Exam #2 OBGYN Mount Sinai School of Nursing

Vaccines allowed during pregnancy?

Hepatitis B Influenza (inactivated) injection Tetanus/diphtheria (Tdap) Meningococcal Rabies

What is preeclampsia?

new onset HTN (SBP>140 or DBP> 90) and proteinuria (>300mg in 24hrs) occuring at >20wks gestation

What is an assessment for Gestational diabetes?

Healthy history, physical examination, risk factors Screening at first prenatal visit, 24 to 28 weeks screening only for those at risk

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?

"Come to the health facility with any vaginal material passed."

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further."

A nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess?

"knife-like" abdominal pain with vaginal bleeding

What are danger signs for the 1st trimester?

Abdominal cramping and/or vaginal bleeding Burning on urination Severe / persistent vomiting Fever or chills Lower abdominal pain with dizziness and accompanied by shoulder pain

What is gestational trophoblastic disease? What is the cause?

Abnormal placental development that results in production of fluid filled grape like sacs. The exact cause is unknown.

A nurse is preparing an inservice education program for a group of nurses about dystocia involving problems with the passenger. Which problem would the nurse likely include as the most common? A. macrosomia B. breech presentation C. persistent occiput posterior position D. multifetal pregnancy

C. persistent occiput posterior position Common problems involving the passenger include occiput posterior position, breech presentation, multifetal pregnancy, excessive size (macrosomia) as it relates to cephalopelvic disproportion (CPD), and structural anomalies. Of these, persistent occiput posterior is the most common malposition, occurring in about 15% of laboring women

A nurse is reviewing the medical record of a pregnant client. The nurse suspects that the client may be at risk for dystocia based on which factors? Select all that apply. A. plan for pudendal block anesthetic use B. multiparity C. short maternal stature D. Body mass index 30.2 E. breech fetal presentation

C. short maternal stature D. Body mass index 30.2 E. breech fetal presentation

What are manifestations of Placenta Previa?

Insidious - gradual/subtle onset. Type of bleeding - Always visible; slight, then more than profuse Bright Red Pain - None (painless) Uterine tone - Soft and Relaxed Fetal HR - Normal range Fetal Presentation - May be breech or transverse lie; engagement in absent

What is the most common type of pregnancy related anemia? What are the related risks?

Iron deficiency. Increased risk for preterm delivery, perinatal mortality, PP depression, LBW, poor motor/psychomotor performance by newborn.

A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? A. butorphanol B. fentanyl C. naloxone D. promethazine

Naloxone is an opioid antagonist used to reverse the effects of opioids such as respiratory depression. Butorphanol and fentanyl are opioids and would cause further respiratory depression. Promethazine is an ataractic used as an adjunct to potentiate the effectiveness of the Opioid.

What is testing for premature rupture of membranes?

Nitrazine test - turns blue w/amniotic fluid (6.5-7), Fern test (drop of amniotic/vaginal fluid on slide and ferning pattern seen under microscope, ultrasound, fetal fibronection test - assessment of vaginal fluid to assess for fetal febronection in amniotic fluid - determines risk of onset of preterm delivery w/in 4 days.

What are risk factors for Gestational diabetes?

Obesity, age >25, family history, previous delivery of large infant/stillborn

How do sutures make childbirth possible?

They can overlap so the head can fit down through the vagina

What is HELLP syndrome?

hemolysis, elevated liver enzymes, low platelets A severe variant of preeclampsia.

What is nursing management of Trophoblastic disease?

preoperative preparation emotional support, education: treatment, serial hCG monitoring, prophylactic, chemotherapy, avoid pregnancy for 1 year because patients are at greatest risk of relapse during this time and the rising hCG of pregnancy can prevent early detection and diagnosis of disease recurrence.

A nurse suspects that a client is developing HELLP syndrome. The nurse notifies the health care provider based on which finding?

Elevated Liver Enzymes

What is the therapeutic mgmt of iron deficiency anemia?

Eliminate symptoms, correct deficiency, replenish iron stores

A nurse is providing care to several pregnant women at different weeks of gestation. The nurse would expect to screen for group B streptococcus infection in the client who is at:

36 weeks gestation

What is the visit schedule for a pregnant women?

-Every 4 weeks up to 28 weeks -Every 2 weeks from 29-36 weeks -Every week from 37 weeks to birth

What are the nursing interventions for Group B Streptococci?

-Frequent vital signs, -monitor progression of labor, -Treat with antibiotics as prescribed intrapartal.

What are nursing considerations when performing the Leopold maneuver?

-Make sure mother is not flat on her back, -Have mother void before procedure, -Assess for contractions & if contracting wait until contraction is over

How do you do an assessment for Preeclampsia?

-Monitor DTR with/VS. -Complete HX & Physical exam. -Labs - CBC, electrolytes, BUN creatinine, liver enzymes. -Urine - check for protein; if >1-2+ do a 24-hour urine. -VS - frequency depends on acuity, DTRs, & clonus, edema, -Check for A&O x3, Fetal Mvmt Counts.

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?

History of endometriosis

Where is the largest part of the newborns head?

Metopic suture to the occipital

A primigravida 28-year-old client is noted to have Rh negative blood and her husband is noted to be Rh positive. The nurse should prepare to administer RhoGAM after which diagnostic procedure?

Amniocentesis

What are the risk factors for Placenta Previa?

Previous pregnancies, previous surgeries of the uterus, previous placenta previa carrying more than one fetus, older than 35, smoking and cocaine use.

What is Hep A Torch Disease?

Primarily through fecal-oral route. Vaccination most effective means of preventing HAV transmission.

A client who has experienced an incomplete abortion is prescribed mifepristone to assist in removing the retained products of conception. Which medication would the nurse expect to administer if prescribed before administering mifepristone?

Antiemetic to minimize nausea

What medications used for preeclampsia?

Antihypertensive meds Anticonvulsants: ex. magnesium sulfate : therapeutic levels = 4-8 mg/dl

What is nursing assessment for Premature rupture of membranes?

Risk factors, s/g of labor, electronic FHR monitoring, amniotic fluid characteristics.

Should women stay on the asthma medication throughout pregnancy?

Yes

What is a treatment for Group B Strep?

-Mother w + GBS at time of delivery - antibiotics (penicillin) q4h during labor. Clindaymcin q8h if allergic to penicillin. ABX must be given within four hours of delivery to be considered "adequate" treatment & coverage of the infant -Infant of a mother w/+GBS at delivery: vital signs q4h x 48. If symptomatic, obtain blood culture and CBC. Treat with antibotics depending upon the lab results.

What are manifestations of trophoblastic disease?

-Vaginal bleeding (dark brown like prune juice), --Anemia, -Excessive nausea/vomiting, -Rapid uterine growth, -Cramping, -Preeclampsia prior to 24 weeks.

A pregnant woman is discussing nonpharmacologic pain control measures with the nurse in anticipation of labor. After discussing the various breathing patterns that can be used, the woman decides to use slow-paced breathing. Which instruction would the nurse provide to the woman about this technique?

"Inhale through your nose and exhale through pursed lips."

What are infant symptoms of Group B Strep?

*Note = symptoms of infants with an infection are very subtle: temp instability, hypoglycemia, apnea.

What are normal Lab tests?

-26-28 weeks gestation: GCT -36 weeks gestation repeat GBS if women were positive in first visit exam -Weight and BP compared to baseline values -Urine testing for protein, glucose, ketones, and nitrites -Fundal height to assess fetal growth -Quickening/fetal movement -Fetal heart rate (110-160 bpm) -Teaching: incl. common complaints and danger signs

What are the Five P's of labor

-passageway (birth canal: pelvis and soft tissues -Passenger (fetus and placenta) -Power's (contractions) -Position (maternal) -Psychological response (if anxious or panicky it can slow labor down)

Assessment of a pregnant woman reveals that the presenting part of the fetus is at the level of the maternal ischial spines. The nurse documents this as which station? A. -2 B. -1 C. 0 D. +1

0 Station refers to the relationship of the presenting part to the level of the maternal pelvic ischial spines. Fetal station is measured in centimeters and is referred to as a minus or plus, depending on its location above or below the ischial spines. Zero (0) station is designated when the presenting part is at the level of the maternal ischial spines. When the presenting part is above the ischial spines, the distance is recorded as minus stations. When the presenting part is below the ischial spines, the distance is recorded as plus stations.

What are the seven cardinal movements as a mechanism of labor?

