ALL OB FINAL EXAM MATERIAL

Interventions for newborns

** 1st Priority: Airway maintenence- bulb syringe to get rid of secretions. Irregular RR is normal Maintaining an adequate O2 supply (adequate circulation, perfusion, effective cardiac function) Adequate thermoregulation- !!!Keep them warm!!!!

From 2 hours of birth until discharge

***Gestational age assessment: Appropriate for gest. age Large for gest. age: Above 90th percentile--> increased risk of being larger if genetic obesity or diabetes Small for gest. age: below 10th percentile ** Preterm: before 37w *late preterm: Between 34-36+6/7 weeks Term: between 38-42w Postterm: After 42w Postmature:After 42w with effects of placental insufficiency

Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen? (Select all that apply.)

- Cytomegalovirus (CMV) - Ionizing radiation - Carbamazepine - Lead Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medications (e.g., carbamazepine) and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, may also result in structural and functional abnormalities.

A woman is in for a routine prenatal checkup. The nurse is assessing her urine for glycosuria and proteinuria. Which findings are considered normal? (Select all that apply.)

- Dipstick assessment of trace to +1 - <300 mg/24 hours - Albumin < 30 mg/24 hours Small amounts of protein in the urine are acceptable during pregnancy. The presence of protein in greater amounts may indicate renal problems. A dipstick assessment of +2 and proteinuria >300 mg/24 hours, and albuminuria greater than 30 mg/24 hours are excessive and should be further evaluated.

Pregnancy is a hypercoagulable state in which women are at a fivefold to sixfold increased risk for thromboembolic disease. The tendency for blood to clot is greater, attributable to an increase in various clotting factors. Which of these come into play during pregnancy? (Select all that apply.)

- Factor VII - Factor VIII - Factor IX - Fibrinogen Factors VII, VIII, IX, X, and fibrinogen increase in pregnancy. Factors that inhibit coagulation decrease. Fibrinolytic activity (dissolving of a clot) is depressed during pregnancy and the early postpartum period to protect the women from postpartum hemorrhage.

Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply.)

- Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. - Hb concentration is 50% higher than that of the mother. - Fetal heart rate is 110 to 160 beats per minute. The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

The diagnosis of pregnancy is based on which positive signs of pregnancy? (Select all that apply.)

- Identification of fetal heartbeat - Visualization of the fetus - Verification of fetal movement Identification of a fetal heartbeat, the visualization of the fetus, and verification of fetal movement are all positive, objective signs of pregnancy. Palpation of fetal outline and positive hCG test are probable signs of pregnancy. A tumor also can be palpated. Medication and tumors may lead to false-positive results on pregnancy tests.

The number of routine laboratory tests during follow-up visits is limited; however, those that are performed are essential. Which statements regarding group B Streptococcus (GBS) testing are correct? (Select all that apply.)

- Performed between 35 and 37 weeks of gestation. - Only women planning a vaginal birth should be tested. - Women with a history of GBS should be retested. GBS testing is recommended between 35 and 37 weeks of gestation; cultures collected earlier will not accurately predict the presence of GBS at birth. All women should be tested, even those planning an elective cesarean birth. Membranes may rupture early, requiring prophylactic antibiotics. Clients with a history of GBS should be retested.

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criterion? (Select all that apply.)

- Quickening - Ballottement - Lightening Quickening is the first recognition of fetal movements or feeling life. Quickening is often described as a flutter and is felt earlier in the multiparous woman than in the primiparous woman. Passive movement of the unengaged fetus is referred to as ballottement. Lightening occurs when the fetus begins to descend into the pelvis and occurs 2 weeks before labor in the nulliparous woman and at the start of labor in the multiparous woman. Leukorrhea is a white or slightly gray vaginal discharge that develops in response to cervical stimulation by estrogen and progesterone. Mucus fills the cervical canal creating a plug otherwise known as the operculum. The operculum acts as a barrier against bacterial invasion during the pregnancy.

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, the nurse learns that the client has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? (Select all that apply.)

- Tetanus - Diphtheria - Hepatitis B Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Immunizations with live or attenuated viruses are contraindicated during pregnancy because of their potential teratogenicity. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

Which signs and symptoms should a woman immediately report to her health care provider? (Select all that apply.)

- Vaginal bleeding - Rupture of membranes - Heartburn accompanied by severe headache Vaginal bleeding, rupture of membranes, and severe headaches are signs of potential complications in pregnancy. Clients should be advised to report these signs to their health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

Severe S/S of preeclampsia

-BP >160/110 on two separate occasions 6 hr apart with pregnant woman on bed rest - Proteinuria greater than or equal to 3+ on dipstick -Persistent or severe headache, blurred photophobia vision -Epigastric pain -Right upper quadrant abdominal pain

S/s of Pulmonary embolism

-Dyspnea and tachypnea (>20 breaths/min) -tachycardia (>100 bpm) -chest pain -coughing -presence of crackles

At 1 minute following birth, the newborn exhibited the following: heart rate of 155; loud, vigorous crying with active movement of all extremities; sneezing when nose is stimulated with a catheter; hands and feet bluish and cool to the touch. The Apgar score of this newborn should be recorded as________.

9 The newborn receives 2 points each for a heart rate over 100 beats/min, a vigorous cry, active movement, and sneezing as a response to nasal stimulation. The newborn receives 1 point for color since he exhibits acrocyanosis

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: A. review the woman's current dietary intake. B. teach the woman about the food pyramid. C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. instruct the woman to limit the intake of fatty foods.

A Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required.

Cervical insufficiency tx:

A procedure that sews the cervix closed to reinforce the weak cervix. This procedure is called a cerclage and is usually performed between week 14-16 of pregnancy. These sutures will be removed between 36-38 weeks to prevent any problems when you go into labor.

Bishop Score

A rating system that is used to evaluate inducibility. An example, a score of 8 or more on the 13-point scale means the cervix is soft, anterior, 50% or more effaced, and dilated 2 cm or more and that the presenting part is engaged. When the score is an 8 or more, then induction will probably be successful. The score is documented before any attempts to induce.

D

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding BEST indicates that preterm labor is occurring? A. Pain in the lower back B. Irregular, mild uterine contractions are occurring every 15 minutes C. Fetal fibronectin is present in vaginal secretions D. The cervix is 90% effaced and dilated to 2 cm

d. Placental abruption. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. Eclamptic seizure. c. Placenta previa. b. Rupture of the uterus. d. Placental abruption.

A, C

A woman at 8 weeks gestation has an ectopic pregnancy. Which complication is possible? (Select all that apply) A. Rupture of the involved fallopian tube B. Development of a hydatidiform mole C. Hypovolemic shock D. Progression to placenta previa E. Extreme vomiting, electrolyte imbalance and weight loss

a. 1 centimeter above the umbilicus

A woman gave birth 10 hours ago. Where does the nurse expect to locate this woman's fundus? a. 1 centimeter above the umbilicus b. 2 centimeters below the umbilicus c. Midway between the umbilicus and the symphysis pubis d. Nonpalpable abdominally

Forced Cesarean Birth:

A woman's refusal to undergo cesarean birth when indicated for fetal reasons is often described as a maternal-fetal conflict. Health care providers are ethically obliged to protect the well-being of both the mother and fetus; a decision for one affects the other. If a woman refuses a cesarean birth that is recommended because of fetal jeopardy, providers must make every effort to find out why she is refusing and provide information that may persuade her to change her mind. If the woman continues to refuse surgery, the providers must decide if it is ethical to get a court oder for the surgery. Every effort, should be made to avoid this legal step

he nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs

A, B, C, E All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.

As part of their teaching function at discharge, nurses should tell parents that the baby's respiratory status should be protected by the following procedures: (Select all that apply.) A. Prevent exposure to people with upper respiratory tract infections B. Keep the infant away from secondhand smoke C. Avoid loose bedding, waterbeds, and beanbag chairs D. Do not let the infant sleep on his or her back E. Keep a bulb suction available at home.

A, B, C, E The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants can suffocate in loose bedding and furniture that can trap them.

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A, B, C, E Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

Which of these statements indicate the effect of breastfeeding on the family or society at large. (Select all that apply.) A. Breastfeeding requires fewer supplies and less cumbersome equipment. B. Breastfeeding saves families money. C. Breastfeeding costs employers in terms of time lost from work. D. Breastfeeding benefits the environment. E. Breastfeeding results in reduced annual health care costs.

A, B, D, E Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment, saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother, uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal

A woman is considering using nonpharmacological methods for pain management during her labor. Which of the following are benefits or advantages of their use? (Select all that apply) A. Relief of stress and enhanced relaxation B. Few, if any, maternal or fetal side effects C. Healthcare provider retains control over the birth process D. Do not require the woman to participate E. Usable throughout labor

A, B, E

A woman at 8 weeks gestation has an ectopic pregnancy. Which complication is possible? (Select all that apply) A. Rupture of the involved fallopian tube B. Development of a hydatidiform mole C. Hypovolemic shock D. Progression to placenta previa E. Extreme vomiting, electrolyte imbalance and weight loss

A, C

The nurse is teaching a woman the benefits of breastfeeding to her infant. Which should be included? (Select all that apply). A. Breastfed infants have a reduced risk of developing allergies and asthma B. Breastmilk is absorbed slowly, so feedings are needed less frequently than formula feedings C. Breastfed infants have a reduced risk of respiratory, ear and gastrointestinal infections D. Breastmilk is high in Vitamin D and Iron E. Breastmilk is high in fatty accids that promote brain growth and development

A, C, E

The nurse should include which instructions when teaching a mother about the storage of breast milk? (Select all that apply.) A. Wash hands before expressing breast milk. B. Store milk in 8 to 12 oz containers. C. Store refrigerated milk in the door of the refrigerator. D. Place frozen milk in the microwave for only a few seconds to thaw. E. Milk thawed in the refrigerator can be stored for 24 hours.

