Perinatal Final Exam: Exam Reviews
A pt comes to the prenatal clinic to begin care at 10 wks gestation. The nurse would advise her that the routine test(s) during the initial examination is/are: Select all that apply: 1. Rubella titer. 2. Complete blood count (CBC) 3. Glucose tolerance test 4. Group B strep status 5. Blood type & antibody screen
1, 2, & 5 Rubella titer, CBC, blood type and antibody screen Glucose & GBS done later
What is a common expected emotional reaction of a person during the first trimester to the news that the person is pregnant? A. Ambivalence B. Acceptance C. Depression D. Jealousy
A. Ambivalence - very common during the first trimester Stressed, happy, mixed emotions, etc. Later on: bonding & accepaetance
After delivery, Jane's perineal area is red & edematous. Which of the following nursing actions would be most appropriate in the immediate recovery period? a. Apply an ice pack to the perineum b. Insert a FOLEY catheter c. Call the birth attendant immediately d. Increase the number of sitz baths from 3-6 each day.
A. She is in immediate recovery 2nd or 3rd day recovery - increase the # of sitz baths Ice is good for first 6 hours or so, Ice for pain, but won't help with edema after that 6 hours
A woman's last prenatal visit was when she was 22 weeks pregnant. Now at 28 weeks of pregnancy, she should expect to have which of the following test performed? a. A 1 hour glucose tolerance test. b. 24 hr urine collection c. Blood type & screen d. Genetic testing
A. 1 hour glucose tolerance test at this time b. no c. done early in pregnancy d. done early in pregnancy
The Rudd's baby has begun to develop jaundice 30 hours after birth. The couple is very concerned that their baby has a liver disease. The nurse's best response would be based on the facts that jaundice occurring in the newborn: a. After the first 24 h of life has a normal physiologic cause b. At any time after birth has a normal physiologic cause c. After the first 12 hours of life has a normal physiologic cause d. After the first 36 hours of life has a normal physiologic cause
A. 24 h Before 24 h is pathologic, after 24 hours, its considered normal
At delivery, the fetal head goes through internal rotation, then extension then external rotation. The external rotation allows for which of the following events to occur? a. The newborn to begin respirations b. The shoulders to come under the pubic bone. c. The shoulders to engage in the mid pelvis. d. Expulsion of the fetus.
B. Fetal head journey: Head goes from transverse diameter to anterior-posterior diameter --> extends under pubic bone --> head turns again for shoulders to come under pubic bone.
All of the following contribute to cold stress in the newborn EXCEPT: a. Limited ability to regulate body temp. b. Mobilization of stores of brown fat. c. High surface area to body mass ratio. d. Respiratory distress caused by chilling.
B. around scapula & clavicles, theres a little fat that can be mobilized if hypothermic. A. immature hypothalamus C. yes, proportionally to us, more surface area exposed to hair D. yes, baby working v hard to breathe which uses up stores of glycogen Baby has immature hypothalamus - can't regulate temp very well (why swaddle, hat, etc.)
A woman has just been diagnosed as being pregnant. She is worred bc her breasts are really sensitive. The nurse's BEST explanation for this sensitivity is: a. This is due to decreased progesterone. b. Both estrogen & progesterone make the breasts more sensitiv.e c. The doctor will need to examine you. d. This is due to the increase of prolactin, an early pregnancy hormone.
B. both!!
All of the following are signs of respiratory distress in the newborn EXCEPT: a. chest wall retractions b. 82 respiratory rate c. Shallow, irregular abdominal breathing d. expiratory grunting
C. Baby breathes shallowly, then apnea (irregular), shallow abdominal breathing Resp distress is taking big breaths, pulling chest upwards in seesaw fashion as baby struggles to breathe. A. should not have B. high for a newborn, but could potentially be normal D. not normal
Emili is a term newborn who experienced no respiratory distress at birth. Air entering Emili's lungs immediately after birth affects cardiopulmonary physiology by: a. Increasing CO2 levels in the blood b. Increasing fluid in the alveolar sacs c. Shunting more blood to the lungs. d. Shunting blood away from the lungs
C. Shunting more blood to the lungs A. no B. no D. no Big breath --> high pressure in the lungs overcome by big breath --> blood rushes into lungs to pick up the oxygen the baby is now breathing in
The nurse assesses the postpartum client to have inflamed painful hemorrhoids on the day after birth. Which of the following nursing interventions would be most appropriate? a. Increased fluid intake b. Position the client in a supine position c. Apply tucks pads d. Start giving her a stool softener
C. Tucks Many are appropriate, but the most imp thing rn is her pain - give her pain meds! Increase fluid intake? yes, for a soft BM Supine position? no Tucks? yes Stool softener? yes Problem RN: PAIN!!
Mrs. Gonzalez, a G2 P2, complains of cramping while nursing her baby. The nurse should explain to her that these cramps are uterine contractions caused by: a. a boggy uterus b. excessive stretching of the uterus c. high levels of prolactin d. release of oxytocin during nursing
D. Baby is nursing --> releasing oxytocin from the pituitary --> causes the milk to be ejected & also for the uterus to contract.