1. Engagement 2. Descent 3. Flexion 4. Internal rotation 5. Extension 6. Restitution and external rotation 7. Expulsion *Every Day Fine Infants Enter Eager and Excited.

When do they do a ultrasound to check for placenta previa? What does it mean if the placenta is low lying at this point?

1. Mid-pregnancy 2. Most cases grows toward upper uterus as the uterus expands.

What is required to diagnosis preeclampsia?

1. The absolute blood pressure (value that validates elevation) of 140/90 mm Hg ,on two occasions 4 to 6 hours apart to be diagnostic of preeclampsia. 2. Proteinuria is defined as 300 mg or more of urinary protein per 24 hours or more than 1+ protein by chemical reagent strip or dipstick of at least two random urine samples collected at least 4 to 6 hours apart with no evidence of urinary tract infection (ACOG, 2014c).

When do most seizures occur?

24 hours after birth

A pregnant woman with gestational diabetes comes to the clinic for a fasting blood glucose level. When reviewing the results, the nurse determines that the woman is achieving good glucose control based on which result?

88 mg/dL

A nurse is performing Leopold maneuvers on a pregnant woman. The nurse determines which information with the first maneuver? A. Fetal presentation B. Fetal position C. Fetal attitude D. Fetal flexion

A Fetal Presentation. Leopold maneuvers are a method for determining the presentation, position, and lie of the fetus through the use of four specific steps. The first maneuver determines presentation; the second maneuver determines position; the third maneuver confirms presentation by feeling for the presenting part; the fourth maneuver determines attitude based on whether the fetal head is flexed and engaged in the pelvis.

A woman's amniotic fluid is noted to be cloudy. The nurse interprets this finding as: A. normal. B. a possible infection. C. meconium passage. D. transient fetal hypoxia.

A possible infection Amniotic fluid should be clear when the membranes rupture, either spontaneously or artificially through an amniotomy (a disposable plastic hook [Amnihook] is used to perforate the amniotic sac). Cloudy or foul-smelling amniotic fluid indicates infection. Green fluid may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction, maternal hypertension, diabetes, or chorioamnionitis; however, it is considered a normal occurrence if the fetus is in a breech presentation.

A pregnant client at 30 weeks' gestation calls the clinic because she thinks that she may be in labor. To determine if the client is experiencing labor, which question(s) would be appropriate for the nurse to ask? Select all that apply. A. "Are you feeling any pressure or heaviness in your pelvis?" B. "Are you having contractions that come and go, off and on?" C. "Have you noticed any fluid leaking from your vagina?" D. "Are you having problems with heartburn?" E. "Have you been having any nausea or vomiting?"

A. "Are you feeling any pressure or heaviness in your pelvis?" B. "Are you having contractions that come and go, off and on?" C. "Have you noticed any fluid leaking from your vagina?" E. "Have you been having any nausea or vomiting?"

A nurse is teaching a woman with mild preeclampsia about important areas that she needs to monitor at home. The nurse determines that the teaching was successful based on which statements by the woman? Select all that apply. A. "I should check my blood pressure twice a day." B. "I will weigh myself once a week." C. "I should complete a fetal kick count each day." D. "I will check my urine for protein four times a day." E. "I'll call my health care provider if I have burning when I urinate."

A. "I should check my blood pressure twice a day." C. "I should complete a fetal kick count each day." E. "I'll call my health care provider if I have burning when I urinate."

A nurse is teaching a woman about measures to prevent preterm labor in future pregnancies because the woman just experienced preterm labor with her most recent pregnancy. The nurse determines that the teaching was successful based on which statement by the woman? A. "I'll make sure to limit the amount of long distance traveling I do." B. "Stress isn't a problem that is related to preterm labor." C. "Separating pregnancies by about a year should be helpful." D. "I'll need extra iron in my diet so I have extra for the baby."

A. "I'll make sure to limit the amount of long distance traveling I do."

A 32-year-old black woman in her second trimester has come to the clinic for an evaluation. While interviewing the client, she reports a history of fibroids and urinary tract infection. The client states, "I know smoking is bad and I have tried to stop, but it is impossible. I have cut down quite a bit though, and I do not drink alcohol." Complete blood count results reveal a low red blood cell count, low hemoglobin, and low hematocrit. When planning this client's care, which factor(s) would the nurse identify as increasing the client's risk for preterm labor? Select all that apply. A. African heritage B. Maternal age C. History of fibroids D. Cigarette smoking E. History of urinary tract infections F. Complete blood count results

A. African heritage C. History of fibroids D. Cigarette smoking E. History of urinary tract infections F. Complete blood count results

Which positions would be most appropriate for the nurse to suggest as a comfort measure to a woman who is in the first stage of labor? Select all that apply. A. walking with partner support B. straddling with forward leaning over a chair C. closed knee-chest position D. rocking back and forth with foot on chair E. supine with legs raised at a 90-degree angle

A. Walking with partner support B. Straddling with forward leaning over a chair D. Rocking back and forth with foot on chair Positioning during the first stage of labor includes walking with support from the partner, side-lying with pillows between the knees, leaning forward by straddling a chair, table, or bed or kneeling over a birthing ball, lunging by rocking weight back and forth with a foot up on a chair or birthing ball, or an open knee-chest position.

A nurse is providing care to a woman in labor. The nurse determines that the client is in the active phase based on which assessment findings? Select all that apply. A. cervical dilation of 6 cm B. contractions every 2 to 3 minutes C. cervical effacement of 30% D. contractions every 90 seconds E. strong desire to push

A. cervical dilation of 6 cm B. contractions every 2 to 3 minutes During the active phase, the cervix usually dilates from 6 to 10 cm, with 40% to 100% effacement taking place. Contractions become more frequent, occurring every 2-5 min and increase in duration (45 to 60 seconds). Effacement of 30% reflects the latent phase. Contractions occurring every 90 seconds suggest the second stage of labor. A strong urge to push reflects the later perineal phase of the second stage of labor.

A nurse is taking a history on a woman who is at 20 weeks' gestation. The woman reports that she feels some heaviness in her thighs since yesterday. The nurse suspects that the woman may be experiencing preterm labor based on which additional assessment findings? Select all that apply. A. dull low backache B. viscous vaginal discharge C. dysuria D. constipation E. occasional cramping

A. dull low backache B. viscous vaginal discharge C. dysuria Symptoms of preterm labor are often subtle and may include change or increase in vaginal discharge with mucus, water, or blood in it; pelvic pressure; low, dull backache; nausea, vomiting or diarrhea, and heaviness or aching in the thighs. Constipation is not known to be a sign of preterm labor. Preterm labor is assessed when there are more than six contractions per hour. Occasional asymptomatic cramping can be normal.

When planning the care of a woman in the latent phase of labor, the nurse would anticipate assessing the fetal heart rate at which interval? A. every 30 to 60 minutes B. every 60 to 90 minutes C. every 15 to 30 minutes D. every 10 to 15 minutes

A. every 30 to 60 minutes. FHR is assessed every 30 to 60 minutes during the latent phase of labor and every 15 to 30 minutes during the active phase. The woman's temperature is typically assessed every 4 hours during the first stage of labor and every 2 hours after ruptured membranes. Blood pressure, pulse, and respirations are assessed every hour during the latent phase and every 30 minutes during the active and transition phases. Contractions are assessed every 30 to 60 minutes during the latent phase and every 15 to 30 minutes during the active phase, and every 15 minutes during

What is the medical treatment timing for Dystocia?

After head out time should be called out every one minute. Delivery must occur within five minutes or baby will suffer irreversible brain damage.

A nurse is preparing a class for pregnant women about labor and birth. When describing the typical movements that the fetus goes through as it travels through the passageway, which movements would the nurse include? Select all that apply. A. internal rotation B. abduction C. descent D. pronation E. flexion

A. internal rotation C. descent E. flexion The positional changes that occur as the fetus moves through the passageway are called the cardinal movements of labor and include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus does not undergo abduction or Pronation.

Assessment of a woman in labor reveals cervical dilation of 3 cm, cervical effacement of 30%, and contractions occurring every 7 to 8 minutes, lasting about 40 seconds. The nurse determines that this client is in: A. latent phase of the first stage. B. active phase of the first stage. C. pelvic phase of the second stage. D. early phase of the third stage.

