

A, D, E S/S: Mild: nausea, flushing, headache, hyporeflexia (less than 2+) Moderate: areflexia, hypocalcemia, somnolence SEVERE: resp. paralysis, cardiac arrest Urine output <30 ml/hr is a sign. Loading dose of 4-6 g Mag sulfate followed by maintenance dose of 1-2 g/hr.

The nurse is providing nutrition counseling during a preconception visit to a client who does not eat green vegetables. In addition to a daily prenatal vitamin, which foods can the client add to the daily diet to decrease the risk of neural tube defects? (select all that apply) A)Black beans and rice B)Fortified breakfast cereal and milk C)Medium baked sweet potato D)Peanut butter on whole wheat toast E)Raw carrots with cheese dip

A,B,D Sources include: leafy greens, beans, fortified cereals, bread or pastas, rice, peanut butter. Asparagus, turnip/mustard greens, liver (2 oz cooked), broccoli, peas. Tomato or orange juice & sunflower seeds have some too.

The nurse is planning education for clients in group prenatal care who are entering the 2nd trimester of pregnancy. Which of the following are appropriate for the nurse to include in 2nd trimester teaching? (select all that apply) A)Anticipate light fetal movements around 16-20 weeks gestation B)Expect to have an abdominal ultrasound for fetal anatomy evaluation C)Gain about 1 lb (0.5 kg)/week if pre pregnancy BMI was normal D)Increase consumption of iron rich foods like meat and dried fruit E)Plan for gestational diabetes screening near the end of the second trimester

ALL 2nd trimester (14 weeks --> 27 weeks 6 day) Quickening (the client's first perception of light fetal movement) is expected 16-20 weeks. Ultrasound is done at 18-20 weeks to evaluate fetal anatomy & placenta Iron rich foods should be implemented in diet 20 weeks and after. Gestational diabetes screening is done at 24-28 weeks. IN ADDITION: preterm labor s/s reviewed at 20 weeks

A client indicates the desire to become pregnant. Which of the following are important preconception education topics for the nurse to provide? (select all that apply) A)Aim for BMI of 18.5-24.9 kg/m2 B)Avoid alcohol consumption & tobacco products C)Ensure daily intake of 400 mcg of Folic acid D)Obtain testing for rubella immunity E)Schedule dental wellness appointment

ALL folic acid supplementation for 3 months before pregnancy to reduce incidence of neural tube defects. Periodontal disease is associated w/ poor pregnancy outcomes.

A pregnant client is brought to the emergency department by ambulance after her water broke. She is screaming and bearing down w/ every contraction. Which of the following assessment questions are essential to ask in preparation for the birth and possible newborn resuscitation? (select all that apply) A)Did you receive the influenza vaccine during pregnancy? B)Do you take any medication or illicit drugs? C)How many babies are you expecting? D)What color was the fluid when your water broke? E)When is your due date?

ALL EXCEPT A A is not immediately pertinent & can be delayed until after birth

The initial prenatal laboratory screening results of a client at 12 weeks gestation indicate a rubella titer status of non immune. What will the nurse anticipate as the plan of care for this client? A)Administer measles-mumps-rubella (MMR) vaccine now B)Administer MMR vaccine immediately postpartum C)Administer MMR vaccine in the 3rd trimester D)AN MMR vaccine is not indicated for this patient

B A serum sample is collected for rubella virus immunity on the first prenatal visit. A positive response means immunity, but a negative nonimmune or partial immunity result are treated w/ vaccine. The live vaccine is contraindicated during pregnancy but is safe during breastfeeding. Pregnancy should also be avoided for 1-3 months after administration. Maternal rubella infection can be teratogenic for fetus.

