Exam 3

fundal massage

The nurse's priority intervention for postpartum hemorrhage due to uterine atony

prolonged second stage

This is the most common indication for an operative vaginal delivery

d

A 26-year-old pregnant woman, gravida 2, para 1-0-0-1 is 28 weeks pregnant when she experiences bright red, painless vaginal bleeding. On her arrival at the hospital, what would be an expected diagnostic procedure? A. Amniocentesis for fetal lung maturity B. Contraction stress test (CST) C. Internal fetal monitoring D. Ultrasound for placental location

d

A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that: A. bed rest and analgesics are the recommended treatment. B. a D will be performed to remove the products of conception. C. she will be unable to conceive in the future. D. hemorrhage is the major concern.

a

A after birth woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who: A. has at least 6 to 8 wet diapers per day. B. sleeps for 6 hours at a time between feedings. C. gains 1 to 2 ounces per week. D. has at least one breast milk stool every 24 hours.

caput

A collection of fluid under the newborn's scalp following a vacuum-assisted delivery

hypotension

A common side effect of Procardia, a calcium-channel blocker, often used for preterm labor to relax the smooth muscle of the uterus.

bishop score

A low score on this indicates the need for cervical ripening prior to induction

a

A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 lbs, 6 ounces). The nurse's most appropriate action is to: A. monitor blood glucose levels frequently and observe closely for signs of hypoglycemia. B. leave the infant in the room with the mother. C. perform a gestational age assessment to determine whether the infant is large for gestational age. D. take the infant immediately to the nursery.

a

A maternal indication for the use of forceps is: A. maternal exhaustion. B. a history of rapid deliveries. C. failure to progress past 0 station. D. a wide pelvic outlet.

b

Defining difference between a threatened miscarriage & a inevitable miscarriage is: A. absent FHR B. cervical dilation C. pain D. vaginal bleeding

gestational diabetes

Initial management of this includes diet modification, exercise, and glucose monitoring

methotrexate

Medication given to a woman whose fertilized ovum has implanted in the fallopian tube

b

A new mother asks whether she should feed her newborn colostrum, because it is not "real milk." The nurse's most appropriate answer is: A. giving colostrum is important in helping the mother learn how to breastfeed before she goes home. B. colostrum is high in antibodies, protein, vitamins, and minerals. C. colostrum is lower in calories than milk and should be supplemented by formula. D. colostrum is unnecessary for newborns.

b

A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she: A. has hiccups. B. makes sucking motions. C. stretches her legs out straight. waves her D. arms in the air.

b

A patient is newly diagnosed with gestational diabetes. Based on your knowledge of GDM, which management method would you recommend? A.Oral hypoglycemic B.Diet and exercise C.Insulin D.Strict keto diet

b,c (?)

A patient just arrived in triage to be evaluated. She is 32 weeks. Which of the following statements by the patient indicate that she may be in preterm labor? A."It's painful when I urinate." B."My belly tightens every 30 minutes." C."I've been having low back pain for 2 hours." D."The baby is not moving as much."

a

A placenta previa in which the placental edge just reaches the internal os is more commonly known as: A. choices marginal. B. partial. C. total. D. complete.

b

A plan of care for an infant experiencing symptoms of drug withdrawal should include: A. administering chloral hydrate for sedation. B. swaddling the infant snugly and holding the baby tightly. C. playing soft music during feeding. D. feeding every 4 to 6 hours to allow extra rest.

c

A pregnant woman's amniotic membranes rupture. Prolapsed umbilical cord is suspected. What intervention would be the top priority? A. Starting oxygen by face mask. B. Preparing the woman for a cesarean birth. C. Placing the woman in the knee-chest position. D. Covering the cord in sterile gauze soaked in saline.

a

A primigravida at 40 weeks of gestation is having uterine contractions every 1.5 to 2 minutes and says that they are very painful. Her cervix is dilated 2 cm and has not changed in 3 hours. The woman is crying and wants an epidural. What is the likely status of this woman's labor? A. She is exhibiting hypertonic uterine dysfunction. B. She is experiencing pelvic dystocia. C. She is experiencing a normal latent stage. D. She is exhibiting hypotonic uterine dysfunction.

b

A primigravida is being monitored in her prenatal clinic for preeclampsia. What finding should concern her nurse? A. Blood pressure (BP) increase to 138/86 mm Hg. B. A dipstick value of 3+ for protein in her urine. C. Pitting pedal edema at the end of the day. D. Weight gain of 0.5 kg during the past 2 weeks.

cytotec

A prostaglandin, can be used to expedite a miscarriage, cervical ripening, or active management of postpartum hemorrhage

d

A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as: A. Turner's sign associated with appendicitis. B. Chadwick's sign associated with early pregnancy. C. normal integumentary changes associated with pregnancy. D. Cullen's sign associated with a ruptured ectopic pregnancy.

