Chapter 6 Review:
combined oral contraceptive side effects (warning signs)?
"ACHES" Abdominal pain Chest pain Headache Eye problems (retinopathy) Severe Leg pain can be associated with thrombosis (blood clots)
Interventions Associated With General Anesthesia for Labor and Delivery
-Preoxygenation with 100% O2 for 3-5 min -Rapid intravenous induction -Endotracheal intubation -Maintenance with inhaled agents -Emergence prior to extubation to verify airway reflexes -Oxytocin to avoid hemorrhage (risk for uterine atony and hemorrhage is increased with general anesthesia): 10-30 U/ 500 mL 0.9% saline
Preterm feeding protocol Swab the infants mouth with ____ every ___hours for immunity
-Swab the infant's mouth with the mother's colostrum every 3 h to benefit the immune system. -Initiate parenteral feedings on day 1. -Titrate up enteral feedings by 15 mL/kg/d. Titrate down parenteral feedings as enteral feedings increase. Add fortifier to maternal milk once enteral feedings reach 80 mL/kg/d to increase caloric density. Discontinue parenteral feedings when enteral feedings reach 100 mL/kg/d. Target enteric intake of breast milk at 160 mL/kg/d.1
A client who is a victim of intimate partner violence fails to report the violence primarily because of which reason? 1 The client feels responsible for causing the incident. 2 The client does not want anyone to know. 3 The client thinks it will not happen again. 4 The client feels lucky to be alive.
1
A nurse is conducting a discussion group at a local women's health center about violence and women. The nurse would include that women are at a higher risk for violence at which time? 1 during pregnancy 2 during winter 3 on paydays 4 if they leave the abuser
1
A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. The nurse explains that there are two types, one that uses hormones and one that uses: 1 copper. 2 magnesium. 3 silicone. 4 potassium.
1
The nurse discusses various contraceptive methods with a client and her partner. After the discussion, the nurse determines that the couple understood the information when they identify which method as being available only with a prescription? 1 cervical cap 2 cervical sponge 3 condom 4 spermicide
1
A woman calls the clinic to report that she has had some cramping and spotting since the insertion of her IUD three days ago. Which instruction would be most appropriate? 1 "Come to the clinic as soon as possible." 2 "Consider this normal, because your IUD is newly inserted." 3 "Take your blood pressure daily for the rest of the month." 4 "You'll have to change your method of birth control."
2
The nurse is providing education about barrier contraceptives. Which statement by the patient indicates a need for further education? 1 "I have to wash my cervical caps after each use." 2 "I can leave my diaphragm in for up to 48 hours." 3 "I can insert my female condoms up to 8 hours before intercourse." 4 "Male latex condoms when used correctly are an effective means of contraceptive and very effective at preventing transmission of STDs."
2 The diaphragm stays in for at least 6 hours after intercourse but no more than 24 hours.
Normal PTT? while on therapy for heparin? Heparin antidote?
25-35 seconds Therapy = 1.5-2 x's normal (50-90) ANTIDOTE: PROTAMINE SULFATE
Nonstress test (NST)
An assessment method by which the reaction (or response) of the fetal heart rate to fetal movement is evaluated.
Why should you try to avoid giving the DMPA to obese patients? What is the method for injection
Big side effect is it can cause weight gain Z track.
__________________- permanent birth control achieved through the blocking or cutting of the Fallopian tubes
Bilateral Tubal Ligation (BTL)
A patient is interested in emergency contraception due to unprotected intercourse that occurred 1 week ago. What is the best response by the nurse? A. "Emergency contraception may include a progestin intrauterine device." B. "Emergency contraception is only available after a sexual assault." C. "Emergency contraception should be taken within 72 to 120 hours to be effective." D. "A copper intrauterine device may be inserted at this time for emergency contraception."
C. "Emergency contraception should be taken within 72 to 120 hours to be effective." Emergency contraception may include medications or a copper IUD. Emergency contraception should be obtained before 120 hours to be effective. Emergency contraception is not limited to sexual assault. Progestin intrauterine devices are not used for emergency contraception.
The ___________, similar to the diaphragm, holds spermicide against the cervix to prevent the passage of sperm. Unlike the diaphragm, it is shaped more like a small cup than a saucer.
