NCLEX - OB
diet for hyperemesis
6-8 small/dry meals clear liquids after meals food should be icy cold or hot
what number do we want for BPP
8-10 <4 ominous
what do you want Apgar to be
8-10 done at 1-5 mins
a postpartum hemorrhage is defined as
>500 ml blood loss AND 10% drop of admission hematocrit must have both to be true
if NST isn't reactive, what is done
BPP early contraction stress test
fetal station 0
Baby's head is in line with ischial spines (-1 to -3 = above ischial spine; +1 to +3 = below ischial spine)
VS of hyperemesis
DEHYDRATED: decreased BP decreased UO increased HCT/HGB THROWING UP: decreased potassium weight loss ketones in urine (breaking down body fat)
Where does Ectopic pregnancy most commonly occur?
Fallopian tubes
what is lightening
It is a sensation felt by a pregnant patient when the fetus positions itself for delivery. pt feels less congested and can breathe easier will have urinary frequency again 2 weeks before term
lying on what side enhances uterine perfusion
L side
who is at risk for shoulder dystocia
LGA gestational didabetes previous hx of shoulder dystocia post date delivery
what is a contraction stress test
Measurement of fetal heart rate in response to uterine contraction (contractions can be induced with nipple stimulation or oxytocin) **contractions decrease BF to uterus
Tx of ectopic pregnancy
Methotrexate if that doesn't work then laparoscopic incision to remove embryo or whole tube **if its ruptured, then laparotomy is done
tx for hyperemesis
NPO for 48 hrs 3000 ml of IVF for first 24 hrs antiemetic vitamins
previa vs abruptio sx
PREVIA - attached incorrectly can correct itself painless bright red bleeding uterus soft/nontender ABRUPTIO - attached correctly premature seperation painful dark red bleeding rigid/painful abdomen
how to get shoulder dystocia baby out
Roberts maneuver -hyperflexing legs to abdomen mazzanti techniques - suprapubic pressure
smoking causes ___
SGA tell them to stop, or smoke outside so they dont reinhale
who is at highest risk of uterine rupture?
VBAC pts who are receiving oxytocin scar from section is prone to open under stress
V. C E H A O L P
Variable - Cord compression (move pt) Early decelerations - Head compression Accelerations - Ok (no action needed) Late decelerations - Placental insufficiency (execute actions immediately)
first trimester second trimester third trimester
Weeks 1-13 Weeks 14-26 Weeks 27-40
difference between preeclampsia and eclampsia
actually having a seizure
Naegele's Rule
add 7 days to LMP, subtract 3 months, add 1 year
when can preeclampsia be dx what BP reading is considered preeclampsia
after 20 weeks 130/90 IF baseline isn't known
when is jaundice normal in newborn
after 24 hrs due to hemolysis of excess RBCs
first thing to do when membranes rupture
assess FHT
Mild preeclampsia management
bed rest increase protein
should diaper be below or above cord
below
what is a hydadtidiform mole
benign neoplasm grapelike cluster of vesicles can turn malignant
how is GBS transmitted
birth canal of infected mom to infant **risk is only after rupture of membranes
how to deliver abruptio placenta
c section
if there is a prolapsed cord and variable decelerations.. tx is
c section ASAP
tx for incompetent cervix
cerclage at 10-14 wks 80-90% chance of carrying until term clip the suture to deliver vaginally, section to keep suture intact
incompetent cervix patho
cervix prematurely dilates usually due to weight of baby causing pressure
cord care while baby has it
clean with alcohol or NS no immersion in water until it falls off
difference between complete and incomplete uterine rupture
complete - tear through uterine wall into peritoneal cavity pt will have sharp sudden pain, hypovolemic shock incomplete - tear through uterine wall, but peritoneal cavity is still in tact pt might not have pain, internal bleeding
when should pt go to hospital if they are having signs of labor
contractions 5 min apart or when membranes rupture (worried about prolapsed cord) - need to get fetal HR
what do we not want to see in contraction stress test
decelerations means contractions are causing hypoxia in fetus
how does rhogam work
destroyed fetal cells in moms circulation has to do this before antibodies are formed
What is Leopolds maneuver? done during or b/t contractions
determine fetal position/presention b/t
what should pt do before US
drink water to distend bladder and push uterus up
how to dx and tx miscarriage
dx - hcg levels will drop tx - IV, blood, d/c
what do you give baby at birth
erythromicin vitamin k (phytonadione) hep b
hyperemsis gravidarum patho
excessive vomiting that leads to dehydration and electrolyte imbalances
where do you feel contractions in false labor? in true labor?
