Meternal newborn Midterm

Which statement best indicates that the patient understands the differences in the follicular and luteal phases of the ovarian cycle?

"The first part of my period might vary in length, but not the second". Explaination: For a female with a 28-day cycle, the follicular phase (in ovarian cycle) comprises days 1-14 of the menstrual cycle, and the luteal phase, comprises days 15-28. The luteal phase does not vary. The luteal phase is the second half of the ovarian cycle.

Abdominal ultrasound positioning

*Advise client to drink 1 quart of water prior to the ultrasound to fill the bladder *assist the client into a supine position with a small pillow under the head and knees *place an ultrasonic/ transducer gel to the clients abdomen before the transducer is moved over the skin to obtain a better fetal image *allow the client to empty their bladder at the termination of the procedure

The nurse is teaching a prenatal class about false labor. The nurse should teach clients that false labor will most likely include which of the following? Select all that apply

*Contractions that do not intensify while walking *Pain in the abdomen that does not radiate

Influence of Pregnancy on DM

*DM may be difficult to control because insulin requirements are changeable *during the first trimester, the need for insulin frequently decreases. * Nausea and vomiting may cause dietary fluctuations an increase the risk of hypoglycemia *insulin requirements begin to rise late in the first trimester as glucose using glucose storage by the woman fetus increase. *Increase requirements may double or quadruple by the end of pregnancy *increased energy needs during labor maybe require *increased insulin to balance intravenous glucose after delivery of the placenta, insulin requirements usually decrease abruptly *a decreased renal threshold for glucose leads to a higher incidence of glucosuria *the risk of ketoacidosis, which may occur at lower serum glucose levels in a pregnant woman with DM than in a non pregnant woman with diabetes , increases the vascular disease that accompanies DM may progress during pregnancy *hypertension may occur, contributing to vascular changes *neuropathy may result from renal impairment and retinopathy may develop from occlusion of microscopic blood vessels

The nurse is discharging a client after hospitalization for Pelvis Inflammatory disease (PID). Which statement indicates the teaching was effective? Select all that apply

*I may have infertility because of this infection. *It is important for me to finish my antibiotics. *Tubal pregnancy could occur after PID.

The nurse is planning a group session for parents who are beginning infertility evaluation. Which statement should be included in this session? Select all that apply.

*Infertility can be stressful for a marriage. *Keep communicating with one another through this process.

A pregnant client asks you to described the differences between monozygotic and dizygotic twins. Which statement should you include in your teaching?

*Monozygotic (identical) twins originate from the division of the fertilized ovum at different stages. Develop from a single fertilized ovum. They are of the same sex and phenotype. More information: Dizygotic (fraternal) twins arise from two separate ova and two separate spermatozoa. Two placentas, two chorions, and two amnions which can sometimes fuse to look as one. Can be the same of of different sex.

Initial Prenatal Assessment

- Focus on woman holistically - Prepare woman for physical examination - Cultural assessment - Psychologic status, educational needs - Support system, family functioning - Economic status, stability of living conditions

A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? 1. Decreased fetal movement 2. Intrauterine growth restriction (IUGR) 3. Postmaturity 4. Placenta Previa 5. Amniotic fluid emboli

1. Decreased fetal movement 2. Intrauterine growth restriction (IUGR) 3. Postmaturity

7 cardinal movements

1. Engagement 2. Descent 3. Flexion 4. Internal Rotation 5. Extension 6. External Rotation 7. Expulsion

What are some psychological responses of the expectant mother?

1. Ensuring safe passage though pregnancy, labor, and birth 2. Seeking acceptance of this child by others. 3. Seeking commitment and acceptance of herself as a mother to the child (binding in) 4. Learning to give herself on behalf of her child

What are some factors that can affect the fetal movement?