A, E

Which factors lead to initiation of breathing immediately after birth? Select all that apply. A. Increased pC02 B. Increased intrathoracic pressue from chest compression C. Warm extrauterine environment D. Delayed suctioning of the mouth and nose E. Drying the newborn

A,B, E

A 27 year old pregnant woman has a preconceptual BMI of 18.0. What would be an adequate weight gain for this women during her pregnancy? A. 38 lbs. B. 25 lbs. C. 15 lbs.

A.

A laboring woman who has a history of opioid abuse is experiencing pain. Which pain management strategy would be LEAST appropriate for her? A. Administer the prescribed dose of Stadol B. Assist the woman with relaxation through breathing technique C. Page anesthesia for epidural placement D. Show the woman how to use effleurage

A.

Maternal signs and symptoms of preeclampsia are directly related to: A. Poor perfusion of maternal organs B. Maternal hypervolemia C. Low levels of maternal serum magnesium D. Fetal hypertension

A.

The nurse is getting a woman up to the bathroom for the first time following birth with epidural anesthesia. Which nursing intervention is MOST important? A. Assess for return of sensation to the lower extremities B. Acquire a wheelchair to assist with getting the woman to the bathroom C. Assess the woman's heart rate D. Assess strength in the upper extremities

A.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important? A. Several glasses of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor

The maternity nurse must be cognizant that cultural practices have significant influence on infant feeding methods. Many regional and ethnic cultures can be found within the United States. One cannot assume generalized observations about any cultural group will hold for all members of the group. Which statement related to cultural practices influencing infant feeding practice is correct? A. A common practice among Mexican women is known as los dos. B. Muslim cultures do not encourage breastfeeding due to modesty concerns. C. Latino women born in the United States are more likely to breastfeed. D. East Indian and Arab women believe that cold foods are best for a new mother.

A. This refers to combining breastfeeding and commercial infant formula. It is based on the belief that by combining the two feeding methods, the mother and infant receive the benefits of breastfeeding along with the additional vitamins from formula

The nurse taught new parents the guidelines to follow regarding the bottle-feeding of their newborn. They will be using formula from a can of concentrate. The parents would demonstrate an understanding of the nurse's instructions if they: A. wash the top of the can and can opener with soap and water before opening the can. B. adjust the amount of water added according to the weight gain pattern of the newborn. C. add some honey to sweeten the formula and make it more appealing to a fussy newborn. D. warm formula in a microwave oven for a couple of minutes before feeding.

A. Washing the top of the can and can opener with soap and water before opening the can of formula is a good habit for a parent to get into to prevent contamination

The birth weight of a breastfed newborn was 8 lbs, 4 oz. On the third day the newborn's weight was 7 lbs, 12 oz. On the basis of this finding, the nurse should: A. encourage the mother to continue breastfeeding since it is effective in meeting the newborn's nutrient and fluid needs. B. suggest that the mother switch to bottle-feeding since the breastfeeding is ineffective in meeting newborn needs for fluid and nutrients. C. notify the physician since the newborn is being poorly nourished. D. refer the mother to a lactation consultant to improve her breastfeeding technique.

A. Weight loss of 8 oz falls within the 5% to 10% expected weight loss from birth weight during the first few days of life, which for this newborn would be 6.6 to 13.2 oz.

A woman is experiencing back labor and complains of constant, intense pain in her lower back. An effective relief measure is to use: A. counterpressure against the sacrum. B. pant-blow (breaths and puffs) breathing techniques. C. effleurage. D. biofeedback.

A. Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back.

A woman in latent labor who is positive for opiates on the urine drug screen is complaining of severe pain. Maternal vital signs are stable, and the fetal heart monitor displays a reassuring pattern. The nurse's MOST appropriate analgesic for pain control is: A. fentanyl (Sublimaze). B. promethazine (Phenergan). C. butorphanol tartrate (Stadol). D. nalbuphine (Nubain).

A. Fentanyl is a commonly used opioid agonist analgesic for women in labor. It is fast and short acting. This patient may require higher than normal doses to achieve pain relief due to her opiate use.

Nurses should be aware of the difference experience can make in labor pain, such as: A. sensory pain for nulliparous women often is greater than for multiparous women during early labor. B. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor. C. women with a history of substance abuse experience more pain during labor. D. multiparous women have more fatigue from labor and therefore experience more pain.

A. Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple. Affective pain is greater for nulliparous women during the first stage but decreases for both nulliparous and multiparous during the second stage. Women with a history of substance abuse experience the same amount of pain as those without such a history. Nulliparous women have longer labors and therefore experience more fatigue.

With regard to protein in the diet of pregnant women, nurses should be aware that: A. many protein-rich foods are also good sources of calcium, iron, and b vitamins. B. many women need to increase their protein intake during pregnancy. C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. high-protein supplements can be used without risk by women on macrobiotic diets.

A. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron

A priority question to ask a woman experiencing postpartum depression is: A. "Have you thought about hurting yourself?" B. "How often do you cry?" C. Have you been feeling insecure, fragile, or vulnerable?" D. "Does the responsibility of motherhood seem overwhelming?"

A. "Have you thought about hurting yourself?"

A mother is changing the diaper of her newborn son. She notices that his scrotum appears large and swollen. She asks the nurse, "What is that?" The best response from the nurse is: A. "That is a hydrocele, which is a common finding in newborn males. The swelling usually decreases without intervention." B. "I don't know, but I'm sure it is nothing." C. "Your baby might have testicular cancer." D. "Your baby's urine is backing up into his scrotum."

A. "That is a hydrocele, which is a common finding in newborn males. The swelling usually decreases without intervention."

A primigravida at 10 weeks gestation reports mild uterine cramping and slight vaginal spotting without passage of tissue. When she is examined, no cervical dilation is noted. The nurse caring for this woman should: A. Anticipate that the woman will be sent home with instructions to limit her activity and to avoid stress or orgasm B. Prepare the woman for a dilation and curettage C. Notify a grief counselor to assist the woman with the imminent loss of her fetus D. Tell the woman that the doctor will most likely perform a cerclage to help her maintain her pregnancy

A. Anticipate that the woman will be sent home with instructions to limit her activity and to avoid stress or orgasm (the woman is experiencing a threatened miscarriage; therefore expectant management is attempted first)

Susan, a 34 year old pregnant client, has has a consistently high BP ranging from 148/ 92 to 160/98 since she was 28 years old. Her weight gain has followed normal patterns and urinalysis remains normal as well. This indicates: A. Chronic Hypertension B. Gestational hypertension C. Pre Hypertension D. Stage IV Hypertension

A. Chronic Hypertension

A 32 weeks of gestation, Maria with hypertension since 28 weeks, hyperactive deep tendon reflexes with clonus, and proteinuria of 4+ has a convulsion. This indicates: A. Eclampsia B. HELLP Syndrome C. Preeclampsia mild without sever features D. Preeclampsia sever with severe features

A. Eclampsia

A full term neonate's response to infection is characterized by: A. Limited ability to prevent infection from spreading systemically B. Low levels of IgG due to limited placental transfer C. Enhanced ability of WBCs to move to the site of bacterial infection D. Specific signs of infection that are easy to detect

A. Limited ability to prevent infection from spreading systemically

When preparing to administer a hepatitis B vaccine to a newborn, the nurse should: A. Obtain a syringe with a 25-gauge, 5/8th inch needle B. Confirm that the newborn's mother has been infected with the hepatitis B virus C. Assess the dorsogluteal muscle as the preferred site for injection D. Confirm that the newborn is at least 24 hours old

A. Obtain a syringe with a 25-gauge, 5/8th inch needle

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infant's parents should be based on the knowledge that petechiae: A. are benign if they disappear within 48 hours of birth B. result from increased blood volume C. should always be further investigated D. usually occur with forceps delivery

A. Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face.

The ductus arteriosus may remain patent in a newborn who is: A. Premature or hypoxic B. Crying C. Hyperthermic D. In the first period of reactivity

A. Premature or hypoxic

In a pregnant woman with gestational diabetes, maternal and neonatal complications can be greatly diminished by maintaining normal blood glucose levels during the pregnancy. A. True B. False

A. TRUE

With regard to umbilical cord care, nurses should be aware that: A. The stump can easily become infected. B. A nurse noting bleeding from the vessels of the cord should immediately call for assistance. C. The cord clamp is removed at cord separation. D. The average cord separation time is 5 to 7 days.

A. The cord stump is an excellent medium for bacterial growth

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? A. apical heart rate of 90 beats/min, slightly irregular, when awake and active B. Acrocyanosis C. Harlequin color sign D. Weight loss representing 5% of the newborn's birth weight

A. apical heart rate of 90 beats/min, slightly irregular, when awake and active The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. A harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn.

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is: A. vision B. hearing C. smell D. taste

A. vision The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant's hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes.

When performing vaginal examinations on laboring women, the nurse should be guided by what principle? A. Cleanse the vulva and perineum before and after the examination as needed. B. Wear a clean glove lubricated with tap water to reduce discomfort. C. Perform the examination every hour during the active phase of the first stage of labor. D. Perform an examination immediately if active bleeding is present.

A: Cleansing will reduce the possibility of secretions and microorganisms ascending into the vagina to the cervix. Maternal comfort will also be enhanced.