The nurse provides discharge instructions to a client at 14 weeks gestation who has received a prophylactic cervical cerclage. Which client statement indicates an understanding of teaching? A)I need to be on bed rest for the duration of my pregnancy B)I will notify my HCP if I start having low back aches C)Pelvic pressure is to be expected after cerclage placement D)The cerclage will be removed once my baby is at 28 weeks

B Cervical cerclage is placed to prevent preterm delivery, usually in pts. w/ histories of 2nd trimester loss of premature birth. A heavy suture is placed transvaginally or transabdominally to keep the internal cervical os closed. Placement occurs at 12-14 weeks gestation for pts. w/ hx. of cervical insufficiency (painless, premature cervical dilation & miscarriage or preterm delivery) or up to 23 weeks gestation if signs of cervical insufficiency (ex: short cervix) are noted. Discharge instructions include activity restriction (bed rest for a short time after placement) & recognition of signs of preterm labor (ex: low back aches, regular contractions, pelvic pressure) & rupture of membranes. Option A: long term bed rest is individualized but uncommon (increases risk of DVT). Pelvic rest (avoiding sexual intercourse) determined by HCP. Option C: Mild abdominal cramping is common following cerclage placement. Option D: The cerclage remains in place until 36-37 weeks gestation. Early removal indicated by rupture of membranes (to prevent infections) or preterm labor (to prevent damage to cervix as it dilates).

The graduate nurse (GN) is caring for a client at 20 weeks gestation w/ secondary syphilis. The client reports an allergic reaction to penicillin as a child but does not know what kind of reaction occurred. When discussing the client's potential tx. plan w/ the precepting nurse, which statement by the GN indicates an appropriate understanding? A)Doxycycline is an acceptable alternative to penicillin for tx. of syphilis during pregnancy B)The client will require penicillin desensitization to receive appropriate tx. C)The newborn can be treated after birth if antepartum tx. is contraindicated D)Tx. is only effective if provided during the primary stage of syphilis

B Doxycycline is contraindicated in pregnancy b/c it can impair fetal bone mineralization & discolor permanent teeth. Some infants may require tx. after birth, complications can be prevented w/ prenatal tx. Many clients w/ primary syphilis have nonreactive serologic tests d/t delay in antibody development. IM penicillin therapy is appropriate for tx. of primary, secondary or latent syphilis.

The nurse is assessing a pt. at 36 weeks gestation during a routine prenatal visit. Which statement by the pt. should the nurse investigate first? A)I am not sleeping as well due to cramps in my calves at night B)I have noticed less kicking movements as the baby grows bigger C)Over the last few weeks, I have not been able to wear any of my shoes D)Sometimes I feel SOB after walking up a flight of stairs

B Fetal movement & HR are signs of fetal health. Fetal movements should not decrease as the fetus increases in size. Decreased fetal movement is a potential warning sign of fetal compromise (ie. impaired oxygenation). Other options are common discomforts.

The nurse is caring for a pt. in the first trimester during an initial prenatal clinic visit. Based on the info provided by the pt, which factor places the pt. at an increased risk for preterm labor? A)age 25 B)periodontal disease C)vegetarian diet D)white ethnicity

B Infection - UTI or periodontal disease are strongly associated w/ preterm labor esp. when untreated. Infection releases inflammatory mediators such as prostaglandins which are uterotonic (promote contractions). Other risk factor s: Hx of preterm birth, previous cervical surgery (cone biopsy), tobacco or drug use, maternal ages <17 or >35. Non-hispanic black women.

A nurse is caring for a baby born at 30 weeks gestation and diagnosed with necrotizing enterocolitis. Which nursing action should be implemented? A)Encourage parents to increase skin to skin care B)Measure abdominal girth daily C)Measure rectal temperature every 3-4 hours D)Position client on side and check diaper for stool

B Necrotizing enterocolitis is a life-threatening complication in preemies d/t underdeveloped intestine & gut immunity. Frequent abdominal girth measurements are essential to assess for worsening distension. Clients are placed supine & undiapered. AVOID RECTAL TEMPS!

A graduate nurse is caring for a client at 39 weeks gestation who is receiving an oxytocin infusion. Oxytocin is infusing at 20 mU/min. Based on the electronic fetal monitoring strip (showing late decelerations), which action by the graduate nurse would cause the registered nurse to intervene? A)Administers o2 by face mask at 10L/min B)Decreases oxytocin to 10 mU/min C)Notifies the HCP D)Repositions the client to left lateral position

B Simply decreasing the dose is inappropriate - must STOP OXYTOCIN. Also side-lying position, o2, IV fluid bolus, notify HCP, document, Prepare to administer SQ terbutaline (Brethine) to relax uterus Uterine tachysystole (>5 contractions in 10 mins averaged over 30 mins) + late decelerations.