1. Sleep wake cycle 2. Maternal factors (ie. weight) 3. Fetal trunk movement frequency 4. Sound 5. Cigarette smoking and drugs 6. Fetal death 7. Poor placental perfusion

A 32 year-old laboring client demonstrates cervical dilatation of 9 cm. Her contractions are 2 minutes apart and 60 to 90 seconds in duration. She complains of excruciating rectal pressure. How should the nurse interpret this complaint? 1. The client's complaint is congruent with her current stage of labor. 2. The client's complaint may indicate the need for delivery via cesarean section. 3. Based upon the client's complaint, she is experiencing the active phase of labor. 4. The client's complaint is consistent with placental separation, which is normal for her current stage of labor.

1. The client's complaint is congruent with her current stage of labor.

A nurse is administering magnesium sulfate IV for seizure prophylaxis to a client who has severe preeclampsia. Which of the following indicates magnesium sulfate toxicity? Select all that apply 1. Urinary output less than 25 mL/hr 2. Decreased level of consciousness 3. Flushing and sweating 4. Respirations less than 12/min 5. Hyperreflexic deep-tendon reflexes

1. Urinary output less than 25 mL/hr 2. Decreased level of consciousness 4. Respirations less than 12/min

The primiparous patient at 40 weeks' gestation reports to the nurse that she has had increased pelvic pressure and increased urinary frequency. Which response by the nurse is best? 1. "Unless you have pain with urination, we don't need to worry about it." 2. "These symptoms usually mean the baby's head has descended further." 3. "Come in for an appointment today and we'll check everything out." 4. "This might indicate that the baby is no longer in a head down position."

2. "These symptoms usually mean the baby's head has descended further."

A nurse is reviewing findings of a clients biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? Select all that apply. 1. Fetal weight 2. Fetal breathing movement 3. Fetal tone 4. Fetal position 5. Amniotic fluid volume

2. Fetal breathing movement 3. Fetal tone 5. Amniotic fluid volume

The nurse identifies the following assessment findings on a patient with preeclampsia: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 11 on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which of the following new assessment findings would be an indication of worsening of the preeclampsia? 1. Blood pressure 158/104 2. Urinary output 20 mL/hour 3. Reflexes 21 4. Platelet count 150,000

2. Urinary output 20 mL/hour

Which statement indicates that teaching has been effective? 1. "Because I have toxoplasmosis, my baby might be born with an abnormally long body." 2. "The rubella infection I experienced in my second trimester may lead me to become deaf." 3. "My baby may develop a serious blood infection because I have group B strep in my vagina." 4. "My 8-year-old's parvovirus infection won't affect my baby because I am four months along."

3. "My baby may develop a serious blood infection because I have group B strep in my vagina."

The community nurse is working with a client at 32 weeks' gestation who has been diagnosed with preeclampsia. Which statement indicates that additional information is needed? 1. "l should call the doctor if I develop a headache or blurred vision." 2. "Lying on my left side as much as possible is good for the baby." 3. "My urine may become darker and smaller in amount each day." 4. "Pain in the top of my abdomen is a sign my condition is worsening."

3. "My urine may become darker and smaller in amount each day.

A couple would like their 5-year-old to attend the birth. Which statement by the nurse would assist in the family's plan to include their 5-year-old in the birth? 1. "You should let your child stay home because you will be focusing on the birth." 2. "Children under 12 are not allowed to be present at the birth." 3. "You should bring someone who will tend to any specific needs of your child." 4. "Bring some toys to keep your child occupied."

3. "You should bring someone who will tend to any specific needs of your child."

The primiparous client at 39 weeks' gestation calls the clinic and reports increased bladder pressure but easier breathing and irregular, mild contractions. She also states that she just cleaned the entire house. Which statement should the nurse make? 1. "You shouldn't work so much at this point in pregnancy." 2. "What you are describing is not commonly experienced in the last weeks." 3. "Your body may be telling you it is going into labor soon." 4. "If the bladder pressure continues, come in to the clinic tomorrow."

3. "Your body may be telling you it is going into labor soon."