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure is to use: A. Counterpressure against the sacrum B. Pant-blow (breaths and puffs) breathing techniques C. Effleurage D. Biofeedback

A: Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back.

The nurse providing care for the laboring woman understands that accelerations with fetal movement: A. Are reassuring B. Are caused by umbilical cord compression C. Warrant close observation D. Are caused by uteroplacental insufficiency

A: Episodic accelerations in the fetal heart rate (FHR) occur during fetal movement and are indications of fetal well-being.

Fetal well-being during labor is assessed by: A. The response of the fetal heart rate (FHR) to uterine contractions (UCs) B. Maternal pain control C. Accelerations in the FHR D. An FHR greater than 110 beats/min

A: Fetal well-being during labor can be measured by the response of the FHR to UCs. In general, reassuring FHR patterns are characterized by an FHR baseline in the range of 110 to 160 beats/min with no periodic changes, a moderate baseline variability, and accelerations with fetal movement.

With regard to breathing techniques during labor, maternity nurses should be aware that: A. Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction B. By the time labor has begun, it is too late for instruction in breathing and relaxation C. Controlled breathing techniques are most difficult near the end of the second stage of labor D. The patterned-paced breathing technique can help prevent hyperventilation

A: First-stage techniques promote relaxation of abdominal muscles, thereby increasing the size of the abdominal cavity.

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? A. Fetal position B. Uterine contractions C. Blood pressure D. Umbilical cord blood flow

A: Maternal position may affect fetal circulation; however, fetal position is unlikely to disturb umbilical blood flow.

The nurse caring for a laboring woman is aware that maternal cardiac output can be increased by: A. Change in position B. Oxytocin administration C. Regional anesthesia D. Intravenous analgesic

A: Maternal supine hypotension syndrome is caused by the weight and pressure of the gravid uterus on the ascending vena cava when the woman is in a supine position. This reduces venous return to the woman's heart, as well as cardiac output, and subsequently reduces her blood pressure. The nurse can encourage the woman to change positions and avoid the supine position. Everything else may reduce maternal cardiac output

A woman in active labor receives an opioid agonist analgesic. Which medication relieves severe, persistent, or recurrent pain, creates a sense of well-being, overcomes inhibitory factors, and may even relax the cervix but should be used cautiously in women with cardiac disease? A. Meperidine (Demerol) B. Promethazine (Phenergan) C. Butorphanol tartrate (Stadol) D. Nalbuphine (Nubain)

A: Meperidine is the most commonly used opioid agonist analgesic for women in labor throughout the world. It overcomes inhibitory factors in labor and may even relax the cervix. Because tachycardia is a possible adverse reaction, meperidine is used cautiously in women with cardiac disease.

When assessing a multiparous woman who has just given birth to an 8-pound boy, the nurse notes that the woman's fundus is firm and has become globular. A gush of dark red blood comes from her vagina. The nurse concludes that: A. The placenta has separated B. A cervical tear occurred during the birth C. The woman is beginning to hemorrhage D. Clots have formed in the upper uterine segment

A: Placental separation is indicated by a firmly contracting uterus, a change in the uterus from a discoid to a globular ovoid shape, a sudden gush of dark red blood from the introitus, an apparent lengthening of the umbilical cord, and a finding of vaginal fullness. If clots have formed in the upper uterine segment, the nurse would expect to find the uterus boggy and displaced to the side.

Nurses should be aware of the difference experience can make in labor pain, such as: A. Sensory pain for nulliparous women often is greater than for multiparous women during early labor B. Affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of labor C. Women with a history of substance abuse experience more pain during labor D. Multiparous women have more fatigue from labor and therefore experience more pain

A: Sensory pain is greater for nulliparous women because their reproductive tract structures are less supple.

When using intermittent auscultation (IA) to assess uterine activity, nurses should be aware that: A. The examiner's hand should be placed over the fundus before, during, and after contractions B. The frequency and duration of contractions are measured in seconds for consistency C. Contraction intensity is given a judgment number of 1 to 7 by the nurse and client together D. The resting tone between contractions is described as either placid or turbulent

A: The assessment is done by palpation; duration, frequency, intensity, and resting tone must be assessed.

42. Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Which is the most common cause of spontaneous abortion? a. Chromosomal abnormalities c. Endocrine imbalance b. Infections d. Immunologic factors

ANS: A At least 50% of pregnancy losses result from chromosomal abnormalities that are incompatible with life. Maternal infection may be a cause of early miscarriage. Endocrine imbalances such as hypothyroidism or diabetes are possible causes for early pregnancy loss. Women who have repeated early pregnancy losses appear to have immunologic factors that play a role in spontaneous abortion incidents.

Which description most accurately describes the augmentation of labor? a. Is part of the active management of labor that is instituted when the labor process is unsatisfactory b. Relies on more invasive methods when oxytocin and amniotomy have failed c. Is a modern management term to cover up the negative connotations of forceps-assisted birth

ANS: A Augmentation is part of the active management of labor that stimulates uterine contractions after labor has started but is not progressing satisfactorily. Augmentation uses amniotomy and oxytocin infusion, as well as some more gentle, noninvasive methods. Forceps-assisted births are less common than in the past and not considered a method of augmentation. A vacuum-assisted delivery occurs during childbirth if the mother is too exhausted to push. Vacuum extraction is not considered an augmentation methodology.

14. Your patient is being induced because of her worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active despite several hours of oxytocin administration. She asks the nurse, "Why is it taking so long?" The most appropriate response by the nurse would be: a. "The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor." b. "I don't know why it is taking so long." c. "The length of labor varies for different women." d. "Your baby is just being stubborn."

ANS: A Because magnesium sulfate is a tocolytic agent, its use may increase the duration of labor. The amount of oxytocin needed to stimulate labor may be more than that needed for the woman who is not receiving magnesium sulfate. "I don't know why it is taking so long" is not an appropriate statement for the nurse to make. Although the length of labor does vary in different women, the most likely reason this woman's labor is protracted is the tocolytic effect of magnesium sulfate. The behavior of the fetus has no bearing on the length of labor.

2. Because pregnant women may need surgery during pregnancy, nurses should be aware that: a. The diagnosis of appendicitis may be difficult because the normal signs and symptoms mimic some normal changes in pregnancy. b. Rupture of the appendix is less likely in pregnant women because of the close monitoring. c. Surgery for intestinal obstructions should be delayed as long as possible because it usually affects the pregnancy. d. When pregnancy takes over, a woman is less likely to have ovarian problems that require invasive responses.

ANS: A Both appendicitis and pregnancy are linked with nausea, vomiting, and increased white blood cell count. Rupture of the appendix is two to three times more likely in pregnant women. Surgery to remove obstructions should be done right away. It usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian problems.

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

ANS: A Breastfeeding is contraindicated when mothers have certain viruses, are undergoing chemotherapy, or are using/abusing illicit drugs. A lack of confidence, the need for others to feed the baby, and the convenience of bottle-feeding are all honest reasons for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) could change some minds. In any case the nurse must provide information in a nonjudgmental manner and respect the mother's decision. Nonetheless, breastfeeding is definitely contraindicated when the mother has medical or drug issues of her own.

10. According to the recommendations of the American Academy of Pediatrics on infant nutrition: a. Infants should be given only human milk for the first 6 months of life. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. If infants are weaned from breast milk before 12 months, they should receive cow's milk, not formula. d. After 6 months mothers should shift from breast milk to cow's milk.

ANS: A Breastfeeding/human milk should also be the sole source of milk for the second 6 months. Infants start on solids when they are ready, usually at 6 months, whether they start on formula or breast milk. If infants are weaned from breast milk before 12 months, they should receive iron-fortified formula, not cow's milk.

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

ANS: A Colostrum is important because it has high levels of the nutrients needed by the neonate and helps protect against infection. Supplementation is not necessary; it will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.

39. Which order should the nurse expect for a patient admitted with a threatened abortion? a. Bed rest b. Ritodrine IV c. NPO d. Narcotic analgesia every 3 hours, prn

ANS: A Decreasing the woman's activity level may alleviate the bleeding and allow the pregnancy to continue. Ritodrine is not the first drug of choice for tocolytic medications. There is no reason for having the woman placed NPO. At times dehydration may produce contractions, so hydration is important. Narcotic analgesia will not decrease the contractions. It may mask the severity of the contractions.

3. A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas: a. Increases the risk that the infant will develop allergies. b. Helps the infant sleep through the night. c. Ensures that the infant is getting iron in a form that is easily absorbed. d. Requires that multivitamin supplements be given to the infant.

ANS: A Exposure to cow's milk poses a risk of developing allergies, eczema, and asthma. "Bottle-feeding using commercially prepared infant formulas helps the infant sleep through the night" is a false statement. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.

32. Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is valid? a. A premature infant more easily digests breast milk than formula. b. A glass of wine just before pumping will help reduce stress and anxiety. c. The mother should pump only as much as the infant can drink. d. The mother should pump every 2 to 3 hours, including during the night.

ANS: A Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy infants. Greater physiologic stability occurs with breastfeeding compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother's milk ejection reflex. To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

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

ANS: A Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.

9. The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching? a. "I can store my breast milk in the refrigerator for 3 months." b. "I can store my breast milk in the freezer for 3 months." c. "I can store my breast milk at room temperature for 8 hours." d. "I can store my breast milk in the refrigerator for 3 to 5 days."