false - abdomen true - back
tx for mastitis
feed baby frequently offer affected breast first take pcn after feeding baby
what are positive signs of pregnancy
fetal HB (doppler) fetoscope fetal movement (what a clinician feels) US
how much weight should you gain during first trimester second third
first - 4 lbs second - 4 lbs/month third - no more than 4 lbs/month
how often should you see a doctor during pregnancy
first 28 weeks (1/2 trimester) - 1x/month 28-36 - 2x/month 36 - weekly until delivery
when do most miscarriages happ-en
first trimester if 2nd trimester - usually means incompetent cervix
what supplements should you take while pregnant
folic acid - 400 mg (prevents neural tube defects) iron - take it with vitamin c to enhance absorption (can cause constipation/gi upset) 9
what do you do if rh+ fetus and sensitized mom
frequent US if baby stops growing, early delivery
Gravidity Parity T P A L
graviddity - number of times someone has been pregnant parity - # of pregnancy in which fetus reaches 20 weeks t - term (37 weeks) p- preterm a - abortion l - living children
why should you not get pregnant during followup period for hydatidiform mole
hcg levels will show malignancy
#1 concern with ectopic pregnancy
hem
if postpartum pt has tachy what should you think
hemorrhage
sx of preeclampsia
htn protienuria edema sudden weight gain headache blurred vision increased DTR clonus -> seizure
preterm labor can be stopped by ___ or ________
hydration treating vaginal infections
main complication of epidural
hypotension bolus pt with 1000ml
perineal care after birth
ice packs for first 12 hrs to reduce edema sitz bath warm water rinse if pt has episiotomy/hemorrhoids
why are we worried about how much weight pregnant pt gains
if its 2 or more lbs a week think PIH
when is a prolapsed cord most likely to happen
if presenting part isn't engaged and membranes rupture
what causes it
increased hcg and estrogen levels
how to dx
indirect Coombs - done on mom (measures antibodies in blood) direct Coombs - done on baby (measures antibodies stuck to RBC)
after the placenta is delivered what do you do
inspect for intactness tie it off 4 inches from babies navel and 8 inches
positioning for epidural
left side, legs flexed back isn't as arched as it is during LP
nursing actions for prolapsed cord
lift presenting part off of cord trendlenburg or knee to chest 02 monitor fetal heart tones
Tx of hydatidiform mole
make sure it hasn't metastasized (chest X-ray) d/c dont get pregnant hcg measured weekly until normal, then rechecked 1-2 months for a year
main priorities of abruptio placenta
manage shock monitor for fetal distress
what is the first thing you do if the fundus is boggy
massage until its firm then check for bladder distention (distended bladder won't let uterus contract normally)
can placenta previa deliver normally
maybe - csection preferred but can fix itself
do you want a negative or positive CST
negative ** if positive, put pt in hospital and plan for delivery
should a pt push between contractions
no
should you apply fundal pressure
no
how big of a clot is ok in lochia
no bigger than a nickel
what is the peripad rule
no more than 1 saturated pad/hr
if mom isn't breastfeeding, what should they do
no stimulation! ice packs breast binders support bra chilled cabbage leaves (decrease inflammation/engorgement)
How does Rh Incompatibility work?
occurs when you have rh- mom and rh + baby doesn't affect first rh+ baby, antibodies are built up and attacks the next rh+ baby
what meds to give for hemorrhage
oxytocin misoprostol methylergonovine carboprost
Sx of abruptio placenta
painful dark red vaginal bleeding rigid abdomen severe abdominal pain
placenta previa sx
painless vaginal bleeding bright red 2nd half of pregnancy
difference between pathologic/physoilogical jaundice
pathologic - not normal, occurs in first 24 hrs means rh/abo incompatibility physiological - normal, after 24 hrs
do not _______ with placenta previa or abruptio placenta
perform vaginal exams **or with unexplained vaginal bleeding
patho of placenta previa
placenta has implanted on the side of the uterus or covering the cervix
probably signs of pregnancy
positive pregnancy test Goodell's sign Hegar sign Chadwick sign Braxton Hicks contractions pigmentation/changes of skin (linea nigra, facial chloasma, abdominal straie)
abrupt placentae patho
premature separation of placenta from uterine wall
what hormone causes amenorrhea what secretes it
progesterone corpus luteum
tx of GBS
prophy abx (penicillin)
Do you want the NST to be reactive or non reactive?
reactive
cardinal sign of incompetent cervix
repated, painless, 2nd trimester miscarriages *month 4/5
severe preeclampsia management
sedation to delay seizures mag if diastolic is over 100, give apresoline with mag
what is goodells sign what is Chadwick's sign what is hegars sign
softening of the cervix (2 month) blue color of vagina mucosa (week 4) softening of the lower uterine segment (2 month)
is spotting and cramping normal during pregnancy
spotting is normal - but spotting and cramping are indicative of miscarriage
first 2 things you do when baby is born
suction mouth then nares dry the baby
s/e of terbutaline
tachy
how do the antibodies attack
through placenta cause hemolysis erythroblastosis fetalis (immature RBC in fetal circulation)
besides preeclampsia, mag is also used for___
to stop preterm labor
Causes of abruptio placenta
trauma - MVC, domestic violence rapid decompression of uterus cocaine, smoking, htn
where should a placenta attached
up high
mag is excreted through the ___
urine UOP must be monitored
Sx of Hydatidiform Mole
uterus grows too fast FHT not detectable bleeding
best exercise for pregnancy
walking/swimming no high impact or new programs
how long does it take for placenta to deliver
within 30 mins
Rho(d) immune must be given
within 72 hrs BEFORE antibodies develop
is it normal to have a temp of 100.4 after birth
yes
should you feel the cord pulsate
yes if not then fetal death has occurred
does placenta previa need to be admitted to hospital early
yes if completely covering the cervix - admit at 32 weeks
what to do with late decelerations
**discontinue oxytocin FLIP - turn left side FLOP - IV fluid bolus FLOW - o2 prepare for delivery, notify provider
Sx of ectopic pregnancy
**pain usual signs of pregnancy (missed period, vaginal spotting) if ruptured - then vaginal bleeding
What are presumptive signs of pregnancy?