Clamping the cord at birth stops blood flow from the placenta through the umbilical vein, decreasing circulating pO2 levels in the newborn. What is the next physiologic process? a. Decreased pCO2, ultimately triggering the respiratory center & breathing. b. Immediately causes the ductus arteriosus to functionally close. c. Decreased systemic pressure & increased pulmonary artery pressure d. Circulating pCO2 levels increase, triggering the resp center & breathing
D. pO2 levels go down so pCO2 goes up--> triggers respiratory center & breathing in the newborn Increased systemic pressure, decreased pulmonary artery pressure, decreased pressure in the lungs B. is wrong, not immediate, takes a while to close A. pCO2 increases
A nurse is assigned to a 2 day old breastfed baby who is getting tx for being jaundiced (hyperbilirubinemia). Which assessment finding needs further investigation? a. Pulse 120 b. Yellow tint to skin c. Loose stools d. Axillary temp 97.3F
D. Axillary temp 96.3F - too low The question isn't about hyperbilirubemia (trick q) Normal temp is 97.5-99.3 A. is normal (110-160) B. obv bc they're jaundiced C. Babies being tx for hyperbilirubinemia may have diarrhea
In planning when women should start taking folic acid for a healthy fetus, it is recommended that ideally folic acid be started: a. 400 mcgs as soon as pregnancy is confirmed b. 500 mgs thorughout pregnancy c. 800 mgs if the woman has had a previous baby w/ a neural tube defect. d. 400 mcgs starting before pregnancy begins.
D. Before pregnancy, pre-conception If PLANNING & IDEALLY
At the time of implantation, the fertilized egg is referred to as a(n): a. Embryo b. Fetus c. Morula d. Blastocyst
D. Blastocyst Egg --> Zygote --> morula --> Blastocyst
Martina (10 weeks pregnant) asks if she should now be able to "feel the uterus" in her lower abdomen. The nurse's response should be based on knowledge that the uterus: a. Begins mild regular contractions early in pregnancy and the woman may feel this muscular activity. b. May be felt in the midline just above the symphysis pubis by this point in pregnancy. c. Should have a fundal height of 6 inches above the symphysis pubis. d. Cannot be felt through the abdominal wall as it is not yet large enough to rise out of the pelvic cavity.
D. Cannot be felt through the abdominal wall 10 weeks pregnant, uterus is way down in the pelvis, not until 12 weeks can be felt at symphysis pubis.
Four mintues after the birth of a client's baby, there is a sudden gush of blood from the client's vagina & about 8 inches of umbilical cord slides out of her vagina as the placenta is delivered. What is the priority nursing action? a. Apply an ice bag to the perineum b. Examine the placenta c. Slow down the Pitocin drop d. Massage the uterine fundus
D. Massage the uterine fundus. lots of ppl got wrong Most imp is to make sure the uterus is contracting back to size right after placenta comes out (blood vessels where placenta was need to have uterine muscles wrap around the blood vessels to prevent bleeding).
A comes in for her first prenatal visit stating she is 12 weeks pregnant. She denies nausea, vomiting, & fatigue. Instead, she reports a feeling of energy & wellbeing & being able to feel the baby move. The nurses suspect which of the following as being the MOST likely explanation for why the nurse's expectation is different than the report by the patient? a. The placenta is not functioning well. b. The woman is nulliparous c. The woman has a mental illness d. The woman has miscalculated her LNMP
D. Miscalculated LNMP 12 weeks? uterus is barely at the symphysis pubis, should not be able to feel the baby move
The major distinction between true & false labor is that when true labor is present, the laboring person will demonstrate: a. An urge to push b. Discomfort w/ uterine contractions c. An increase in vaginal discharge d. Progressive changes in the cervix.
D. Progressive changes in the cervix. No change in cervix, then contractions may be false labor.
12 hours after delivery, a woman's uterine fundus is firm, midline, & at the level of the umbilicus. The nurse correctly recognizes this as a sign of: a. Urine retention b. Normal involution c. Delayed involution D. Retained pieces of the placenta.
Involution: shrinkage of uterus after birth B. normal involution, nothing wrong here!
Which one of the following nursing actions is of most immediate importance if the fetal head is not well engaged and spontaneous rupture of membranes occurs? a. Assess for signs of inadequate uterine relaxation. b. Restrict pelvic examinations because of the possibility of infection. c. Check fetal heart tones d. Palpate intensity of contractions and assess the women's response to labor
No well engaged = high up in the pelvis where the 2 ischial pines are sticking out if we were to draw a line from one side to the other, what is called 0-station (we want it down, in the middle of the pelvis) A. no B. yes C. yes D. yes Which is most important? C. -check the baby, we don't want an umbilical cord prolapse bc there's so much space --> emergency c-section
The labor and delivery nurse does a vaginal exam on his/her patient in labor. The fetal occiput is palpated towards the front of the pelvis. Thus, the fetal position is: a. Occiput is not engaged b. Occiput transverse c. Occiput anterior d. Occiput posterior
Occiput = skull (back of head) Occiput is anterior - Baby comes out looking at the floor If posterior, you would feel further back, towards mother's back
Shalonda had an epidural anesthetic administered 10 minutes ago. Nursing actions would include all of the following EXCEPT: a. supine position b. maintain hydration with IV fluids c. Monitor fetal heart tones d. Frequent blood pressure checks.