Cervical cap
what is a long term non hormonal contraceptive?
Cooper IUD
what is the first thing you would hear that would cause major concern for a patient with preexisting cardiac conditions?
Crackles/ Rales
Which of the following signs and symptoms are most likely due to a pulmonary embolism in a postpartum patient? A. Feeling that something isn't right and shortness of breath. B. Fever and wheezing. C. Unilateral leg swelling, redness, and tenderness. D. Dyspnea and tachypnea.
D
the best contraceptive drug to give for Catamenial epilepsy (CE), also known as menstrual seizures (catmail Seizure_
DMPA injection
________________ is a progestin-only injection given every 13 weeks until pregnancy is desired.
Depomedroxyprogesterone acetate (DMPA, brand name: Depo Provera
How many C sections can you have before you are not eligible for vaginal delivery?
If you have 2 you can still be eligible but after 3 you are not longer eligible.
_______ is defined as lack of pregnancy after 12 months of well-timed intercourse (6 months if the woman is over 35 years old).
Infertility
What would be a lab value to look at that may be a contraindication of giving and epidural?
Low platelet count
Heparin lab values include checking?
PTT
AMA (advanced maternal age) complications?
Placental abnormalities (placenta previa etc. ) preterm birth, trisomy abnormalities, gestational diabetes, macrsominia. low birth weight, preeclampsia, stillbirth
Potential complications of a vasectomy?
Potential complications include bleeding, infection, and postvasectomy pain
what should be the very first intervention for a patient who has missed a period?
Pregnancy test.
Nutrition for preterm infants: give ___________ for immunity.
Probably on respiratory support so they will be on TPN Give colostrum inside their mouth around their oral mucus membranes for immunity
A diaphragm should be replaced every ___ years? A fit of the sized diaphragm should be checked and possibly resized if a women ?
Silicone diaphragms should be replaced Every 2 years The fit of the sized diaphragm should be checked if the woman gives birth, has a miscarriage or abortion, gains or loses more than 10 lb, or has pelvic surgery.
___________ is investigated if no pregnancy after 6 months for women over 35.
Subfertility
TEARS categorization helped to organize and describe examination findings after sexual assault. What does TEARS stand for?
The TEARS categorization (tears, ecchymoses, abrasions, redness, and swelling) is often used to help organize and describe examination findings
The dominant feature of IPV is what?
The dominant feature of IPV is the power one partner has over another
human trafficking consist of what?
The illegal trade of human beings, a modern-day form of slavery, for the purpose of commercial sexual exploitation, forced labor, or involuntary military combat.
The role of the nurse in IPV (intimate partner violence)?
Therefore, a critical consideration when caring for victims of IPV is patient empowerment. The nurse should allow the patient to direct her own care as much as possible. It is not the role of the healthcare provider to tell the patient to leave her abuser. The role of the nurse is to build a trusting relationship with the patient and to facilitate patient decisions. The nurse can provide ongoing support, educate women about available resources and services, and, critically, assess patient safety. Care should be nonjudgmental and confidential. Whenever possible, the nurse should discuss IPV privately with the patient, without the presence of friends or family members.
TPN is a vesicant that can cause ________ damage with infiltration?
Tissue damage.
Tubing for TPN should include _________?
inline filter
The cervical cap can be inserted up to how many hours prior to sex and removed within ___ to ___ hours after intercourse.
insert it up to 6 hours prior to sex and should remove it 6 to 48 hours after intercourse. She should insert additional spermicide into the cap without removing it for each additional episode of intercourse. Care of the cervical cap is similar to that for the diaphragm. Vaginal irritation is possible with use of the cervical cap as with the diaphragm.
The main signs of hypoglycemia of the infant include ____________, ________ and _________?
jitteriness, poor feeding, and irritability
Mifepristone is administered in the office and then Misoprostol can be administered by the routes of _______, _____ or _______ at home.
misoprostol administered vaginally, buccally, or sublingually at home.