*Amenorrhea (an abnormal absence of menstruation.)- often the first sign *Nausea- *morning sickness* *breast tenderness/ enlargement
what is a NST
-noninvasive way to monitor fetal well-being. -monitors heartbeat have pt push button when they feel a contraction should see acceleration 15 beats/min that lasts 15 seconds
what can we give to stop preterm labor
-tocolytic: terbutaline -mag -betamethasone - stimulate maturation of baby lungs
what 5 things does BPP look at
-was NST reactive? -muscle tone (1 flexion/extension in 30 min) -movement (move 3 times in 30) -breathing (breathing movements 1 time in 30) -is there enough amniotic fluid around baby
how often should a pt have contractions on oxytocin
1 every 2-3 minutes each contraction lasting 60 seconds ** discontinue if they happen too often or last too long
How long are CST results good for?
1 week
The nurse is assessing a newborn to determine gestational age. What findings by the nurse would indicate the infant is premature? You answered this question Incorrectly 1. Folded ear pinna springs back slowly. 2. Peripheral cyanosis on feet and hands. 3. Shoulders and chest have moderate lanugo. 4. Vernix covering axilla, back and buttocks. 5. Feet soles entirely covered with creases.
1, 3. & 4. Correct: The nurse is assessing a neonate for indications of premature gestational age. In a full term infant, the ear pinna would spring back firmly and quickly, so a slow response indicates probable prematurity. Lanugo is also an indicator of gestational age. Lanugo that covers all the shoulders and chest indicate prematurity. Vernix is the waxy, cheesy coating that is noted on the neonate after birth. A large amount of vernix, in this case covering axilla, back and the buttocks, denotes prematurity. 2. Incorrect: Peripheral cyanosis on an infant's hands and feet is common in full term infants due to immature circulation the first few hours after birth. If the cyanosis continues after that point in time, the nurse would check the infant's body temperature or blood glucose. 5. Incorrect: Creases on the soles of an infant's foot are an indication of gestational age. Soles that are covered entirely with creases indicate full term maturity.
sx of mag toxicity should be checked every ___ what are the sx
1-2 hrs decreased resp hypotension decrease LOC decrease DTR
A primipara at 36 weeks gestation is seen in the OB/GYN clinic. Which sign/symptom should the nurse immediately report to the primary healthcare provider? You answered this question Incorrectly 1. Puffy hands and face 2. Reports indigestion 3. Pedal edema 4. Trace proteinurea
1. Correct: Facial and upper extremity edema can be a sign of pre-eclampsia, which can endanger both the mother and fetus. Preeclampsia is a pregnancy complication characterized by high blood pressure and signs of damage to another organ system, often the kidneys. Preeclampsia usually begins after 20 weeks of pregnancy in a woman whose blood pressure had been normal. Even a slight rise in blood pressure may be a sign of preeclampsia. Left untreated, preeclampsia can lead to serious, even fatal, complications. Signs and symptoms of preeclampsia include hypertension and may include: Proteinuria; Severe headaches; Changes in vision; Upper abdominal pain; Nausea or vomiting; Decreased urine output; Thrombocytopenia; Impaired liver function; Shortness of breath; Sudden weight gain, and edema, particularly in face and hands. 2. Incorrect: Indigestion should be assessed for severity, but it is a common symptom in 3rd trimester of pregnancy. 3. Incorrect: Pedal edema should be assessed but is common in 3rd trimester of pregnancy. 4. Incorrect: Trace proteinurea is a benign sign in 3rd trimester of pregnancy.
A client comes to an obstetric clinic for a routine prenatal checkup at 32 weeks gestation. The nurse palpates the client's abdomen to determine fetal position so that fetal heart sounds can be assessed. It is determined that the fetal position is left occipital anterior (LOA). Where should the nurse place the Doppler to hear fetal heart sounds? You answered this question Correctly 1. Below the umbilicus, on the mother's left side. 2. Below the umbilicus, on the mother's right side. 3. Above the umbilicus, on the mother's right side. 4. Above the umbilicus, on the mother's left side.
1. Correct: The point of maximal intensity of the fetus is on the mom's abdomen where the fetal heart tones (FHT) is the loudest, usually over the fetal back. Divide the mom's pelvis into 4 quadrants (right and left anterior and right and left posterior). The occiput of the head is the most common presenting part and is abbreviated O. The occiput and back are pressing against left side of mom's abdomen; FHT would be heard below umbilicus on left side. 2. Incorrect: Fetal heart sounds (FHS) would be found below the umbilicus, but not on the mother's right side if the fetal position is LOA. 3. Incorrect: FHS heard above the umbilicus indicate a breech presentation. If the fetal position is determined to be LOA the FHS would be on the mother's left side. 4. Incorrect: FHS heard above the umbilicus indicate a breech presentation, rather than LOA. The FHS would be heard on the mother's left side, but below the umbilicus.