Supine position is flat on back, bc compresses vena cavae which may make you lightheaded B yes, C yes, D yes
In attaining the maternal role & psychological adaptation to the pregnancy, most women will form an attachment to the fetus. Seeing the baby as separate from herself usually begins at what point in the pregancy? a. Around 20 weeks b. The end of the 2nd trimester c. Not until labor starts d. The end of the first trimester
a. 18-28 weeks when the baby starts feeling the baby move --> start thinking more
Bonnie has been experiencing regular contractions with cervical dilation changing from 3 to 7 cm in the last half hour. Her membranes are still intact. Bonnie is now in which of the following phases/stages of labor? a. Active phase of the first stage of labor b. Early phase of the second stage of labor. c. Placental stage or the 3rd stage of labor. d. Latent phase of the first stage of labor.
A. Active phase of the first stage of labor 1st stage: 0-10 cm (3 phases: early/latent, (0-6cm), active (6-8cm), transition(8-10)) 2nd stage: 10 cm to birth (2 phases: Latent, pushing) 3rd Stage: Birth to delivery of placenta 4th Stage: Placenta delivery to first 2h after birth (recovery period)
During admission of a patient to labor, it is important to determine the fetal presentation when doing a vaginal exam. Which of the following statements is true? a. Fetal presentation may determine whether the person has a vaginal or c-section birth b. All fetal presentations can delivery safely vaginally c. Fetal presentation is only important in multigravidas d. Fetal presentation does not affect progress in labor
A. Fetal presentation may determine whether the person has a vaginal or c-section birth Fetal presentation is v important. Vertex/occiput (head) presentations then let them labor. Breech presentation (buttocks/feet/legs) or transverse (baby's head on one side or shoulder presenting) --> C-section.
You are the postpartum nurse assessing a client's fundus & find it firm, 2 cm above the umbilicus, and displaced to the right. What is the most appropriate intervention? a. have the client void & reassess the fundus b. massage the fundus until firm c. start a pad count d. Insert a FOLEY catheter
A. Have the client void & reassess
Which of the following maternal cardiovascular findings is expected during labor? a. Increased cardiac output b. Decreased blood pressure c. Increased hemoglobin & hematocrit d. Decreased pulse
A. Increased cardiac output Body working so hard → putting out more blood → heart experiencing increased workload
In discussing the importance of folic acid the developing fetus, the nurse should emphasize which of the following points to the pregnant person? a. It reduces the occurrence of neural tube defects. b. It increases the production of red blood cells in the pregnant person. c. It reduces B12 deficiency in the pregnant person. d. It reduces the occurrence of ventral wall defects.
A. Reduces the occurrence of neural tube defects Any defects from brain to spin to coxxyc can be affected by inadequate folic acid --> why we have supplementation of folic acid in grains, cereals, and supplementation in pregnancy.
In the delivery room shortly after birth, the nurse knows the best way to prevent heat loss of the newborn from conduction is by: a. Closing the door to the room b. Drying the neonate c. Warming equipment used on the neonate d. Placing the crib near a warm wall
C. B. prevents evaporation, question asking about conduction Conduction: baby to solid object Another ex: warming stethoscope before putting on baby
In preparing for birth, pregnant couples experience anxiety over "safe passage." Safe passage refers to which parental concern? a. Ending pregnancy & going into labor. b. Making it to the hospital in time for delivery. c. Completing labor & birth w/o harm to mother or baby. d. Successfully completing the tasks of bonding to the baby.
