OB final/ Holding Avery

After a class for expectant parents on the various forms of birth control after the birth of their newborn, the nurse realizes 1. more training is needed when a participant makes which comment?

I'm going to be breastfeeding occasionally, so we won't need to use any other birth control for at least 6 weeks

An adolescent patient asks the nurse about how the ovaries work. The nurse would include which information in the reply?

Storage of ova and maturation of them is one of the main functions of the ovaries

A woman is admitted for repair of cystocele and rectocele. She has nine living children. In taking her health history, what would the nurse expect to find?

Stress incontinence with felling of low abdominal pressure

Which assessment finding would indicate dehydration in the newborn?

Sunken fontanels

After teaching a group of expectant mothers about how to best protect the fetus while in utero, which statement by a mother would best validate understanding of the teaching session?

"I will not take any medications that the doctor has not prescribed without checking first."

A patient at 36 weeks' gestation comes in for her weekly primary care provider visit. She tells the nurse, "I am having contractions, but they are irregular and go away when I rest. Do you think I am going into labor?" The best response by the nurse would be:

"These are called Braxton-Hicks contractions and are preparing your body for labor, but are not "true" labor contractions."

A patient who is breastfeeding her newborn tells the nurse, "I notice that when I feed him, I feel fairly strong contraction-like pain. Labor is over. Why am I having contractions now?" which response by the nurse would be the MOST appropriate?

"Your baby's sucking releases a hormone that causes the uterus to contract."

What is the primary goal of nursing care immediately after birth?

. To maintain the safety of the neonate from intrauterine to extrauterine life.

APGAR assessments are routinely taken at which timing intervals following birth of a newborn? a. 5 and 10 minutes b. 1 and 10 minutes c. 1, 5, and 10 minutes d. 1 and 5 minutes

1 and 5 minutes

On the above fetal monitoring strip, provide the following information: baseline FHR; duration of first contraction; periodic pattern; intervention necessary

150-160; 90; early decel; no intervention.

When did Heidi write her story?

4 years after Averys death

A woman has six children, with two sets of twins, and she has had one miscarriage at 18 weeks. When documenting parity on the medical note, which number would the nurse note?

4- each twin set is 1 pregnancy, the miscarriage is before viable

Maternal psyche is an important consideration for achievement of a positive birth outcome. Which is not?

A focus on technology during the birth experience will promote a trusting relationship between the nurse and patient

Which maternal factor may inhibit fetal descent?

A full bladder

Your patient, who is a primigravida, has come to the prenatal clinic for scheduled visit. She is concerned about her facial chloasma which has developed since her last prenatal visit. What is the best response by the nurse?

Avoiding sun exposure may help to reduce the pigmentation from getting any darker.

Where did they get the name Avery from?

Binder company (office supply company)

Heidis SROM and the date? How far along was Heidi

Bloody gush of discharge at 12:20am June 30th 37 1/2 weeks pregnant

During assessment of the mother during the postpartum period, what sign should alert the nurse that the patient is likely experiencing uterine atony?

Boggy (soft) or relaxed uterus

Assessment of a patient reveals evidence of cystocele. The nurse interprets this as:

Bulging of the bladder into the vagina

Pt has a positive history of genital herpes is in active labor. The nurse should prepare the pat for which type of birth?

C-section

What was the name of her second child?

Carter Christopher Chandler

Which event is the best indicator of true labor?

Cervical dilation and effacement

Birth for the nulliparous woman with a fetus in a breech presentation is usually a:

Cesarean section

What happened in September 2009

Chris was offered a job 1200 miles away in Texas

An IUD has been inserted into a patient as a requested birth control method. What is an advantage

Continuous protection without clients active participation

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy?

Human Chorionic gonadotropin (hCG)

1. Pt presents at a clinical for emergency contraception. The nurse explains that EC must be used withing 72 hrs to be effective:

EC prevents embryo creation and uterine implantation from occurring

As the student nurse providing couplet care (care of mother and her newborn), a mother is concerned about the bluish discoloration of her baby's hand and feet. What is your best response to this new mother?

Educate the new mother that this is a normal finding and it should resolve itself as the baby continues to transition to life outside of the womb.

A primipara, 30 weeks' gestation, has no family support and frequently calls the health care provider's office with questions. Which report by the woman would alert the nurse that she may be having a complication related to the pregnancy and needs to come to the clinic for further assessment?

Feeling of an achy, cramping in vaginal area accompanied by bleeding that has saturated 1 pad/hour.

The nurse is planning to teach a class of expectant parents about the cardinal movements that occur as the fetus passes through the birth canal

Flexion, Internal Rotation, External Rotation, Expulsion

Duration of a contraction is best measured:

From the start of contraction to the end of the contraction

Your patient presents to triage and reports increased energy, contractions, and carrying baby lower

From what you describe, it seems as though your body is preparing for delivery. These are all normal findings and are considered

When doing a health assessment, at which location would the nurse expect to palpate the fundus in a woman on the second postpartum day and how should it feel?