In which client should the nurse question a prescription for a contraction stress test? You answered this question Incorrectly 1. Client at 26 weeks gestation. 2. Client at 38 weeks with 4 Cesarean section deliveries. 3. Client at 38 weeks with a history of gestational diabetes. 4. Client at 37 weeks gestation. 5. Client with a current history of placenta previa.
1., 2., & 5. Correct: 26 weeks is too early to stimulate contractions. This could lead to a precipitous delivery. Stimulating contractions in a client with previous cesarean deliveries is not recommended. This may lead to uterine rupture. Stimulating contractions in a client with placenta previa is not recommended. This may lead to hemorrhage. 3. Incorrect: There is no reason to suspect complications from a contraction stress test for this client. 4. Incorrect: There is no reason to suspect complications from a contraction stress test for this client.
Which prescriptions are appropriate for the nursery nurse to initiate on a newborn prior to discharge home? You answered this question Incorrectly 1. Hepatitis B vaccine 2. Erythromycin Ointment 3. Vitamin K 4. Lanolin 5. PKU Screening
1., 2., 3. & 5. Correct: This vaccine is recommended at birth to decrease the incidence of hepatits B virus. Mandatory prophylactic agent is applied in newborn's eyes as precaution against ophthalmia neonatorium. Vitamin K (Aquamephyton) routine injection to prevent hemorrhagic disease of newborn. PKU-Screening for phenylketonuria is not reliable until the newborn has ingested an ample amount of the amino acid, phenylalanine, a constituent of both human and cow's milk. Nurse must document initial ingestion of milk and perform test at least 24 hours after that time. This test is thus done just prior to discharge. 4. Incorrect: Lanolin is not something that is applied on newborns when admitted to the nursery. Lanolin is an emollient for the skin. The normal newborn does not need an emollient applied to the skin.
What should the nurse tell the parents of a newborn about a Guthrie test? You answered this question Correctly 1. The purpose of this test is to determine the presence of phenylalanine in the blood. 2. A positive test indicates a metabolic disorder. 3. To conduct this test, a sample of blood is taken from the baby's heel. 4. An increase in protein intake can interfere with the test. 5. This test will be done when your baby is 6 weeks old.
1., 2., 3. Correct: These are true statements. A positive test indicates decreased metabolism of phenylalanine, leading to phenylketonuria. The normal level of phenylalanine in newborns is 0.5to 1 mg/dl. The Guthrie test detects levels greater than 4 mg/dl. Only fresh heel blood, not cord blood, can be used for the test. The main objective for diagnosing and treating this disorder is to prevent cognitive impairment. 4. Incorrect: A lack of protein intake can interfere with the test. The screening test is most reliable when the blood sample is obtained after the baby has ingested a source of protein. 5. Incorrect: Screening protocol involves testing the infant as close to discharge as possible but no later than 7 days after birth. If the infant is less than 24 hours old when the specimen is collected, a repeat test should be done before the infant is 2 weeks of age.
A nurse is planning to provide education to a client wishing to breastfeed. What instructions should the nurse include when teaching this client? You answered this question Incorrectly 1. Apply warm compresses to breast just prior to breastfeeding. 2. Establish a routine for breastfeeding. 3. Massage breasts during feeding. 4. Wear well-fitting bra continuously for first 24 hours after birth. 5. Wash hands before breastfeeding.
1., 3., & 5. Correct: Applying warm compresses or taking a warm shower prior to breastfeeding will help the let-down reflex. Massaging breasts during feeding can help with emptying. Emphasize the importance of hand hygiene prior to breastfeeding to prevent infection. 2. Incorrect: Allow newborns to nurse on demand. Allow newborns to feed 15-20 minutes per breast or until the breast softens. Begin the next feeding session on the breast that was not completely emptied. 4. Wear well fitting bra continuously for at least 72 hours after birth to avoid milk stasis.
A nurse is instructing a client who had a cesarean birth 2 days ago about adverse signs that should be reported to the primary health care provider. Which signs should the nurse include? You answered this question Incorrectly 1. Fever greater than 100.4° F (38° C) for 2 or more days. 2. Change in lochia from rubra to serosa. 3. Calves with localized pain, redness, and swelling. 4. Burning with urination. 5. Feeling of apathy toward newborn. 6. Able to provide self care.
1., 3., 4., & 5. Correct: Fever for 2 or more days can indicate infection. Calf pain, redness, and swelling could indicate thrombophlebitis. Burning on urination could indicate urinary tract infection (UTI). Feeling of apathy about the newborn could mean postpartum depression. All should be reported to the primary healthcare provider. 2. Incorrect: You would report change from serosa to rubra lochia. Also, report changes in vaginal discharge with increased amount, large clots, and change to a previous lochia color, such as bright red bleeding and a foul odor. 6. Incorrect: We want the client to be able to provide self care. This does not warrant a call to the primary healthcare provider.
