OB EXAM 2 Studyguide
A mother asks why she cannot be on her back during the NST. The nurse's best response is : a) the doctor ordered for you to be in this position b) to ensure the best position for fetal movement and reactive tracing c) to prevent the mother from experiencing back pain and maternal SOB d) none of the above
c
A pregnant woman makes an appointment for an ultrasound. The nurse reminds her that: a) she should wear light clothing b) she should bring someone to drive her back just in case c)she should drink 1 to 1.5 quarts of water 2 hours before the exam d) none of the above
c
At what week does the fetus being to practice intrauterine respiratory movements? a) 10th week b) 13th week c) 17th week d) 24th week
c
During a community class, the nurse informs mothers warning signs regarding fetal movement. The information includes: a) notify the doctor if there is less than 10 in a 3 hour period b) if the fetal movement is less than normal c) a&b d) none of the above
c
What nursing indications are for Vitamin K?
Nurse must watch for bleeding on the second or third day. Signs like ecchymoses or bleeding from umbilical cord, circumcision site, nose, or GI tract.
Is GBS harmful to baby and mom?
Only baby!
What does the oxygenation of fatty acids depend on?
Oxygen supply, glucose, and ATP
A nurse is teaching a group of pregnant women what PTL is. What should the nurse teach?
PTL can be caused by an infection, dehydration
What is the difference between preeclampsia and eclampsia?
Preeclampsia is BP, and eclampsia is grand mal seizures
What is PROM?
Premature rupture of the membranes
What is the difference between placenta previa and placentae abruption?
Previa is bleeding without pain with an intervention of bed rest & Abruption is bleeding with severe pain ( or pain without bleeding depending on placement) & it is treated as an emergency
A mother has PROM, what should the nurse expect in the mother's care?
Prophylactic antibiotics, education about baby being born naturally or C-section, upon admission, CBC, C-reactive protein, and a urinalysis is obtained, VS Q4H, corticosteroids are adminstered
What are problems associated with prematurity?
RDS, PDA, Cold stress, feeding difficulties, necrotizing enterocolitis, marked insensible water loss, infection, anemia, apnea, intraventricular hemorrhage, retinopathy
What are fetal/newborn risks r/t to PROM
RDS, fetal sepsis, malpresentation, prolapse of umbilical cord, noreassuring FHR, compression of cord, premature birth, increased perinatal morbidity and mortality
What are crack moms at risk for?
SAV, abruptio placentae, preterm birth, stillbirth, IUGR, small head circ, cerebral infarctions, shorter body length, altered brain development, malfromation of GI tract, lower apgar scores
What are fetal risks to preeclampsia?
SGA, fetal hypoxia, malnutrition, premature birth, oversedated at birth, hypermagnesemia (d/t mag sulfate)
How would treat eclampsia?
Safety precautions, bed rest, high protein, moderate sodium diet, F& E replacement to correct hypovolemia, betamethasone, and mag sulfate
What are maternal adverse effects?
Seizures, hallucinations, pulmonary edema, cerebral hemorrhage, respiratory failure, heart problems
How is Rh incompatibility & alloimmunization screened?
TNurse must take a history of past pregnancies, previous sensitization, abortions, blood transfusions, children who developed jaundice or anemia during newborn period, determine maternla blood type and Rh factor, routine antibody screening test, identify other medical complications
The mother notices her baby has a little vomit after he feeds. The mother is worried. What explanation by the nurse is the best? a) Your child may have an upset stomach from the breast milk. You may need to do formula instead b) Your child may be too full, so the body is naturally trying to get rid of the excess fluid in the stomach c) The hole that connects the stomach and esophagus is not like an adult's hole, so a newborn baby may regurgitate his food d) That is not normal, I will inform the doctor right away
c
A new mother notices that her baby's first poop is black and tarry. She asks if that is a normal finding. The nurse explains:
black stool is normal for a newborn within the first 24 hours of life.
What is a symptom of severe preeclampsia?
blurred vision, BP 180/110+, edema, epigastric pain,
What are longterm needs/problems of premature infants?
bronchopulmonary dysplasia, speech defects, sensorineural hearing loss, neurologic sequelae
What is acrocyanosis
It is bluish discoloration of the hands and feet. It is present for the 1st 2-6 hours after birth but is normal up 24 hours
What causes physiologic jaundice?
It is caused by accelerated destruction of fetal RBCs, impaired conjugation of bilirubin, and increased bilirubin re absorption from intestinal tract
What is placenta abruption?
It is premature separation of placenta from its site of implantation after 20 weeks & before delivery
What is bethamethasone used for?
It is shown in studies that is is capable of inducing pulmonary maturation and decreasing the incidence of respiratory distress sydnrome in preterm infants
What is CVS used for?
It is taking chorionic villi from placenta at 8 weeks to see chromosomal and DNA; get to see karyotype of baby right away compared to amniocentesis
What is neutral thermal environment (NTE) ?
It is the minimal rate of O2 consumption and metabolism and internal body temperature that is maintained for thermal balance
What is a seroconversion?
It is when a specific antibody becomes detectable in the blood and the corresponding antigen becomes undetectable
What risks come with using nicotine?
It reduces uterine blood flow, CO2 binds to Hgb, which decreases the carrying capacity to the blood
What is amniocentesis used for?
It removes amniotic fluid to test for lung maturity, fetal abnormalities, and genetic abnormalities (trisomy 13 and 18) in the third trimester of pregnancy
What happens to kidneys during eclampsia?
LOW UP d/t decreased perfusion from high BP
How is PIH/preeclampsia treated?
Low dose aspirin to decrease levels of thromboxane or nitric oxide (vasodilator)
What kind of respiratory adaptations does the the newborn experience at birth?