A laboring client with epidural anesthesia experiences spontaneous rupture of membranes, immediately followed by an abrupt change in the fetal HR. The nurse knows that considering the probable cause of the change in the fetal HT, which action should be taken first? A)Administer IV fluid bolus B)Assess for umbilical cord prolapse C)Notify the HCP D)Reposition client to alternate side

B umbilical cord prolapse causes cord compression, fetal HR deceleration and disruption of fetal oxygen supply. The priority w/ fetal bradycardia after suspected rupture of membranes is to assess for a prolapsed cord. The nurse should then manually elevate the presenting fetal part off the cord, leave the hand in place, and call for help.

The client at 34 weeks gestation reports constipation. The client has been taking 325 mg ferrous sulfate tid for anemia since the last appointment 4 weeks ago. Which recommendations should the nurse make for this client? (select all that apply) A)Decreased daily dairy intake B)Increased fruit & veggie intake C)Moderate-intensity regular exercise D)One laxative twice daily for a week E)Two cups of hot coffee each morning

B & C Interventions: high fiber diet (fruits, veggies, cereal, whole grain, prunes), high fluid intake (10-12 cups), regular exercise (walking, swimming, aerobics) & bulk forming fiber supplements: psyllium, methylcellulose, wheat dextrin. laxatives & greater than 300 mg of caffeine/day are not recommended in pregnancy.

A nurse is preparing to administer oxytocin to induce labor in a pregnant client at term gestation. Which of the following nursing actions are appropriate during oxytocin infusion? (Select all that apply) A)Administer oxytocin through the primary IV line B)Assess the uterine contraction patten C)Initiate continuous fetal HR monitoring D)Place IV oxytocin on an electronic infusion pump E)Titrate oxytocin to achieve cervical dilation of 1 cm every 2 hours

B, C, D Oxytocin goes through secondary line on electronic infusion pump & is titrated to achieve adequate contraction pattern until contractions are 2-3 mins apart and last for 80-90 seconds starting at lowest possible dosing (to prevent uterine tachysystole). NOT titrated based on cervical dilation.

The nurse is performing an assessment on a 2-day-old infant w/ suspected Hirschsprung disease. Which findings should the nurse anticipate? (select all that apply) A)Bright red bleeding from anus B)Distended abdomen C)Has not passed stool (meconium) D)Nonbilious vomiting E)Refusal to feed

B, C, E Hirchsprung disease is caused by lack of specialized nerve cells in portions of the distal large intestine; this renders the internal sphincter unable to relax & there is no peristalsis. Infants will not pass meconium & have distended abdomens & bilious emesis (vomit).

The nurse is performing the initial assessment of a newborn. Which of the following findings should the nurse report to the HCP? (select all that apply) A)Cyanosis of the hands & feet B)Decreased muscle tone C)HR of 150/min D)Sacral dimple w/ 0.4 min (1cm) skin tag E)Single artery in the umbilical cord

B, D, E Abnormal findings in newborns include: decreased muscle tone (may indicate congenital issue or spinal injury), sacral dimple (spina bifida) & single artery (should be 2 arteries + 1 vein) in umbilical cord.

The nurse is performing an assessment on a 39 week neonate an hour after a spontaneous vaginal delivery. What are common expected newborn findings? (Select all that apply) A)One artery and one vein in the umbilical cord B)Plantar creases up the entire sole C)Skin on the nose blanches to a yellowish hue D)Toes fan outward when the lateral sole surface is stroked E)White pearl-like cysts on gum margins

B, D, E Expected (normal) finding for a term newborn include plantar creases up the sole of the foot, Babinski reflex (toes hyperextend & fan out - lasts 1 yr) & Epstein's pearls (disappear within weeks)

The graduate nurse is assisting the nurse preceptor to provide education to a client diagnosed with a molar pregnancy. Which statement by the GN requires the precepting nurse to intervene? A)A uterine evacuation procedure is the typical tx. for removing the abnormal tissue B)We can provide you with resources for coping with perinatal loss if needed C)You may start trying to conceive again as soon as you and your partner feel ready D)You will need Rh immune globulin following a molar pregnancy because you have a Rh-negative blood type

C A molar pregnancy or hydatidiform mole is a type of gestational trophoblastic disease from abnormal fertilization. It causes rapidly growing trophoblastic tissue that is initially benign but may progress to gestational trophoblastic neoplasia (GTN) (EX: invasive mole, choriocarcinoma). This results in levels of HCG to rise. Therefore, it is important to avoid pregancy while following up/monitoring these levels for 6-12 months postpartum. D is true b/c trophoblastic cells may contain genetic material that expresses the Rh factor.