ANS: A If the mother states that she can store her breast milk in the refrigerator for 3 months, she needs additional teaching about safe storage. Breast milk can be stored at room temperature for 8 hours, in the refrigerator for 3 to 5 days, in the freezer for 3 months, or in a deep freezer for 6 to 12 months. It is accurate and does not require additional teaching if the mother states that she can store her breast milk in the freezer for 3 months, at room temperature for 8 hours, and in the refrigerator for 3 to 5 days.

19. In planning care for women with preeclampsia, nurses should be aware that: a. Induction of labor is likely, as near term as possible. b. If at home, the woman should be confined to her bed, even with mild preeclampsia. c. A special diet low in protein and salt should be initiated. d. Vaginal birth is still an option, even in severe cases.

ANS: A Induction of labor is likely, as near term as possible; however, at less than 37 weeks of gestation, immediate delivery may not be in the best interest of the fetus. Strict bed rest is becoming controversial for mild cases; some women in the hospital are even allowed to move around. Diet and fluid recommendations are much the same as for healthy pregnant women, although some authorities have suggested a diet high in protein. Women with severe preeclampsia should expect a cesarean delivery.

The exact cause of preterm labor is unknown but believed to be multifactorial. Infection is thought to be a major factor in many preterm labors. Which type of infection has not been linked to preterm birth? a. Viral b. Periodontal c. Cervical d. Urinary tract

ANS: A Infections that increase the risk of preterm labor and birth are bacterial and include cervical, urinary tract, periodontal, and other bacterial infections. Therefore, early, continual, and comprehensive participation by the client in her prenatal care is important. Recent evidence has shown a link between periodontal infections and preterm labor. Researchers recommend regular dental care before and during pregnancy, oral assessment as a routine part of prenatal care, and scrupulous oral hygiene to prevent periodontal infections.

With one exception, the safest pregnancy is one during which the woman is drug and alcohol free. What is the optimal treatment for women addicted to opioids? a. Methadone maintenance treatment (MMT) b. Detoxification c. Smoking cessation d. 4 Ps Plus

ANS: A MMT is currently considered the standard of care for pregnant women who are dependent on heroin or other narcotics. Buprenorphine is another medication approved for the treatment of opioid addiction that is increasingly being used during pregnancy. Opioid replacement therapy has been shown to decrease opioid and other drug use, reduce criminal activity, improve individual functioning, and decrease the rates of infections such as hepatitis B and C, human immunodeficiency virus (HIV), and other STIs. Detoxification is the treatment used for alcohol addiction. Pregnant women requiring withdrawal from alcohol should be admitted for inpatient management. Women are more likely to stop smoking during pregnancy than at any other time in their lives. A smoking cessation program can assist in achieving this goal. The 4 Ps Plus is a screening tool specifically designed to identify pregnant women who need in-depth assessment related to substance abuse.

21. The nurse providing couplet care should understand that nipple confusion results when: a. Breastfeeding babies receive supplementary bottle feedings. b. The baby is weaned too abruptly. c. Pacifiers are used before breastfeeding is established. d. Twins are breastfed together.

ANS: A Nipple confusion can result when babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks, because the two require different skills. Abrupt weaning can be distressing to mother and/or baby but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. Breastfeeding twins requires some logistical adaptations, but this should not lead to nipple confusion.

According to research, which risk factor for PPD is likely to have the greatest effect on the client postpartum? a. Prenatal depression b. Single-mother status c. Low socioeconomic status d. Unplanned or unwanted pregnancy

ANS: A Prenatal depression has been found to be a major risk factor for PPD. Single-mother status and low socioeconomic status are both small-relationship predictors for PPD. Although an unwanted pregnancy may contribute to the risk for PPD, it does not pose as great an effect as prenatal depression.

17. Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct? a. Frequent feedings during predictable growth spurts stimulate increased milk production. b. The milk of preterm mothers is the same as the milk of mothers who gave birth at term. c. The milk at the beginning of the feeding is the same as the milk at the end of the feeding. d. Colostrum is an early, less concentrated, less rich version of mature milk.

ANS: A These growth spurts (10 days, 3 weeks, 6 weeks, 3 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

The induction of labor is considered an acceptable obstetric procedure if it is in the best interest to deliver the fetus. The charge nurse on the labor and delivery unit is often asked to schedule clients for this procedure and therefore must be cognizant of the specific conditions appropriate for labor induction. What are appropriate indications for induction? (Select all that apply?) a. Rupture of membranes at or near term b. Convenience of the woman or her physician c. Chorioamnionitis (inflammation of the amniotic sac) d. Postterm pregnancy e. Fetal death

ANS: A, C, D, E The conditions listed are all acceptable indications for induction. Other conditions include intrauterine growth restriction (IUGR), maternal-fetal blood incompatibility, hypertension, and placental abruption. Elective inductions for the convenience of the woman or her provider are not recommended; however, they have become commonplace. Factors such as rapid labors and living a long distance from a health care facility may be valid reasons in such a circumstance. Elective delivery should not occur before 39 weeks of completed gestation.

44. A client who has undergone a dilation and curettage for early pregnancy loss is likely to be discharged the same day. The nurse must ensure that vital signs are stable, bleeding has been controlled, and the woman has adequately recovered from the administration of anesthesia. To promote an optimal recovery, discharge teaching should include (Select all that apply): a. Iron supplementation. b. Resumption of intercourse at 6 weeks following the procedure. c. Referral to a support group if necessary. d. Expectation of heavy bleeding for at least 2 weeks. e. Emphasizing the need for rest.

ANS: A, C, E The woman should be advised to consume a diet high in iron and protein. For many women iron supplementation also is necessary. Acknowledge that the client has experienced a loss, albeit early. She can be taught to expect mood swings and possibly depression. Referral to a support group, clergy, or professional counseling may be necessary. Discharge teaching should emphasize the need for rest. Nothing should be placed in the vagina for 2 weeks after the procedure. This includes tampons and vaginal intercourse. The purpose of this recommendation is to prevent infection. Should infection occur, antibiotics may be prescribed. The client should expect a scant, dark discharge for 1 to 2 weeks. Should heavy, profuse, or bright bleeding occur, she should be instructed to contact her provider.

A number of methods can be used for inducing labor. Which cervical ripening method falls under the category of mechanical or physical? a. Prostaglandins are used to soften and thin the cervix. b. Labor can sometimes be induced with balloon catheters or laminaria tents. c. Oxytocin is less expensive and more effective than prostaglandins but creates greater health risks. d. Amniotomy can be used to make the cervix more favorable for labor.

ANS: B Balloon catheters or laminaria tents are mechanical means of ripening the cervix. Ripening the cervix, making it softer and thinner, increases the success rate of induced labor. Prostaglandin E1 is less expensive and more effective than oxytocin but carries a greater risk. Amniotomy is the artificial rupture of membranes, which is used to induce labor only when the cervix is already ripe.

The nurse who elects to work in the specialty of obstetric care must have the ability to distinguish between preterm birth, preterm labor, and low birth weight. Which statement regarding this terminology is correct? a. Terms preterm birth and low birth weight can be used interchangeably. b. Preterm labor is defined as cervical changes and uterine contractions occurring between 20 and 37 weeks of gestation. c. Low birth weight is a newborn who weighs below 3.7 pounds. d. Preterm birth rate in the United States continues to increase.

ANS: B Before 20 weeks of gestation, the fetus is not viable (miscarriage); after 37 weeks, the fetus can be considered term. Although these terms are used interchangeably, they have different meanings: preterm birth describes the length of gestation (before 37 weeks), regardless of the newborn's weight; low birth weight describes only the infant's weight at the time of birth (2500 g or less), whenever it occurs. Low birth weight is anything below 2500 g or approximately pounds. In 2011, the preterm birth rate in the United States was 11.7 %; it has dropped every year since 2008.

38. A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of: a. Anxiety due to hospitalization. b. Worsening disease and impending convulsion. c. Effects of magnesium sulfate. d. Gastrointestinal upset.

ANS: B Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. These are danger signs showing increased cerebral edema and impending convulsion and should be treated immediately. The patient has not been started on magnesium sulfate treatment yet. Also, these are not anticipated effects of the medication.

31. To prevent nipple trauma, the nurse should instruct the new mother to: a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.

ANS: B If the infant's mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. This will also limit access to the higher-fat "hindmilk." Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.

During an inpatient psychiatric hospitalization, what is the most important nursing intervention? a. Contacting the client's significant other b. Supervising and guiding visits with her infant c. Allowing no contact with anyone who annoys her d. Having the infant with the mother at all times

ANS: B In the hospital setting, the reintroduction of the infant to the mother can and should occur at the mother's own pace. A schedule is set that increases the number of hours the mother cares for her infant over several days, culminating in the infant staying overnight in the mother's room. These supervised and guided visits allow the mother to experience meeting the infant's needs and giving up sleep for the infant. Reintroducing the mother to her infant while in a supervised setting is essential. Another important task for a mother under psychiatric care is to reestablish positive interactions with others.

32. Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae c. Ectopic pregnancy b. Total placenta previa d. Eclampsia

ANS: B In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted in cases of partial abruptio placentae. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

43. The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment to involve: a. Corticosteroids to reduce inflammation. b. IV therapy to correct fluid and electrolyte imbalances. c. An antiemetic, such as pyridoxine, to control nausea and vomiting. d. Enteral nutrition to correct nutritional deficits.

ANS: B Initially, the woman who is unable to keep down clear liquids by mouth requires IV therapy for correction of fluid and electrolyte imbalances. Corticosteroids have been used successfully to treat refractory hyperemesis gravidarum; however, they are not the expected initial treatment for this disorder. Pyridoxine is vitamin B6, not an antiemetic. Promethazine, a common antiemetic, may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding tube may be necessary to correct maternal nutritional deprivation. This is not an initial treatment for this patient.