C. "safe passage" specific to birthing, meaning "I just want my baby to be okay"
The low risk pt who is 16 weeks pregnant should be told to return to the prenatal clinic in how many weeks? a. 6 weeks b. 2 weeks c. 4 weeks d. 2 months
C. 4 wks High risk: more often (2 weeks possibly)
The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience which of the following musculoskeletal changes? a. Increased abdominal muscle tone b. Decreased sensation in the pelvis. c. An increased lumbosacral curvature of the spine. d. A shift of gravity backward decreasing backaches
C. An increased lumbosacral curvature of the spine --> Back aches most common complaint A. no B. no D. no
A woman c/o severe back pain in labor. On exam, the fetal occiput is found to be in a posterior position. What position would the most helpful for this laboring woman? a. Semi-fowlers b. Left side-lying c. Hands & knees d. Sitting on a chair w/ pillows
C. hands & knees A. maybe (sitting halfway up) Occiput is posterior: pressing on birthing person's spine --> severe back pain --> want to get the occiput off the spine --> put on hands & knees position
Enlargement of the uterus during the first trimester is due primarily to which processes? a. Stretching of the uterine cavity as the embryo grows. b. High levels of HCG (human chorionic gonadotropin) c. Hypertrophy & hyperplasia of the myometrium (uterine) cells d. Effects of oxytocin on the endometrium
C. hypertrophy & hyperplasia think of when doing FOLEY insertions, the labia are much bigger than normal Hypertrophy: enlargement of the cells already there Hyperplasia: growing new cells
Susan's bladder is noted to be distended a few hours after a difficult delivery a. An infection of the bladder b. Fear of rupturing her episiotomy stitches c. Edema in the are of the urinary meatus d. Pressure of the uterus on the urethra
C. is correct This (d.) usually happens in labor when baby is bag and pressure on bladder, not urethra Too soon to have an infection probably B. maybe C. for sure D. usually happens in labor, when the baby is big & there would be pressure on the bladder, not the urethra
A 25 yo woman gave birth to her 2nd child 6 hours ago. She informs the nurse that she is bleeding more than w/ her previous birth experience. The initial nursing action is to: a. Giver her 10 units of oxytocin as per standing order b. Explain that this is normal for second-time moms c. Assess the location and firmness of the fundus d. Change her pad & return in on hour and reassess
C. is most important! Ex in class: Multiparous woman on the way to the restroom & is bleeding, let her void first, and then assess (or fundus may be to the right) A. yes, give pit B. yes D. yes
Which of the following statements is true about weight gain during pregnancy? a. All pregnant persons should gain at least 25 to 35 lbs. b. Average weight gain throughout pregnancy is 1 lb per week. c. It is recommended that weight gain be based on pre-pregnancy BMI. d. It is recommended that weight gain be based on the BMI during the first trimester.
C. pre-BMI a. no b. sort of d. no
First trimester screen (FTS) is done between 11-13 weeks. What is the primary purpose of the screen? a. To rule out a cardiac defect. b. To reassure parents about the health of the fetus. c. To diagnose Down syndrome. d. To identify the possibility of a genetic fetal defect.
D. Identify a possible genetic fetal defect b. be more specific c. yes, but that's a genetic defect
A woman's cousin gave birth to a baby w/ a heart defect. The woman asks you when such anomalies occur. Your best response is: a. It depends on what caused the defect b. We don't really know. c. It usually occurs during the first 2 weeks of development. d. They occur btwn the 3-5th week of development.
D. Most insults to various systems that are forming are between 3-8 weeks so yes this is correct (only one that fits that) A. No B. Sure, we don't really know, but we assume. C. First 2 weeks - all or nothing either doesn't survive, or doesn't. So badly damaged --> miscarried or nothing happens to it Happens between the 3-8 week.
Amina has been admitted in labor & an external fetal monitor applied. When the nurse reviews the monitor strip, contractions are difficult to assess but appear to occur every 2 minutes and 30 seconds. What should the nurse do to get a more accurate evaluation of Amina's contractions? a. Ask Amina about her contractions. b. Make the monitor belts tighter so the contractions can be seen more clearly. c. Change Amina's position. d. Palpate the contractions
D. most accurate As a professional, know what the contraction feels like A. yes, but subjective B. yes, but not very accurate C. yes Put hand on fundus & palpate contraction
Which of the following statements if false regarding cardiovascular changes in a pregnant woman? a. Pulse increases slightly b. Blood pressure decreases slightly due to low systemic vascular pressure. c. Cardiac output increases. d. Blood pressure increases due to increased work load on the heart.
D. no BP decreases slightly, does not increase --> this is false BP going up is a red flag (beginning of preeclampsia) a. yes, this is true b. true c. slightly, sure
A pt, who is 18 yo, presents to a prenatal clinic bc her menstrual period is 9 days late. She tells a nurse "I'm sure I'm pregnant bc my period is late & my breasts are tender." Which response by the nurse would be most appropriate? a. "A missed menstrual period & breast tenderness are - signs of pregnancy." b. "A missed menstrual period & breast tenderness are probable signs of pregnancy." c. "A missed menstrual period & breast tenderness are + signs of pregnancy." d. "A missed menstrual period & breast tenderness are presumptive signs of pregnancy."
D. presumptive
Pregnant women are susceptible to UTIs bc of which of the following processes? a. Renal workload is decreased due to changes in maternal metabolism & excretion of fetal waste. b. Pressure from the growing fetus & uterus interfere w/ the flexibility of the kidneys. c. The increased vaginal discharge known as leukorrhea provides a medium for bacterial growth. d. Dilation of the ureters and renal pelvis during pregnancy causes stasis of urine.
D. stasis of urine --> source of infection a. no b. no c. can lead to an infection, mostly a yeast infection in the vagina tho
Which of the following situations related to a newborn's birth would most probably lead to respiratory distress in the newborn? a. Adequate surfactant in the lungs b. Reduced vascular resistance in the lungs c. Chest recoil following a spontaneous vaginal delivery. d. Inadequate fluid movement from the lungs to the lymphatic system.