Lungs convert from fluid filled organ to air-filled organ; first breath of life initiates the serial opening of the alveoli; fetal gasp and active exhaltation removes the 80-100 ml of lung fluid; inhalation causes negative intrathroacic pressure, causing fluid to flow from alveoli across alveolar membranes into pulmonary interstitial tissue; pulmonary vascular resistance decreases and pulmonary blood flow increases --> more fluid absorbed into blood stream
What treatment can the woman who has an ectopic pregnancy get to ensure she can have future pregnancies?
Methotrexate
What kind of care would you provide for a HIV + mother?
Monitor fetus closely, weekly NST starting 32 weeks gestation, serial ultrasounds to detect IUGR, biophysical profiles, amniocentesis avoided to prevent contamination of noninfected infant d/t invasive procedures, teach about possible C-section at 38 weeks unless plasma HIV is <1000 copies
What signs of cocaine usage?
Mood swings, appetite change, withdrawal symptoms (depression, irritability, psychomotor changes)
During assessment, how can a nurse check for physiologic jaundice? a) blanching the skin on forehead or nose b) a skin temp of 36.5 C c) monitor stool d) all of the above
d
A mother comes to the clinic and explains that she has painful lesions in the genital area. What does the nurse suspect the mother has? a) cytomegalovirus b) Strep c)toxoplasmosis d) Herpes Simplex Virus
D
What are the 5 major areas of change?
- Increased aortic pressure and decreased venous pressure - increased systemic pressure and decreased pulmonary artery pressure - closure of foramen ovale - closure of ductus arteriosus - closure of ductus venosus
How is terbutaline given?
0.25 subQ
What dose of vitamin K is give to a newborn?
0.5 mg - 1 mg IM within 1 hour of birth or after breastfeeding in delivery/birthing area
Despite keeping the newborn in a flexed posture and swaddled, the child still cannot maintain thermal stability during diaper changes. The nurse understands what factors can affect the child's thermal instability? a) inadequate amount of subcutaneous fat b) thin epidermis c) blood vessels close to the skin d) all of the above
D
How much do you give erythromycin to the eye?
1 cm long ribbon
How long do you listen to a newborn's HR?
1 minute
The mother comes to the clinic and states that her baby hasn't moved in the last hour. The nurse reassures her that it's okay. The mother asks when should she worry. The nurse states: a) after 5 hours b) after 7 hours c) after 10 hours d) no movement within 24 hours
D
How many weeks are in the first trimester?
1-12 weeks
What kind of teaching would you teach to mom who was once a cocaine user during pregnancy about child's development?
Most children exposed to cocaine are normal and average intelligence; although it is to be expected for them to have behavioral and learning problems; however, a good home environment can help reduce
What can affect fetal movement counts?
Mother's blood sugar, multiple gestation, maternal weight, maternal psychological factors, maternal weight, fetal trunk movement frequency, sound, cigarette smoking, and drugs
What is a normal newborn pulse range
110-160 bpm
How is bethamethasone given?
12 mg each day for 2 days
What is a normal baseline HR for baby?
120-160 Bpm
How many weeks are in the second trimester?
13-28
What effects does cocaine have on newborns in utero?
Neurobehavioral disturbances, marked irritability, exaggerated startle reflex, labil emotions increased risk of SIDS
Do baby's shiver?
No they do nonshivering thermogenesis
What does a reactive NST look like?
2 accelerations of FHR with fetal movement of 15 bpm, lasting 15 sec or more, over 20 minutes
What are you looking for in a reactive NST?
2 accelerations with 15 BPM over baseline HR that last 15 seconds within 20 minutes
If a mom is GDM, would insulin treatment continue after delivery?
No, because unless mom has preexisting diabetes type 2, patient's GDM should disappear after birth
A nurse in LnD has a patient who is high risk for being GBS positive, but has unknown lab results. What indications would the nurse have to know the start prophylatic anitbiotic treatment?
< 37 GA, membranes rupture 18 hours or longer, temp greater than or equal to 38 C (100.4)
What gestational age is considered a premature infant/birth?
<37 weeks
How much iron does a newborn have at birth?
270mg
How many weeks are in the 3rd trimester?
29-41 weeks
What is a normal newborn BP
50-70 (systolic)/ 30-45 (Diastolic)
At how many hours after birth does a newborn's blood glucose reach a steady state?
3 hours
What would you assess for with a patient with preeclampsia?
Hyperreflexes, swelling, edema, protein in urine, rapid weight gain, epi gastric pain
At what week can a new mother start doing NST testing?
30-32 weeks
What is a normal newborn respiration range?
30-60 RR/min; diaphragmatic and irregular
What is a pregnant mother screen for GBS?
35 and 37 weeks gestation
What is a normal temperature range for a newborn?
36.5-37.5
What are the discomforts in the 1st trimester pregnancy?
Hypertrophy of breasts, increased vascularization/pigmentation; urinary urgency and frequency; lack of energy, fatigue, N/V, ptyalism
What is Vitamin K shots needed for in a newborn?
It is a prophylactic treatment of vitamin K deficiency bleeding, which is a common hemorrhage disease of the newborn. It promotes liver formation of clotting factos
What is a normal blood glucose level?
45-96
What is cocaine?
It is a stimulant that causes placental vasocontriction and decreases blood flow to fetus. EUPHORIA DRUG
When an infant is asleep, what is the lowest allowable HR?
80 bpm
What is number of a normal blood volume for a term infant?
85 mL/kg
What is a normal BP by day 10?
90/50
What position are women in during NSTs?
A left tilted semi-Fowlers, sitting position, and left lateral position b/c these positions have more fetal movement and more likely to have a reactive tracing
`Before a mother and child can be discharged from the postpartum unit, the child must have a bilirubin lab drawn up. What can the nurse expect from the child's bilirubin lab?