The graduate nurse (GN) receives report on a postpartum client w/ an Rh-negative blood type. Which statement by the GN regarding the Rh immune globulin injection requires the preceptor to provide further teaching? A)Additional doses of Rh immune globulin may be required if excessive fetomaternal hemorrhage is suspected B)I should administer Rh immune globulin to the client within 72 hrs after birth C)If the maternal antibody screen is negative, I will hold Rh immune globulin and contact the HCP D)Rh immune globulin is not required if the newborn's blood type is Rh negative

C After the first birth in an Rh- mother, the Rh+ infants RBCs enter maternal bloodstream & generate maternal anti-D antibodies. These Anti-Rh (D) antibodies cross placenta & cause lysis of fetal RBCs in future pregnancies. Rh immune globulin (RhoGAM) prevents antibody formation by suppressing the maternal immune response and is effective only if the client has never developed antibodies to the Rh antigen (Rh sensitization). The nurse should verify that the client is not Rh sensitized by checking for a negative antibody screen (ex: indirect Coombs tests) and then proceeding w/ administration of Rh immune globulin. It should be administered within 72 hours of birth. If the newborn is Rh negative, Rh immune globulin is NOT necessary.

A newborn client is seen in the ED for vomiting. Which assessment finding indicates a possible emergency? A)Frequent vomiting since birth B)Tiny blood streaks in the vomit C)Vomit that is green D)Vomiting through the nose

C Bile made by the liver is green and is released into duodenum. When there is an intestinal obstruction & stool cannot pass, it may come back up as green vomit. A bowel obstruction is an emergency that can lead to bowel rupture, peritonitis & sepsis. Tiny blood streaks may be from rupture of esophageal veins from frequent vomiting. This is not cause for concern UNLESS large amt. of blood or persists. Scant amounts seen in vomit can be normal. It is not uncommon for a newborn to have vomiting through the nose b/c the esophagus is connected to the nose & mouth. The vomit comes up through the esophagus & if forceful enough, will come out both orifices.

The nurse is performing assessments of several clients during prenatal visits. Which client should the nurse discuss w/ the health care provider first? A)Client at 30 weeks gestation w/ darkened patches of skin on the face B)Client at 32 weeks gestation w/ painless, flesh-colored bumps on the perianal area C)Client at 34 weeks gestation w/ intense itching on the hands & feet that worsens at night but no rash D)Client at 38 weeks gestation w/ stretch marks on the abdomen that have become reddened and pruiritc

C Intrahepatic cholestasis of pregnancy is a liver disorder exclusive to pregnancy which manifests w/ intense, generalized itching (esp. on hands/feet & worsens at night) but with no rash. The condition requires immediate intervention as it increases risk of fetal demise. Management includes lab testing (ie. elevated bile salts), fetal surveillance (biophysical profile, nonstress test), medication (ursodeoxycholic acid) and labor induction around 37 weeks. It resolves after birth

The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client's assessment findings are most important to report to the health care provider? A)Client at 28 weeks gestation with an asymptomatic systolic murmur B)Client at 34 weeks gestation with 1+ edema of bilateral lower extremities C)Client at 35 weeks gestation with painful genital lesions D)Client at 39 weeks gestation with brownish, mucoid vaginal discharge

C Painful genital lesions can be genital herpes simplex virus (HSV) & can be transmitted to infant in utero (congential HSV), perinatally or postnatally from direct contact. Neonatal HSV has serious morbidity (ex: permanent neurologic sequealae) & mortality. Immediate antiviral therapy must be initiated (acyclovir). Vaginal births are not recommended w/ active lesions (c-section instead). For option A, a systolic murmur is common during pregnancy from increased total body flow (flow murmur) and resolves postpartum, Option B, edema in the LE is common in 3rd trimester. Option D, this is expected esp. in days approaching labor