D. too much amniotic fluid in the lungs A. no B. no C. no - does not cause problems
EXAM 2
EXAM 2
Exam 1
Exam 1
Which of the following is a potential fetal outcome of poor maternal weight gain? a. Polyhydramnios b. Microsomia c. Preterm labor d. Macrosomia
c. Preterm labor
Sarah has just had her pregnancy confirmed by a positive maternal HCG test (human chorionic gonadotropin). The nurse knows that this hormone can be detected as early as 8-10 days after conception but it is produced by which structure? a. The corpus luteum in the ovary. b. The fertilized ovum. c. The placenta d. The trophoblastic tissue of the blastocyst.
A. The corpus luteum in the ovary.
Closure of the ductus venosus begins when: a. the umbilical cord is cut b. left atrial pressure exceeds R atrial pressure c. The O2 is given per face mask d. Blood flows from the pulmonary artery to the aorta
A. When umbilical cord is cut Ductus venosus is in the liver. Blood comes from mother --> placenta --> umbilical cord --> liver --> bypasses liver (baby does not need liver, the mother is detoxing everything for the baby). Ductus venosus shunts everything away from liver into vena cava Question is asking: when does baby need liver?
A laboring primigravida complains of increasing rectal pressure. A vaginal examination reveals a cervix that is 9.5 cm dilated, 100% effaced, and the fetal head at a +2 station. The nurse can correctly conclude that the: a. Woman may start to push when she feels the urge to do so. b. Woman should deliver w/in the next 30 minutes c. Baby is very high and women will need to do a lot of pushing d. Fetus is at the level of the ischial spines.
A. Woman may start to push when she feels the urge to do so. Rectal pressure, almost completely dilated, cervix is very effaced, +2 head is way down. EBP says push bc the urge is there! B. most likely will happen, but we don't know for sure.
A pregnant woman coming in for her second prenatal visit is advised that her CBC shows a hemoglobin of 10.7 g/dL and a hematocrit of 31%. The MOST appropriate nursing intervention would be to: a. Ask the woman if she is taking her prenatal iron as directed b. suggest that the woman increase her intake of dark greens & legumes c. Tell the woman that further testing would be required d. Tell the woman that this is normal during pregnancy.
A. fastest way to increase H& H is through the prenatal iron <10.5 is true anemia, 31% a lil low a. yes b. yes, suggest c. maybe d. sort of
The longest phase of labor is: a. latent or early phase of the first stage of labor b. active c. transition d. pushing
A. latent or early phase of labor
In normal labor, as the uterine contractions become stronger, they usually also become: a. Longer in duration b. Less painful c. Shorter in duration d. Easier to palpate
A. longer in duration Early labor contractions are short, frequency is not very often. Longer, harder, & firmer contractions as labor progresses.
All of the following behabiors are normally present during the transition phase of the first stage of labor EXCEPT: a. difficulty in controlling behaviors b. strong desire for interaction c. Acute sensitivity & irritability d. Discouragement & fearfulness
A. yes, C. yes, D. yes B. is correct answer
You have just administered the MMR vaccine to your postpartum patient who is being discharged home. What is the priority teaching about the vaccine that is necessary? a. This will prevent your baby getting measles, mumps, or rubella b. Be sure to use birth control for the next month. c. You may develop flu-like symptoms in the next 24 hours. d. This will prevent you from getting measles, mumps, or rubella
B. MMR - live, attenuated virus Measles, Mumps, Rubella Virus isn't actually alive, but has those properties Virus causes birth defects.
When during pregnancy is quickening usually first felt by the primigravida? a. 10-12 weeks b. 18-20 weeks c. 12-14 weeks d. 24-26 weeks
B. 18-20 weeks Multigravida: 16-18 weeks
The nurse determines that Mazie has several presumptive indicators of pregnancy. They are called "presumptive" because they: a. Result from physiologic changes in the pelvic organs & hormonal influences. b. Are caused by symptoms the woman experiences & may be caused by other conditions. c. Appear in the first trimester before the woman is sure that she is pregnant. d. Originate from the fetus rather than from the woman's reproductive tract.
B. Caused by symptoms the woman experiences a. sure
Mrs. Lee who is in labor has just had an epidural. The nurse takes the blood pressure & finds that it has dropped. What should the nurse do next? a. Call the anesthesiologist. b. Change MRs. Lee's position. c. Ask Mrs. Lee if she has a headache d. Give Mrs. Lee oxygen per face mask.
B. Change positions! A. probably B. yes C. not really indicated D. no Most common intervention in labor is changing positions. After changing and BP still dropping then call anesthesiologist.