A little rise to serum bilirubin, especially in the child's first few days of life
The nurse checks the lab results of a woman who plans to get pregnant. Her hemaglutination inhibition shows that her rubella titer is at 1.5. What does that mean for the patient? a) patient is not immune and is susceptible to rubella b) patient is immune to rubella c) The hemaglutination has nothing to do with rubella d) none of the above
A) A titer that shows 1.8 or less indicates the patient is susceptible to rubella infection
From the four methods of heat loss, which ones loses the most heat? a) evaporation b) conduction c) convection d) radiation
A) evaporation
What test is most useful in determining a dibaetics long term control?
A1C1 or glycosylated hemoglobin
How can an infant lose heat through convection?
Air-conditioned rooms, air currents with temperature below the infant skin temp, oxygen by mask, and removal from an incubator for procedures
What are normal blood sugars for a baby?
Anything above 40 mg/dL
What kind of teaching would you do for a patient receiving methotrexate?
Avoid sun exposure, expect mild abd pain for the next 24-48 hours; report for any heavy vaginal bleeding, dizziness, or high HR; have an increased risk for ectopic pregnancies
Based on her knowledge of rubella, what would confirm that the patient has rubella? a) a positive increased IgM antibody titer before birth b) a positive increased IgM antibody titer after birth c)a negative decreased IgG antibody titer before birth d) a positive increased IgG antibody titer after birth
B) A rubella diagnosis can be confirmed with an elevated rubella IgM antibody titer after birth
A mother is concerned about knowing how she would know that the baby is moving well and is healthy. What response by the nurse is best? a) as long as the baby is moving each hour, it is healthy b) when the baby kicks, there should be about 10 movements within an hour; c) movement does not matter because the baby is just sleeping majority of the time d) none of the above
B) Kick counts are very important to show the baby is alive and "kicking". As they are farther along the pregnancy, the baby should have 10 movements in an hour
A patient is allergic to PCN and has GBS. What can the nurse do? a) inform the doctor and wait for orders b) test to see if the organism is susceptible to clindamycin and erythromycin c) do nothing for the patient d) none of the above
B) Must culture to see if clindamycin is susceptible, if the organisms is resistant, give vancomycin
Which of the following puts a mother at risk for Group B streptococcus infection? a) older maternal age b) young maternal age c) asian heritage d) C-section
B) The risk factors for Group B streptococcus infections are : young maternal age, African or Hispanic descent, PTL, maternal intrapartum fever, PROM, previous birth of infected ifnant, GBS bacteriruia in current pregnancy
A nurse is teach a patient about TORCH. What response shows the nurse that the patient understands how Toxoplasmosis is contracted? a) "I can get toxoplasmosis from eating washed vegetables" b) "I will be fine as long as I properly cook my meat" c) "I can drink unpasteurized goat milk and be fine" d) "I cannot get Toxoplasmosis from eating foods that has beend known to be in contact with cat feces"
B) Toxoplasmos is contracted by eating raw or under-cooked meat, unpasteurized goat milk, contact with feces of infected cats
A nurse is teaching a community class about what puts a person at risk for a UTI. Which of the following responses shows that the class understood? a) You can only get a UTI if you wipe yourself every time in a public bathroom b) If you tend to wait to go urinate and suppress the desire multiple times c) If you use the bathroom that a person who had a UTI used d) If you eat spoiled foods
B) Voluntarily suppressing the desire to urinate is a predisposing factor, because retention can over distend the bladder and lead to an infection later on; other factors include: sexual activity at a younger age and general poor health that causes a weak immune system can increase woman' susceptibility to UTI
A husband brings his pregnant wife to the ER. The nurse does VS on a patient and find that she has a low grade fever. The husband mentions that the wife told him that she has seen blood in her urine. The nurse suspects that the wife has: a) pyelonpehritis b) cystitis c) neither d) this is a common occurence during pregnancy
B) the wife's low grade fever and hematuria are signs of cystitisl; Cystitis is inflammation of the bladder
A nurse is teaching at clinic about how to prevent pregnant women from contracting group b streptococcus infection. Which of the following shows that the class needs more instruction? a) mothers should be screened vaginally and rectally for GBS colonization at 35-37 weeks gestation b) GBS carriers should not receive a prophylactic antibiotic at labor or rupture of membranes c) Women w/ GBS in urine shoul dbe treated according to UTI treatment guidelines d) Women who have given birth to a newborn with invasive GBS should receive intrapartum antibiotic prophylaxis
B) they should receive an antibiotic prophylaxis
What must be monitored when betamethasone is given?
BP, pulse, weight, edema, electrolytes, and blood glucose
What would a baby with a molding on its head indicate about the birth?
Baby was vacummed out or had foreceps used on them or baby was in the birth canal for a prolonged period of time
After one of her patients gives birth to a baby boy, the nurse notices that the baby is jittery and feels cold. What should the nurse first do? a) warm up the baby b) put the baby on mother's chest for golden hour c) Do a heel stick to check for hypoglycemia d) Do nothing
C) Babies can be cold d/t the room temp; however, the baby's jitteriness can be a sign of hypoglycemia so it is important the nurse checks that the baby has a glucose level above 40 mg/dL
What is a lethal side effect to having a UTI? a) HELLP syndrome b) Kidney stones c) TORCH d) PTL
C) TORCH is the answer
A nurse has a patient in postpartum that has a sudden onset of chills, a high temp of 39.6 and right side flank pain. The nurse suspects the patient has: a) cystitis b) appendicitis c) acute pyelonephritis d) cancer
C) The patient has signs of pyelonephritis. Cystitis is low grade fever, has no flank pain, and has no symptom of chills. Appecdictis is sharp pain on the right lower side. Cancer would not be indicated by these symptoms only
For women, what is the most common health problem they can experience? a) DM type 2 b) Stroke c) UTI d) GERD
C) Uti is the most common problem women experience,
What would be diagnostic of acute pyelonephritis? a) right flank side pain b) nausea and vomiting c) positive fluorescent antibody titer d) increased diastolic BP
C) all of the others would be symptoms of acute pyelonephritis, but what would truly diagnose the patient with the disease is a positive fluorescent antibody titer.