Fundus two fingerbreadths (2cm) below the umbilicus and firm

The pregnant patient (G1) reports that she has a 3 y.o. child at home (G2; P1) who was born at term, had a miscarriage at 10 weeks gestation (G3) and delivered a set of twins at 28 weeks gestations (G4; P2) that died within 24 hours of birth. How should the nurse record the patient's status in the prenatal record?

G 4; P 2

Following confirmation of pregnancy, the patient has come to the clinic for her first prenatal visit (G1;P1;L2). She reports having a 5 y.o. child who was born at 40 weeks gestations (G2;T1;L2), a set of 3 y.o triplets who were born at 34 weeks gestations (G3;P1;L3) and a first trimester abortion (A1) when she was in college. On her medical record, the nurse would make which entry?

G4; T1; P1;A1;L4

Holding Avery: Where did Heidi grow up?

Gaylord MI

A nurse is caring for a preg pt whose fetus has been diagnosed with macrosomia. When reviewing the pt history, which information would the nurse expect to find?

Gestational diabetes

Which hormone stimulates the release of the follicle-stimulating hormone (FSH) from both make and female glands?

Gonadotropin-releasing hormone (GHR)

What did Heidi do for work?

High school journalism teacher and did the yearbook

Which of the following pt responses indicates that the nurses teaching about care following chorionic villus sampling has been successful?

If the woman starts to bleed or to contract, she should notify her provider

The nurse auscultates the fetal heart rate and determines a rate of 120. Which nursing intervention is appropriate?

Inform the mother that the rate is normal

Which measure may prevent engorgement in a breastfeeding mother?

Initiate early and frequent feedings

A new parent is distraught and asks the nurse, "Is there something wrong with my newborn?" My newborn has a white discharge coming from the breasts." What will the nurse explain to the parent about this discharge?

It is caused by the mother's hormones

The nurse is reviewing the functions of the ovaries, uterus, clitoris and vagina with a group of high school students. What would be the BEST response by a high school student about the function of the vagina?

It receives sperm, provides an exit for menstrual flow and serves as the birth canal

When was her second child born?

July 22 2009- 1 am she started pushing (planned for July 21, she dilated slow) 14 hour after arrival she had contractions and got an epidural

When was Avery born?

July 2nd 2008

A patient whose cervix is dilated to 2 cm is considered to be in which phase of labor? a. Latent phase b. Active phase c. Transition phase d. 1st stage

Latent phase

If the position of the fetus is in a cephalic presentation is left occiput anterior, the nurse should assess the fetal heart rates in which quadrant of the maternal abdomen?

Left lower

Which fetal position may cause the laboring woman more back discomfort?

Left occiput posterior

A pregnant patient in her 3rd trimester is diagnosed with suprine hypotension. What would the nurse instruct the patient to do

Lie laterally, preferably on the left side

What is the correlation between Lulu and Averys death?

Lulu exhibited childlike symptoms and when she escapes that could symbolize the death of Avery. The birds that she described in the story weeks leading up to the death could have also been a sign.

What happened to Lulu?

Lulu was found at 2am wedged under a chair with a brown bag rope handle tightly around her neck, Heidi cut her free then two months later she walked out the back door and never seen her again

Where did Heidi attend college?

MSU

The nurse completes an assessment of an adolescent patient's menstrual pattern. Which finding should the nurse identify as being within normal limits?

Menstrual flow usually lasts 4-6 days

After teaching a group of adolescent girls about female reproductive development, the nurse determines that teaching was successful when the girls state that menarche is defined as a woman's first:

Menstrual period

Assessment of a newborn reveals tiny white pinpoint papules on a newborn's nose. The nurse documents this finding as:

Milia

A male pt visits a fertility clinic after one year of attempting unsuccessfully to impregnate his wife. What is a risk factor associated with male infertility?

No or few sperm cells produced.

When did they conceive their second child?

November 6th 2008 at their friends wedding

How long had it been since she has given birth to Avery when she went in to give birth to her son?

One year and 19 days.

A 30 year old female is attending a health fair for women. The nurse at the fair is reviewing hormonal contraceptives. Which should the nurse include at the fair

Oral contraceptives Vaginal ring Intrauterine device Subdermal implant

During the birth, the primary care provider performed a mediolateral episiotomy. During the postpartum period the patient reports discomfort. To reduce this discomfort and increase hygiene to the perineum, the nurse would encourage the new mother to use which intervention?

Peri bottle and warm water

To initiate the milk ejection reflex, the mother should:

Place the newborn to the breast

A preg pt late in the 2 trimester comes to ED with report of painless, bright red vaginal bleeding. The pt states "it started all of a sudden and now it seems to have stopped"

Placenta previa

What is the name of her third child? How many years apart are the two boys?