Alicia, a 21 year old primigravida is admitted in labor. She is experiencing back labor & complains of intense pain in the lower back. An effective relief measure would be to use: a. Conscious relaxation or guided imagery. b. Counter pressure against the sacrum c. Pant-blow (breaths & puffs) breathing techniques d. Effleurage
B. Counter pressure against the sacrum Pain - push back on baby's head
Which of the following neonatal bacterial infections is definitely decreasing bc of screening during pregnancy & effective drug tx w/ penicillin during labor? a. Herpes infection b. Group B streptococcal infection c. Monilial infection d. Hepatitis B infeciton
B. GBS
A client reports that she has a 3-year old child at home born at term, had a miscarriage at 10 weeks gestation, and delivered a set of twins at 28 weeks gestation who died w/in 24 hours. What is the gravida/para that the nurse should record in the chart? a. G2, P1 b. G4, P2 c. G5, P4 d. G3, P3
B. Gravida 4, para 2 Para 2: 3 yo, set of twins
Which type of episiotomy is most likely to extend (tear) further with the delivery of the newborn? a. 2nd degree laceration b. ML (midline) c. RML (right mediolateral) d. LML (left mediolateral)
B. ML Surgical incision w/ midline episiotomy, head is more likely to tear & become a 3rd degree lac
A laboring woman is resting after receiving an epidural 40 minutes ago. The nurse assesses that the IV is patent, the epidural is infusing, BP 108/70, and the FHR (fetal heart rate) baseline is 120 bpm w/ average variability. Which additional assessment is a priority? a. Movement in both legs b. Condition of the bladder c. Patient's comfort level. d. Respirations
B. No indication she doesn't have a FOLEY or has voided recently. "Hardest question" Pt is resting after epidural (no indication of pain), IV is patent is good, BP is normal (a lil low, but normal), FHR is good, baseline has variability is good D. Theoretically could be in resp distress, but there's no indication. BP & FHR is good After epidural: check body alignment (can't feel legs), comfortable, change positions q hour, don't put on back, VS
In fetal circulation, the foramen ovale allows for the flow of blood from the: a. Pulmonary artery into the aorta b. Right atrium into the left atrium c. Left atrium into the right atrium d. Right ventricle into the left atrium
B. Right atrium to left atrium Foramen ovale- hole in the heart, from right to left Adults: right atrium to right ventricle to lungs--> left atrium --> left ventricle --> aorta--> rest of body
Which one of the following normal physiologic changes require the nurse to review appropriate dietary interventions? a. Maternal blood glucose decreases b. Slowed gastric emptying and slowed intestinal peristalsis c. The gums become pale and firm. d. Rapid gastric emptying produces diarrhea
B. Slowed gastric emptying & slowed intestinal peristalsis Meaning: drink fluids, excercise, get ruffage in diet A. actually goes up during pregnancy c. no, gums become red & edematous D. no, opposite
The nurse who determines a laboring client is anxious anticipates that this may result in: a. Increased need for fetal monitoring b. Increased pain during labor c. Rapid progression of labor d. Need for an episiotomy
B. Yes Relaxation vs contraction of muscles → being anxious & tense (contracting muscles) is more painful A. no, could just monitor normally D. episiotomy - the lac between vag & anus
Which of the following physiologic changes occur in pregnant persons? a. Systemic vascular pressure increases b. Systemic vascular pressure decreases c. The cervix becomes pale & firm. d. The respiratory rate decrease due to the flattening of the rib cage.
B. all blood vessels dilated --> blood is free to go to maternal body & fetus. a. no, opposite; Systemic vascular pressure only increases when high BP & preeclampsia --> vasculature constricts --> systemic vascular pressure increases c. no, becomes red d. no, RR
Vitamin K is normally given IM to the newborn under which of the following conditions? a. After the 5th day of life. b. Soon after birth c. 24 hours after the baby's first feeding. d. When a risk for bleeding has been identified
B. first 2 hours after birth
In discussing urinary frequency in the first trimester, the nurse would explain that the cause is due to: a. It is directly influenced by the posture of the person. b. The hormones of pregnancy c. The rotation of the uterus causing pressure on the ureterus d. The enlargement of the uterus.
B. hormones a. no c. way later in preg d. no, its still small during early
A primary function of the amniotic fluid during pregnancy is to: a. Produce hormones for fetal growth b. Provide protection for the fetus from pathogens c. Produce fetal urine d. Allow for chest movements of the fetus as it practices breathing.
B. keeps temp constant, any trauma to stomach--> baby will float away a. no b. yes c. not rlly d. imp, but meh
During the 2nd and 3rd trimesters of pregnancy, estrogen & progesterone are produced primarily by which organ? a. Fetus b. Placenta C. Uterus D. Corpus luteum
B. placenta Corpus luteum produces estrogen and progesterone up to 12 weeks, then after is placenta
What is the cause of physiologic anemia during pregnancy? a. The diameter of the red blood cells increase, occupying more space. b. Plasma volume increases more rapidly than red blood cell volume c. Iron intake is decreased during pregnancy because of associated nausea & vomiting d. Red blood cell production is less than red cell destruction.