What is terbutaline? When is it given?
It is a tocolytic drug that attempts to stop labor by decreasing contraction frequency and intensity. It is given when mother is <37 weeks, when there is a nonreassuring fetal status
What is the antidote for magnesium sulfate?
Calcium gluconate
What are urinary tract adaptations for newborns?
Child is able to concentrate urine by 3 months; during the newborn period, concentration and dilutional limitations in newborn period; It is important to monitor fluids to prevent dehydration or overhydration
How can an infant lose heat through conduction?
Chilly hands, cool scales, cold examination tables, cold stethoscopes
What do nurses do to promote heat loss?
Conduction (cold object on baby), Convection (incubator), radiation, put in room with a cold object nearby), and evaporation
A baby is born from a mother who has herpes simplex virus. Upon assessment the baby has no abnormal clinical manifestations. However, the nurse should suspect: a) these babies are asymptomatic at birth b) symptoms can include fever hypothermia, jaundice, poor feeding, seizures, vesicular skin lesions c) the baby will be treated with acyclovir d) all of the above e) none of the above
D
What kind of parents do we give Rhogam to? a) parents who are both RH positive having their second child b) parents who are both RH negative who are having their first child c) parents who are opposite RHs who are having their first child d) parents who are opposite RHs who are having their second child e) none of the above
D) Because parents who are opposite RHs, have to be careful of mother's blood attacking the baby; however, it does not happen with the first baby, you take Rhogam with the second baby and others after the 2nd baby
What are the different diagnostic tests that a patient with toxoplasmosis goes through to confirm it? a) serologic test of antibody titers: IgG and IgM fluorescent antibody (IFA) b) Toxoplasmosis Polymerase Chain Reaction (PCR) c) Ultrasound d) all of the above
D) Serologic testing of anitbody titers: IgG and IgM fluorescent antibody (IFA) are used to treat diagnose patients. A positive IgG but negative IGm in 3rd trimester should be followed by confirmatory tests; however any positive IgM should be followed by confirmatory testing PCR: tests amniotic fluid to diagnose congenital infection and is treated with pyrimethamine and leucovorin Ultrasound: to detect signs of fetal infection such as ascites, microcephaly, intracranial calcifications, fetal growth restriction
A pregnant woman with cystitis asks a community health nurse how she can avoid cystitis in the future. The nurse informs her of the ways to avoid cystisis. Which of the following responses would show that the teaching was successful? a) I will drink alcohol and coffee as much as I need in my daily life b) I will wife back to front to prevent any UTI c) I will save any left over meds from my current infection for another UTI just to save money d) I will avoid long waits and make regular urination patterns.
D) To avoid cystitis: you should avoid bladder irritants (Alcohol, caffeine, carbonated beverages), increase fluid intake (6-8 glasses of water every day ), avoid having a full bladder before and after intercourse, drink cranberry juice to acidify urine & relieve symptoms; don't save meds; avoid long waits; wipe front to back; when using contraception, use the right size or different method ("pulling out" maybe)
A nurse has a pregnant patient with cystitis. What would the nurse suspect the urine specimen would show? a) abnormal number of leukocytes b) blood c) high number of neutrophils d) a&b e) all of the above
D) With Cystitis, the urine specimen usually contains abnormal number of leukocytes and hematuria is commonly seen with Cystitis patients.
The nurse is doing a newborn assessment. With head circumference, what is important for a normal full-term newborn to have? a) a head circumference that is the same as the chest circumference b) a head circumference that is less that 10 centimeters c) the chest is bigger than the head d) the head is 2 cm bigger than the chest
D) in any child, a normal finding is the head being 2 cm bigger than the chest.
What are definitive signs of pregnancy?
Detection of fetal heartbeat, fetal movement, and ultrasound images of fetal outline
A mother has PROM at 34 weeks. The nurse does an assesment on the mother. What is the most important component to assessment for the nurse to find out?
Determining the duration of the rupture of membrane.
What are disadvantages of NSTs?
Difficult to obtain suitable tracing, the woman has to remain relative still for at least 20 min; has a high false-positive rate
A nurse has a patient who she suspects is a drug abuser. How should the nurse approach the patient about drug abuse history?
Direct questions that starts of general (caffeine, tobacco, otc) than invasive
What are two interventions when fetal RBC are attacked?
Early birth and intrauterine infusion of Rhogam
What two components do clinical gestational age assessment tools have?
External physical characteristics and neuromuscular development
What are women with pyelonephritis at major risk for? a) Preterm Labor b) Premature rupture of membranes c) Intrauterine Growth Restriction d) a&b e) b&c f) a &c g) all of the above
F) Those who have pyelonpehritis during pregnancy are at risk of PTL and IUGR
What are the five biophysical profile variables?
Fetal breathing movement, fetal movements of body or limbs, fetal tone, amniotic fluid volume, and reactive fetal HR w/ activity
What are the fetal risks to erythroblastosis fetalis?
Fetal edema (Hydrops fetalis), CHF, icterus gravis, and kernicterus (neuro damage)
What muscle is betamethasone given?
Gluteal muscle
How would a mother be diagnosed with GDM?
HA1C equal to or greater than 6.5% would be diagnostic, gasting plasma glucose level equal to 126, or OGTT > 200
What are the discomforts in the 2nd and 3rd trimester?
Heartburn, ankle edema, hemorrhoids, constipation, SOB, faintness, varicose veins, backache, round ligament pain
How does TORCH infections affect pregnancy?
If they have TORCH infections during the 1st trimester, it will affect fetal organogesis. If they have TORCH infections during the 3rd trimester, the baby will be born with the infection.
How can thermogenesis happen in a baby?
Increased basal metabolic rate, muscular activity, and chemical thermogenesis
What are the maternal side effects of bethamethasone?