27. The hormone necessary for milk production is: a. Estrogen. c. Progesterone. b. Prolactin. d. Lactogen.

ANS: B Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

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

ANS: B The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. This can be confirmed through ultrasonography. Amniocentesis would not be performed on a woman who is experiencing bleeding. In the event of an imminent delivery, the fetus would be presumed to have immature lungs at this gestational age, and the mother would be given corticosteroids to aid in fetal lung maturity. A CST would not be performed at a preterm gestational age. Furthermore, bleeding would be a contraindication to this test. Internal fetal monitoring would be contraindicated in the presence of bleeding.

A pregnant woman at 29 weeks of gestation has been diagnosed with preterm labor. Her labor is being controlled with tocolytic medications. She asks when she might be able to go home. Which response by the nurse is mostaccurate? a. "After the baby is born." b. "When we can stabilize your preterm labor and arrange home health visits." c. "Whenever your physician says that it is okay." d. "It depends on what kind of insurance coverage you have.

ANS: B This client's preterm labor is being controlled with tocolytics. Once she is stable, home care may be a viable option for this type of client. Care of a client with preterm labor is multidisciplinary and multifactorial; the goal is to prevent delivery. In many cases, this goal may be achieved at home. Managed care may dictate an earlier hospital discharge or a shift from hospital to home care. Insurance coverage may be one factor in client care, but ultimately, client safety remains the most important factor.

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

ANS: B This is an accurate statement. b-Human chorionic gonadotropin (hCG) levels will be drawn for 1 year to ensure that the mole is completely gone. There is an increased chance of developing choriocarcinoma after the development of a hydatidiform mole. The goal is to achieve a "zero" hCG level. If the woman were to become pregnant, it could obscure the presence of the potentially carcinogenic cells. Women should be instructed to use birth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive method except an intrauterine device is acceptable.

27. A laboring woman with no known risk factors suddenly experiences spontaneous rupture of membranes (ROM). The fluid consists of bright red blood. Her contractions are consistent with her current stage of labor. There is no change in uterine resting tone. The fetal heart rate begins to decline rapidly after the ROM. The nurse should suspect the possibility of: a. Placenta previa. b. Vasa previa. c. Severe abruptio placentae. d. Disseminated intravascular coagulation (DIC).

ANS: B Vasa previa is the result of a velamentous insertion of the umbilical cord. The umbilical vessels are not surrounded by Wharton jelly and have no supportive tissue. They are at risk for laceration at any time, but laceration occurs most frequently during ROM. The sudden appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should immediately alert the nurse to the possibility of vasa previa. The presence of placenta previa most likely would be ascertained before labor and would be considered a risk factor for this pregnancy. In addition, if the woman had a placenta previa, it is unlikely that she would be allowed to pursue labor and a vaginal birth. With the presence of severe abruptio placentae, the uterine tonicity would typically be tetanus (i.e., a boardlike uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting factors and causes widespread external bleeding, internal bleeding, or both. DIC is always a secondary diagnosis, often associated with obstetric risk factors such as HELLP syndrome. This woman did not have any prior risk factors.

13. The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient? a. Women who breastfeed have a decreased risk of breast cancer. b. Breastfeeding is an effective method of birth control. c. Breastfeeding increases bone density. d. Breastfeeding may enhance postpartum weight loss.

ANS: B Women who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker postpartum weight loss. Breastfeeding delays the return of fertility; however, it is not an effective birth control method.

1. Women with hyperemesis gravidarum: a. Are a majority, because 80% of all pregnant women suffer from it at some time. b. Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance. c. Need intravenous (IV) fluid and nutrition for most of their pregnancy. d. Often inspire similar, milder symptoms in their male partners and mothers.

ANS: B Women with hyperemesis gravidarum have severe vomiting; however, treatment for several days sets things right in most cases. Although 80% of pregnant women experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV administration may be used at first to restore fluid levels, but it is seldom needed for very long. Women suffering from this condition want sympathy because some authorities believe that difficult relationships with mothers and/or partners may be the cause.

37. Late in pregnancy, the woman's breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include(Select all that apply): a. Everted nipples b. Flat nipples c. Inverted nipples d. Nipples that contract when compressed e. Cracked nipples

ANS: B, C, D Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infant's mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be used to draw the nipples out before feedings after delivery. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latch. The infant should be repositioned during feeding. Application of colostrum and breast milk after feedings will aid in healing.

Indications for a primary cesarean birth are often nonrecurring. Therefore, a woman who has had a cesarean birth with a low transverse scar may be a candidate for vaginal birth after cesarean (VBAC). Which clients would beless likely to have a successful VBAC? (Select all that apply.) a. Lengthy interpregnancy interval b. African-American race c. Delivery at a rural hospital d. Estimated fetal weight <4000 g e. Maternal obesity (BMI >30)

ANS: B, C, E Indications for a low success rate for a VBAC delivery include a short interpregnancy interval, non-Caucasian race, gestational age longer than 40 weeks, maternal obesity, preeclampsia, fetal weight greater than 4000 g, and delivery at a rural or private hospital.

A woman at 24 weeks of gestation states that she has a glass of wine with dinner every evening. Why would the nurse counsel the client to eliminate all alcohol? a. Daily consumption of alcohol indicates a risk for alcoholism. b. She will be at risk for abusing other substances as well. c. The fetus is placed at risk for altered brain growth. d. The fetus is at risk for multiple organ anomalies.

ANS: C No period exists when consuming alcohol during pregnancy is safe. The documented effects of alcohol consumption during pregnancy include mental retardation, learning disabilities, high activity level, and short attention span. The brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use.

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

ANS: C A woman with a threatened abortion presents with spotting, mild cramps, and no cervical dilation. A woman with an incomplete abortion would present with heavy bleeding, mild to severe cramping, and cervical dilation. An inevitable abortion manifests with the same symptoms as an incomplete abortion: heavy bleeding, mild to severe cramping, and cervical dilation. A woman with a septic abortion presents with malodorous bleeding and typically a dilated cervix.

14. While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the patient accordingly. Which statement as part of this discussion would be incorrect? a. Breastfeeding requires fewer supplies and less cumbersome equipment. b. Breastfeeding saves families money. c. Breastfeeding costs employers in terms of time lost from work. d. Breastfeeding benefits the environment.

ANS: C Actually less time is lost to work by breastfeeding mothers, in part because infants are healthier. Breastfeeding is convenient because it does not require cleaning or transporting bottles and other equipment. It saves families money because the cost of formula far exceeds the cost of extra food for the lactating mother. Breastfeeding uses a renewable resource; it does not need fossil fuels, advertising, shipping, or disposal.

29. As the nurse assists a new mother with breastfeeding, the client asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains: a. More calories. c. Important immunoglobulins. b. Essential amino acids. d. More calcium.

ANS: C Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.

What is the primary purpose for the use of tocolytic therapy to suppress uterine activity? a. Drugs can be efficaciously administered up to the designated beginning of term at 37 weeks gestation. b. Tocolytic therapy has no important maternal (as opposed to fetal) contraindications. c. The most important function of tocolytic therapy is to provide the opportunity to administer antenatal glucocorticoids. d. If the client develops pulmonary edema while receiving tocolytic therapy, then intravenous (IV) fluids should be given.

ANS: C Buying time for antenatal glucocorticoids to accelerate fetal lung development may be the best reason to use tocolytic therapy. Once the pregnancy has reached 34 weeks, however, the risks of tocolytic therapy outweigh the benefits. Important maternal contraindications to tocolytic therapy exist. Tocolytic-induced edema can be caused by IV fluids.

36. What condition indicates concealed hemorrhage when the patient experiences an abruptio placentae? a. Decrease in abdominal pain c. Hard, boardlike abdomen b. Bradycardia d. Decrease in fundal height

ANS: C Concealed hemorrhage occurs when the edges of the placenta do not separate. The formation of a hematoma behind the placenta and subsequent infiltration of the blood into the uterine muscle results in a very firm, boardlike abdomen. Abdominal pain may increase. The patient will have shock symptoms that include tachycardia. As bleeding occurs, the fundal height will increase.

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

ANS: C Cullen's sign, the blue ecchymosis seen in the umbilical area, indicates hematoperitoneum associated with an undiagnosed ruptured intraabdominal ectopic pregnancy. Linea nigra on the abdomen is the normal integumentary change associated with pregnancy. It manifests as a brown, pigmented, vertical line on the lower abdomen. Turner's sign is ecchymosis in the flank area, often associated with pancreatitis. Chadwick's sign is the blue-purple color of the cervix that may be seen during or around the eighth week of pregnancy.

26. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? a. 50 to 65 c. 95 to 110 b. 75 to 90 d. 150 to 200

ANS: C For the first 3 months the infant needs 110 kcal/kg/day. At ages 3 to 6 months the requirement is 100 kcal/kg/day. This level decreases slightly to 95 kcal/kg/day from 6 to 9 months and increases again to 100 kcal/kg/day until the baby reaches 12 months.

7. The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of: a. Eclampsia. b. Disseminated intravascular coagulation (DIC). c. HELLP syndrome. d. Idiopathic thrombocytopenia.