A. latent phase of the first stage. The latent phase of the first stage of labor involves cervical dilation of 0 to 3 cm, cervical effacement of 0% to 40%, and contractions every 5 to 10 minutes lasting 30 to 45 seconds. The active phase is characterized by cervical dilation of 4 to 7 cm, effacement of 40% to 80%, and contractions occurring every 2 to 5 minutes lasting 45 to 60 seconds. The perineal phase of the second stage occurs with complete cervical dilation and effacement, contractions occurring every 2 to 3 minutes and lasting 60 to 90 seconds, and a tremendous urge to push by the mother. The third stage, placental expulsion, starts after the newborn is born and ends with the separation and birth of the placenta.

After teaching a pregnant woman with iron deficiency anemia about nutrition, the nurse determines that the teaching was successful when the woman identifies which foods as being good sources of iron in her diet? Select all that apply. A. Dried fruits B. peanut butter C. meats D. milk E. white bread

A.Dried fruits B. Peanut butter C. Meats

What is nursing management for Ectopic Pregnancy?

Assess with Hx & P, vital signs and pain levels, prepare for treatment provide emotional support, educate the patient & partner re: prevention.

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission?

Assessing fetal heart tones by use of an external monitor

Which action is a priority when caring for a woman during the fourth stage of labor? A. assessing the uterine fundus B. offering fluids as indicated C. encouraging the woman to void D. assisting with perineal care

Assessing the uterine fundus. During the fourth stage of labor, a priority is to assess the woman's fundus to prevent postpartum hemorrhage. Offering fluids, encouraging voiding, and assisting with perineal care are important but not an immediate priority.

How do you do an assessment for asthma during pregnancy?

Auscultate lungs, assess respiratory/hr, include rate, rhythm and depth of respirations. Urine protein/glucose/ketones. Showing signs of fatigue? Fundal height at 1cm? Cyanosis espeically of the lips. Pursed lip breathing can help.

A nurse is conducting a class for a group of nurses who are newly hired for the labor and birth unit. After teaching the group about fetal heart rate patterns, the nurse determines the need for additional teaching when the group identifies which finding as indicating normal fetal acid- base status? Select all that apply. A. sinusoidal pattern B. recurrent variable decelerations C. fetal bradycardia D. absence of late decelerations E. moderate baseline variability

B. Recurrent variable decelerations C. Fetal Bradycardia Predictors of normal fetal acid-base status include a baseline rate between 110 and 160 bpm, moderate baseline variability, and absences of later or variable decelerations. Sinusoidal pattern, recurrent variable decelerations, and fetal bradycardia are predictive of abnormal fetal acid-base status.

A woman telephones the prenatal clinic and reports that her water just broke. Which suggestion by the nurse would be most appropriate? A. "Call us back when you start having contractions." B. "Come to the clinic or emergency department for an evaluation." C. "Drink 3 to 4 glasses of water and lie down." D. "Come in as soon as you feel the urge to push."

B. "Come to the clinic or emergency department for an evaluation." When the amniotic sac ruptures, the barrier to infection is gone, and there is the danger of cord prolapse if engagement has not occurred. Therefore, the nurse should suggest that the woman come in for an evaluation. Calling back when contractions start, drinking water, and lying down are inappropriate because of the increased risk for infection and cord prolapse. Telling the client to wait until she feels the urge to push is inappropriate because this occurs during the second stage of labor.

A pregnant woman at 31-weeks' gestation calls the clinic and tells the nurse that she is having contractions sporadically. Which instructions would be most appropriate for the nurse to give the woman? Select all that apply. A. "Walk around the house for the next half hour." B. "Drink two or three glasses of water." C. "Lie down on your back." D. "Try emptying your bladder." E. "Stop what you are doing and rest."

B. "Drink two or three glasses of water." D. "Try emptying your bladder." E. "Stop what you are doing and rest."

After describing continuous internal electronic fetal monitoring to a laboring woman and her partner, which statement by the woman would indicate the need for additional teaching? A. "This type of monitoring is the most accurate method for our baby." B. "Unfortunately, I'm going to have to stay quite still in bed while it is in place." C. "This type of monitoring can only be used after my membranes rupture." D. "You'll be inserting a special electrode into my baby's scalp." Rationale: With continuous internal electronic monitoring, maternal position changes and movement do not interfere with the quality of the tracing. Continuous internal monitoring is considered the most accurate method, but it can be used only if certain criteria are met, such as rupture of membranes. A spiral electrode is inserted into the fetal presenting part, usually the Head.

B. "Unfortunately, I'm going to have to stay quite still in bed while it is in place."

A nurse is providing care to a pregnant woman in labor. The woman is in the first stage of labor. When describing this stage to the client, which event would the nurse identify as the major change occurring during this stage? A. regular contractions B. cervical dilation (dilatation) C. fetal movement through the birth canal D. placental separation

B. Cervical dilation (dilatation) The primary change occurring during the first stage of labor is progressive cervical dilation (dilatation). Contractions occur during the first and second stages of labor. Fetal movement through the birth canal is the major change during the second stage of labor. Placental separation occurs during the third stage of labor.

A client is admitted to the labor and birthing suite in early labor. On review of her prenatal history, the nurse determines that the client's pelvic shape as identified in the antepartal progress notes is the most favorable one for a vaginal birth. Which pelvic shape would the nurse have noted? A. platypelloid B. Gynecoid C. android D. anthropoid

B. Gynecoid The most favorable pelvic shape for vaginal birth is the gynecoid shape. The anthropoid pelvis is favorable for vaginal birth, but it is not the most favorable shape. The android pelvis is not considered favorable for a vaginal birth because descent of the fetal head is slow and failure of the fetus to rotate is common. Women with a platypelloid pelvis usually require cesarean birth.

A nurse is describing the risks associated with post-term pregnancies as part of an inservice presentation. The nurse determines thatmore teaching is needed when the group identifies which factor as an underlying reason for problems in the fetus? A. aging of the placenta B. increased amniotic fluid volume C. meconium aspiration D. cord compression

B. Increased amniotic fluid volume

A nurse is assessing a woman after birth and notes a second-degree laceration. The nurse interprets this as indicating that the tear extends through which area? A. skin B. muscles of perineal body C. anal sphincter D. anterior rectal wall

B. Muscles of the perineal body. The extent of the laceration is defined by depth: a first-degree laceration extends through the skin; a second-degree laceration extends through the muscles of the perineal body; a third-degree laceration continues through the anal sphincter muscle; and a fourth-degree laceration also involves the anterior rectal wall.

A couple has just given birth to a baby who has low Apgar scores due to asphyxia from prolonged cord compression. The neonatologist has given a poor prognosis to the newborn, who is not expected to live. Which interventions are appropriate at this time? Select all that apply. A. Advise the parents that the hospital can make the arrangements. B. Offer to pray with the family if appropriate. C. Leave the parents to talk through their next steps. abirb.com/test D. Initiate spiritual comfort by calling the hospital clergy, if appropriate. E. Respect variations in the family's spiritual needs and readiness.

B. Offer to pray with the family if appropriate. D. Initiate spiritual comfort by calling the hospital clergy, if appropriate. E. Respect variations in the family's spiritual needs and readiness.

What are common treatments for preeclampsia?

Birth generally resolves, mgmt condition to get as close to due date, bed rest, hospitalization, medications for hypertension, anticonvulsive medication, corticordsteriods to help babies lungs to develop.

A pregnant woman is admitted with premature rupture of the membranes. The nurse is assessing the woman closely for possible infection. Which findings would lead the nurse to suspect that the woman is developing an infection? Select all that apply. A. fetal bradycardia B. abdominal tenderness C. elevated maternal pulse rate D. decreased C-reactive protein levels E. cloudy malodorous fluid

B. abdominal tenderness C. elevated maternal pulse rate D. decreased C-reactive protein levels

A newborn has an Apgar score of 6 at 5 minutes. Which action would be the priority? A. initiating IV fluid therapy B. beginning resuscitative measures C. promoting kangaroo care D. obtaining a blood culture

B. beginning resuscitative measures

A woman calls the health care facility stating that she is in labor. The nurse would urge the client to come to the facility if the client reports which symptom? A. increased energy level with alternating strong and weak contractions B. moderately strong contractions every 4 minutes, lasting about 1 minute C. contractions noted in the front of abdomen that stop when she walks D. pink-tinged vaginal secretions and irregular contractions lasting about 30 seconds

B. moderately strong contractions every 4 minutes, lasting about 1 minute. Moderately strong regular contractions 60 seconds in duration indicate that the client is probably in the active phase of the first stage of labor. Alternating strong and weak contractions, contractions in the front of the abdomen that change with activity, and pink-tinged secretions with irregular contractions suggest false labor.