The women with diabetes mellitus is prone to what factors during pregnancy? Select all that apply 1. Palpitations 2. Diarrhea 3. Preeclampsia 4. Infection 5. Decreased tissue perfusion

3. Preeclampsia 4. Infection 5. Decreased tissue perfusion

While caring for a labor client, the nurse determines during a vaginal exam that the baby's head has internally rotated. This information is given to the family. The labor support person asks the nurse, "What other position changes will the baby undertake during labor and birth? How should the nurse describe the rest of the cardinal movements for a baby in a vertex presentation? 1. Flexion, extension, restitution, external rotation, and expulsion 2. Expulsion, external rotation, and restitution 3. Restitution, flexion, external rotation, and expulsion 4. Extension, restitution, external rotation, and expulsion

4. Extension, restitution, external rotation, and expulsion

The nurse is assisting an expectant couple in developing a birth plan. Which of the following instructions would the nurse include in the teaching plan? 1. The birth plan includes only patient choices and does not take into account standard choices of the healthcare provider. 2. The birth plan allows the patient to make choices about the birth process; however, these choices cannot be altered. 3. The birth plan is a legally binding contract between the patient and the healthcare provider. 4. The birth plan is a communication tool between the patient and the healthcare provider

4. The birth plan is a communication tool between the patient and the healthcare provider

Chorionic villus sampling (CVS)

A technique associated with prenatal diagnosis in which a small sample of the fetal portion of the placenta is removed for analysis to detect certain genetic and congenital defects in the fetus. Drink 1 to 2 glasses of fluid prior to test and avoid urinating for several hours prior to test.

amniocentesis

A technique of prenatal diagnosis in which amniotic fluid, obtained by aspiration from a needle inserted into the uterus, is analyzed to detect certain genetic and congenital defects in the fetus 15- 20 weeks gestation. Also, to assess fetal lung maturity between 33-40 weeks gestation.

Fetal Kick Counts

After 27 weeks Should be able to feel 10 flutters, kicks, rolls within 2 hours

Subjective (presumptive) signs of pregnancy

Amenorrhea nausea and vomiting of pregnancy; excessive fatigue urinary frequency changes in the breast quickening uterine enlargement

A pregnant adolescent asks the nurse, "Why does the physician call measuring my uterus a fundal height?". The nurse's answer is based on the fact that the fundus of the uterus is located:

At the uppermost (dome-shaped top) portion

The nurse is caring for a client who is pregnant twins. Which statement indicates the client needs additional information?

Because both of my twins are boys, I know they are identical.

A nurse is providing care for a client who is in preterm labor at 32 weeks gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity?

Betamethasone

Premonitory signs of labor include which of the following?

Braxton hicks contractions cervical softening and effacement rupture of membranes

Discomforts of pregnancy: 1st trimester

Breast tenderness Urinary frequency Fatigue N/V Ptyalism - excessive salivation Nasal stuffiness and nose bleeds (epistaxis) Leukorrhea ( increased milky vaginal discharge)

Breastfeeding Programs

Classes and support groups typically include information about the following topics: *advantages and challenges of breastfeeding *techniques and positioning *methods of breast pumping and milk storage *how to involve the father partner in feeding process *ways of successfully breastfeeding and returning to work Information can be obtained from lactation consultants, peer counselors, labor and postpartum nurses, birthing centers, hospitals, and health clinics.

A 31 year old woman with normal ovaries, a normal prolactin level, and an intact pituitary gland is undergoing initial pharmacologic treatment anovulation. Which medication would the nurse anticipate being prescribed for this client?