Preston Carter is three at this time

Vascular volume increases by 40-50% during pregnancy to:

Provide adequate perfusion of the placenta

Your patient questions the use of an electronic fetal monitor for her childbirth experience. In providing the advantages of EFM, the nurse will be certain to include:

Provides fetal response to each contraction

When assessing a newborns reflexes, the nurse strokes the newborns cheek and the newborn turns toward the side that was stroked and begins sucking behaviors. The nurse documents which reflex as being present?

Rooting Reflex

The fetal scalp electrode (FSE) is one measure of internal fetal monitoring. Successful use of the FSE includes which of the following?

Ruptured membranes

When giving a postpartum patient self-care instruction in preparation for discharge, the nurse instructs her to report heavy or excessive bleeding. How should the nurse describe "heavy bleeding"?

Saturation one (1) pad in one (1) hour

A patient whose is actively "pushing" with contractions is considered to be in which stage of labor?

Second stage

The provider has ordered an oxytocin challenge test. The nurse should interpret which of the following as a negative OTC

The FHR remains stable in relation to 3 contractions

A nurse is providing care to a newborn would use which concept underlying adaptation of the newborn's immune system when planning nursing care?

The newborn is unable to limit invading organisms at their point of entry

Which evaluating the FHR monitor tracing on a laboring pt, the nurse notes that there are FHR decels present. Which of the following assessments must the nurse make?

The relationship between the decel and the labor contractions.

A mother is concerned because her 2-day-old newborn's birth weight was 8 lb (3584g) and his current weight is 7 lb 8oz (3360g). What would be the nurse's response to the mother's concern?

The weight loss is a normal finding, since newborns lose 5% to 10% of their birth weight in the first few days after birth."

What is the big banana?

Their boat

Based on the nurse's knowledge level about the postpartum period and the increased coagulability post-delivery, the nurse will closely assess the patient for which condition?

Thromboembolism

Autopsy results of Avery?

Tight nuchal cord, medically Avery was healthy. Thrombosis of all three cord vessels that caused asphyxia and death in utero.

The mother-baby nurse formulates which nursing goal for a newborn in transition from intrauterine to extrauterine life in the first few hours following birth?

To identify actual or potential problems that may require immediate or emergency attention

During pregnancy a woman's cardiovascular system expands to care for the growing fetus. After birth, during the early postpartum period, the woman eliminates the additional fluid volume she has been carrying. What is one way she does this?

Urinary elimination

1. A mother asks the nurse why her newborn is getting a Vitamin K injection in the birthing suite. The nurse explains that the injection is necessary because:

Vitamin K is needed for coagulation and the newborn does not produce vitamin K in the first few days following birth.

A pt is 11 weeks' pregnant after many years trying to conceive. Calls the nurse and reports having soaked pad with fresh vaginal blood in fewer than 30 min. the uterine cramping is worsening. What is the most app. Response from the nurse?

You need to seek immediate attention from the primary care provider

Which interventions should be included when caring for a patient with a third-degree laceration?

a. Increase fiber in diet b. Increase her fluid intake c. Administer an oral stool softener

Pathologic influences on fetal oxygenation include which of the following: Select all that apply.

a. Placental disruption b. Alterations in umbilical flow c. Uterine activity

Benign and malignant disorder of the female breast are important. Patient has been diagnosed with optimizing woman's health care. Diagnosed with intraductal papilloma and the requested more information regarding her diagnosis, you will be careful to include which of the following in your plan of care?

a. Recognize and address any noted anxiety based on this diagnosis b. Educate you patient on the importance of ongoing care as this diagnosis has been associated with malignant tendencies.

A new mother is bottle-feeding her newborn. The nurse should teach the patient to take which actions when the baby regurgitates small amounts of formula? Select all that apply.

a. Recognized this as a normal occurrence b. Understand that this may occur as a result of overfeeding

Which of the following are true regarding surfactant? a. Surfactant is present in sufficient amount by 34-36 weeks gestation b. Surfactant is a water-soluble fat c. Surfactant lowers surface tension to prevent alveolar collapse d. Surfactant is readily available at the point of viability

a. Surfactant is present in sufficient amount by 34-36 weeks gestation c. Surfactant lowers surface tension to prevent alveolar collapse

Some pregnancies result in a negative outcome. On the basis of your knowledge regarding genetic and hereditary influences on childbearing. Which of the following are true regarding genetic counseling (select all that apply):

a. The process may be slow b. The process may be inconclusive

1. On performing Leopold's maneuvers on a multiparous patient in early labor, the nurse finds no fetal parts in the fundus or above the symphysis. The fetal head is palpated in the right mid-quadrant. The nurse notifies the admitting physician and anticipates which event? a. An external version b. An internal version c. A cesarean delivery d. Prolonged labor

c. A cesarean delivery

The labor and delivery nurse knows that internal monitoring during labor is an invasive technique. She correctly identifies an increase in the risk of which of the following for both mother and fetus if this is done?

infection

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra-pigmentation on the skin. What is the name of this phenomenon?

linea nigra