ANS: C HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

16. With regard to the nutrient needs of breastfed and formula-fed infants, nurses should be understand that: a. Breastfed infants need extra water in hot climates. b. During the first 3 months breastfed infants consume more energy than do formula-fed infants. c. Breastfeeding infants should receive oral vitamin D drops daily at least during the first 2 months. d. Vitamin K injections at birth are not needed for infants fed on specially enriched formula.

ANS: C Human milk contains only small amounts of vitamin D. Neither breastfed nor formula-fed infants need to be given water, even in very hot climates. During the first 3 months formula-fed infants consume more energy than do breastfed infants and therefore tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby's stomach at birth.

31. In providing nutritional counseling for the pregnant woman experiencing cholecystitis, the nurse would: a. Assess the woman's dietary history for adequate calories and proteins. b. Instruct the woman that the bulk of calories should come from proteins. c. Instruct the woman to eat a low-fat diet and avoid fried foods. d. Instruct the woman to eat a low-cholesterol, low-salt diet.

ANS: C Instructing the woman to eat a low-fat diet and avoid fried foods is appropriate nutritional counseling for this client. Caloric and protein intake do not predispose a woman to the development of cholecystitis. The woman should be instructed to limit protein intake and choose foods that are high in carbohydrates. A low-cholesterol diet may be the result of limiting fats. However, a low-salt diet is not indicated.

22. With regard to basic care of the breastfeeding mother, nurses should be able to advise her that she: a. Will need an extra 1000 calories a day to maintain energy and produce milk. b. Can go back to prepregnancy consumption patterns of any drinks, as long as she ingests enough calcium. c. Should avoid trying to lose large amounts of weight. d. Must avoid exercising because it is too fatiguing.

ANS: C Large weight loss would release fat-stored contaminants into her breast milk. It would also likely involve eating too little and/or exercising too much. A breastfeeding mother need add only 200 to 500 extra calories to her diet to provide extra nutrients for the infant. The mother can go back to her consumption patterns of any drinks as long as she ingests enough calcium, only if she does not drink alcohol, limits coffee to no more than two cups (caffeine in chocolate, tea, and some sodas), and reads the herbal tea ingredients carefully. The mother needs her rest, but moderate exercise is healthy.

20. Magnesium sulfate is given to women with preeclampsia and eclampsia to: a. Improve patellar reflexes and increase respiratory efficiency. b. Shorten the duration of labor. c. Prevent and treat convulsions. d. Prevent a boggy uterus and lessen lochial flow.

ANS: C Magnesium sulfate is the drug of choice to prevent convulsions, although it can generate other problems. Loss of patellar reflexes and respiratory depression are signs of magnesium toxicity. Magnesium sulfate can increase the duration of labor. Women are at risk for a boggy uterus and heavy lochial flow as a result of magnesium sulfate therapy.

25. Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole c. Unruptured ectopic pregnancy b. Missed abortion d. Abruptio placentae

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae.

8. A new mother wants to be sure that she is meeting her daughter's needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother's knowledge about appropriate infant care. The mother meets her child's needs when she: a. Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition. b. Warms the bottles using a microwave oven. c. Burps her infant during and after the feeding as needed. d. Refrigerates any leftover formula for the next feeding.

ANS: C Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. Solid food should not be introduced to the infant for at least 4 to 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, and this may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infant's saliva has mixed with it.

28. To initiate the milk ejection reflex (MER), the mother should be advised to: a. Wear a firm-fitting bra. c. Place the infant to the breast. b. Drink plenty of fluids. d. Apply cool packs to her breast.

ANS: C Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but this alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.

Which is the most accurate description of PPD without psychotic features? a. Postpartum baby blues requiring the woman to visit with a counselor or psychologist b. Condition that is more common among older Caucasian women because they have higher expectations c. Distinguishable by pervasive sadness along with mood swings d. Condition that disappears without outside help

ANS: C PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum baby blues. PPD, even without psychotic features, is more serious and persistent than postpartum baby blues. PPD is more common among younger mothers and African-American mothers. Most women need professional help to get through PPD, including pharmacologic intervention.

Prostaglandin gel has been ordered for a pregnant woman at 43 weeks of gestation. What is the primary purpose of prostaglandin administration? a. To enhance uteroplacental perfusion in an aging placenta b. To increase amniotic fluid volume c. To ripen the cervix in preparation for labor induction d. To stimulate the amniotic membranes to rupture

ANS: C Preparations of prostaglandin E1 and E2 are effective when used before labor induction to ripen (i.e., soften and thin) the cervix. Uteroplacental perfusion is not altered by the use of prostaglandins. The insertion of prostaglandin gel has no effect on the level of amniotic fluid. In some cases, women will spontaneously begin laboring after the administration of prostaglandins, thereby eliminating the need for oxytocin. It is not common for a woman's membranes to rupture as a result of prostaglandin use.

9. A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment the nurse finds the following vital signs: temperature of 37.3° C, pulse rate of 88 beats/min, respiratory rate of 10 breaths/min, blood pressure (BP) of 148/90 mm Hg, absent deep tendon reflexes, and no ankle clonus. The client complains, "I'm so thirsty and warm." The nurse: a. Calls for a stat magnesium sulfate level. b. Administers oxygen. c. Discontinues the magnesium sulfate infusion. d. Prepares to administer hydralazine.

ANS: C The client is displaying clinical signs and symptoms of magnesium toxicity. Magnesium should be discontinued immediately. In addition, calcium gluconate, the antidote for magnesium, may be administered. Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a diastolic BP greater than 110 mm Hg.

18. In assisting the breastfeeding mother position the baby, nurses should keep in mind that: a. The cradle position usually is preferred by mothers who had a cesarean birth. b. Women with perineal pain and swelling prefer the modified cradle position. c. Whatever the position used, the infant is "belly to belly" with the mother. d. While supporting the head, the mother should push gently on the occiput.

ANS: C The infant inevitably faces the mother, belly to belly. The football position usually is preferred after cesarean birth. Women with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

6. A breastfeeding woman develops engorged breasts at 3 days' postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman: a. Skips feedings to let her sore breasts rest. b. Avoids using a breast pump. c. Breastfeeds her infant every 2 hours. d. Reduces her fluid intake for 24 hours.

ANS: C The mother should be instructed to attempt feeding her infant every 2 hours while massaging the breasts as the infant is feeding. Skipping feedings may cause further swelling and discomfort. If the infant does not feed adequately and empty the breast, the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.

40. What finding on a prenatal visit at 10 weeks could suggest a hydatidiform mole? a. Complaint of frequent mild nausea b. Blood pressure of 120/80 mm Hg c. Fundal height measurement of 18 cm d. History of bright red spotting for 1 day, weeks ago

ANS: C The uterus in a hydatidiform molar pregnancy is often larger than would be expected on the basis of the duration of the pregnancy. Nausea increases in a molar pregnancy because of the increased production of hCG. A woman with a molar pregnancy may have early-onset pregnancy-induced hypertension. In the patient's history, bleeding is normally described as brownish.

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, what is the nurse's primary concern in planning the client's care? a. Displaying outbursts of anger b. Neglecting her hygiene c. Harming her infant d. Losing interest in her husband

ANS: C Thoughts of harm to herself or to the infant are among the most serious symptoms of PPD and require immediate assessment and intervention. Although outbursts of anger and neglecting personal hygiene are symptoms attributable to PPD, the major concern remains the potential of harm to herself or her infant. Although this client is likely to lose interest in her spouse, it is not the nurse's primary concern.

21. Preeclampsia is a unique disease process related only to human pregnancy. The exact cause of this condition continues to elude researchers. The American College of Obstetricians and Gynecologists has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? a. A 30-year-old obese Caucasian with her third pregnancy b. A 41-year-old Caucasian primigravida c. An African-American client who is 19 years old and pregnant with twins d. A 25-year-old Asian-American whose pregnancy is the result of donor insemination

ANS: C Three risk factors are present for this woman. She is of African-American ethnicity, is at the young end of the age distribution, and has a multiple pregnancy. In planning care for this client the nurse must monitor blood pressure frequently and teach the woman regarding early warning signs. The 30-year-old client only has one known risk factor, obesity. Age distribution appears to be U-shaped, with women less than 20 years and more than 40 years being at greatest risk. Preeclampsia continues to be seen more frequently in primigravidas; this client is a multigravida woman. Two risk factors are present for the 41-year-old client. Her age and status as a primigravida put her at increased risk for preeclampsia. Caucasian women are at a lower risk than African-American women. The Asian-American client exhibits only one risk factor. Pregnancies that result from donor insemination, oocyte donation, and embryo donation are at an increased risk of developing preeclampsia.

7. At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to: a. Begin solid foods. b. Have a bottle of formula after every feeding. c. Add at least one extra breastfeeding session every 24 hours. d. Start iron supplements.

ANS: C Usually the solution to slow weight gain is to improve the feeding technique. Position and latch-on are evaluated, and adjustments are made. It may help to add a feeding or two in a 24-hour period. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle-feeding may cause nipple confusion and limit the supply of milk. Iron supplements have no bearing on weight gain.

11. According to demographic research, the woman least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding would be: a. A woman who is 30 to 35 years of age, Caucasian, and employed part time outside the home. b. A woman who is younger than 25 years of age, Hispanic, and unemployed. c. A woman who is younger than 25 years of age, African-American, and employed full time outside the home. d. A woman who is 35 years of age or older, Caucasian, and employed full time at home.

ANS: C Women least likely to breastfeed typically are younger than 25 years of age, have a lower income, are less educated, are employed full time outside the home, and are African-American.

12. Which statement concerning the benefits or limitations of breastfeeding is inaccurate? a. Breast milk changes over time to meet changing needs as infants grow. b. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. c. Breast milk/breastfeeding may enhance cognitive development. d. Breastfeeding increases the risk of childhood obesity.