Clomiphene Citrate (Clomid or Serophene)

Different types of hormonal contraceptives

Combined estrogen-progestin-inhibits the process that allows sperm to pernitrate the ovum. Combined oral contraceptives- also called birth control pills. Generally taken for 21 days, menses occurs 1-4 days after last pill is taken Other combined hormonal methods- can be administered transdermally using a contrceptive skin patch called Ortho Evra. Is worn for 3 weeks and for 1 week removed for menses to occur. Another form is NuvaRing vaginal contraceptive ring a kow-dose sustained release hormonal contraceptive. Ring is also left in place for 3 weeks and then removed for 1 week to allow for menses to occur. One size fits all. Progestin Contraceptives- progestin only pill, also called minipill. Primarily used bu nursing mothers because it does not interfer w/ milk production and also used by women who have a contraindication to estrogen in the combination pill. Long-acting progestin-only contraceptives include Depo-Provera and Nexplanon. Depo-privera is administered by IM-effective for 3 months. Need new injection every 10 - 14 weeks. Return to fertility may be delayed after stopping injections up to 10 months.

Which of the following diagnostic tests would the nurse see ordered for a patient diagnosed with Pelvic Inflammatory disease (PID)?

Complete CBC with differential A rapid plasma reagin (RPR) Venereal Disease research laboratory (VDRL) test Often PID has an elevated C-reactive protein and elevated sedimentation rate.

The nurse is creating a care plan for a client who is unable to conceive as a consequence of endometriosis. Which statement accurately reflects a nursing diagnosis that may apply to the care of this client?

Compromised family coping related to depression secondary to endometriosis. Explanation: Pelvic pain is a frequent symptom of endometriosis. Dyspareunia (painful intercourse) and abnormal bleeding are other common signs. Tx: Combined oral contraceptives Progestins such as medroxyprogesterone acetate (MPA) and Dienogest Danazol-short-term therapy Gonadotropin-releasing hormone (GnRH) analogs such as nafarelin acetate and leuprolide acetate A woman w/ endometriosis is often advised not to delay pregnancy because of the increased risk of infertility that women with endometriosis face.

term

Delivery occurring after 37 weeks of gestation regardless of whether the infant was born alive or stillborn

A client has decided to use a vaginal contraceptive ring as her method of contraception. Which statement suggests the client needs further instruction?

Every three months, I will need to remove the contraceptive ring and replace it with a new one. Explanation: The ring is left in place for 3 weeks and removed for 1 week to allow for withdrawal bleeding.

A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medications? Select all that apply

Fetal distress Vaginal bleeding Cervical dilation greater than 6 cm

Work hazards during pregnancy

Fetotoxic hazards Tell pt to contact her company physician or nurse about possible hazards in her work environment as well as her partner

Discomforts of pregnancy: 3rd trimesters

Heartburn (pyrosis) Ankle edema Varicose veins Hemorrhoids Constipation backaches leg cramps faintness dyspnea flatulence carpal tunnel syndrome

What is the best indicator that the client is experiencing menopause?

High serum FSH with low serum estrogen Explanation: Examining hormone levels of FSH and estrogen is a very accurate indication of menopause. Menopause is defined as 12 months of amenorrhea.

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea; vomiting; and scant, prune-colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse expect?

Hydatidiform mole (part of gestational trophoblastic disease)

The client with insulin-dependent type 2 diabetes and an HbA1c of 5.0% is planning to become pregnant soon. What information should the nurse provide this client?

Insulin needs decrease in the first trimester and increase during the third trimester.

As nurse is caring for a client who is pregnant and undergoing a nonstress test (NST). The client asks why the nurse is using an acoustic vibration device. Which of the folllowing responses should the nurse make?

It awakens a sleeping fetus

Which statement is best to include when teaching a pregnant adolescent about nutritional needs of pregnancy?

It is important to eat iron-rich foods like meat, every day.

fetal station

Location of the presenting part in relation to the midpelvis or ischial spines; expressed as cm above or below the spines; station 0 is engaged, station -2 is 2 cm above the ischial spines

Exercise during pregnancy

Maintaining an exercise program during pregnancy can help you stay healthy and feel your best Improves posture and decreases common ailments such as back pain and fatigue Can prevent gestational diabetes, relieve stress, and build stamina Best to continue same regimen pre-pregnancy if possible

The nurse is explaining the menstrual cycle to a group of women. The teaching on phases of the menstrual cycle should include the fact that the corpus luteum begins to degenerate, estrogen and progesterone levels fall, and the blood supply to the endometrium is reduced in which phase?