When is the cervical cap most effective?
most effective for women who have not given birth, having a 16% failure rate over the course of a year in this population. For women who have given birth, the failure rate with typical use over a year is 32% In the United States, the cervical cap is marketed under the name FemCap.
complications of obesity in pregnancy?
neural tube defects, gestational diabetes, macosomnia, preterm birth, low birth weight,
a contraceptive implant is a A 4-cm rod of ________________ is inserted under the skin of the inner upper arm.
nonestrogen etonogestrel
Where should the contraceptive patch NOT be placed?
on the breast
headache, swelling in face, lightheadness, seeing aura, swelling in legs are all associated with ________ in pregnancy and the patient should be seen by a doctor
preeclampsia
The affects of obesity in labor?
prolonged labor, increase need for higher doses of pitocin, and postpartum hemorrhage.
Although male condoms provide some protection against STIs, particularly gonorrhea and chlamydia, female condoms provide better protection against diseases that are transmitted skin to skin, such as _________________, ____________, and ________________.
such as herpes simplex virus, syphilis, and human papillomavirus
DMPA works by suppressing __________________ hormone and ___________ hormone, therefore inhibiting follicle maturation and ovulation.
suppressing follicle stimulating hormone and luteinizing hormone, therefore inhibiting follicle maturation and ovulation.
____________ is a flexible saucer that is placed into the vagina to cover the cervix. With typical use, it has a 12% failure rate within a year, making it the most effective of the barrier methods of contraception Unlike the male and the female condoms, however, this does not provide protection against STIs
the diaphragm
Women with AMA are increased risk for?
*Placental abnormalities. Spontaneous abortion Stillbirth Preeclampsia, eclampsia, gestational hypertension, HELLP syndrome Gestational diabetes Cesarean birth. Infants are increased risk for anomalies.
Steps for performing infant Heel stick?
-Expose the foot -Select an area on either SIDE of the heel that is away from the bony prominence and nerves. -Wrap a heel warmer around the food and leave for 5 minutes to help bring blood to surface. -clean the area with alcohol or cleaner -Hold foot securely in a dorsiflexed position. -lance the area -apply gentle pressure to express a drop of blood -wipe away the first drop of blood -collect blood for testing.
Normal INR? -on therapy for Warfarin? Warfarin Antidote?
0.8-1.2 Therapy = 2.0-3.0 ANTIDOTE: Vit. K
Normal Hemoglobin
12-18 g/dL
Women is considered advances maternal age after age ____?
35
normal hematocrit
35-45%
A client with liver disease is seen in the clinic wanting to begin contraception. The nurse recognizes that which type of contraception is best for this client? 1 Oral combination contraception 2 Subdermal hormone implant 3 Intramuscular injections 4 Vaginal estrogen/progestin ring
4
Normal blood glucose in a newborn is to aim above _____ mg/dL. How is blood glucose test performed on the infant?
50 mg/dL Infant Heel Stick.
If taken vaginally, misoprostol may be taken as soon as ____ hours after the mifepristone. If taken buccally or sublingually, misoprostol should be taken _____ to ____ hours after the mifepristone.
6 hours 24-48 hours
Optimally, a woman should start DMPA within ?
7 days of the start of her last menstrual cycle.
Which of the following would a provider diagnose with infertility? A. A 37-year-old woman trying to get pregnant for 7 months B. A 24-year-old woman trying to get pregnant for 11 months C. A 30-year-old woman trying to get pregnant for 6 months D. None of the above
A
A common regimen for a medical abortion includes 200 mg of _______- followed by 800 μg of __________ 6 hours later (if vaginal route).
A common regimen for a medical abortion includes 200 mg of mifepristone followed by 800 μg of misoprostol 6 hours later.
How is a contraceptive patch rotated? Where should it be applied on the body?
A contraceptive patch contains estrogen and progestin and is applied weekly for 3 weeks. Followed by a patch-free week, which will cause a withdrawal bleed. The patch should be applied on the upper back, upper arm, upper buttock, or lower abdomen, but not on the breast. The woman should rotate the cite weekly to avoid skin irritation.
first trimester lab values?
A1C Hemoglobin= if greater than 6.5 it could be a sign of preexisting diabetes CBC for anemia Rubella, Hepatitis, HIV, HPV, Gon/ chlamydia testing Urinary analysis- test for UTI
Warning signs for combined oral contraceptives "ACHES" acronym?