a

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding indicates that preterm labor is occurring? A. The cervix is effacing and dilated to 2 cm. B. Irregular, mild uterine contractions are occurring every 12 to 15 minutes. C. Fetal fibronectin is present in vaginal secretions. D. Estriol is not found in maternal saliva.

c

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to: A. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy. B. suppress uterine contractions. C. stimulate fetal surfactant production. D. reduce maternal and fetal tachycardia associated with ritodrine administration.

c

A woman is having her first child. She has been in labor for 15 hours. Two hours ago her vaginal examination revealed the cervix to be dilated to 5 cm and 100% effaced, and the presenting part was at station 0. Five minutes ago her vaginal examination indicated that there had been no change. What abnormal labor pattern is associated with this description? A. Prolonged latent phase B. Protracted descent C. Arrest of active phase D. Protracted active phase

d

A woman presents to the emergency department with complaints of bleeding and cramping. The initial nursing history is significant for a last menstrual period 6 weeks ago. On sterile speculum examination, the primary care provider finds that the cervix is closed. The anticipated plan of care for this woman would be based on a probable diagnosis of which type of spontaneous abortion? A. Incomplete B. Inevitable C. Septic D. Threatened

b

A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of 24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: A. diazepam. B. hydralazine. C. magnesium sulfate bolus. D. calcium gluconate.

d

The most common cause of pathologic hyperbilirubinemia is: A. postmaturity. B. hepatic disease. C. congenital heart defect. D. hemolytic disorders in the newborn.

a

As relates to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: A. its most important function is to afford the opportunity to administer antenatal glucocorticoids. B. there are no important maternal (as opposed to fetal) contraindications. C. if the patient develops pulmonary edema while receiving tocolytics, intravenous (IV) fluids should be given. D. the drugs can be given efficaciously up to the designated beginning of term at 37 weeks.

poor latch

The most common cause of sore nipples in a breastfeeding patient

breech

The most common malpresentation that increases the risk of prolapsed cord and trapping of the fetal head

c

According to the recommendations of the American Academy of Pediatrics on infant nutrition: A. after 6 months mothers should shift from breast milk to cow's milk. B. infants fed on formula should be started on solid food sooner than breastfed infants. C. infants should be given only human milk for the first 6 months of life. D. if infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula.

amniocentesis

Administration of Rhogam is indicated for Rh negative women receiving this diagnostic test after 14 weeks' gestation

nubain

Agonist-antagonist, used during labor, contraindicated for opioid-dependent patients

birth control

Although breastfeeding may delay menstruation, it should NOT be the only method of this used postpartum

d (can go into shock very quickly)

An acute rupture of a fallopian tube is a surgical emergency. Nursing care is aimed at: A. pre-op teaching B. antibiotic admin C. controlling hemorrhage D. combating shock

b

An assessment of a pt's uterus w/ placenta previa would include: A. very firm d/t small leakage of blood B. remain soft on palpation C. be hyperactive D. have increased braxton-hicks ctx

NAS

An infant born to a mother taking Methadone during her pregnancy is at risk for this condition

b

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? A. Immunologic factors B. Chromosomal abnormalities C. Infections D. Endocrine imbalance

a

Before the physician performs an external version, the nurse should expect an order for a: A. tocolytic drug. B. contraction stress test (CST). C. Foley catheter. D. local anesthetic.

pre-gestational (DM 1/2)

Cardiac abnormalities are most commonly seen in patients with this type of diabetes

placenta previa

Common symptoms include painless, bright red vaginal bleeding and a non-tender uterus after the 20th week of gestation

breastfeeding benefits

Decreased newborn illness, faster maternal weight loss, cost-effectiveness, and less environmental waste are all examples of this

prevention

Developing risk and resource maps is a key task in this stage of disaster management

Hypothermia

Due to a lack of brown fat, the preterm newborn is at an increased risk of this

uterine rupture

Due to an increased risk of this, patients with only one or two previous low transverse uterine incisions are candidates for a VBAC

community empowerment

Helping individuals, families, and groups gain insight and mastery over life situations through problem solving and dialogue

d

Immediately after the forceps-assisted birth of an infant, the nurse should: A. give the infant prophylactic antibiotics. B. measure the circumference of the infant's head. C. apply a cold pack to the infant's scalp. D. assess the infant for signs of trauma.

c

In caring for an immediate after birth patient, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: A. hemorrhage. B. HELLP syndrome. C. disseminated intravascular coagulation (DIC). D. amniotic fluid embolism (AFE).

b

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? A. Bronchopulmonary dysplasia (BPD) B. Retinopathy of prematurity (ROP) C. Necrotizing enterocolitis (NEC) D. Intraventricular hemorrhage (IVH)

c

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? A. Administration of steroids B. Restriction of intravascular fluids C. Administration of blood D. Preparation of the patient for invasive hemodynamic monitoring

d

In planning for home care of a woman with preterm labor, which concern must the nurse address? A. Restricted activity and medications will be necessary to prevent recurrence of preterm labor. B. Nursing assessments will be different from those done in the hospital setting. C. Home health care providers will be necessary. D. Prolonged bed rest may cause negative physiologic effects.