What is dystocia of labor?

Babies anterior shoulder stuck under mother's public bone

A client states, "I think my water broke! I felt this gush of fluid between my legs." The nurse tests the fluid with nitrazine paper and confirms membrane rupture if the swab turns:

Blue

What is the recommendation for placenta Previa births?

C-section to ensure mother does not lose excessive blood and baby does not have hypoxia.

A woman in her 40th week of pregnancy calls the nurse at the clinic and says she is not sure whether she is in true or false labor. Which statement by the client would lead the nurse to suspect that the woman is experiencing false labor? A. "I'm feeling contractions mostly in my back." B. "My contractions are about 6 minutes apart and regular." C. "The contractions slow down when I walk around." D. "If I try to talk to my partner during a contraction, I can't."

C. "The contractions slow down when I walk around."False labor is characterized by contractions that are irregular and weak, often slowing down with walking or a position change. True labor contractions begin in the back and radiate around toward the front of the abdomen. They are regular and become stronger over time; the woman may find it extremely difficult if not impossible to have a conversation during a Contraction.

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate? A. "There is a new vaccine available that prevents the infection from returning." B. "All you need is a dose of penicillin and the infection will be gone." C. "There is no cure, but drug therapy helps to reduce symptoms and recurrences." D. "Once you have the infection, you develop an immunity to it."

C. "There is no cure, but drug therapy helps to reduce symptoms and recurrences."

Assessment of a woman in labor reveals that the fetus is in a cephalic presentation and engagement has occurred. The nurse interprets this finding to indicate that the presenting part is at which station? A. -2 B. -1 C. 0 D. +1

C. 0 Fetal engagement signifies the entrance of the largest diameter of the fetal presenting part (usually the fetal head) into the smallest diameter of the maternal pelvis. The fetus is said to be engaged in the pelvis when the presenting part reaches 0 station.

A pregnant woman with a fetus in the cephalic presentation is in the latent phase of the first stage of labor. Her membranes rupture spontaneously. The fluid is green in color. Which action by the nurse would be appropriate? A. Check the pH to ensure the fluid is amniotic fluid. B. Prepare to administer an antibiotic. C. Notify the health care provider about possible meconium. D. Check the maternal heart rate.

C. Notify the health care provider about possible meconium. Amniotic fluid should be clear when the membranes rupture. Green fluid may indicate that the fetus has passed meconium secondary to transient hypoxia, prolonged pregnancy, cord compression, intrauterine growth restriction, maternal hypertension, diabetes, or chorioamnionitis. Therefore, the nurse would notify the health care provider. Antibiotic therapy would be indicated if the fluid was cloudy or foul-smelling, suggesting an infection. Color of the fluid has nothing to do with the pH of the fluid. Spontaneous rupture of membranes can lead to cord compression, so checking fetal heart rate, not maternal heart rate, would be appropriate

When applying the ultrasound transducer for continuous external electronic fetal monitoring, the nurse would place the transducer at which location on the client's body to record the FHR? A. over the uterine fundus where contractions are most intense B. above the umbilicus toward the right side of the diaphragm C. between the umbilicus and the symphysis pubis D. between the xiphoid process and umbilicus

C. between the umbilicus and the symphysis pubis. The ultrasound transducer is positioned on the maternal abdomen in the midline between the umbilicus and the symphysis pubis. The tocotransducer is placed over the uterine fundus in the area of greatest contractility.

A nurse is assisting with the birth of a newborn. The fetal head has just emerged. Which action would be performed next? A. suctioning of the mouth and nose B. clamping of the umbilical cord C. checking for the cord around the neck D. drying of the newborn

C. checking for the cord around the neck. Once the fetal head has emerged, the primary care provider explores the fetal neck to see if the umbilical cord is wrapped around it. If it is, the cord is slipped over the head to facilitate delivery. Then the health care provider suctions the newborn's mouth first (because the newborn is an obligate nose breather) and then the nares with a bulb syringe to prevent aspiration of mucus, amniotic fluid, or meconium. Finally the umbilical cord is double-clamped and cut between the clamps. The newborn is placed under the radiant warmer, dried, assessed, wrapped in warm blankets, and placed on the woman's abdomen for warmth and closeness.

A client has not received any medication during her labor. She is having frequent contractions about every 1 to 2 minutes and has become irritable with her coach and no longer will allow the nurse to palpate her fundus during contractions. Her cervix is 8 cm dilated and 90% effaced. The nurse interprets these findings as indicating: A. latent phase of the first stage of labor. B. perineal phase of the first stage of labor. C. late active phase of the first stage of labor. D. early phase of the third stage of labor.

C. late active phase of the first stage of labor. Late in the active phase of labor, contractions become more frequent (every 2 to 5 minutes) and increase in duration (45 to 60 seconds). The woman's discomfort intensifies (moderate to strong by palpation). She becomes more intense and inwardly focused, absorbed in the serious work of her labor. She limits interactions with those in the room. The latent phase is characterized by mild contractions every 5 to 10 minutes, cervical dilation of 0 to 3 cm and effacement of 0% to 40%, and excitement and frequent talking by the mother. The pelvic phase of the second stage of labor is characterized by complete cervical dilation and effacement, with strong contractions every 2 to 3 minutes; the mother focuses on pushing. The perineal phase of the second stage is the period of active pushing. The third stage, placental expulsion, starts after the newborn is born and ends with the separation and birth of the placenta

A nurse is providing care to a woman during the third stage of labor. Which finding would alert the nurse that the placenta is separating? A. Boggy, soft uterus B. uterus becoming discoid shaped C. sudden gush of dark blood from the vagina D. shortening of the umbilical cord

C. sudden gush of dark blood from the vagina. Signs that the placenta is separating include a firmly contracting uterus; a change in uterine shape from discoid to globular ovoid; a sudden gush of dark blood from the vaginal opening; and lengthening of the umbilical cord protruding from the vagina.

What is another condition related to gestational diabetes?

Can also go with gestational hypertension which is related to cardio issues related to pregnancy.

When describing the stages of labor to a pregnant woman, which of the following would the nurse identify as the major change occurring during the first stage? A. Regular contractions B. Cervical dilation C. Fetal movement through the birth canal D. Placental separation

Cervical Dilation. The primary change occurring during the first stage of labor is progressive cervical dilation. Contractions occur during the first and second stages of labor. Fetal movement through the birth canal is the major change during the second stage of labor. Placental separation occurs during the third stage of labor.

A woman in labor is to receive continuous internal electronic fetal monitoring. The nurse prepares the client for this monitoring based on the understanding that which criterion must be present? A. intact membranes B. cervical dilation of 2 cm or more C. floating presenting fetal part D. a neonatologist to insert the electrode

Cervical dilation of 2cm or more. Rationale: For continuous internal electronic fetal monitoring, four criteria must be met: ruptured membranes, cervical dilation of at least 2 cm, fetal presenting part low enough to allow placement of the electrode, and a skilled practitioner available to insert the electrode.

Which suggestion by the nurse about pushing would be most appropriate to a woman in the second stage of labor?

Choose whatever method you feel most comfortable with for pushing.

What is the COAT diagnosis for rupture of membranes?

Color - eg: clear, straw colored, thick greenish, bloody Odor - should not have an odor Amount - How much was seen? Wet panties, a puddle, etc? Time of rupture - what time/day did the mother notice ROM? Important to determine how many hours have passed before the 24 hour mark after ROM. Time will affect the plan of care for her labor and delivery.

A pregnant woman with diabetes at 10 weeks' gestation has a glycosylated hemoglobin (HbA1c) level of 13%. At this time the nurse should be most concerned about which possible fetal outcome?

Congenital anomalies. A HbA1c level of 13% indicates poor glucose control. This, in conjunction with the woman being in the first trimester, increases the risk for congenital anomalies in the fetus. Elevated glucose levels are not associated with incompetent cervix, placenta previa, or placental abruption (abruptio placentae).

What are signs of True Labor?

Contractions with cervical dilation & effacement Contractions cause progressive cervical changes of dilation and effacement and ends with placental delivery -Begins in lower back & gradually sweeps around to lower ab -Tend to increase with walking Discomfort - may persist as back pain/like menstrual cramps Follows a specific sequence of events called the cardinal mvmts of labor Contraction timing: regular, becoming closer together, usually 4-6 min apart, lasting 30-60 second Contraction strength: becoming stronger with time, vaginal pressure is usually felt Contraction discomfort: Starts in the back and radiated around toward the front of the ab Any change in activity: Contractions continue no matter what positional change is made Stay home until contractions are 5 min apart, last 45-60 sec, and are strong enough so that a conversation during one is not possible - then go to the hospital/birthing center.