Menstrual phase

Magnesium Sulfate monitoring

Monitor for loss of deep tendon reflexes Urinary output less than 30 mL/hr pulmonary edema severe hypotension chest pain Inform pt to notify nurse of blurred vision, headache, n/v, or difficulty breathing

The client with a normal pregnancy weight asks why she has been told to gain 25-35 lbs during pregnancy, but her underweight friend was told to gain more weight. The nurse should tell the client that recommended weight gain should be:

More than 25-35 lbs for an underweight woman.

Postpartum nutrition- Formula feeding

Mothers should REDUCE daily caloric intake to pre-pregnancy intake, about 300 kcal.

The nurse is caring for a client diagnosed with endometriosis. Which statement by the client requires immediate follow up?

My legs have become painful and swollen since I started taking birth control pills.

A woman who is at 12 weeks' gestation asks the nurse if she can undergo chorionic villus sampling (CVS) testing in order to determine whether her baby has a neural tube defect. Which response is best?

No, because CVS testing alone at any stage cannot detect neural tube defects.

Which client is not a good candidate for Depo-Provera (DMPA)?

One who wishes to get pregnant within three months. Explanation: Return of fertility after DMPA takes on average of nine months. Studies proven no harm to breastfed babies for those on DMPA

In preparation for teaching a women's community center class about physiological changes during menopause, the nurse is preparing a handout for students. Which information should the nurse include in her teaching?

Ovarian secretion of estrogen decreases between age 45-55 , after which point ovulatory activity ceases.

Tx for Group B Strep

Penicillin G or ampicillin

History of positive culture w/ previous pregnancy. Risk factors for early onset of neonatal Group B strep

Positive GBS culture in pregnancy Prolonged (18h or more) rupture of membranes Preterm delivery Low birth weight Use of intrauterine monitoring Intrapartum maternal fever 100.4 or greater

Positive Group B strep can have maternal and fetal effects. What are they?

Preterm labor and delivery Chorioamnionitis UTIs Maternal Sepsis Endometritis after delivery

Anemia in pregnancy

Sickle cell anemia: Monitor those with sickle cell anemia as pregnancy can bring on vaso-occlusive crisis, UTI, pneumonia. The goal is to reduce anemia and maintain good health Folic acid anemia: Has an increased risk of hemorrhaging and may need a blood transfusion during labor. Instruct pt to eat a healthy diet rich in folic acid Iron deficiency anemia: most common medical complication of pregnancy. Increased risk for preeclampsia-eclampsia and post-partum hemorrhage

A 63-year-old female client requests information about complementary and alternative therapies that promote wellness during menopause. Which therapies should the nurse recommend?

Soy for reducing insomnia symptoms Research suggests that isoflavones, which are found in soy, are effective in reducing symptoms of insomnia in postmenopausal women.

Clincal therapy- DM

Step 1: women given 50 g, 1h OGTT, if glucose level elevated, move to step 2 Step 2: women give 100 g, 3h OGTT, unrestricted diet, consuming at least 150 g of carbs/day for 3 days before scheduled test. Glucose is measure at 1, 2, and 3 h. One-Step approach (recommended by IADPSG): Morning following an overnight fast, women ingests a 75 g glucose solution. PLasma levels are determined fasting at 1 and 2 h.

Care plan for Gestational diabetes

Teach women to monitor blood glucose level Exercise daily Eat a proper diet During labor, goal is to avoid neonatal hypoglycemia

While teaching a preconception class, the nurse should include which of the following recommendations concerning intake of vitamins during pregnancy?

The pregnant woman should consult the recommended dietary allowance (RDA) guidelines regarding vitamins.