A pregnant client who had been on a magnesium drip for severe pregnancy induced hypertension (PIH) has had an emergency cesarean section at 35 weeks. The nursery nurse should anticipate what findings in the newborn related to the magnesium therapy? You answered this question Correctly 1. Hypotension 2. Hypoglycemia 3. Hyperreflexia 4. Flaccid muscle tone 5. Respiratory depressio
1., 4. & 5. Correct: When magnesium sulfate is administered to the mother for preeclampsia, the intent is to prevent seizures and decrease blood pressure by suppressing the central nervous system, thus preventing premature labor. The dose of this drug and the length of time administered will determine what side effects might be seen in the newborn, since magnesium crosses the placental barrier. The nurse will most likely note hypotension and some degree of respiratory depression in the newborn. Additionally, the newborn may have flaccid or weak muscles along with poor, or even absent reflexes. Treatment of the newborn will be based on the degree of depression. 2. Incorrect: The use of magnesium sulfate in the mother prior to delivery does not affect the blood glucose level of the fetus/newborn. Magnesium sulfate affects the central nervous system, not the pancreas, so blood sugar should be within normal limits. 3. Incorrect: Magnesium is a central nervous system depressant that crosses the placental barrier. Side effects to the newborn would be similar to those noted in the mother, including depressed or absent reflexes. The nurse would not find hyperreflexia.
when can you doppler a babies HB
10-12 weeks
when should cord fall off
10-14 days
lochia alba
10-6 wks white
baby HR should be at ______ by 2nd trimester
120-160
HR should stay below ___ when exercising
140 CO and uterine perfusion will drop
Severe preeclampsia BP
160/110
n/v and urinary frequency are sx pt experiences during ______ trimester
1st
A client has developed preeclampsia at 30 weeks' gestation. The nurse is instructing the client on an appropriate diet for preeclampsia. The nurse knows the teaching was successful when the client selects what menu? You answered this question Incorrectly 1. Caesar salad with feta cheese 2. Grilled cheese with tomatoes 3. Chipped ham on a croissant roll 4. Hot dog with a glass of soda pop 5. Chicken sandwich on wheat toast
2 and 5. CORRECT: A high protein, calcium rich diet is most important for the preeclampsia client who is losing protein in urine. Grilled cheese is an excellent selection for lunch, especially since it contains tomato slices, which adds another level of nourishment and vitamins. Additionally, a chicken sandwich, particularly on whole wheat toast, is very appropriate for this preeclampsia client. 1. INCORRECT: Caesar dressing is made with raw eggs, exposing the client to the potential for salmonella. Pregnant woman should not eat raw foods, including eggs, fish, or meat. Additionally, feta cheese is a 'soft cheese', exposing the client to another bacterium known as listeria. Although a salad could be a good choice, this particular salad is not healthy. 3. INCORRECT: The need to restrict salt is not a priority for preeclampsia clients, but chipped ham is a processed meat containing less protein than other meats and increasing the risk for contracting listeria. The croissant roll is made of refined white flour and sugar. The client would benefit more from whole grain products. 4. INCORRECT: Processed meats, such as hot dogs, are not the healthiest choice for the client, as they increase the risk for listeria. Also, a client with preeclampsia should avoid alcohol, caffeine, and refined sugar to help control the blood pressure. The glass of soda pop is not a healthy selection.
Where should the fundus be immediately after delivery? 3 hrs after? how much should it go down each day what is that process called
2-3 fingers below umbilicus few hours later will rise to umbilicus 1 finger each day involution
Which finding in fetal heart rate during a non-stress test would indicate to the nurse that a potential problem for the fetus may exist? You answered this question Incorrectly 1. Increases 30 beats per minute for 20 seconds with fetal movement. 2. Increases 8 beats per minute for 10 seconds with fetal movement. 3. Remains unchanged with maternal movement. 4. Increases 5 beats per minute for 30 seconds with maternal movement.
2. Correct. A non-reactive test is when the FHR accelerates less than 15 beats per minute above baseline. This may indicate fetal compromise. 1. Incorrect. This would be a reactive test. This is characterized by acceleration of fetal heart rate of more than 15 beats per minute above baseline, lasting for 15 seconds or more. 3. Incorrect. This test does not look at fetal heart rate with maternal movement. 4. Incorrect. This test does not look at fetal heart rate with maternal movement.
A primary healthcare provider informs the nurse to prepare for an amniotomy on a client who's labor has not progressed. What should the nurse assess for prior to the primary healthcare provider performing this procedure? You answered this question Correctly 1. Fetal attitude 2. Fetal engagement 3. Fetal lie 4. Fetal position
2. Correct: Fetal engagement is important prior to rupturing the membranes so that the umbilical cord cannot prolapse. Fetal engagement is when the fetus is at station 0 (level of mom's ischial spines). 1. Incorrect: Fetal attitude is where the extremities and chin of the fetus are in relation to the fetal body. 3. Incorrect: Fetal lie refers to the maternal spine in relation to the fetal spine. 4. Incorrect: Fetal position tells us the presenting part of the fetus to mom's pelvis.
The oncoming nurse has just received report and is preparing to make initial rounds. Which postpartum client should the nurse see first? You answered this question Incorrectly 1. A primipara 6 hours postpartum saturating one peripad every two hours 2. A multigravida 1 hour postpartum and reporting intense perineal pain 3. A primigravida 12 hours postpartum with the uterine fundus at the umbilicus 4. A multigravida 72 hours postpartum with a brownish pink lochia discharge.