TTN

Infants born via C-section are at an increased risk for this due to a lack of thoracic squeeze during delivery

d

Magnesium sulfate is given to women with preeclampsia and eclampsia to: A. shorten the duration of labor. B. prevent a boggy uterus and lessen lochial flow. C. improve patellar reflexes and increase respiratory efficiency. D. prevent and treat convulsions.

maternal mortality

Major causes of this include hemorrhage, hypertensive disorders, and infection

b

Methotrexate is recommended as part of the treatment plan for which obstetric complication? A. Abruptio placentae B. Unruptured ectopic pregnancy C. Complete hydatidiform mole D. Missed abortion

c

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. To develop an optimal plan of care for this infant, the nurse must understand which intervention has the greatest effect on lowering the risk of NEC: A. early enteral feedings. B. exchange transfusion. C. breastfeeding. D. prophylactic probiotics.

d

Nurses should be aware that HELLP syndrome: A. can be diagnosed by a nurse alert to its symptoms. B. is a mild form of preeclampsia. C. is associated with preterm labor but not perinatal mortality. D. is characterized by hemolysis, elevated liver enzymes, and low platelets.

b

Nursing intervention for the pregnant diabetic patient is based on the knowledge that the need for insulin: A. decreases throughout pregnancy and the after birth period. B. varies depending on the stage of gestation. C. increases throughout pregnancy and the after birth period. D. should not change because the fetus produces its own insulin.

community assessment

Parameters of this include the environment, industry, transportation, and public services

HBM

Perceived susceptibility and seriousness of a disease influences a person's likelihood to change health behaviors according to this model

b

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with: A. hyperemesis gravidarum. B. congenital anomalies in the fetus. C. frequent episodes of maternal hypoglycemia. D. polyhydramnios.

Incomplete miscarriage

Profuse vaginal bleeding after the delivery of a fetus less than 20 weeks' gestation is termed this

c

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is: A. pharmacologic treatment. B. adequate nutrition and maintenance of fluid and electrolyte balance. C. neonatal abstinence syndrome scoring. D. reduction of environmental stimuli.

Betamethasone

Recommended to women in preterm labor to help increase fetal lung surfactant production

preeclampsia severe features

Symptoms include BP >160/110, proteinuria, thrombocytopenia, elevated liver enzymes, RUQ pain, and visual disturbances

molar pregnancy

Symptoms include dark brown bleeding and enlarged uterine size with development of proliferative grape-like clusters of vesicles

d

The best reason for recommending formula over breastfeeding is that: A. the mother sees bottle-feeding as more convenient. B. other family members or care providers also need to feed the baby. C. the mother lacks confidence in her ability to breastfeed. D. the mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

b

The hormone necessary for milk production is: A. lactogen. B. prolactin. C. estrogen. D. progesterone.

a

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: A. intense abdominal pain. B. bleeding. C. uterine activity. D. cramping.

b

The nurse practicing in a labor setting knows that the woman most at risk for uterine rupture is: A. a gravida 2 who had a low-segment vertical incision for delivery of a 10-lb infant. B. a gravida 4 who has had all cesarean births. C. a gravida 3 who has had two low-segment transverse cesarean births. D. a gravida 5 who had two vaginal births and two cesarean births.

d

The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention: A. is adopted from classical British nursing traditions. B. gets infants ready for breastfeeding. C. helps infants with motor and central nervous system impairment. D. helps infants to interact directly with their parents and enhances their temperature regulation.

a

The nurse providing care for a woman with preterm labor who is receiving terbutaline would include which intervention to identify side effects of the drug? A. Assessing for chest discomfort and palpitations B. Assessing for bradycardia C. Assessing deep tendon reflexes (DTRs) D. Assessing for hypoglycemia

d

The patient that you are caring for has severe preeclampsia and is receiving a magnesium sulfate infusion. You become concerned after assessment when the woman exhibits: A. deep tendon reflexes of 2. B. absent ankle clonus. C. a sleepy, sedated affect. D. a respiratory rate of 10 breaths/min.