ANS: D Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk/breastfeeding may enhance cognitive development.

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

ANS: D Cervical changes such as shortened endocervical length, effacement, and dilation are predictors of imminent preterm labor. Changes in the cervix accompanied by regular contractions indicate labor at any gestation. Estriol is a form of estrogen produced by the fetus that is present in plasma at 9 weeks of gestation. Levels of salivary estriol have been shown to increase before preterm birth. Irregular, mild contractions that do not cause cervical change are not considered a threat. The presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation could predict preterm labor, but it has only a 20% to 40% positive predictive value. Of more importance are other physiologic clues of preterm labor such as cervical changes.

The nurse is performing an assessment on a client who thinks she may be experiencing preterm labor. Which information is the most important for the nurse to understand and share with the client? a. Because all women must be considered at risk for preterm labor and prediction is so variable, teaching pregnant women the symptoms of preterm labor probably causes more harm through false alarms. b. Braxton Hicks contractions often signal the onset of preterm labor. c. Because preterm labor is likely to be the start of an extended labor, a woman with symptoms can wait several hours before contacting the primary caregiver. d. Diagnosis of preterm labor is based on gestational age, uterine activity, and progressive cervical change.

ANS: D Gestational age of 20 to 37 weeks, uterine contractions, and a cervix that is 80% effaced or dilated 2 cm indicates preterm labor. It is essential that nurses teach women how to detect the early symptoms of preterm labor. Braxton Hicks contractions resemble preterm labor contractions, but they are not true labor. Waiting too long to see a health care provider could result in essential medications failing to be administered. Preterm labor is not necessarily long-term labor.

8. A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: a. Insert an oral airway. b. Suction the mouth to prevent aspiration. c. Administer oxygen by mask. d. Stay with the client and call for help.

ANS: D If a client becomes eclamptic, the nurse should stay her and call for help. Insertion of an oral airway during seizure activity is no longer the standard of care. The nurse should attempt to keep the airway patent by turning the client's head to the side to prevent aspiration. Once the seizure has ended, it may be necessary to suction the client's mouth. Oxygen would be administered after the convulsion has ended.

Which statement related to the induction of labor is most accurate? a. Can be achieved by external and internal version techniques b. Is also known as a trial of labor (TOL) c. Is almost always performed for medical reasons d. Is rated for viability by a Bishop score

ANS: D Induction of labor is likely to be more successful with a Bishop score of 9 or higher for first-time mothers or 5 or higher for veterans. Version is the turning of the fetus to a better position by a physician for an easier or safer birth. A TOL is the observance of a woman and her fetus for several hours of active labor to assess the safety of vaginal birth. Two thirds of cases of induced labor are elective and not done for medical reasons.

34. All parents are entitled to a birthing environment in which breastfeeding is promoted and supported. The Baby Friendly Hospital Initiative endorsed by WHO and UNICEF was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which instruction is not included in the "Ten Steps to Successful Breastfeeding for Hospitals"? a. Give newborns no food or drink other than breast milk. b. Have a written breastfeeding policy that is communicated to all staff. c. Help mothers initiate breastfeeding within one half hour of birth. d. Give artificial teats or pacifiers as necessary.

ANS: D No artificial teats or pacifiers (also called dummies or soothers) should be given to breastfeeding infants. No other food or drink should be given to the newborn unless medically indicated. The breastfeeding policy should be routinely communicated to all health care staff. All staff should be trained in the skills necessary to maintain this policy. Breastfeeding should be initiated within one half hour of birth, and all mothers need to be shown how to maintain lactation even if they are separated from their babies.

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

ANS: D Postterm gestation is not likely to occur with a breech presentation. The presence of meconium in a breech presentation may be a result of pressure on the fetal wall as it traverses the birth canal. Fetal heart tones heard at the level of the umbilical level of the mother are a typical finding in a breech presentation because the fetal back would be located in the upper abdominal area. Breech presentations often occur in preterm births.

The obstetric provider has informed the nurse that she will be performing an amniotomy on the client to induce labor. What is the nurse's highest priority intervention after the amniotomy is performed? a. Applying clean linens under the woman b. Taking the client's vital signs c. Performing a vaginal examination d. Assessing the fetal heart rate (FHR)

ANS: D The FHR is assessed before and immediately after the amniotomy to detect any changes that might indicate cord compression or prolapse. Providing comfort measures, such as clean linens, for the client is important but not the priority immediately after an amniotomy. The woman's temperature should be checked every 2 hours after the rupture of membranes but not the priority immediately after an amniotomy. The woman would have had a vaginal examination during the procedure. Unless cord prolapse is suspected, another vaginal examination is not warranted. Additionally, FHR assessment provides clinical cues to a prolapsed cord.

30. When responding to the question "Will I produce enough milk for my baby as she grows and needs more milk at each feeding?" the nurse should explain that: a. The breast milk will gradually become richer to supply additional calories. b. As the infant requires more milk, feedings can be supplemented with cow's milk. c. Early addition of baby food will meet the infant's needs. d. The mother's milk supply will increase as the infant demands more at each feeding.

ANS: D The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. Solids should not be added until about 4 to 6 months, when the infant's immune system is more mature. This will decrease the chance of allergy formations.

19. Nurses should be able to teach breastfeeding mothers the signs that the infant has latched on correctly. Which statement indicates a poor latch? a. She feels a firm tugging sensation on her nipples but not pinching or pain. b. The baby sucks with cheeks rounded, not dimpled. c. The baby's jaw glides smoothly with sucking. d. She hears a clicking or smacking sound.

ANS: D The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign. Rounded cheeks are a positive indicator of a good latch. A smoothly gliding jaw is a good sign.

5. A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant's correct latch-on by helping the woman hold the infant: a. With his arms folded together over his chest. b. Curled up in a fetal position. c. With his head cupped in her hand. d. With his head and body in alignment.

ANS: D The infant's head and body should be in correct alignment with the mother and the breast during latch-on and feeding. Holding the infant with his arms folded together over his chest, curled up in a fetal position, or with his head cupped in her hand are not ideal positions to facilitate latch-on.

What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? a. Genetic changes and anomalies b. Extensive CNS damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive CNS damage. Addiction to tobacco is not a usual concern related to the neonate.

24. A newly delivered mother who intends to breastfeed tells her nurse, "I am so relieved that this pregnancy is over so I can start smoking again." The nurse encourages the client to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the client is aware that: a. Smoking has little or no effect on milk production. b. There is no relation between smoking and the time of feedings. c. The effects of secondhand smoke on infants are less significant than for adults. d. The mother should always smoke in another room.

ANS: D The new mother should be encouraged not to smoke. If she continues to smoke, she should be encouraged to always smoke in another room removed from the baby. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the immunologic properties of breast milk. Research supports that mothers should not smoke within 2 hours before a feeding. The effects of secondhand smoke on infants include sudden infant death syndrome.

In evaluating the effectiveness of magnesium sulfate for the treatment of preterm labor, which finding alerts the nurse to possible side effects? a. Urine output of 160 ml in 4 hours b. DTRs 2+ and no clonus c. Respiratory rate (RR) of 16 breaths per minute d. Serum magnesium level of 10 mg/dl

ANS: D The therapeutic range for magnesium sulfate management is 4 to 7.5 mg/dl. A serum magnesium level of 10 mg/dl could lead to signs and symptoms of magnesium toxicity, including oliguria and respiratory distress. Urine output of 160 ml in 4 hours, DTRs of 2+, and a RR of 16 breaths per minute are all normal findings.

11. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. Eclamptic seizure. c. Placenta previa. b. Rupture of the uterus. d. Placental abruption.

ANS: D Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.

Mongolian spot

African American baby with something that resembles a bruise on the bottom

Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)?

All women, regardless of risk factors An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

What does the ductus arteriosus do

Allows oxygenated blood to bypass the lungs, it diverts blood to the placenta for gas exchange. Oxygen-rich blood from the placenta flows rapidly through the umbilical vein into the fetal abdomen. The duct constricts after birth as oxygenation. When the fetal ductus arterioles fails to close after birth, PDA occurs.

Which sign of a potential complication is the most important for the nurse to share with the client?

Alteration in the pattern of fetal movement An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation?

Amenorrhea Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

Which information regarding amniotic fluid is important for the nurse to understand?

Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

Ectopic pregnancy Tx:

An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery.

Which statement accurately describes the centering model of care?

Approximately 8 to 12 women are placed in each gestational-age cohort group. Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group. The groups remain intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Before the group sessions, the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own BP, weight, and urine dips and enter these findings in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, the number of LBW infants decreased and breastfeeding rates increased.

The maternity nurse is cognizant of what important structure and function of the placenta?

As one of its early functions, the placenta acts as an endocrine gland. The placenta produces four hormones necessary to maintain the pregnancy: hCG, hPL, estrogen, and progesterone. The placenta widens until 20 weeks of gestation and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

Marfan syndrome

Autosomal dominant genetic disorder characterized by generalized weakness of the connective tissue, resulting in joint deformities, ocular lens disclocation, and weakness of the aortic wall and root.

Cystic fibrosis

Autosomal recessive genetic disorder in which exocrine glands produce excessive viscous secretions, which cause problems with both respiratory and digestive functions.

A new father wants to know what medication was put into his infant's eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to: A. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind B. Prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal C. Prevent potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes D. Prevent the infant's eyelids from sticking together and help the infant see

B

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lbs.