2. Correct: Intense perineal pain is a symptom of a perineal hematoma which is a medical emergency. 1. Incorrect: Expected findings for the postpartum period are described here. This is a normal peripad saturation and does not indicate a problem. 3. Incorrect: Expected findings for the postpartum period are described here. This is the proper position of the fundus 12 hours postpartum. 4. Incorrect: Expected findings for the postpartum period are described here also. A client postpartal 72 hours should have a brownish pink lochia discharge.
A new nurse is preparing to give a medication to a nine month old client. After checking a drug reference book, the nurse crushes the tablet and mixes it into 3 ounces of applesauce. The new nurse proceeds to the client's room. What priority action should the supervising nurse take? You answered this question Incorrectly 1. Tell the new nurse to recheck the drug reference book before administering the medication. 2. Suggest that the new nurse reconsider the client's developmental needs. 3. Check the prescription order and the client dose. 4. Observe the new nurse administer the medication.
2. Correct: Mixing medication with applesauce is appropriate in some circumstances, but the volume of 3 ounces is excessive for a nine month old. The nurse will want to make sure the client gets all of the medication. Additionally, applesauce may or may not have been introduced into the diet, and it is inappropriate to introduce a new food during an illness. 1. Incorrect: There is nothing in the stem about a problem with the medication dose or route. 3. Incorrect: There is nothing in the stem about a problem with the medication dose or route. 4. Incorrect: This is an appropriate action. However, it is not the priority over ensuring that the new nurse knows how to appropriately prepare the medication for this client.
A client is curious about visible appearance changes related to menopause. What menopausal changes, in general, would the nurse explain to the client? You answered this question Correctly 1. Bone loss and fractures. 2. Loss of muscle mass. 3. Improved skin turgor and elasticity. 4. A reduction in waist size.
2. Correct: Visible changes associated with menopause include loss of muscle mass, increased fat tissue leading to thicker waist, dryness of the skin and vagina, hot flashes, sleep abnormalities, and mood changes. 1. Incorrect: Bone loss is dependent on bone mass, weight-bearing exercise, and nutrition. Some bone loss may occur, but may not lead to fractures. 3. Incorrect: A decrease in turgor and elasticity may occur as we grow older. 4. Incorrect: There is increased fat tissue with an increase in waist size.
What does a non-stress test tell the nurse about a pregnant client? You answered this question Correctly 1. That the baby is going to be a boy or girl 2. The baby is doing well and the placenta is providing enough oxygen at this time 3. That the baby's heart is healthy and there are no birth defects 4. That the mother is strong enough to undergo vaginal delivery
2. Correct: Yes, the non-stress test identifies whether an increase in the fetal heart rate (FHR) occurs when the fetus moves, indicating adequate oxygenation, a healthy neural pathway from the fetal central nervous system to the fetal heart and the ability of the fetal heart to respond to stimuli. 1. Incorrect: No, the sex is not determined by this test. 3. Incorrect: No, we can't determine birth defects from a non-stress test. 4. Incorrect: No, we can't determine if the mother is strong enough to undergo vaginal delivery from a non-stress test.
A nurse is caring for a client who delivered a baby vaginally two hours ago. What signs and symptoms of postpartum hemorrhage should the nurse report to the primary healthcare provider? You answered this question Correctly 1. Two blood clots the size of a dime. 2. Perineal pad saturation in 10 minutes. 3. Constant trickling of bright red blood from vagina. 4. Oliguria 5. Firm fundus
2., 3., & 4. Correct: Lochia should not exceed an amount that is needed to partially saturate four to eight peripads daily, which is considered a moderate amount. Perineal pad saturation in 15 minutes or less is considered excessive and is reason for immediate concern. Saturation of a peripad in one hour is considered heavy. Also, trickling of bright red blood from the vagina can indicate hemorrhage and is often a result of cervical or vaginal lacerations. Bright red blood indicates active bleeding. Oliguria is a sign of fluid volume deficit. As blood volume goes down, renal perfusion decreases and urinary output (UOP) decreases. The kidneys are also attempting to hold on to what little fluid volume is left. 1. Incorrect: A few small clots would be considered normal and occur due to pooling of the blood in the vagina. Passage of numerous or large blood clots (larger than a quarter) would indicate a problem. 5. Incorrect: We worry about a boggy uterus. Uterine atony is a major cause of postpartal hemorrhage. The fundus feels firm as the uterus and uterine muscles contract to reduce the blood loss.
pts experience quickening during ___ trimester
2.. fetal movement
when does postpartum diurese
24 hrs after delivery
When is a fetus considered viable?
24 weeks
CST is rarely performed before how many weeks?
28 weeks (3rd trimester start) because we are inducing a contraction which may be dangerous, can induce labor
BPP is done in ____ trimester if it is high risk, how often?
3 every week
Lochia color rubra?