The nurse is preparing a handout on the ovarian cycle to a group of middle school girls. What information should the nurse include?

There are two phases of the ovarian cycle follicular and luteal.

Heroin and pregnancy

This patient is HIGH RISK because of the increased incidence of poor nutrition, iron deficiency anemia, and preeclampsia. Fetus who's born addicted to heroin is at an increase risk for preterm birth, IUGR, meconium aspiration, and withdrawal symptoms such as restlessness, shrill, high pitched cry; irritability; Fist sucking; Vomiting; and seizures. Signs of withdrawal usually appear within 72 hours in may last for several days. Buprenorphine, can decrease the severity of NAS (neonatal abstinence syndrome) in the newborn. methadone is a common therapy for women who are dependent on opioids such as heroin.

Who is most at risk for pre-eclampsia?

Those women who have chronic hypertension or gestational hypertension

Magnesium Sulfate Indications

Tocolytic for Eclampsia and pre-eclampsia, relaxing smooth muscles -Status asthmaticus

HIV

Transmission can occur through birth and breast milk Tx: Zidovudine Do not use forceps, intrauterine devices, or anything that would ne placed inside the pt Be careful of all fluids These pts are usually scheduled cesarean

Clinical applications for IUGR (intrauterine growth restriction)

Ultrasounds (abdominal, transvaginal, and doppler)

The nurse is caring for a client in labor. Which signs and symptoms would indicate the client is progressing to the second stage of labor?

Uncontrollable urge to push Bulging perineum Increased bloody show

Gestational Trophoblastic Disease (GTD) symptoms/ assessment

Usually begins in second trimester *Abnormal vaginal bleeding during or after pregnancy that is often dark brown resembling prune juice, or bright red that is either scant or profuse *A uterus that is larger than expected due to over proliferation of trophoblastic cells *Severe nausea and vomiting-hyperemesis gravidarum (due to elevated hCG levels) *Anemia from blood loss *Clinical findings of preeclampsia

A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching?

You should empty your bladder prior to the procedure.

early term

births occurring between 37 weeks 0 days and 38 weeks 6 days of gestation

full term

births occurring between 39 weeks 0 days and 40 weeks 6 days

late term

births occurring between 41 weeks 0 days and 41 weeks 6 days of gestation

Magnesium Sulfate antidote

calcium gluconate

Leopold's Maneuvers

external palpation of the maternal uterus through the abdominal wall to determine the following: *# of fetuses *presenting part, fetal lie, and fetal attitude *degree of descent of the presenting part into the pelvis *location of the fetus's back to assess for fetal heart tones o vertex presentation: fetal heart tones should be assessed below the clients umbilicus in either the right or left lower quadrant of the abdomen o breech presentation: fetal heart tones should be assessed above the clients umbilicus and either the right or left upper quadrant of the abdomen

Nagele's Rule

first day of LMP, subtract 3 months, add 7 days, add 1 year

Traveling while pregnant

if having a normal healthy pregnancy, traveling is okay discuss travel plans with Dr or midwife before-hand don't fly after 36 weeks best to travel after first trimester (N/V reduces) Stop every 2 hours to walk at least 10 minutes each time

Group B Streptococcus (GBS)

is a bacterial infection that can be passed to a fetus during labor and delivery. Lab tests are vaginal and rectal cultures performed at 35-38 weeks gestation.

Post-term

labor or birth that occurs after 42 weeks gestation

pre-term birth

labor that occurs after 20 weeks' but before completion of 37 weeks' gestation

Who is at risk for preeclampsia?

maternal age younger than 19 or older than 40 years first pregnancy extreme obesity multifetal gestation chronic renal disease chronic hypertension familiar history of preeclampsia diabetes mellitus rheumatoid arthritis systemic lupus erythematosus

Sex while pregnant

no medical reason to limit sexual activity unless contraindicated for other reasons

fetal presentation

part of the fetus that is entering the pelvic inlet first and leads through the birth canal during labor