d

The perinatal nurse is giving discharge instructions to a woman after suction curettage secondary to a hydatidiform mole. The woman asks why she must take oral contraceptives for the next 12 months. The best response from the nurse would be: A. "Oral contraceptives are the only form of birth control that will prevent a recurrence of a molar pregnancy." B. "If you can avoid a pregnancy for the next year, the chance of developing a second molar pregnancy is rare. Therefore, to improve your chance of a successful pregnancy, it is better not to get pregnant at this time." C. "If you get pregnant within 1 year, the chance of a successful pregnancy is very small. Therefore, if you desire a future pregnancy, it would be better for you to use the most reliable method of contraception available." D. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult."

a

The priority nursing intervention after an amniotomy should be to: A. assess the fetal heart rate. B. change the patient's gown. C. estimate the amount of amniotic fluid. D. assess the color of the amniotic fluid.

d

The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to: A. perform a venipuncture for hemoglobin and hematocrit levels. B. monitor uterine contractions. C. place clean disposable pads to collect any drainage. D. assess fetal heart rate (FHR) and maternal vital signs.

feeding cues

These are early signs of hunger and include rooting and hand-to-mouth motions

McRoberts, suprapubic pressure

These are the two most common nursing interventions performed during a shoulder dystocia delivery, often simultaneously

vitamin K

This IM medication is given to prevent newborn hemorrhagic disease

Amniotic embolism

This condition is a rare obstetric emergency, characterized by the acute onset of hypotension, hypoxia, cardiovascular collapse, and coagulopathy

complete bedrest

This management option has adverse effects, such as cardiovascular deconditioning, muscle atrophy, psychologic stress, and an increased risk for thrombophlebitis.

Mag Sulfate

This medication is a smooth muscle relaxant used during pregnancy to prevent eclamptic seizures

pitocin

This medication is administered immediately after the third stage of labor, either via IV bolus or an IM injection

duramorph

This medication is used during spinal anesthesia to provide pain relief for up to 24 hours

umbilical cord prolapse

This obstetric emergency can occur following the spontaneous or artificial rupture of membranes and is why the FHR should be immediately assessed

physiologic jaundice

This occurs in most infants and is mainly caused by an immature liver

football hold

This position is recommended for early feedings and post C-section delivery as it limits weight on the abdomen

fetal fibronectin

This test is used to predict who will NOT go into preterm labor

autosomal dominant

This type of disorder is expressed when one mutated gene is inherited from an affected parent

HELLP syndrome

This variant of preeclampsia often presents as non-specific malaise, epigastric pain and BP within normal limits.

b

To prevent nipple trauma, the nurse should instruct the new mother to: A. wash the nipples daily with mild soap and water. B. position the infant so the nipple is far back in the mouth. C. limit the feeding time to less than 5 minutes. D. assess the nipples before each feeding.

4+

When assessing deep tendon reflexes, this grade means "brisk, hyperactive, with intermittent or transient clonus"

b

When assessing the preterm infant the nurse understands that compared with the term infant, the preterm infant has: A. well-developed flexor muscles. B. greater surface area in proportion to weight. C. few blood vessels visible through the skin. D. more subcutaneous fat.

a

Which assessment is least likely to be associated with a breech presentation? A. Postterm gestation B. Meconium-stained amniotic fluid C. Fetal heart tones heard at or above the maternal umbilicus D. Preterm labor and birth

c

Which condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? A. Decrease in abdominal pain B. Bradycardia C. Hard, board-like abdomen D. Decrease in fundal height

a

Which factor is known to increase the risk of gestational diabetes mellitus? A. Previous birth of large infant B. Underweight before pregnancy C. Maternal age younger than 25 years D. Previous diagnosis of type 2 diabetes mellitus

b

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? A. Hypoinsulinemia B. Hypoglycemia C. Hypobilirubinemia D. Hypercalcemia

d

Which maternal condition always necessitates delivery by cesarean section? A. Eclampsia Partial B. abruptio placentae C. Total placenta previa D. Ectopic pregnancy

b

Which of the following would indicate the need for prophylactic cerclage placement? A.History of preterm birth at 34 weeks. B. Cervical dilation of 2cm at 28 weeks. C. PPROM at 14 weeks. D. History of two late miscarriages at 14 and 18 weeks.

b

Which type of formula is not diluted before being administered to an infant? A. Powdered B. Ready-to-use C. Concentrated D. Modified cow's milk

d

Your patient is receiving magnesium sulfate for preeclampsia. Her husband is concerned and asks if the medication is necessary. You respond by saying: A."It is being used to lower her blood pressure." B."Magnesium sulfate will help prevent her from going into preterm labor." C."Her magnesium level is 4.0, which is high. We will lower the rate." D."It is helpful to prevent her from having a seizure."

Cephalohematoma

hemorrhage between skull-periosteum, may develop jaundice, hypotension- takes weeks to resolve

caput

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days