Abdominal pain Chest pain Headache Eye problems Severe Leg pain "Aches"= relates to the risk of clots. Even retinopathy clots
YOU CAN NOT TAKE ___________ WITHIN 5 DAYS OF TAKING ELLA
Birth control
___________ is given to hyperandrogenism (most often polycystic ovary syndrome [PCOS] or for irregular menstrual bleeding (dysmenorrhea, amenorrhea)
COC
Spinnbarkeit test would test what?
Clear, slippery, stretchy quality of cervical mucus during ovulation.
When caring for a patient after a sexual assault, what should the nurse include in the care? A. Document personal hygiene activities since the assault. B. Use caring and nonjudgmental approach. C. Ask about the circumstances of the assault. D. All of the above.
D
____________ scale is a 10-item questionnaire that was developed to identify women who have postpartum depression. Items of the scale correspond to various clinical depression symptoms, such as guilt feeling, sleep disturbance, low energy, anhedonia, and suicidal ideation.
Edinburgh postnatal depression scale
Initial nursing responsibility in a situation of violence or sexual assault?
Establish trust and rapport
Is the following statement true or false? Nurses should be mindful about giving victims of IPV or human trafficking resources for help.
False
Complications related to IUD
Fever, unusual bleeding, missing IUD string, late period (cooper IUD still has periods so late period could be sign of pregnancy),
The number one cause of congenital anomalies is?
Gestational Diabetes.
___________ is the safest means of permanent sterilization and the most cost-effective
Vasectomy
Do you have to add spermicide to the cervical cap?
Yes: the woman places spermicide in the dome and around the edges on one side and in the folds of the device on the other side. She then inserts it so that it covers the cervix
how to prevent pulmonary embolism
ambulate and hydrate Do not cross legs for a long time Do not smoke. Anticoagulant therapy if needed.
AST test
asparate aminotransferase. Enzyme in the liver. when liver is damaged it released AST into bloodstream. Test can help provider diagnose liver damage.
The only absolute contraindications to progestin only pills (POP) are a current diagnosis of ___________ and acute ________.
breast cancer and acute viral hepatitis
Antidote for magnesium sulfate?
calcium gluconate
how do we confirm DVT or PE? Administer _______,_________,___________ medication as order
compression ultrasound (CUS) Administer anticoagulant, antianxiety, and pain medications as ordered.
arborization test
fluid is placed on a slide and looked under a microscope.
What does misoprostol do to the uterus?
gets it contracting. used in the case of medication abortions or for cervical ripening procedures and postpartum hemorrhage.
Vaginal birth after cesarean may be possible if uterine incision was cut _________(what direction)
if its cut horizontal rather than vertical
the inability to conceive a child?
infertility
The use of estrogen-progestin methods is also associated with an increased risk of _________ and ______________.
strokes and venous thromboembolism (VTE)
_________- prolonged time to conceive
sub-fertilization
Ovulation-suppressing methods
type of contraception that prevents the oocyte to mature
The most common side effect of contraceptive etonogestrel implants? Ovulation happens fast after implant is removed
unscheduled bleeding Only progesterone. Long acting. NO estrogen so break through bleeding is very common
What causes hypoglycemia in macrosomic infants.
v Glucose passes from mother to fetus in utero. v Infant makes his/her own insulin. v After birth, infant no longer has maternal glucose supply, but may continue to produce excess insulin. v Results in hypoglycemia of the infant.
side effects of Depo shot?
weight gain, spotting, depression, nausea, breast tenderness, Give every 13 weeks.
What is gender identity?
what gender you internally express (male, female, neither). It may be the same as or different from biological identity.
A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize? 1 Wash with clean water and soap after intercourse. 2 Insert the product by applicator in the vagina several hours prior to intercourse. 3 Apply the spermicide directly to the glans penis to kill the sperm when they exit the penis. 4 Leave the product in place for 24 hours after intercourse.
2 It is designed to be inserted vaginally immediately before or within a few hours before sexual intercourse. Hygiene is always important and is unrelated to the use of spermicides. Applying the spermicide to the penis would be ineffective as it would rub off. The product is immediately effective and can be removed right after intercourse.
Obesity is associated with risk for blood clots. Postpartum risk factor for blood clotting is having a BMI greater than ____?