The nurse receives report for a client at 36 weeks gestation who is being transferred to the unit for labor induction from a rural health care facility w/ an intrauterine fetal demise of unknown duration. Which intervention is MOST important when receiving care of the client? A)Apply tocodynamometer & evaluate current contraction pattern B)Ask the pt. about the family's desire for speaking w/ a chaplain C)draw coag tests, fibrinogen & CBC w/ platelets D)Initiate oxytocin rx. to begin induction of labor

C Pregnant pts, esp. those w/ placental abruption or intrauterine fetal demise, are at risk for developed DIC (disseminated intravascular coagulation). The nurse should prioritize assessment for s/s of DIC (ie. abnormal labs (coag studies, fibrinogen, platelets) & signs of bleeding). Next would be induction of labor, THEN apply toco.

The nurse is performing an assessment on a neonate shortly after delivery. The nurse is MOST concerned about which assessment finding? A)Bilateral rales found on lung auscultation B)Dullness over bladder found on percussion C)Ptosis of right eyelid found on facial inspection D)Single testicle found on genital palpation

C Ptosis (drooping of the eyelid below level of pupil) could indicate paralysis of the oculomotor nerve. Crackles are expected immediately after birth and rales will clear. Wheezes, stridor or persistence of crackles after the first few hours of birth are abnormal. Percussing dullness in the hypogastric area is normal when the bladder is full. The neonate should void spontaneously within a few hours after birth. Most undescended testes spontaneously descend by age 6 months.

The nurse receives report on 4 first-trimester pregnant clients. Which client should the nurse assess first? A)Client with hydatidiform mole reporting dark brown vaginal discharge B)Client with hyperemesis gravidarum reporting excess vomiting & weight loss C)Client w/ suspected ectopic pregnancy reporting abdominal and shoulder pain D)Client w/ suspected miscarriage who states "I'm a Jehovah's Witness"

C Ruptured ectopic pregnancy presents as unilateral abdominal pain, hypotension, vaginal spotting/bleeding & referred shoulder pain. It results when a fertilized egg implants & begins to grow outside the uterine cavity (most commonly Fallopian tubes). Ectopic pregnancy rupture --> hemorrhage & hemodynamic compromise & require emergency surgical intervention & hemodynamic support. For option A, dark brown vaginal discharge is suspected w/ molar pregnancies (which are edematous, cystic chorionic villi) until the pregnancy is evacuated. For Option B, this is normal presentation for condition and usually not life-threatening.

The postpartum nurse is assessing a client who gave birth by cesarean section 5 hours ago and is requesting pain medication. The client appears restless, has a HR of 110/min and admits to recent onset of anxiety. What priority action should the nurse take? A)Assess for lower extremity warmth and redness B)Instruct the client in relaxation breathing techniques C)Obtain oxygen saturation reading by pulse oximeter D)Offer the client prescribed PRN pain medication

C S/S of Pulmonary Embolism (greater risk w/ c-section) are ANXIETY/RESTLESSNESS, SOB, chest pain/tightness, tachycardia, hypoxemia, hemoptysis

A pregnant client at 39 weeks gestation is brought to the emergency department in stable condition following a motor vehicle collision. The client, who is secured supine on a backboard, suddenly becomes pale with a BP of 88/50 mmHg. Which action should the nurse take first? A)Administer NS fluid bolus B)Ask about any prenatal complications C)Initiate fetal HR monitoring D)Tilt the backboard to one side

D During stabilization of pregnant pt. after trauma, uterine displacement is the first step to prevent/correct supine hypotension and stimulate fetal blood circulation. May correct aortocaval compression. C would be next step. Isotonic fluids should be considered if position change does not help hypotension or if hemorrhage from placental abruption is suspected.