Increased risk for infection with PROM, Type 1 diabetics may need more insulin infusions to prevent ketoacidosis, may increase risk of pulmonary edema when used with tocolytics such as Terabutiline
How does fetus respond to maternal antibodies?
Increases RBC production, jaundice, and anemia
What are the S/S of ectopic pregnancy?
Initial S/S of pregnancy, sharp-one sided pain, syncope, referred right shoulder pain, adnexal tenderness, chronic slow bleeding, extreme pain upon pelvic examination, low H/H,
What does HIV+ increase risk for complication?
Intrapartum or postpartum hemorrhage, pp infection,
What is rhogam?
Is a treatment to prevent fetal RBCs from being attacked due to mother antibodies; acts as a trickster to prevent maternal body to not produce antibodies of its own (active immunity)
When can/is Rhogam given?
It can be given during 28 weeks, if an antibody screen is negative, woman is given 300 mcg of Rhogam IM; after abortion, ectopic pregnancy, chorionic villus sampling, multifetal pregnancy reduction, partial molar pregnancy
What are advantages of NST?
It can be performed quickly and interpreted easily; inexpensive; can be done in office or clinic
Cocaine mother teaching in regards to breastfeeding?
It can cross into breastmilk, baby can become exttreme irritable, vomit, diarrhea, dilated pupils, apnea, however if cocaine usage is continued should avoid nursing
What are the risks to using cocaine?
It causes vasoconstriction, affects the placenta and uterus, can cause placenta abruption and placenta previa. Sometimes, babies are born with CNS issues
What are the insulin requirements during 1st trimester?
It decreases insulin requirements d/t n/v
What are the insulin requirements for 2nd trimester?
It increases due to baby's growth and hormone changes
What is an amniocentesis?
It is a diagnostic test that obtains amniotic fluid for genetic testing for fetal abnormalities or determine fetal lung maturity in the 3rd trimester of pregnancy; removes 15-20mls; Fetal HR and maternal VS are taken; RH negative women are given Rh immune globulin; this test can help provide info on genetic disorders, fetal health, and fetal lung maturity (lecithin/sphinomyelin ratio)
What are the risks to using alcohol during pregnancy?
It is a legal and common teratogen. It can cause fetal alcohol spectrum disorder
What is a transvaginal ultrasound?
It is a probe inserted into the vagina to produce a clearer more defined image of fetal structure characteristics; can also preduct preterm birth, cervical shortening
What is erythromycin used for?
It is an opthalmic prophylactic treatment for Gonorrhea; MUST NOT IRRIGATE AFTER INSTILLATION
What does the NST look for?
The NST checks that the fetus as adequate oxygenation and an intact central nervous system.
When does a nurse establish a newborn's GA?
The first 4 hours after birth
What is an ectopic pregnancy?
The implantation of the gertilized ovum in a site other than the endometrial lining of the uterus
What are the maternal risks of PROM?
The mother can contract chorioamnionitis and endometritis (infection), abruptio placentae (occurs frequently with it), retained placenta, hemorrhage, maternal sepsis, and maternal death
What are key facts to remember in regards to Rh factors?
There are 2 types of tests : indirect coombs test (done on mom to measure # of Rh positive antibodies) & direct coombs test (done on fetus to detect antibody coated Rh positive RBCs)
Why are babies who are born to GDM moms susceptible to hypoglycemia?
They had high levels of insulin while in the womb; therefore they produce more insulin and once they deliver they still produce high levels of insulin and therefore become hypoglyemic
How is Cytomegalovirus transmitted?
Through bodily fluids! It can transmit through placenta, cervical route during birth, kissing, breastfeeding, and sexual intercourse
How does the baby thermo regulates their temperature?
Thye increase basal metabolic rate, muscular activity, and use their brown fat.
What is the biophysical profile for?
To identify if fetus is healthy or compromised; it also provides an assessment of placental funtioning
What is fundal height checking for?
To indicate uterine size, measures from top of symphysis pubis to top of uterine fundus; correlates well with gestational weeks ; differs for very short or tall women; should have voided 30 min before exam; a lag in progression of measurements of fundal height from month to month and week to week may signal IUGR or hydramnios
What is magnesium sulfate used primarily for?
To prevent seizures seizures by raising the threshold for a seizure occurring
When is it given and who cannot get it?
To stop PTL, cannot be given to diabetics, can be given 3 times only until you change to a different drug; have to have a pulse of mom < 120bpm; common side effect: anxiety
What is a culture and sensitivity test used for?
To test mothers for infection of UTI and ASB; especially checking for glomerularnephritis, which is dangerous for the mother and baby
What does TORCH stand for?
Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex Virus
What are the nursing indications for PIH?
VS Q4H, UO should be 30ml/hr, urine specific gravity checked hourly, urinary protein, edema, weight, deep tendon reflexes, check for bleeding, HA, visual disturbance, epigastric pain, lab results
What is contraindicated for HIV mothers?
Vaginal exams
What kind of activities can consume carbohydrates faster for babies?
WOB, loss of heat when exposed to cold, activity, activation of muscle tone
What fetal S/S would be indicative of rubella? a) mental retardation & congeintal heart defects (PDA) b) inconsolability & tremors c) jittery baby d) rashes all over the baby's backside
a) The fetal S/S of rubella included congenital cataracts, sensorineural deafness, congenital heart defects, mental retardation, cerebral palsy
How can an infant lose heat through radiation?
Walls of room or incubator, placing cold objects on incubator
What results in erythroblastosis fetalis?
When an RH negative mom is pregnant with RH positive fetus, maternal antibodies cross placenta and destroy fetal RBCs
What is Rh sensitization?