What are the signs of False Labor?

Contractions without cervical dilation or effacement Can mimic true, early labor Contractions: inconsistent in freq, duration and intensity; Do not change or may decrease with activity. Discomfort: felt in ab & groin maybe more annoying than painful Cervix: does not significantly change in effacement or dilation Contraction timing - irregular, not occurring together Frequently weak, not getting stronger with time or alternating (strong followed by weaker) Contraction discomfort: Usually felt in the front of the ab Any chance in activity: may slow down or stop with positional change Drink fluids and walk around to see if there is any change in the intensity of the contractions, if contractions diminish in intensity after either or both - stay home.

A nurse is conducting a presentation for a group of pregnant women about measures to prevent toxoplasmosis. The nurse determines that additional teaching is needed when the group identifies which measure as preventive?

Cooking all meat to an internal temp of 125F

A nurse is explaining the use of effleurage as a pain relief measure during labor. Which statement would the nurse most likely use when explaining this measure? A. "This technique focuses on manipulating body tissues." B. "The technique requires focusing on a specific stimulus." C. "This technique redirects energy fields that lead to pain." D. "The technique involves light stroking of the abdomen with breathing."

D. "The technique involves light stroking of the abdomen with breathing." Effleurage involves light stroking of the abdomen in rhythm with breathing. Therapeutic touch is an energy therapy and is based on the premise that the body contains energy fields that lead to either good or ill health and that the hands can be used to redirect the energy fields that lead to pain. Attention focusing and imagery involve focusing on a specific stimulus. Massage focuses on manipulating body tissues.

After spontaneous rupture of membranes, the nurse notices a prolapsed cord. The nurse immediately places the woman in which position? A. supine B. side-lying C. sitting D. knee-chest

D. knee-chest Pressure on the cord needs to be relieved. Therefore, the nurse would position the woman in a modified Sims, Trendelenburg, or knee-chest position. Supine, side-lying, or sitting would not provide relief of cord compression.

A nurse suspects that a pregnant client may be experiencing a placental abruption based on assessment of which finding? Select all that apply. A. dark red vaginal bleeding B. insidious onset C. absence of pain D. rigid uterus E. absent fetal heart tones

Dark red vaginal bleeding, rigid uterus, absent fetal heart tones.

What causes contractions?

Decreased progesterone as she gets closers causes the uterine to relax causing contractions.

A client is diagnosed with gestational hypertension and is receiving magnesium sulfate. The nurse determines that the medication is at a therapeutic level based on which finding?

Deep tendons reflexes 2+ With magnesium sulfate, deep tendon reflexes of 2+ would be considered normal and therefore a therapeutic level of the drug. Urinary output of less than 30 mL, a respiratory rate of less than 12 breaths/minute, and a diminished level of consciousness would indicate magnesium toxicity.

A nurse is conducting a program for pregnant women with gestational diabetes about reducing complications. The nurse determines that the teaching was successful when the group identifies which factor as being most important in helping to reduce complications associated with pregnancy and diabetes?

Degree of blood glucose control achieved during the pregnancy.

When assessing cervical effacement of a client in labor, the nurse assesses which Characteristic?

Degree of thinning. Effacement refers to the degree of thinning of the cervix. Cervical dilation refers to the extent of opening at the widest diameter. Passage of the mucous plug occurs with bloody show as a premonitory sign of labor. The fetal presenting part is determined by vaginal examination and is commonly the head (cephalic), pelvis (breech), or shoulder.

What is the treatment for premature rupture of membranes?

Dependent on gestational age; no unsterile digital cervical exams until woman is in active labor; expectant mgmt if fetal lungs immature.

What is important during nursing mgmt of Rh Factor?

Diagnosis important. Same father?

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?

Ensures passage of all the products of conception

What are gestational diabetes levels?

Fasting 126 mg/dL HbA1c <7% Random 200 mg/DL *If any abnormal do a three hour glucose tolerance test

What is Ectopic pregnancy?

Fertilized ovum implants outside the uterine cavity

What is passenger?

Fetal attitude. Posturing as seen with flexion & extension of the cephalic presentation.

A nurse is conducting an in-service program for a group of nurses working at the women's health facility about the causes of spontaneous abortion. The nurse determines that the teaching was successful when the group identifies which condition as the most common cause of first trimester abortions?

Fetal genetic abnormalities

What are complications of RH antibodies?

Fetal heart problems, breathing difficulties, jaundice and a form of anemia known as hemolytic disease of the newborn.

What do you diagnose using Leopold's maneuver?

Fetal position & presentation, Number of fetuses, Degree of presenting part's descent/engagement into the maternal pelvis, expected location of best spot to hear the FHR.

What is Herpes Torch Disease?

Fetal transmission - by exposure to lesion during birth process or in utero in pregnancy w/ROM; most severe complication of HSV Fetal outcomes - development of herpetic skin lesions herpetix, encephalopathy & death. C-section is often advised if no ruptured membranes. If ruptured membranes come immediately to hospital.

What is Syphilis Torch Disease?

Fetal transmission - via placenta Fetal outcomes - CNS damage, hearing loss or death. Test for syphillis for every pregnant women - serum RPR. Primary stage - Chancre - screening/diagnosis - pregnant women, serologic tests, false positives Mangaement - penicillin, sexual abstinence during treat

A primigravida whose labor was initially progressing normally is now experiencing a decrease in the frequency and intensity of her contractions. The nurse would assess the woman for which Condition?

Fetopelvic disproportion.

Can a fetus survive a ectopic pregnancy? What are possible complications?

Fetus cannot survive, generally. Growing tissue can rupture and damage maternal structures. Massive blood loss that could be life threatening.

A nurse is conducting an assessment of a woman who has experienced PROM. Which amniotic fluid finding would lead the nurse to suspect infection as the cause of a client's PROM?

Foul Odor. A foul odor of the amniotic fluid indicates infection. Yellow-green fluid would suggest meconium. A blue color on Nitrazine testing and ferning indicate the presence of amniotic fluid.

What are three things you look for in contractions?

Frequency, length and intensity

A nurse is completing the assessment of a woman admitted to the labor and birth suite. Which information would the nurse expect to include as part of the physical assessment? Select all that apply. A. current pregnancy history B. fundal height measurement C. support system D. estimated date of birth E. membrane status F. contraction pattern

Fundal Height Mgmt Membrane Status Contraction Pattern As part of the admission physical assessment, the nurse would assess fundal height, membrane status, and contractions. Current pregnancy history, support systems, and estimated date of birth would be obtained when collecting the maternal health history.

Which assessment finding will alert the nurse to be on the lookout for possible placental abruption during labor?

Gestational hypertension. Risk factors for placental abruption include preeclampsia, gestational hypertension, seizure activity, uterine rupture, trauma, smoking, cocaine use, coagulation defects, previous history of abruption, intimate partner violence, and placental pathology. Macrosomia, gestational diabetes, and low parity are not considered risk factors

A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure for which sexually transmitted infection (STI)? A. genital herpes B. hepatitis B C. syphilis abirb.com/test D. gonorrhea

Gonorrhea

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia Neonatorum?

Gonorrhea Infection

What is Gravida? and what is Para?

Gravida - # of times women has been pregnant whether or not went to term, etc. Para - # of times a women has given birth to a fetus of at least 20 gestational weeks (viable or not)

What are torch infections?

Group of infections can negatively affect a pregnant women -Can cross the placenta and have teratogenic effects on the fetus

What does HELLP stand for?

H: Hemolysis resulting in anemia and jaundice EL: Elevated liver enzymes resulting in elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and vomiting LP: Low Platelets (<100,000/mm3) resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly disseminated intravascular coagulopathy

What is nursing assessment for iron deficiency anemia?

HX & Physical, Pica, nutrition, multiple gestation, pregnancies close together? Is women fatigued, SOB, weak, anorexic, freq infections/colds, are mucous membranes & skin pale. H/H <11g/dl/<35%.

A client is suspected of having a ruptured ectopic pregnancy. Which assessment would the nurse identify as the priority?

Hemorrhage

A client comes to the clinic for an evaluation. The client is at 22 weeks' gestation. After reviewing a client's history, which factor would the nurse identify as placing her at risk for Preeclampsia?