B. plasma is faster, RBCs are diluted bc of large plasma volume
A pregnant woman shares w/ the nurse that she is fantasizing about the baby. The nurse knows that this is a sign of which of the following tasks of maternal adpatation? a. Preparing for birth b. Identifying w/ the maternal role c. Attachment to the fetus d. Accepting the pregnancy
C. Attachment to the fetus d. sure, but now she's past accepting, she's attached
A nursery nurse is assessing a newborn who is jaundiced. He knows that there are 2 different types of bilirubin. The unconjugated bilirubin is: a. Easily excreted b. Water soluble c. Bound to albumin d. Appears immediately after birth
C. Bound to albumin Has not become conjugated yet, not yet water soluble bc liver enzymes have not acted on it yet. Liver enzymes are immature
During the first prenatal visit, the client denies having had rubella or the rubella vaccine. Which of the following would be an appropriate action based on this information? a. Have the client call her mother to ask if the client had German measles as as a child. b. Tell the client that since rubella has little effect on the fetus, she should not worry about exposure to the disease. c. Take a blood sample to assess the rubella titer. d. Administer the rubella vaccine.
C. Check the rubella titer for ppl when they come in for the prenatal visits A. possibility Check titer at prenatal visits If their titer is not high enough, they are not immune, give them MMR vaccine before going home
The nurse notes that a new father gazes at his baby for prolonged periods of time & comments that his baby is beautiful & he is very happy having a baby. These behaviors are commonly referred to as: a. Parental bonding b. Couvade syndrome c. Engrossment d. Parental attachment
C. Engrossment "Totally engrossed/involved w/ the baby"
A normal finding for vaginal secretions during pregnancy is a(n): a. Decrease in the amount of thin clear mucus b. Increase in thick, white discharge like cottage cheese. c. Increase in thin white, creamy discharge. d. Small amount of bloody discharge.
C. Increase in thin white, creamy discharge a. no b. no d. no, bloody discharge only if they're about to go into labor, and cervix is ripening or they just had intercourse (may rupture some blood vessels)
Baby Juju was delivered 5 minutes ago. The nurse notes that his heart rate is 160, respirations 60 and irregular, crying, and passing meconium. The nurse's reaction is: a. Take the baby to the warmer for an assessment. b. Place oxygen per face mask c. Keep the baby skin to skin with his mother. d. Call the nursery nurse to assess the baby.
C. Keep skin-to-skin This is normal
The nurse is reviewing a pregnant woman's health history. Which of the following is the most likely indicator that the woman is at risk for developing gestational diabetes? a. She is 28 years old b. There is a family history of type 1 diabetes. c. Her last baby weight a 4.5 kg (10 lbs) at birth. d. her last baby was delivered by c-section.
C. Last baby was 10 lb at birth: how were her BG? a. not rlly b. possibly, doesn't have much to do gw/ GD d. no
Elsie asks the nurse what diastasis rectis means. The nurse should respond that it is: a. Separation of the perineal muscles b. Relaxation of the pelvic joints c. Separation of the abdominal muscles d. Similar to hemorrhoids
C. Separation of the abdominal muscles Never goes fully back after pregnancy, no tx Check during PP: lift head up, can palpate the separation
The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is: a. Closure of fetal shunts in the circulatory system b. Maintenance of a stable temperature c. Initiation & maintenance of respiration. d. Full function of the immune defense system at birth.
C. breathing!
A new mother tells the nurse that she is worried that her breastfed baby had only one wet diaper since delivery yesterday. The nurse's best action is: a. Assess the baby's intake b. Assess the mother's breasts c. Reassure the mother is normal. d. Change the diaper & check again in 1 hour
C. yes, explain & educate A. sure, reasonable B. sure, highly unlikely to have any milk, doesn't happen until 3-5 days post delivery First day is 1 wet diaper, 2nd day is 2 wet diapers, 3rd day is 3 wet diabers
The MAIN purpose of a 1 hour 50 gm glucose tolerance test done during pregnancy is to: a. Determine if the mother has a higher than normal blood glucose level which could negatively affect the fetus' health. b. Determine if the mother has a lower than normal blood glucose level which would positively impact the mother's health. c. Determine if the mother has a higher than normal blood glucose level which could positively affect the mother's health. d. Determine if the mother has a higher than normal blood glucose level which could negatively affect her health. e. Determine if the mother has a lower than normal blood glucose level which could positively affect the fetus' health.