When an Rh negative person is exposed to Rh positive blood, it results in agglutination & hemolysis of RBCs. To prevent this, Rh immuneglobulin is administered to mother
What is preeclampsia? Signs of severe and mild
When the pregnant woman has an increase in BP after 20 weeks gestation along with proteinuria, generalized edema (puffy face or hands), weight gain. Severe preeclampsia develops suddenly and has a Bp of 160/110+, urine protein measurement 3+ -4+, oliguria, frontal headaches, change in vision, scotomata, cyanosis, pumonary edema, hyperreflexia, retinal edema, reduced GFR
When is a BPP test indicated?
When there is a risk for IUGR, GDM, cardiac disease, chronic hypertension, preeclampsia, eclampsia, maternal sickle cell anemia, fetal post maturity, history of previous stillbirths, Rh sensitization, abnormal estriol excretion, hyperthyroidism, renal disease, nonreactive NST
A mother with HIV is treated how?
With antiretroviral therapy even during pregnancy. You also educate them on how they cannot give breast milk, because HIV is transmitted through bodily fluids
When is mom give Rh immune globulin?
Within 72 hours if she is not sensitized
When is Rhogam given?
Within 72 hours of birth and given to Rh negative mom and positive baby
A mother who is in her 30th week of pregnancy has a nonreactive NST. She is worried that something is wrong with her baby. The nurse knows: a) this is a normal finding and reassures the mother her baby is fine b) it is not a good sign and calls the doctor immediately c) NSTs aren't always accurate so she reassures it is not normal but it's okay d) none of the above
a
A nurse has a patient with GDM. How would the nurse not take care of the patient? a) give lunch w/ cookies and milk b) glucose monitoring c) insulin before having meals d)none of the above
a
What kind of teaching should the nurse provide for a mother with herpes simplex virus? a) explain that she is at risk for spontaneous abortion, C-section, cervical cancer, and may need a yearly pap smear b) mother just needs to take acyclovir as soon as possible at any stage of the pregnancy c) fetus will die d) the mother must cover the lesions with antibacterial cream to soothe the pain
a
What is heroin?
a injectable CNS depressant/Narcotic that alters perception and gives euphora
A mother comes to the clinic for a check up for hew 2 week old baby and informs the nurse that she is worried that her child has an infection because his temperature is high. The nurse explains
a newborn's immune system is not fully developed due to poor hypothalamic response to pyrogens; a fever is not usually reliable indicator for infection
When a mother is GBS unknown in the change of shift report, the Labor and Delivery nurse knows that prophylaxis GBS treatment is indicated for: a) women who are less than 37 weeks b) women whose memrbanes are rupture 10 hours or longer c) temperature is equal to 34 degrees celcius d) BP that is 100/90
a) Prophylaxis treatment is indicated for this choice and when membranes are rupture 18 hours or longer, temperature equal or greater to 38 degrees celcius
With rubella, what trimster of pregnancy is of greatest teratogenic effect? a) 1st b)2nd c)3rd d) none of the trimester rubella affects after birth
a) The period of greatest teratogenic effect of rubella is the first trimster
When we test to see if the RH factor is compatibile with baby, who do we test on? a) mother only b) father only c) both mother and father d) neither just the baby
a) mother only because 2 people will not cause problem for baby & mother is the one bearing the child
What is magnesium sulfate?
anticonvulsant that can lower BP too
What do you do for HIV patients while they are pregnant?
antiretroviral therapy, routine lab tests such as plat count and CBC w/ differential; teach about no breastfeeding, NST at 32 weeks
A pregnant woman comes in for a transvaginal ultrasound. The nurse positions the patient with: a) patient on her back and legs spread and flexed b)patient is on her back with her butt at the end of the table c) patient is on her side with one leg propped up d) patient is on her knees
b
A pregnant woman comes to the ER saying that she is in labor. She describes that she feels sharp, one sided pain, has low hemoglobin & hematocrit, and upon pelvic examination, screams that she's in pain. The nurse suspects: a) she has pyelonephritis b) she has an ectopic pregnancy c) she is going through septic shock d) she has an upper UTI
b
How can a nurse differentiate if a newborn is trully cyanotic or just acryocyanotic during the 1st 24 hours of birth? a) through blanching the extremities b) checking the pinkness of face and mucous membranes c) checking the pulse oximetry d) all of the above e) neither
b
The nurse stops the nursing student while suctioning a newborn when: a) the student positions the newborn on the back b) the student puts the bulb syringe and is about to compress while in the nares c) the student depresses the bulb syringe and then puts it into one of the nares d) the student uses a DeLee wall suction
b
The nursing student reports to the nurse that a newborn that is 2 hours old has murmurs. The nurse response is: a) I will inform the doctor right away b) It is normal because the child may have an incomplete closure of one of the holes, but will follow up c) That is not normal, I will follow up d) Nod and tell the student to check other newbors
b
When a child is found to have sunken fontanels and breastfeeding jaundice, the nurse teaches the mother how to cure the jaundice. Which response by the mother shows that the teaching was understood? a) I should breastfeed my child every time he/she cues for feeding b) I should breastfeed frequently every 2-3 hours c) I should supplement my child with water d) I should just leave my child on my breast to see if he'll latch on
b
When a pregnant woman is diagnosed with obstructive pyelonephritis, what nursing intervention is priority? a) drinking lots of fluids b) bed rest c) cleaning the perineal area d) giving her painkillers
b
Where is the newborn supply of iron stored until it produces more RBCs in 3 months? a) spleen b) liver c) heart d) kidney
b
A mother states that she has not felt her baby move in the last 3 hours and asks if that's abnormal and what she should do. The nurse should: a) inform the doctor right away b) give the mother juice c) put the mother on oxygen d) make the mother move
b)
The parents find out that the mother herpes simplex virus and asks what does that implies for the unborn child. The nurse's best response is: a) the fetus will be fine, so long as you take acyclovir as soon as you find out about the diagnosis b) the mother may have a spontaneous abortion or have a preterm birth c) the fetus will die as soon as he or she is born d) the fetus will have lung problems
b) The fetal risks for herpes simplex virus are spontaneous abortion, low birht weight, and preterm birth