A laboring client, gravida 3 para 2, is admitted to the labor unit reporting severe perineal pressure & urgently requesting pain relief. The client's cervix is 10 cm dilated and 100% effaced, with the fetal head at 0 station. Which pain management technique is most appropriate for this client's report of perineal pressure? A)Epidural anesthesia B)Hydrotherapy C)IV narcotics D)Pudendal nerve block

D A pudendal nerve block can provide pain relief for clients experiencing perineal pressure in the late second stage of labor. It may also be used in preparation for forceps-assisted birth or laceration repair in clients w/o an epidural. It does NOT provide relief of contraction pain. IV narcotics cross placenta & should not be administered close to birth. An epidural is given in the first or early second stage of labor but may not be feasible in this late second stage when birth is imminent.

The nurse is monitoring a client who is 6 cm dilated w/ recurrent variable decelerations on the FHR monitor. The HCP places an intrauterine pressure catheter and prescribes an amnioinfusion. After the amnioinfusion bolus is complete, which assessment finding should the nurse report to the HCP immediately? A)Cervix is 8 cm dilated & 100 % effaced w/ fetal presenting part at +1 station B)Contractions are every 3 mins and 60-80 seconds each C)Fetal HR baseline is 155/min w/ early decelerations and moderate variability D)Uterine resting tone baseline has increased to 45 mm Hg and perineal pads are dry

D An amnioinfusion is a transvaginal infusion of isotonic fluids through an intrauterine pressure catheter to compensate for low amniotic fluid & relieve recurrent variable decelerations. The nurse should monitor for an elevated uterine resting tone baseline & minimal to absent fluid return, which may indicate uterine overdistension.

The nurse is caring for a 1 day old client at term gestation who is irritable, feeding poorly and only sleeping for very short intervals.. The newborn's mother informs the nurse that she has been taking hydrocodone on a regular basis for several years. Which intervention is appropriate to include in the newborn's plan of care? A)Avoid giving the newborn a pacifier B)Position the newborn supine after feeding C)Stimulate the newborn w/ light regularly D)Swaddle & gently rock the newborn

D At risk for neonatal abstinence syndrome. Swaddling & gentle, rhythmic rocking can soothe newborn, MINIMIZE STIMULATION & prevent skin excoriation from excessive movement cause by hyperactivity & restlessness.

The nurse performs initial assessments of 4 clients in a prenatal clinic. Which client findings are abnormal & require further assessment? A)client at 9 weeks w/ normal BMI & weight gain of 2 lb from pre-pregnancy weight B)Client at 15 weeks w/ headaches relieved by acetaminophen C)Client at 19 weeks gestation w/ bleeding gums after brushing & flossing teeth D)Client at 20 weeks gestation w/ an increase in diastolic BP of 15 mm Hg since last visit

D BP decreases slightly during pregnancy. MONITOR FOR HTN disorders of pregnancy - some clients w/ only mildly elevated BP may develop eclampsia or HELLP syndrome. An increase in BP > or = 30 mm Hg systolic or 15 mm Hg diastolic is abnormal. All other options normal.

The obstetric nurse is reviewing phone messages. Which client should the nurse call first? A)Client at 18 weeks gestation taking ceftriaxone and reporting mild diarrhea B)Client at 22 weeks gestation w/ twins who is taking acetaminophen twice a day C)Client at 28 weeks gestation taking metronidazole and reporting dark colored urine D)Client at 32 weeks gestation taking ibuprofen for moderate back pain

D NSAIDS (ibuprofen) are pregnancy category C during 1st two trimesters (only take if benefits outweigh risks under supervision of MD) & pregnancy category D during the third trimester d/t the risk of causing premature closure of the ductus ateriosus. For option A, these beta lactam antibiotics (amoxicillin, Rocephin (ceftriaxone) are pregancy category B. They may cause diarrhea. For option B, acetaminophen (preg category B) should not exceed 4g/day including any combination meds which contain it. For option C, Flagyl (metronidazole) is preg. category B and dark urine is suspected.