35
A young woman is having trouble conceiving and has come in to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility? 1 Anovulation 2 Endometriosis 3 Tubal transport problems 4 Stenotic cervical os
1
A clinic nurse is interviewing a young client during a subfertility work up. When the client asks the nurse what causes infertility, the nurse informs the client that the problem can rest with the man, the woman, or both. What does the nurse tell the client are common problem areas related to the woman? Select all that apply. 1 ovulation 2 tubal transport 3 diabetes 4 impaired implantation 5 lack of exercise
1,2, 4
A 16-year-old girl is seen in an emergency department following a rape. The management of a rape victim should be directed primarily toward: 1 relieving physical discomfort and pain. 2 decreasing guilt and increasing self-esteem. 3 assessing for sources of infection resulting from the rape. 4 teaching the client how to prevent further attacks.
2
A patient asks the nurse if a cervical cap is better than a diaphragm for contraception. What should the nurse explain is the advantage of a cervical cap? 1 No initial fitting is required. 2 It can be left in place longer. 3 It needs no spermicidal jelly. 4 It does not need to be refitted after pregnancy.
2
A couple comes in and tells the nurse that they have been trying diligently to conceive for the last 3 months and are subfertile. What should the nurse explain to the couple about the definition of subfertility? 1 Subfertility is said to exist when a pregnancy has not occurred after at least 3 months of engaging in unprotected coitus. 2 Subfertility is said to exist when a pregnancy has not occurred after at least 6 months of engaging in unprotected coitus. 3 Subfertility is said to exist when a pregnancy has not occurred after at least 1 year of engaging in unprotected coitus. 4 Subfertility is said to exist when a pregnancy has not occurred after at least 2 years of engaging in unprotected coitus.
3
EC medications work by delaying ____________, whereas copper IUCs inhibit _______ viability.
EC medications work by delaying ovulation, whereas copper IUCs inhibit sperm viability.
Signs of rupture of membranes
Gush or trickle Meconium fluid Sterile speculum exam Nitrazine PH test arborization test
__________________ consists of medications used to treat the possibility of HIV and is taken for 28 days after a sexual assault.
HIV postexposure prophylaxis (PEP)
Babies on Total parentral nutrition should be monitored for ________ in the neonate
Hyperglycemia
Long term Birth control hormone free?
IUD copper Cooper is toxic to sperm and kills it
How to choose size for cervical cap?
It comes in three sizes: small, medium, and large. The small size is indicated for women who have never been pregnant, medium for women who have had an abortion or cesarean birth, and large for women who have delivered a pregnancy vaginally.
a vasectomy is generally performed in office with only ________ anesthetic. Testing performed after ___ months confirms sterility.
It is generally performed in office with only local anesthetic. Testing performed after 3 months confirms sterility.
the type of emergency contraceptive that is Available over the counter or by prescription and is most effective when taken within 72 hours of unprotective intercourse. Works by preventing ovulation. Does not affect an established pregnancy.
Levonorgestrel (PlanB):
Obesity risk in pregnancy for mom, baby and what it risk are increased for childhood of baby?
Maternal: Gestation diabetes, gestation hypertension, preeclampsia, C sections, wound complications Fetal: Neural tube defects, prematurity, stillbirth, Congenital anomalies, Macrosomia, Low birth weight Child risks: Childhood obesity, hypertension, increase all cause mortality.
TPN in the premature infant can be administered through a ____________ catheter or a ________ catheter.
May be administered through a central venous catheter or a peripheral venous catheter (central line preferred).
For abortion _______ medication is taken first and gets the uterus ready for labor and stops cell division. ____________ medication is then given later to cause uterine contractions.
Mifepristone Misoprostol
Number one sign of NEC?
Neonatal necrotizing enterocolitis Abdominal distension
What criteria is needed for a non-stress test to be reactive?