A patient asks about the risks that come with Toxoplasmosis. What response by hte nurse is the best response about untreated toxoplasmosis? a) patient is fine because the likelihood of fetal infection decreases with each trimester b) If left untreated, the baby could have mild inflammation of retina or in a severe case, convulsions, hydropcephaly, or be deaf/blind/or severely retarded c) the baby will be born prematurely with severe skin rashes all over his body if given birth vaginally d) the baby will be born with an infection and must be treated immediately with antibiotics
b) The mild cases of a untreated toxoplasmosis infection are retinochoroiditis & other manifestations that don't appear until adolescence. The severe cases are convulsions, coma, microcephaly, hydrocephalus, death soon after birth. Survivors are often left blind, deaf, or severely retarded
The nurses assess a rubella patient. What signs and symptoms would this patient show? a) splenomegaly & rash around the perineal area b) red flat rash with little bumps & lympadenopathy c) malaise & vomiting d) diarrhea and diaphoresis
b) Women with rubella may be asymptomatic or show signs of mild infection such as maculopapular rash, lympadenopathy, muscular achiness, joint pain
When a baby is born, how does the baby regulate its body temperature by itself? a) shivering mechanism b) non shivering thermogenesis c) nothing, nurses and doctor have to keep baby warm at all times d) none of the above
b) non shivering thermogenesis is how the baby produces heat through its brown fat; this is a preferred method because we do not want baby to do extra compensatory things b/c if they shiver they break down glucose
The new mother wonders what an ultrasound can do and the advantages of the diagnostic test. The nurse explains: a) it is a noninvasive radiating test that deflects off tissues within the woman's abdomen b) it is invasive test that can identify what the baby looks like c) it is noninvasive non radiating that has no known harm to mother and baby that shows structures of baby in varying densities d) none of the above
c
What causes breastfeeding jaundice? a) poor feeding practice b) inadequate fluid intake c) a&b d) neither
c
What can betamethazone do for a pregnant woman? a) help prevent infection b) help stop Preterm labor c) helps surfactant development for lung development d) help completely form all of the organ systems
c) Betamethazone aids fetal lung development
A pregnant mother is worried about Cytomegalovirus. What would be the best response from the nurse to alleviate her fears? a) Cytomegalovirus is fatal to children and fetus b) The virus is fatal only if you contract it through the air c) The virus does not show symptoms in children and pregnant women, but it can fatal to fetuses d) There is nothing to worry about this virus. It will pass with antivirals
c) Cytomegalovirus is asymptomatic in childrena nd gravid women, but fatal to fetus
A nurse assesses a patient and suspects toxoplasmosis. What findings in her assessment would confirm her suspicions? a) cephalomegaly & yellowing of skin b) hematomas & swollen feet c) an enlarged spleen & rash d) swollen belly & pitting edema
c) During an assessment, the nurse would find myalgia, rash, splenomgealy, enlarged posterior cervical lymph nodes
When a mother with cytomegalovirus is close to her due date, she asks what possible complications the child could have if the child survives. The nurse's best respond would be: a) the child will have no chance of having complications at birth b) the child's complication will appear at a later time in life c) the child that survives may have microcephaly, hydrocephaly, cerebral palsy, or no damage at all d) the child will have jaundice
c) The children with Cytomegalovirus who survive may have microcephaly, hydrocephaly, cerebral palsy, or no damage at all, small for gestational age
When teaching her patients about what babies can eat/drink for the first few months, the mother asks if she can give her baby water to keep her hydrated. The nurse's best response is: a) yes you can give the baby water to make sure she/he is hydrated b) no giving the baby water is too early c) you should not give your newborn water because it fills the belly up and prevents nutrients from being absorb when they take in breast milk and such d) water is always good to give at any age
c) at a newborn age, no water should be given because they need to drink things that will give them the nutrients they need; water has no nutrients
A mother calls the nurse and says she hasn't felt the baby move in an hour. The nurse's best response is: a) come to the hospital immediately b) give it time, walk around, maybe he/she did move and you didn't notice c) drink some juice, if the baby still doesn't move in the next hour, come to the hospital immediately d) none of the above
c) sometimes the baby will stop moving if they are asleep in the womb; to alleviate the mother's fears, inform her to drink juice to make the baby move and essentially "hyper"
What are the fetal/newborn risks to GDM?
congenital anomalies, macrosomia, shoulder dystocia, traumatic birth injuries, perinatal morbidity/mortality, IUGR, RDS, polycythemia, hyperbilirubinemia
A nurse interviews a mother about her iron intake. The mother states that she had been eating iron rich foods throughout her pregnancy and took iron supplement pills. The nurse can estimate that the mother had adequate iron intake, which means newborn child will have iron that will last for: a) 3 weeks b) 1 month c) 2 months d) 5 months
d
A nurse is taking care of a PROM patient. Which of the following actions must the nurse NOT take? a) have woman lie on her left side b) check WBC count and VS for signs of infection c) educate on the importance of drinking fluids d) vaginal examinations every 5 hours
d
When teaching about rubella prevention, what would the nurse include in her teaching? a) women cannot get vaccinated until after becoming pregnant b) women should wait a month after birth of the child to get vaccinated c) women should wait at least half a year after vaccination after giving birth d) pregnant women can get vaccinated before getting pregnant
d) The best prevention therapy is to get vaccinated before getting pregnant (at least a month before getting pregnant)
When a patient with acute pyelonephritis starts ti have a decrease in urinary output & colicky pain, what does the nurse suspect is happening? a) it is a normal side effect of acute pyelonephritis b) the patient is experiencing kidney stones too c) the patient is imagining the pain d) there is edema or blockage that is narrowing the ureter
d) acute pyelonephritis may cause edema of renal parenchyma or ureteritis with blockage of the ureter that may lead to temp suppression of urinary output
When the mother gives birth to her newborn son, the child has trouble clearing out the fluid in his lungs. What would have caused this? a) the mother using analgesia or anesthetics during labor b) an underdeveloped lymphatic system c) aspiration of amniotic fluid, blood, or meconium d) all of the above e) none of the above
d) another cause could be inadequate compression of chest wall in a very small newborn (SGA, VLBW) --> these complications interfere with adequate lung expansions and cause failure to decrease pulmonary vascular resistance
What are signs of Mag sulfate toxicity?