Her mother had preeclampsia during pregnancy.

After teaching a woman who has had an evacuation for gestational trophoblastic disease (hydatidiform mole or molar pregnancy) about her condition, which statement indicates that the nurse's teaching was successful?

I will be sure to avoid getting pregnant for at least 1 year.

A pregnant woman is diagnosed with iron-deficiency anemia and is prescribed an iron supplement. After teaching her about her prescribed iron supplement, which statement indicates successful teaching?

I'll need to eat foods high in fiber.

What is the treatment for Ectopic Pregnancy?

If detected early methotrexate maybe inject to dissolve the pregnancy tissue. Keyhole/laparoscopic surgery. If rupture open surgery to remove the ruptured tube. *HcG levels are monitored to ensure its all taken out.

What is the treatment of trophoblastic disease?

Immediate evacuation of uterine contents (D&C), Rhogam post expulsion if Rh negative, long term follow-up and monitoring of serial hCG levels.

A nurse is preparing to auscultate the fetal heart rate of a pregnant woman at term admitted to the labor and birth suite. Assessment reveals that the fetus is in a cephalic presentation. At which area on the woman's body would the nurse best hear the sounds? A. At the level of the woman's umbilicus B. In the area above the woman's umbilicus C. In the woman's lower abdominal quadrant D. At the upper outer quadrant of the woman's abdomen

In the woman's lower abdominal quadrant. The fetal heart rate is heard most clearly at the fetal back. In a cephalic presentation, the fetal heart rate is best heard in the lower quadrant of the maternal abdomen. In a breech presentation, it is heard at or above the level of the maternal umbilicus.

What is parvovirus B19?

Infection is spread to the fetus transplacentally, by the oropharyngeal route in casual contact and through infected blood. Common self limiting childhood disease. Also known as 5th disease.

What is nursing mgmt?

Infection prevention, ID of uterine contractions, education and support, discharge home (PPROM) if no labor within 48 hours. Determined individually for each woman. At term birth is the best option. Managed expectantly and conservatively. Vigilance for signs of infections.

Vaccined contraindicated during pregnancy?

Influenza (live, attenuated vaccine) nasal spray Measles Mumps Rubella Varicella BCG (tuberculosis) Meningococcal Typhoid

A nurse is teaching a pregnant woman with preterm prelabor rupture of membranes about caring for herself after she is discharged home (which is to occur later this day). Which statement by the woman indicates a need for additional teaching?

It's okay for my husband and me to have sexual intercourse.

What is a biophysical profile (BPP)?

It's ultrasound to assess 5 parameters: -Fetal Tone -Fetal Breathing -Fetal Movements -Amniotic fluid volume -Nonstress test Overall, a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus; further investigation of fetal well-being is needed.

What is the station?

Level of the presenting part in relation to maternal ischia spines. Maternal ischial spines: 0 station, Above ischial spines: (-) minus station, Below ischial spines: (+) plus station. For example, +4 cm means that fetal head is at the pelvic outlet

A woman in her third trimester comes to the clinic for a prenatal visit. During assessment the woman reports that her breathing has become much easier in the last week but she has noticed increased pelvic pressure, cramping, and lower back pain. The nurse determines that which event has most likely occurred? A. cervical dilation B. lightening C. bloody show D. Braxton Hicks contractions

Lightening. Lightening occurs when the fetal presenting part begins to descend into the maternal pelvis. The uterus lowers and moves into the maternal pelvis. The shape of the abdomen changes as a result of the change in the uterus. The woman usually notes that her breathing is much easier. However, she may complain of increased pelvic pressure, cramping, and lower back pain.

What is the therapeutic mgmt for HELLP syndrome?

Lowering high blood pressure with rapid-acting agents (hydralazine or labetalol) Prevention of seizures (magnesium sulfate) Blood component therapy (fresh-frozen plasma, packed RBCs, platelets) Delivery of fetus as soon as feasible (steroids for fetal lung maturity)

What is toxoplasmosis?

Maternal ingestion of infested undercooked meat, cat littler or gardening near cat feces & poor hand hygiene. Fetal transmission as it passes through the vagina. Fetal outcomes - miscarriage if early in pg, microcephaly, blind, deaf, severe mental retardation, and seizures.

What are complications of preeclampsia?

Maternal organ damage/failure, impaired fetal growth, placental abruption, stillbirth

What are signs of ectopic pregnancy?

May have no signs at first. Positive hCG. First symptoms after four weeks - ab pain, vaginal bleeding, shoulder pain. If fallopian tube ruptures: heavy bleeding, fainting and shock. Medical ER.

Will a women gain or loss weight right before birth?

May have slight decrease

What is a nonstress test?

Measurement of fetal heart rate, pattern, and accelerations for 20 minutes (should go up in response to fetal movement)

How do you manage placenta abruption?

Medical ER. Ensure adequate tissue perfusion. Support/Education. Accurate & frequent communication with HCP.

Which medication will the nurse anticipate the health care provider will prescribe as treatment for an unruptured ectopic pregnancy?

Methotrexate

What is the treatment for placenta previa?

Mgmt bleeding to get as close to due date as possible. Bed rest, pelvic rest. Heavy blooding may require blood transfusion. If delivery before 37 weeks corticosteroids given to help baby's lung grows.

A nurse is reading a journal article about the various medications used for pain relief during labor. Which drug would the nurse note as producing amnesia but no analgesia? A. Midazolam B. prochlorperazine C. fentanyl D. meperidine

Midazolam is given intravenously and produces good amnesia but no analgesia. It is most commonly used as an adjunct for anesthesia. Prochlorperazine is typically given with an opioid such as morphine to counteract the nausea of the opioid. Fentanyl and meperidine are opioids that produce analgesia.

What are common risks factors for preeclampsia?

More common in 1st pregnancy, diabetes, kidney disease, lupus, chronic hypertension, obesity, multiple pregnancy, previous pregnancy complications, IVF, Family history, mother older than 40 or younger than 20, Race: African or hispanic more at risk.

What is Hep C Virus Torch Disease?

Most common blood borne infection in the US. Risk factor for pregnant women is history of injecting IV drugs. Interferon Alfa or ribacirin is main therapy for HCV infection. Effectiveness of treatment varies.

What is Hep B Torch Disease?

Most threatening to the fetus and neonate. Disease of the liver and often a silent infection. Transmitted parenterally, perinatally and rarely orally, as well as through intimate contact. Vaccination series.

The nurse is caring for an Rh-negative non-immunized client at 14 weeks' gestation. What information would the nurse provide to the client?

Obtain Rho(D) immune globulin at 28 weeks' gestation.

What generally comes out of first during childbirth?

Occipital

What are manifestations of Placenta Abruption?

Onset - Sudden Type of bleeding - Can be concealed or visible Blood description - Dark Discomfort/pain - Constant; uterine Uterine tenderness on palpation Uterine tone- Firm to rigid Fetal HR - Fetal distress or absent Fetal Presentation - No relationship

A woman with gestational hypertension develops eclampsia and experiences a seizure. Which intervention would the nurse identify as the priority?

Oxygenation

What is the main symptom of placenta previa?

Painless bleeding in the second half of pregnancy.

What are risk factors for Ectopic Pregnancy?

Pelvic inflammatory disease, inflammation/infection generally caused by gonorrhea or chlamydia; IUD, tubal ligation tubal reversal, D&C, previous ectopic pregnancy, abnormal tube shape, fertility drugs, smoking, daughters of mothers who took

What is the powers?

Physiological forces of L&D. Uterine contractions = primary force/powers. Parameters = frequency, duration and intensity.

client at 33 weeks' gestation comes to the emergency department with vaginal bleeding. Assessment reveals the following: • Onset of slight vaginal bleeding at 29 weeks with spontaneous cessation • Recent onset of bright red vaginal bleeding, more than with previous episode • No uterine contractions at present • Fetal heart rate within normal range • Uterus soft and nontender Based on the assessment findings, which condition would the nurse likely suspect?

Placenta Previa The assessment findings suggest placenta previa, a bleeding condition that occurs during the last two trimesters of pregnancy. It is characterized by slight birght red vaginal bleeding initially that stops spontaneously and then recurs later in amounts greater than the initial episode; absence of pain/contractions; soft, relaxed uterine tone; and a fetal heart rate within normal parameters.

What is placenta previa?

Placenta attaches to low end of the utuerus, near or covering the cervical opening.

What are complications of HELLP?