3-4 days after
A client at 34 weeks gestation with pregnancy induced hypertension (PIH) reports "heartburn." Which action by the nurse has priority? You answered this question Incorrectly 1. Administer an antacid per standing orders. 2. Check client's blood pressure. 3. Call the primary healthcare provider immediately. 4. Assure client this is a normal discomfort of pregnancy.
3. Correct: Epigastric discomfort is commonly described as "heartburn" by pregnant clients, but epigastric discomfort is a symptom of impending rupture of the liver capsule and seizures associated with worsening PIH and eclampsia. As a new nurse we need to assume the worst. Call the primary healthcare provider. 1. Incorrect: Not a concern as much as impending seizure symptoms. Administering an antacid will not fix the problem if PIH is worsing. This is delaying care. 2. Incorrect: Not a concern as much as impending seizure symptoms. Checking the client's blood pressure is not the priority in this situation. It will not fix the problem. 4. Incorrect: Not in this situation. Heartburn is a normal discomfort or right upper quadrant pain in a client with PIH may indicate impending rupture of the liver capsule which is a life threatening complication.
A client's membranes spontaneously rupture at 10 cm dilation and +2 station. The nurse notes that the fluid is colored green. What client preparation is the priority nursing action? You answered this question Correctly 1. Emergency cesarean delivery 2. Immediate high forceps delivery 3. Equipment for immediate suctioning of the newborn 4. Administration of IV oxytocin
3. Correct: Green stained fluid indicates fetal passage of meconium. The fetus must be suctioned by the healthcare provider when the head is still on the perineum and before the baby takes its first breath. This will remove any particulate matter from the meconium that may cause aspiration. 1. Incorrect: Delivery will probably occur soon and vaginal delivery is preferable to cesarean. This is an unrealistic and inappropriate action for this client. 2. Incorrect: High forceps are never indicated and would not provide safe delivery for the baby. The concern is the meconium stained fluid and potential aspiration for the baby. 4. Incorrect: The meconium passage is an indicator of fetal stress, and increased uterine contractions may stress the fetus further. This would not be safe for the baby or the mother at this stage of labor.
A client at 36 weeks gestation is receiving magnesium sulfate for treatment of pre-eclampsia. Which finding by the nurse requires immediate action? You answered this question Incorrectly 1. Respiratory rate of 12 2. Deep tendon reflexes (DTR) of 3+ 3. Urinary output (UOP) of 100cc/4hours 4. Fetal heart rate (FHR) of 120
3. Correct: Magnesium sulfate is a potent central nervous system depressant that is excreted through the kidneys. Adequate kidney function is vital to prevent magnesium toxicity. A urinary output of at least 30 mL/hr is the minimum standard to evaluate adequate kidney function. 1. Incorrect: A respiratory rate of 12 is within the acceptable range for the client. Magnesium sulfate can cause bradycardia, tachycardia, or irregular rhythm. 2. Incorrect: Magnesium sulfate causes decreased DTRs. A 3+ DTR is a very brisk response and does not reflect a symptom of magnesium sulfate toxicity. 4. Incorrect: Fetal heart rate of 120 is within the normal range of 110-160 bpm. A heart rate of 110-120 tells the nurse to be "worried and watching", but the range is acceptable.
A female client has used medroxyprogesterone acetate injections for birth control for several years. For the past 6 months, attempts to become pregnant have been unsuccessful. What instruction should the nurse provide to the client? You answered this question Correctly 1. Be seen in the fertility clinic by a primary healthcare provider who specializes in this problem. 2. Have a sperm count performed on the client's partner. 3. Be aware that ovulation may not occur for many months after using medroxyprogesterone acetate. 4. Ensure proper nutrition, rest, and establish an exercise program.
3. Correct: Medroxyprogesterone acetate is an injectable progestin that prevents ovulation for 14 weeks (although injections should be scheduled every 12 weeks). After discontinuing injections, it may take approximately 9 to 10 months to reestablish normal ovulation and menstruation. 1. Incorrect: A fertility workup for the client and her partner may be warranted after adequate time to reestablish ovulation has passed. Fertility is not expected to return until approximately 9 to 10 months and this couple has only been attempting a pregnancy for 6 months. 2. Incorrect: A sperm count on the client's partner may be warranted after adequate time to reestablish ovulation has passed. 4. Incorrect: Good nutrition, rest, and exercise are important for all individuals, but does not apply to this client's concerns.
A client calls the prenatal clinic at 37 weeks gestation to report expelling large amounts of fluid. What instruction by the nurse is most appropriate at this time? You answered this question Incorrectly 1. Lie on left side and take slow, deep breaths. 2. Call an ambulance and go to emergency room. 3. Come to the clinic for assessment and evaluation. 4. Go directly to the hospital emergency room.
3. Correct: This client is full term and the expulsion of large amounts of fluid indicates the client has experienced a rupture of membranes. The next step would be to evaluate the client for effacement and dilation as well as fetal heart tones. The best approach would be for the client come to the clinic for a quick evaluation and assessment. 1. Incorrect: This is neither safe nor appropriate. The client should be examined by the primary healthcare provider as soon as possible. Lying on the left side and taking deep breaths would be a delay of the appropriate treatment. 2. Incorrect: There is no indication the client is experiencing a situation serious enough to warrant an ambulance trip to the emergency room. The question suggests normal rupture of membranes, and while the client should be assessed, this can be accomplished without a trip to the emergency room. 4. Incorrect: It is not necessary for the client to go directly to the emergency room. Because the clinic is still open, the client could be examined by the primary healthcare provider to determine the stage of labor as well as dilation. If the client had called the clinic after hours, the nurse might have recommended a trip to the labor & delivery unit.