decreased reflexes, decreased RR, slurred speech, awkward movement, decreased appetite, dysphagia, excessive drooling
After 2 days, the nurse looks at the labs of the fetus and sees that the hemoglobin is 1 g/dL above the normal fetal level, the nurse knows that this could be due to: a) high fluid intake b) diminished ECF volume c) inadequate fluid intake d) a& c e) b&c f) none of the above
e
To help a newborn maintain thermal stability, what can a nurse do? a) keep the infant at a supine position b) keep the infant at a flexed posture c) swaddle the infant after cleaning him/her d) a& b e)b&c
e
What ABG changes does the first breath trigger for a newborn?
elevated PCO2 (hypercapnia), decrease in pH (Acidosis), and decrease in PO2 (hypoxia)
If a nurse has a nonreactive NST, how can she stimulate the baby?
encourage mother to eat, give a foot passage, or palpate the baby
What are the S/S of placenta abruption?
external bleeding, dark venous blood, anemia, preeclampsia may be present, pain is severe and steady, uterine tenderness, firm uterine tone, uterine contour may enlarge and change shape, FHR present or absent, engagement may be present, no relationship to fetal representation
What vitamin decreases neural tube defects?
folic acid
What is eclampsia? & when can it occur?
grand mal seziures or coma; anytime during, before or after pregnancy
What is HELLP?
hemodialysis, elevated liver enzymes, low platelet count, liver distention; essentially it is a multiple organ failure syndrome, which leads to high mortality with mother and fetus
What are the diagnostic tests for PIH?
high BP, HA, epigastric pain, swelling, apid weight gain, elevate uric acid, elevated liver enzymes, low platelets, proteinuria
What are the maternal risks to GDM?
hydramnios, preeclampsia-eclampsia, hyperglycemia, retinopathy, monilial vaginitis, UTI
What is a mother with GDM at risk for?
hydramnios, preeclampsia-eclampsia, hyperglycemia, retinopathy, monilial vaginitis, UTI d/t glycosuria
What can alter a newborn's ability to generate heat?
hypoxia, acidosis, hypoglycemia, medications that bloack norepinephrine release (meperidine), hypothermia
What are the effects on mothers who are Heroin users?
increase incidence of poor nutrition, iron deficiency anemia, preeclampsia
What interventions should be given to women who are PTL?
lots of fluid, antibiotics,
What effects does alcohol have on mother?
malnutrition (thiamine and folic acid deficiencies), bone marrow suppression, increased incidence of infections, liver disease, delirium tremens, alcohol dependence
What can interfere with ultrasounds?
maternal obesity, fetal positioning and technician skill
What are the effects of alcohol on fetus/ newborn?
mental retardation, microcephaly, midfacial hypoplasia, cardiac anomalies, IUGR, potential teratogenic effects, FAS, FAE
What are diagnostic tests of cocaine?
metabolites in urine within 4-7 days after use
What kind of treatment would heroin using mothers be on?
methadone and maybe buprenorphine (to decrease NAS incidence)
For hyperemesis gravidarum, what nursing interventions are necessary?
monitor sodium, K+, albumin, I/Os
Who is at risk for gestational diabetes?
obesity, history of GDM, glycosuria, strong family history of diabetes
What kind of antibiotic is given to mothers who are GBS positive?
penicillin G
If you have a patient with a cocaine problem, what is she at risk for during pregnancy?
placenta abruption, preterm birth or still birth
What are the fetal risks of heroin usage?
preterm birht, IUGR, meconium aspiration, withdrawal symptoms: restless, high pitched cry, irritability, fist sucking, vomiting seizures (blinking a lot)
What are the S/S of PIH
proteinuria, edema, swelling, epigastric pain, visual disturbances, oliguria
After an infant has been dried after birth, the highest losses of heat generally result from?
radiation and convection
A pregnant patient with history of alcohol abuse is assigned to Nurse Joy. What kind of care does this nurse expect for this patient?
sedation to decrease irritability and tremors, seizure precautions (padded side rails), IV fluid therapy (hydration d/t dehydration), prep for addicted newborn, breastfeeding is not contraindicated , but too much can intoxicate infant and inhibit maternal let down reflex
What is HELLP associated with?
severe PIH
What does a reactive NST look like for a preterm fetus?
the rate is 10 bpm above baseline for 10 seconds in a 20 minutes period
What is the patho behind PIH?
there are vasospams that decrease perfusion and cause BP to increase d/t increased peripheral resistance; could also be due to prostacyclin : thromboxane ratio; during preeclampsia there is a decrease in prostacyclin; these hormones are produced by placenta which explains why condition resolves after delivery
What are the fetal withdrawal symptoms of NAS?
tremors, irritability, sneezing, vomiting, fever, diarrhea, abnormal respiratory function, possible seizures
What symptoms would indicate early signs of complications for HIV mothers?
weight loss in 2nd or 3rd trimester, fever, vaginal infections, thrus, hairy leukoplasia, pneumonia, lymph nodes, liver, and spleen are palpated for enlargement
How can an infant lose heat through evaporation?
when baby is wet with amniotic fluid, during baths, (DRYING IS SO IMPORTANT); lower gestational age have higher incidence of evaporative heat loss; radiant warming beds, bank phototherapy lights
When do withdrawal symptoms appear?
within 72 hours and last for days