a. Determine of the mother has a higher than normal blood glucose level which could negatively affect the fetus' health Worried that bc insulin doesn't work well during pregnancy--> high blood sugar crosses the placenta (insulin does not) b. well yes, but more worried about fetus c. not so worried about mother's health Looking at blood glucose level: affects fetus' health more imp. than mother's
Which of the following will reduce a pregnant woman's chance of exposure to one of the TORCH diseases? a. Cooking meat until it is well done. b. Undergoing repeated cervical cultures c. Getting a measles, mumps, rubella vacc d. Getting tested for HIV
a. Yes, found in soil,meat T-Toxoplasmosis (found in soil, uncooked meat) O-Other R-Rubella C-Cytomegaly H-Herpes
A nurse assesses a pt who is 15 yo, g1 para 0, and is 11 wks gestation. Which prenatal lab test would indicate a risk factor for this pt? a. Hemoglobin = 9 gm/dL b. Random serum glucose = 105 gm/dL c. Hematocrit = 33% d. White blood cell count = 12,000
a. not good, true anemia b. maybe just had bfast? c. normal limits d. normal
In teaching the woman w/ pre-gestational diabetes about desired glucose levels, the nurse explains that a normal fasting glucose level such as before bfast is in the range of: a. 150-180 mg/dL b. 65-95 mg/dL c. 95-120 mg/dL d. 100-120 mg/dL
b. 65-96 mg/dL - low
During labor, the nurse assess the fetal monitor strip and notes that the fetal heart rate baseline is 118, variability is moderate, and the fetal heart rate slows slightly at the beginning of a contraction and then returns to normal at the end of the contraction. Which factor is of concern to the nurse? a. The fetal heart rate baseline b. None as this is a normal fetal heart rate tracing c. The slowing of the fetal heart rate during a contraction d. The fetal heart rate variability
b. None as this is a normal fetal heart rate tracing Normal rage of FHR: 110-160 Baseline & variability is okay FHR slowing - early decels due to head compression which is not something we worry about. There are no interventions for head compression (just know that the head must be coming down, keep monitoring).
If a pregnant person does not know their LNMP, then the most accurate method of determining the fetal gestation is which of the following methods? a. Fundal height measurement b. Ultrasound c. Calculate using Nagele's rule d. Determine the date of conception.
b. Ultrasound a. not very accurate c. can only use Nagele's rule if you know LNMP d. not helpful
Fetal flexion helps the fetus move through the pelvis. When fetal flexion is absent, the nurse knows that labor: a. May be less intense b. May require internal fetal monitoring. c. May last longer d. May require medication to relax the uterus.
c. May last longer. Head is not well-flexed --> (baby is not in a nice round ball) --> labor will last longer
Which of the following is a positive sign of pregnancy? a. Fetal movements felt by the pregnant person b. Breast changes c. Palpation of the fetal movement by the caregiver. d. Amenorrhea
c. Palpation of the fetal mvmt by the caregiver A. presumptive B. "not rlly positive" C. presumptive Caregiver is experienced; fetal mvmt & amenorrhea (absence of menstrual periods) are presumptive
Which hormone decreases uterine contractility during pregnancy? a. Estrogen b. Human chorionic gonadotropin c. Progesterone d. Human placental lactogen
c. Progesterone
Most fetal malformations occur during which part of pregnancy?
c. organ-o-genesis = organ-forming, when we are most concerned During organogenesis (embro=yotic stage) up until week 8 Organ-forming a. no b. no
For an insulin dependent pre-gestational diabetic, the nurse knows to discuss the effects of pregnancy hormones in the first trimester on the fasting blood sugar. What change in insulin adminstation might the pregnant person most likely expect? a. An increased amount of insulin needed. b. The amount needed will depend on gestational weight. c. An unchanged amount of insulin might be needed. d. A decreased amount of insulin might be needed.
d. Had diabetes coming into pregnancy & alr in insulin. During 1st trimester, body producing more insulin & feeling nauseous & vomiting --> blood sugar may tank --> change insulin
In response to pregnancy, some father experience a process that is thought to be both physiologic & psychologic. What is the name of this process? a. gestational hypertension b. prenatal engrossment c. Physical & psychologic isolation d. Couvade syndrome
d. Couvade's syndrome
Normal stretching of the skin & hormonal changes in pregnancy produce "stretch marks." A patient asks the nurse for suggestions for preventing stretch marks. The nurse's best response is which of the following? a. "There are many products on the market you can try" b. "Soaking in a warm bath may soften the skin & help prevent stretch marks." c. "Massaging the abdomen daily w/ lotion may help." d. "Unfortunately, there is no tx for preventing stretch marks."
d. Nothing- no tx for stretch marks, genetic
In explaining to a client during her initial prenatal exam the importance of testing for IV< the nurse should emphasize that the goal of testing is to: a. Determine if the mother has AIDS & start treatment b. Prevent the transmission of co-infections like GC (gonorrhea) c. Treat the mother who can be more easily cured during pregnancy d. Treat HIV positive mothers to decrease the chance of HIV transmission to the fetus.
d. Treat HIV positive mothers to decrease the chance of HIV transmission to the fetus. V effective technique
The nurse assesses Yolanda, a G2 P2 on the 2nd day after a vaginal delivery of a 9lb 2 oz baby boy. Which of the following findings is of concern? a. Moderate lochia rubra b. Patient passed a plum sized clot? c. Moderate lochia rubra w/ 4 pea sized clots d. Small amount of bright red lochia
d. bright red = fresh bleeding Big baby A. pretty normal (G2P2 so maybe a lil more lochia) B. Plum is smaller than an egg Lochia rubra - dark red, first seen until about 4 days Lochia serosa - pin, for about 10 days Lochia alba - white to yellow in color, 10-14th day