The nurse is caring for a client immediately following a bilateral salpingo-oophorectomy. Which position would be best for this client? You answered this question Incorrectly 1. Fowler's 2. Modified Sims 3. Side-lying 4. Supine
3. Correct: We want to position for comfort with the knees flexed and on the side for airway. 1. Incorrect: Avoided to prevent pooling and edema in pelvis 2. Incorrect: Partial lying on stomach is going to be painful 4. Incorrect: Stretching out straight puts pressure on the abdomen and should be avoided
mild preeclampsia BP
30/15 off of baseline (documented 6 hrs apart)
increase calories by how much after first trimester how much protein how much should you increase while BF
300 60 g (normally 40-45) 500
when do you test for GBS
35-37 weeks again on admission to L&D
lochia serosa
4-10 days after pink/brown
A pregnant woman who has just been admitted to the labor and delivery room states that her "water just broke". What should the nurse do immediately? You answered this question Incorrectly 1. Confirm that fluid is amniotic fluid with a pH test strip 2. Obtain maternal vital signs 3. Observe amniotic fluid color 4. Check fetal heart rate (FHR) pattern
4. Correct: Check the FHR immediately following the rupture of membranes. Changes in FHR pattern such as bradycardia or variable decelerations may indicate prolapsed umbilical cord. 1. Incorrect: The first thing the nurse should do is check FHR pattern. Changes in the FHR, such as bradycardia or variable decelerations could indicate prolapsed cord. Interruption of the blood flow through the cord interferes with oxygenation and is potentially fatal. 2. Incorrect: FHR is the priority as a change could indicate prolapsed cord. If the umbilical cord slips downward after the membranes rupture. it can become compressed which would be indicated by changes in the FHR, not the maternal vital signs. 3. Incorrect: The nurse should observe the amniotic fluid color after checking the FHR.
What is the priority nursing action for a pregnant client in labor who is having an epidural catheter inserted for pain management? You answered this question Incorrectly 1. Perform a thorough skin prep of the insertion site. 2. Obtain the client's consent for the procedure. 3. Assure the client that residual effects of the procedure won't be felt. 4. Monitor maternal blood pressure.
4. Correct: Epidural anesthesia may result in distal vasodilation and a precipitous drop in maternal blood pressure, which will adversely affect placental blood flow. Evidence-based practice guidelines from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) suggests assessing the maternal blood pressure and fetal heart rate every 5 minutes during the first 15 minutes after initiation of epidural medication. 1. Incorrect: Preparing the insertion site is the responsibility of the primary healthcare provider. 2. Incorrect: Obtaining consent is the responsibility of the primary healthcare provider. This is not the priority nursing action. 3. Incorrect: Residual effects of epidural anesthesia include infection and headache. So this is an incorrect statement.
A client with gestational diabetes delivers an infant with macrosomia. What is the most vital component of the infant's assessment for the nurse to perform? You answered this question Incorrectly 1. Evaluation of the infant for cephalhematoma. 2. Determining if the infant sustained a clavicle fracture. 3. Observing for arm movement to evaluate for facial palsy. 4. Frequent blood glucose monitoring to ensure stable values.
4. Correct: Infants of diabetic mothers are at risk for hypoglycemia following birth. Hypoglycemia can trigger seizures and cognitive deficits. 1. Incorrect: Assessing for cephalhematoma is important in macrosomia infants, but not as vital as ensuring stable glucose levels. 2. Incorrect: Assessing for clavicle fracture is important in macrosomia infants, but not as vital as ensuring stable glucose levels.
The nurse is caring for a client in the 8th week of pregnancy. The client is spotting, has a rigid abdomen and is on bedrest. What is the most important assessment at this time? You answered this question Incorrectly 1. Protein in the urine 2. Fetal heart tones 3. Cervical dilation 4. Hemoglobin and hematocrit levels
4. Correct: The client may be bleeding, and that is an emergency! Common causes of hemorrhage during the first half of pregnancy include abortion and ectopic pregnancy. Ectopic pregnancy is a significant cause of maternal death from hemorrhage and the classic signs of ectopic pregnancy include positive pregnancy test, abdominal pain and vaginal "spotting". Remember that in the ruptured ectopic pregnancy, bleeding may be concealed and severe pain could be the only symptom. 1. Incorrect: Protein in the urine indicates preeclampsia, which is a condition in which hypertension develops during the last half of pregnancy. 2. Incorrect: We can't hear them yet because the client is just 8 weeks pregnant. It may be possible to detect heart beat with a Doppler transducer at 10 weeks, but this client is only in the eighth week of pregnancy. 3. Incorrect: A vaginal exam may stimulate heavier bleeding and will not provide information about concealed bleeding. A transvaginal ultrasound will be performed to determine whether a fetus is present and if so, whether it is alive.