A nurse is caring for a pt. at 12 weeks gestation admitted for hyperemesis gravidarum. Which clinical manifestation should the nurse expect? A)Abdominal pain & low grade fever B)BP > or = 140/90 mm Hg C)High urine protein level D)Moderate to high urine ketones

D S/s: SEVERE PERSISTENT N & V, weight loss, poor skin turgor, dry mucous membranes, hypotension, tachycardia LABS: hypokalemia/hyponatremia, ketonuria, increased urine specific gravity, hemoconcentration, metbolic alkalosis. FLUID & ELECTROLYTE IMBALANCES, DEHYRDATION, HYPOVOLEMIA

The nurse is teaching a clas of expectant parents about infant safety. Which statement by the class participant indicates a need for further instruction? A)I will allow my baby to sleep w/ a pacifier B)I will dress my baby in a sleep sack to prevent my baby from getting cold C)I will make sure there is a firm mattress in the crib D)I will tie bumper pads to the sides of the crib to protect my babys head

D SIDS is the leading cause of death among infants 1 month-1 year. SIDS protocol is to avoid bumper pads b/c never cribs have improved side rails to prevent the infants head from getting stuck b/t slats. In addition: smoke free environment, breastfeed, immunizations, nothing in bed & sleep supine (on back) on firm surface. Other options help reduce incidence of SIDS.

A laboring client reports feeling the need to have a bowel movement and begins vomiting. The nurse notes that the client's legs are trembling. What cervical examination finding would the nurse most expect this client to have? A)2 cm dilated, 50% effaced, -2 station B)6 cm dilated, 70% effaced, -1 station C)7 cm dilated, 80% effaced, 0 station D)8 cm dilated, 100% effaced, +1 station

D The end of the first stage of labor (8-10 cm dilation) is commonly referred to as the "transition phase", characterized by perineal/rectal pressure. Descent of fetal station (+1 station or greater) often results in N&V, trembling or shivering; also increased pain, self-doubt, anxiety, irritability, fear.

A pregnant client comes in for a routine first prenatal examination. According to the LMP, the estimated gestational age is 12 weeks. Where would the nurse expect to palpate the uterine fundus in this client? A)12 cm above the umbilicus B)At the level of the umbilicus C)Halfway between the symphysis pubis and the umbilicus D)Just above the symphysis pubis

D The enlarging pregnant uterus should be just above the symphysis pubis at approximately 12 weeks. It reaches the umbilicus at 20-22 weeks gestation & reaches the xiphoid process at 36 weeks gestation. AFTER 20 WEEKS, the fundal height in cm correlates to the weeks of gestation.

The labor and delivery charge nurse receives report on several clients. Which task is appropriate for the nurse to delegate to the unlicensed assistive personnel? A)Assist a client to the restroom 1 hour after a vaginal birth w/ regional anesthesia B)Check the perineal pad of a client who is in triage w/ possible rupture of membranes C)Obtain vital signs on a newborn who is skin-to-skin w/ the mother 1 hour after birth D)Reposition an unmedicated client who is in active labor onto a birthing ball

D UAP may perform low-risk , routine tasks that have predictable outcomes and do not require clinical judgment or assessment. Option A & B require assessment & option C is unstable

A nurse is caring for a client following a forceps-assisted vaginal birth. The client reports severe vaginal pain & fullness. On assessment, the nurse notices a firm, midline uterine fundus. Lochia rubra is light. Which diagnosis should the nurse anticipate? A)Cervical lacerations B)Inversion of the uterus C)Uterine atony D)Vaginal hematoma

D Vaginal hematomas may be caused by operative vaginal delivery or episiotomy. The pt. reports severe pain or persistent feeling of fullness in the region. Assessment shows a firm, midline uterine fundus w/ minimal or unchanged vaginal bleeding. If the hematoma is large the Hgb level and vital signs may be an important indicator of hematoma.

The nurse is evaluating a client's understanding of postcircumcision care for a 24 hr old newborn. Circumcision was performed using the clamp method. Which statement by the client demonstrates a need for further teaching? A)Bleeding should be no larger than the size of a quarter B)I should cleanse the glans w/ warm water occasionally C)I should expect at least 2 wet diapers in the next 24 hours D)Yellow exudate on the glans penis indicates infection

D Yellow exudate on the glans penis indicates normal healing. Exudate should not be removed forcefully & disappears within 2-3 days. Unusual swelling, increasing redness, odor, abnormal discharge, excessive bleeding or absent/decreased urine output should be reported.