Placental abruption Acute renal failure Subcapsular hepatic hematoma Hepatic rupture Recurrent preeclampsia Preterm birth Fetal and maternal death

What is therapeutic mgmt for diabetes?

Preconception counseling. Blood glucose control (A1c <7%, bgl 70-110 mg/dL), nutritional mgmt, hypoglycemic agent, close maternal and fetal surveillance, mgmt during labor/birth.

A woman with a history of asthma comes to the clinic for evaluation for pregnancy. The woman's pregnancy test is positive. When reviewing the woman's medication therapy regimen for asthma, which medication would the nurse identify as problematic for the woman now that she is pregnant?

Prednisone

A woman pregnant with twins comes to the clinic for an evaluation. While assessing the client, the nurse would be especially alert for signs and symptoms for which potential problem?

Preeclampsia Women with multiple gestations are at high risk for preeclampsia, preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, and antepartal hemorrhage. There is no association between multiple gestations and the development of chorioamnionitis.

The nurse is teaching a pregnant woman with type 1 diabetes about her diet during pregnancy. Which client statement indicates that the nurse's teaching was successful?

Pregnancy affects insulation production, so i'll need to make adjustments in my diet.

What is Rh factor?

Pregnant woman's immune system creates antibodies against fetal Rh blood factors Mother is Rh(-), biologic father is Rh (+) and fetus is Rh(+) Issues arise after 1st pregnancy.

What is engagement?

Presenting part at 0. When the widest diameter of the fetal presenting part has passed through the pelvic inlet.

What is prevention of Rh Factor?

Prevention = mother is given anti-D immune globulin prophylaxis (RhoGAM) at 26 weeks gestation and within 72 hrs. of delivery to reduce the possibility of forming antibodies and anytime there may have been a crossing over of fetal to maternal blood i.e., with a SAB or CVS or amniocentesis.

What are common signs of Preeclampsia?

Proteins in urine, increased swelling in face/hands, blood pressure >140/90, headache, blurred vision, right upper quad ab pain, nausea/vomiting, decreased urine output, SOB

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The nurse teaches a primigravida client that lightening occurs about 2 weeks before the onset of labor. What will the mother likely experience at that time? A. dysuria B. dyspnea C. constipation D. urinary frequency

Rationale: Lightening refers to the descent of the fetal head into the pelvis and engagement. With this descent, pressure on the diaphragm decreases, easing breathing, but pressure on the bladder increases, leading to urinary frequency. Dysuria might indicate a urinary tract infection. Constipation may occur throughout pregnancy due to decreased peristalsis, but it is unrelated to lightening.

A nurse is reviewing a client's history and physical examination findings. Which information would the nurse identify as contributing to the client's risk for an ectopic pregnancy?

Recurrent pelvic infections. In the general population, most cases of ectopic pregnancy are the result of tubal scarring secondary to pelvic inflammatory disease.

What is the cause of Ectopic pregnancy?

Reduction in number of cilia slows down mvmt, tubal tissue scarring, effect of chemical/drugs.

What are danger signs for Second trimester?

Regular uterine contractions Pain in calf Vaginal fluid loss or bleeding Decreased fetal movement

A woman in labor received an opioid close to the time of birth. The nurse would assess the newborn for which effect? A. Respiratory depression B. urinary retention C. abdominal distention D. hyperreflexia

Respiratory Depression Opioids given close to the time of birth can cause central nervous system depression, including respiratory depression, in the newborn, necessitating the administration of naloxone. Urinary retention may occur in the woman who received neuraxial opioids. Abdominal distention is not associated with opioid administration. Hyporeflexia would be more commonly associated with central nervous system depression due to opioidsA. Respiratory depression

A nurse is assessing a woman in labor. Which finding would the nurse identify as a cause for concern during a contraction?

Respiratory rate of 10 breaths/minute During labor, the mother experiences various physiologic responses including an increase in heart rate by 10 to 20 bpm, a rise in blood pressure by up to 35 mm Hg during a contraction, an increase in white blood cell count to 25,000 to 30,000 cells/mm3, perhaps as a result of tissue trauma, and an increase in respiratory rate with greater oxygen consumption due to the increase in metabolism. A drop in respiratory rate would be a cause for concern.

What are complications of severe/persistent asthma?

Severe persistent asthma linked to development of maternal hypertension, preeclampsia, placenta previa, uterine hemorrhage, and oligohydramnios. Increased risk infant death, preeclampsia, IUGR, preterm birth, and low birth weight. Linked to severity of asthma; more severe asthma increases these risks. *Usually problems in the last weeks of pregnancy

What is the nursing mgmt of HELLP syndrome?

Similar to management of woman with severe preeclampsia Chart review & communication w/ other health care team professional Review of systems with interim Hx. Taking Assess fetal status Stabilize mom Communicate, report & document

What is the position?

Site of presenting fetal part to the four quadrants of the maternal pelvis. First letter references side of maternal pelvis: Right (R) or Left (L) Second letter references presenting part of fetus: Occiput (O), Mentum (M), Sacrum (S), or Acromion process (A) Third letter references part of maternal pelvis: Anterior (A), Posterior (P), or Transverse (T)

A 44-year-old client has lost several pregnancies over the last 10 years. For the past 3 months, she has had fatigue, nausea, and vomiting. She visits the clinic and takes a pregnancy test; the results are positive. Physical examination confirms a uterus enlarged to 13 weeks' gestation; fetal heart tones are heard. Ultrasound reveals that the client is experiencing some bleeding. Considering the client's prenatal history and age, what does the nurse recognize as the greatest risk for the client at this time?

Spontaneous abortion (miscarriage)

What is premature rupture of membranes? And the cause? and when?

Spontaneous rupture of amniotic sac and leakage of fluid prior to the onset of labor at any gestational age. Unknown Cause PROM - women beyond 37 weeks gestation PPROM - women less than 37 weeks

What is stage 1 and stage 2 of preeclampsia?

Stage 1 - Vasospasm - Wide spread vasospasm Stage 2 - Hypoperfusion - S/S - impaired liver function & subcapsular hemorrhage

What are danger signs for Third Trimester?

Sudden weight gain Edema of face and hands Severe upper abdominal pain Headaches with visual changes Decreased fetal movement

A nurse is describing how the fetus moves through the birth canal. Which component would the nurse identify as being most important in allowing the fetal head to move through the pelvis? A. sutures B. fontanelles C. frontal bones D. Biparietal diameter

Sutures are important because they allow the cranial bones to overlap in order for the head to adjust in shape (elongate) when pressure is exerted on it by uterine contractions or the maternal bony pelvis. Fontanelles are the intersections formed by the sutures. The frontal bones, along with the parietal and occipital bones are bones of the cranium that are soft and pliable. The biparietal diameter is an important diameter that can affect the birth process.

What is patient teaching for iron deficiency anemia?

Take prenatal vitamins + with Vitamin C and between meals. Eating green vegetables. Beware of side effects of iron supplementation. Avoid taking with coffee, tea, choco, and high fiber foods. Eat foods rich in iron such as: meat, green leafy veg, legumes, dried fruits, and whole grain. Peanut butter, bean dip. INcrease fluid/exercise to avoid constipation.

What are two other types of pregnancy related anemia?

Thalassemia - depends on ancestry. African, med, greek and asian descendent are more likely. Alpha minor - has little effect. Beta can be more severe & genetic counseling maybe be warranted. Frequent hemoglobin and ferritin levels should be monitored to avoid iron overload. Sickle Cell Anemia - Hemoglobin S replaces hbA & hbB - causing sickling of the RBCs - trauma, illness, stress, excessive cold exposure, infection, hypoxia. Preconceptual screening with hemoglobin electrophoresis. Being part of collaborative team.

A nurse is conducting a class for a group of nurses new to the labor and birth unit about labor and the passage of the fetus through the birth canal. As part of the class, the nurse explains that specific diameters of the fetal skull can affect the birth process. Which diameter would the nurse identify as being most important in affecting the birth process? Select all that apply. A. Occipitofrontal B. Occipitomental C. Suboccipitobregmatic D. Biparietal E. Diagonal conjugate

The diameter of the fetal skull is an important consideration during the labor and birth process. Fetal skull diameters are measured between the various landmarks of the skull. Diameters include occipitofrontal, occipitomental, suboccipitobregmatic, and biparietal. The two most important diameters that can affect the birth process are the suboccipitobregmatic (approximately 9.5 cm at term) and the biparietal (approximately 9.25 cm at term) diameters. Diagonal conjugate is a measure of the pelvic inlet of the mother.