Normal baseline (between 110-160) Moderate variability Two accelerations (at least 15 beats increased from baseline for at least 15 seconds) ALL WITHIN 20 MINUTES
A problem with the hormonal contraceptive patch is if the patient is __________ so the patch can not absorb properly
Obesity
A nurse is providing education to a client with infertility concerns. Which statement by the client indicates appropriate understanding of the Spinnbarkeit Test? 1 "I will need to purchase a microscope and look for a fern-like pattern from a sample of my cervical mucus to indicate when I am ovulating." 2 "I will need to purchase an over-the-counter ovulation kit that will tell me when I am currently ovulating." 3 "Halfway in my cycle I will need to check my cervical mucus to see if I can stretch it in to long strands, indicating I am close to ovulating." 4 "At midpoint in my menstrual cycle, I need to come to the clinic for a cervical exam looking for color changes to my cervical mucus."
3
A pregnant woman delivered her last baby by cesarean section at 24 weeks gestation. A vertical incision was used due to the infants size. The nurse knows: A. The patient will require a repeat cesarean section because of the previous vertical incision. B. The patient may choose to attempt a vaginal delivery with her current pregnancy. C. The woman will not likely carry her current baby past 24 weeks. D. The patient will need to make a delivery decision when she goes into labor with the current pregnancy.
A
A couple plans to try for a baby after they get married in 3 months. Based on their situation, what method of birth control might be best for them? A. A progestin intrauterine device B. A Depo Provera injection C. Condoms D. None of the above
C. Condoms Progestin intrauterine devices are long-acting reversible contraception likely not cost effective if removed in 3 months. It may take several months for women who use Depo Provera to become fertile and therefore, not a good choice for this couple. Condoms are a barrier method of birth control and likely the best choice for their situation.
__________ lowers the risk for endometrial and ovarian cancers and uterine cancers.
Combined oral contraceptives (COC)
Combined oral contraceptives (COCs) are synthetic _______ and ________.
Commonly called birth control pills or "the pill" cocs are a form of contraception that uses a combination of a synthetic estrogen and a progestin.
Good option to birth control for teens because they don't have pelvic exam.
Contraceptive implant
Contraindications for birth containing estrogen include migraines with _____, history of blood ____, and _____tension. also smoking, diabetes, breast cancer.
Contraindications for birth control containing estrogen include migraine with aura (light, smell), history of blood clots, and hypertension, smoking, diabetes, breast cancer.
A common cause for having a baby who is macrosomia?
Gestational diabetes, obesity
Nutrition in the Premature Infant includes parenteral nutrition combined with _____ feedings?
Often used in combination with oral feedings of breast milk. Cause exposure to colostrum gives neonates immunities.
Specifically, these methods require women to avoid having intercourse during the following times based off secretions?
On days when menses might obscure secretions On days between menses and ovulation following intercourse, to avoid the obscuring of secretions by semen On days when secretions are stretchy, transparent, wet, or slippery, and therefore suggestive of ovulation For 4 days after the last day of secretions suggestive of ovulation
Cervical Mucous Method for avoiding pregnancy patient teaching: Secretions/ mucus are ? to suggest ovulation.
On days when secretions are stretchy, transparent, wet, or slippery, and therefore suggestive of ovulation
nonstress test reactive?
Over 20 minutes there should be No D cels, 2 A cels, moderate variability, and fetal heartrate baseline of 110-160
________ and ___________ is increased with general anesthesia
Oxytocin to avoid hemorrhage (risk for uterine atony and hemorrhage is increased with general anesthesia
A patient with pre-existing cardiac conditions and you hear persistent rales (crackles) that is a first signs of ___________ and __________
PE (pulmonary embolism and heart failure. Patients with cardiac disease are at higher risk for having PE.
Plan B is a really high dose of ___________. Prevents ovulation by controlling LH and FSH. IF you are pregnant and you take it then it does not hurt the baby.
Progesterone
Pre excisting cardiac conditions and hearing rales usually signs of?
Pulmonary embolism and heart failure
signs of human trafficking
Signs of physical abuse. Lack of food, water, medical care, and sleep. Restricted communication. Numerous occupants in a small residency. Always accompanied by someone else in public. Lack of identification documentation.
the type of contraception that is Available by prescription only. May be used within 120 hours of unprotected intercourse. Works as a progesterone blocker (anti-progesterone) and may affect an existing pregnancy. Completely delays ovulation.
Ulipristal (Ella): Progesterone helps the implantation of the embryo in the uterus so by having the progesterone blocked it can prevent implantation