The nurse is caring for a client who reports severe abdominal pain and vaginal spotting. The client had a positive urine pregnancy test at home, and her last menstrual period was 8 weeks ago. Which client report to the nurse is most concerning? A)Abdominal pain rated as 8 out of 10 B)History of pelvic inflammatory disease C)Intermittent nausea & vomiting for the past 7 days D)Right shoulder pain & dizziness

D s/s of ectopic rupture (hypotension/dizziness, referred shoulder pain, unilateral abdominal pain, tachycardia) It is not A b/c this is sign of a unruptured ectopic pregancy as pain is not severe.

Syphilis screening during pregnancy

For ALL in initial prenatal visit & high risk pts. again during 3rd trimester & labor.

Shira is 37 weeks pregnant with a girl, she has 2- year-old twin boys born at 35 weeks. At 16 years old, she had an elective abortion when the fetus was 8 weeks gestation. Using GP and GTPAL, what should the nurse document in the client's chart?

GP = 3, 1 GTPAL = 3-0-2-1-2

A pregnant client arrives in the L&D unit w/ mild contractions & brisk, painless bleeding. The client received no prenatal care & reports being 7-8 months. Which actions should the nurse anticipate? (select all that apply) A)Blood draw for type & screen B)Electronic fetal monitoring C)Initiation of 2 large bore IV catheters D)Pad counts to assess bleeding E)Vaginal examination for cervical dilation

all except E Placenta previa is suspected in pts. presenting w/ painless vaginal bleeding after 20 weeks gestation. Type & screen for potential blood loss. Fetal monitoring to assess appropriate timing of birth. LARGE BORE iv access for anticipated fluid resuscitation & blood transfusion. PELVIC REST - nothing by vagina & vaginal examinations contraindated.

Cholasma (melasma)

pregnancy mask due to increased melanocytes usually appears in 2nd trimester, is benign and fades postpartum.

Ectopic pregnancies may report a positive _______.

pregnancy test

PUPP

pruritic urticarial papules and plaques of pregnancy. Form w/in abdominal striae, spare the umbilicus & may spread to arms, legs & back. Discomfort but not harmful

Ectopic Pregnancy Risk Factors

recurrent STIs, tubal damage or scarring, intrauterine devices, previous tubal surgeries (tubal litigation for sterilization)

Delayed PPH (> 24 hours after birth) usually results from _______ associated with a long third stage of labor, lasting >____ minutes.

retained placental fragments, 30 mins

Eclampsia occurs when a ______ happens in women with existing preeclampsia.

seizure/coma

Neonates are unable to generate heat by _____ d/t their lack of muscle tissue & immature nervous systems; they therefore produce heat by increasing their metabolic rates through ______________. __________, developed during the 3rd trimester, is metabolized for thermogenesis when available. Once BAT is depleted, the neonate may experience cold stress & since _____ neonates have fewer stores they are at higher risk for cold stress.

shivering; nonshivering thermogenesis; Brown adipose tissue (BAT)

Placenta previa found early in pregnancy may resolve by ______. Women w/ persistent placenta previa or hemorrhage require ______.

third trimester; immediate c-section

Carpal tunnel syndrome in pregnancy & postpartum

tingling or burning sensation of the hands caused by physiologic fluid retention in pregnancy causing medial nerve compression

Zika Virus

transmitted by mosquitos, sexually and infected bodily fluids. S/s: low grade fever, athralgias. In fetus, causes microcephaly, encephalitis & developmental dysfunction. Women should avoid travel to areas w/ Zika. If live in area: use DEET, safe sex practices and routine Zika testing.

The posterior fontanel is ____ shaped & smaller than the ___ shaped anterior fontanel.

triangle, diamond

Clients attempting vaginal birth after cesarean are slightly increased risk for ________.

uterine rupture

Amniofusion is administered through intrauterine pressure catheter to relieve ____ decelerations.

variable - usually caused by cord compression s/t loss of amniotic fluid (after ROM or b/c of oligohydramnios)

A holosystolic murmur (heard during the entire systole phase) at the left sternal border is a classic sign of a _______ defect.

ventricular septal (VSD) - most spontaneously close within 1st 6 months of life

Prevention of supine hypotensive syndrome includes using a ____ under the clients hip while in a supine position.

wedge