A nurse is conducting a continuing education program for a group of nurses working in the perinatal unit. After reviewing information about the maternal bony pelvis with the group, the nurse determines that the teaching was successful based on which statement by the group?

The pelvic outlet is associated with the true pelvis. Ture pelvis (below linea terminalis - inlet, medpelvis, and outlet)

What happens to hemoglobin and hematocrit during pregnancy?

This hemodilution can lead to physiologic anemia of pregnancy, which does not indicate a decrease in oxygen-carrying capacity or true anemia.

What is CMV torch disease?

Transmission - by respiratory droplet, semen, cervical/vaginal secretions, urine and feces. Easily transmitted to daycare providers, institutions for the mentally retarded, & HC settings. Fetal outcomes - hemolytic anemia, hydrocephaly, microcephaly, deafness or death.

How does Group B Streptococci affect pregnancy?

Transmission - vertically from the birth canal of the infected mother to the fetus during delivery or from ruptured membranes more than 24 hours PT delivery. Maternal effects - chorioamnionitis, premature ROM, UTI & PP infections Fetus - neonatal sepsis, neonatal meningitis, septic shock Early onset of GBS in newborn has high mortality rate (within 1st 24-48 hours)

How do you mgmt type 1 diabetes vs gestational diabetes?

Type 1 - insulin therapy throughout pregnancy. Diet, fetal surveillance GDM - diet, sometimes insulin (not common) but exercise, fetal surveillance.

What fetal surveillance happens when a women has gestational diabetes?

Ultrasound, AF levels, biophysical profile (measure fetal growth), nonstress testing, amniocentesis.

A woman is in the first stage of labor. The nurse would encourage her to assume which position to facilitate the progress of labor? A. supine B. lithotomy C. upright D. knee-chest

Upright. The use of any upright position helps to reduce the length of labor. Research shows that women who assumed the upright position during the first stage of labor experienced significant improvement in the progress of labor, faster fetal head descent, significant reduction of pain, and a good Apgar score. Additionally, studies show that recumbent positions result in supine hypotension, diminishing uterine activity and reducing the dimensions of the pelvic outlet. The knee-chest position would assist in rotating the fetus in a posterior position.

What is the Nagele Rule?

Use first day of LMP, subtract three months, add 7 days, add 1 year. -Gestational or birth calculator or wheel -Ultrasound is the most accurate method of dating

A woman in labor is experiencing hypotonic uterine dysfunction. Assessment reveals no fetopelvic disproportion. Which group of medications would the nurse expect to administer?

Uterine stimulants

A client is in the third stage of labor. Which finding would alert the nurse that the placenta is separating? A. uterus becomes globular B. fetal head at vaginal opening C. umbilical cord shortens D. mucous plug is expelled

Uterus becomes globular. Placental separation is indicated by the uterus changing shape to globular and upward rising of the uterus. Additional signs include a sudden trickle of blood from the vaginal opening, and lengthening (not shortening) of the umbilical cord. The fetal head at the vaginal opening is termed crowning and occurs before birth of the head. Expulsion of the mucous plug is a premonitory sign of labor.

A nurse is reviewing the fetal heart rate pattern and observes abrupt decreases in FHR below the baseline, appearing as a U-shape. The nurse interprets these changes as reflecting which type of deceleration? A. early decelerations B. variable decelerations C. prolonged decelerations D. late decelerations

Variable Decelerations Variable decelerations present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. The shape of variable decelerations may be U, V, or W, or they may not resemble other patterns. Early decelerations are visually apparent, usually symmetrical and characterized by a gradual decrease in the FHR in which the nadir (lowest point) occurs at the peak of the contraction. They are thought to be a result of fetal head compression that results in a reflex vagal response with a resultant slowing of the FHR during uterine contractions. Late decelerations are visually apparent, usually symmetrical, transitory decreases in FHR that occur after the peak of the contraction. The FHR does not return to baseline levels until well after the contraction has ended. Delayed timing of the deceleration occurs, with the nadir of the uterine contraction. Late decelerations are associated with uteroplacental insufficiency. Prolonged decelerations are abrupt FHR declines of at least 15 bpm that last longer than 2 minutes but less than 10 minutes.

What is a key feature of preeclampsia?

Vasospasm

What is rubella?

Viral transmission, fetal transmission - vertical across placenta, congenital cataracts, deafness, & heart defects. Rubella vaccine at discharge: nursing education - practice safe sex at a minimum 1 month but preferably 2-3 months after vaccination.

What can happen to vital signs, even when women lose up to 39% of their blood volume?

Vital signs can still be normal. Signs of shock can sometimes not show until more than 40% lost.

A nurse is describing the different types of regional analgesia and anesthesia for labor to a group of pregnant women. Which statement by the group indicates that the teaching was successful? A. "We can get up and walk around after receiving combined spinal-epidural analgesia." B. "Higher anesthetic doses are needed for patient-controlled epidural analgesia." C. "A pudendal nerve block is highly effective for pain relief in the first stage of labor." D. "Local infiltration using lidocaine is an appropriate method for controlling contraction pain."

We can get up and walk around after receiving combined spinal epidural analgesia. When compared with traditional epidural or spinal analgesia, which often keeps the woman lying in bed, combined spinal-epidural analgesia allows the woman to ambulate ("walking epidural"). Patient-controlled epidural analgesia provides equivalent analgesia with lower anesthetic use, lower rates of supplementation, and higher client satisfaction. Pudendal nerve blocks are used for the second stage of labor, an episiotomy, or an operative vaginal birth with outlet forceps or vacuum extractor. Local infiltration using lidocaine does not alter the pain of uterine contractions, but it does numb the immediate area of the episiotomy or laceration.

A client's membranes spontaneously ruptured, as evidenced by a gush of clear fluid with a contraction. What would the nurse do next? A. Check the fetal heart rate. B. Perform a vaginal exam. C. Notify the primary care provider immediately. D. Change the linen saver pad.

When membranes rupture, the priority focus is on assessing fetal heart rate first to identify a deceleration, which might indicate cord compression secondary to cord prolapse. A vaginal exam may be done later to evaluate for continued progression of labor. The primary care provider should be notified, but this is not a priority at this time. Changing the linen saver pad would be appropriate once the fetal status is determined and the primary care provider has been Notified.

After teaching a group of nurses working at the women's health clinic about the impact of pregnancy on the older woman, which statement by the group indicates that the teaching was Successful?

Women over age 35 and are pregnant have an increased risk for spontaneous abortions.

What is Varicella Zoster Torch Infection?

causes varicella & herpes zoster, congenital varicella, LBW, skin lesions, spontaneous Abortion. Nursing Assessment: HX & P, assess maternal immunity. Nursing mgmt - preconception counseling for prevention, check maternal immunity & give vaccine if needed; education. No vaccine during pregnancy per CDC.

What is McRobert's Maneuver?

lower babies head so almost flat. Increased tilt to allow additional 1cm extra space.

What is lab data from preeclampsia?

mag. Levels should be therapeutic, ↑ serum creatinine,↑ liver enzymes, ↓ platelets

What is nursing mgmt for gestational diabetes?

optimal glucose control - blood glucose levels; medication therapy. Nutritional therapy. Measures during labor/birgh: postpartum. Prevention of complications. Client education and counseling. May see them more often depending on how well controlled. *Women with well-controlled diabetes generally do not require early birth unless complications arise such as preeclampsia or fetal compromise. An early delivery date might be set for the women with poorly controlled diabetes or a large fetus who is having complications. -nutrient requirements and recommendations for weight gain are same as non diabetic women. Checking urine

A pregnant client with iron-deficiency anemia is prescribed an iron supplement. After teaching the woman about using the supplement, the nurse determines that more teaching is needed based on which client statement?

will take the iron with milk instead of orange or grapefruit juice. The pregnant client should take the iron supplement with vitamin C-containing fluids such as orange juice, which will promote absorption, rather than milk, which can inhibit iron absorption. Taking iron on an empty stomach improves its absorption, but many women cannot tolerate the gastrointestinal discomfort it causes. In such cases, the woman is advised to take it with meals. The woman also needs instruction about adverse effects, which are predominantly gastrointestinal and include gastric discomfort, nausea, vomiting, anorexia, diarrhea, metallic taste, and constipation. Taking the iron supplement with meals and increasing intake of fiber and fluids helps overcome the most common side effects. If the woman misses a dose, she should take a dose as soon as she remembers.