B A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters.

Which of these statements are helpful and accurate nursing advice concerning bathing the new baby. (Select all that apply.) A. Newborns should be bathed every day, for the bonding as well as the cleaning B. Tub baths may be given before the infant's umbilical cord falls off and the umbilicus is healed. C. Only plain warm water can be used to preserve the skin's acid mantle. D. Powders are not recommended because the infant can inhale powder. E. Bathe immediately after feeding while baby is calm and relaxed.

B, D Tub baths may be given as soon as an infant's temperature has stabilized. Unscented mild soap is appropriate to use to wash the infant. Powder is not recommended due to the risk of inhalation

After delivering a healthy baby boy with epidural anesthesia, a woman on the postpartum unit complains of a severe headache. The nurse should anticipate which actions in the patient's plan of care? (Select all that apply.) A. Keeping the head of bed elevated at all times B. Administration of oral analgesics C. Avoid caffeine D. Assisting with a blood patch procedure E. Frequent monitoring of vital signs

B, D, E The nurse should suspect the patient is suffering from a postdural puncture headache (PDPH). Characteristically, assuming an upright position triggers or intensifies the headache, whereas assuming a supine position achieves relief (Hawkins and Bucklin, 2012). Conservative management for a PDPH includes administration of oral analgesics and methylxanthines (e.g., caffeine or theophylline). Methylxanthines cause constriction of cerebral blood vessels and may provide symptomatic relief. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH. Close monitoring of vital signs is essential.

Signs of effective breastfeeding include: A. Weight loss of 10% 3 days after birth B. 6 - 8 wet diapers after day 4 C. Stools remain dark meconium throughout the first week D. Breastfeeding sessions last 30 minutes

B.

The nurse is teaching a woman about foods that are good sources of iron. Which food would NOT be included? A. Red meat B. Milk C. Spinach D. Raisins

B.

The nurse providing newborn stabilization must be aware that the primary side effect of maternal opioid analgesia in the newborn is: A. Bradycardia B. Respiratory depression C. Acrocyanosis D. Hypothermia

B.

The primary finding in placental abruption which best distinguishes it from placenta previa is: A. Vaginal bleeding B. Presence of abdominal pain C. Rupture of membranes D. Presence of chorioamnionitis

B.

When the infant begins to suckle at the breast, nerve impulses cause the anterior pituitary to secrete two hormones. Which hormone increases milk production? A. Oxytocin B. Prolactin C. Relaxin D. Lactoferrin

B.

Which statement is true concerning pain in the newborn? A. Structures that transmit pain first become functional toward the end of the third trimester of pregnancy B. The physiological response to pain in the newborn can be life threatening C. All newborns cry when they experience pain D. Early exposure to painful stimuli has no effect on future sensitivity and interpretation of pain

B.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day.

B. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea.

A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours). C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day.

B. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods, avoid consuming fluids early in the day or when nauseated, and compensate by drinking fluids at other times.

With regard to the long-term consequences of infant feeding practices, the nurse should instruct the obese client that the best strategy to decrease the risk for childhood obesity for her infant is: A. an on-demand feeding schedule. B. breastfeeding. C. lower-calorie infant formula. D. smaller, more frequent feedings.

B. Breastfeeding is the best prevention strategy for decreasing childhood and adolescent obesity. Breastfeeding also assists the woman to return to her prepregnant weight sooner

Which action of a breastfeeding mother indicates the need for further instruction? A. Holds breast with four fingers along bottom and thumb at top. B. Leans forward to bring breast toward the baby. C. Stimulates the rooting reflex and then inserts nipple and areola into newborn's open mouth. D. Puts her finger into newborn's mouth before removing breast.

B. To maintain a comfortable, relaxed position, the mother should bring the baby to the breast, not the breast to the baby.

A laboring woman becomes anxious during the transition phase of the first stage of labor and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed. The nurse's immediate response would be to: A. encourage the woman to breathe more slowly. B. help the woman breathe into a paper bag. C. turn the woman on her side. D. administer a sedative.

B. Just telling her to breathe more slowly does not ensure a change in respirations. The woman is exhibiting signs of hyperventilation. This leads to a decreased carbon dioxide level and respiratory alkalosis. Rebreathing her air would increase the carbon dioxide level.

With regard to systemic analgesics administered during labor, nurses should be aware that: A. systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier. B. effects on the fetus and newborn can include decreased alertness and delayed sucking. C. IM administration is preferred over IV administration. D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

B. Systemic analgesics cross the fetal blood-brain barrier more readily than the maternal blood-brain barrier. Effects depend on the specific drug given, the dosage, and the timing. IV administration is preferred over IM administration because the drug acts faster and more predictably. PCAs result in decreased use of an analgesic.

After change of shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. visceral. B. referred. C. somatic. D. afterpain.

B. Visceral pain is that which predominates the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen. As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions. Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor. Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. critical iron and folic acid levels must be maintained. D. lactating women can go back to their prepregnant calorie intake.

B. A lactating woman needs to avoid consuming too much caffeine

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction. C. diabetes mellitus. D. Down syndrome.

B. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction

Giving formula to breastfeeding infants increases breastfeeding frequency and milk production, making successful breastfeeding more likely. A. True B. False

B. FALSE

At 37 weeks of gestation, Mayrs BP rose from a prepregenant baseline of 118/66 to 142/88. No other problematic signs and symptoms, including proteinuria were noted. This indicates: A. Chronic hypertension B. Gestational hypertension C. Eclampsia D. Preeclampisa with severe features

B. Gestational hypertension

A term newborn experienced symptoms of respiratory distress after birth which resolved within 2 hours. Which condition caused this transient tachypnea of the newborn (TTN) ? A. High systemic vascular resistance B. Inadequate clearance of pulmonary fluid C. Inadequate levels of surfactant D. Rapid clamping of the umbilical cord

B. Inadequate clearance of pulmonary fluid

The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." This response is known as a: A. tonic neck reflex B. Moro reflex C. cremasteric reflex D, Babinski reflex

B. Moro reflex Tonic neck reflex refers to the "fencing posture" a newborn assumes when supine and turns the head to the side. These actions show the Moro reflex. The cremasteric reflex refers to retraction of testes when chilled. The Babinski reflex refers to the flaring of the toes when the sole is stroked.

The newborn's nurse should alert the health care provider when which newborn reflex assessment findings are seen? (Select all that apply.) A. Newborn turns head toward stimulus when eliciting rooting reflex. B. Newborn's fingers fan out when palmar reflex checked. C. Newborn forces tongue outward when tongue touched. D. Newborn exhibits symmetric abduction and extension of arms, and fingers form "C" when Moro reflex elicited. E. Newborn's toes hyperextend with dorsiflexion of big toe when sole of foot stroked upward along lateral aspect.

B. Newborn's fingers fan out when palmar reflex checked The baby's fingers should curl around the examiner's fingers when eliciting the palmar reflex. When eliciting rooting reflex, the characteristic response is for the baby to turn head toward stimulus and open mouth. Extrusion is elicited by touching tongue, and newborn's tongue is forced outward. The newborn should elicit symmetric abduction and extension of the arms and fingers form a "C" with the Moro reflex. The Babinski reflex is elicited by stroking upward along the lateral aspect on the sole of the feet. The expected response is hyperextension of the toes with dorsiflexion of the big toe.

O type blood has: A. A type antigens and B antibodies B. No antigens and A and B antibodies C. O type antigens and A and B antibodies D. A and B type antigens and no antibodies

B. No antigens and A and B antibodies

Following circumcision of a newborn, the nurse provides instructions to his or her parents regarding postcircumcision care. The nurse should tell the parents to: A. apply topical anesthetics with each diaper change. B. expect a yellowish exudate to cover the glans after the first 24 hours. C. change the diaper every 2 hours and cleanse the site with soap and water or baby wipes. D. apply constant pressure to the site if bleeding occurs and call the physician.

B. Parents should be taught that a yellow exudate will develop over the glans and should not be removed

During the complete physical examination 24 hours after birth: A. The parents are excused to reduce their normal anxiety. B. The nurse can gauge the neonate's maturity level by assessing its general appearance. C. Once often neglected, blood pressure is now routinely checked. D. When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second.

B. The nurse can gauge the neonate's maturity level by assessing its general appearance. B. Correct: The nurse will be looking at skin color, alertness, cry, head size, and other features.

Which actions indicate the the patient is in the 4th stage of labor? A. Patients cervix is fully dilated and bearing down efforts have begun B. The placenta has been delivered and the baby has been born for at least 2 hours C. The fetus has been delivered D. Regular uterine contractions have begun

B. The placenta has been delivered and the baby has been born for at least 2 hours

The primary expected outcome for nursing care associated with administration of magnesium sulfate would be met if which assessment finding is present? A. The woman exhibits a decrease in both systolic and diastolic pressure B. The woman experiences no seizures C. The woman states that she feels more relaxed and calm D. The woman urinates more frequently, resulting in a decrease in pathologic edema

B. The woman experiences no seizures

Expected irregular fluctuations in the baseline FHR of 2 cycles per minute or greater as a result of the interaction of the sympathetic and parasympathetic nervous system. A. Early Deceleration B. Variability C. Episodic changes D. Accelerations

B. Variability

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: A. tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. B. alerts the physician that the infant has a dislocated hip. C. informs the parents and physician that molding has not taken place. D. suggests that if the condition does not change, surgery to correct vision problems might be needed.

B. alerts the physician that the infant has a dislocated hip. This is an inappropriate statement that may result in unnecessary anxiety for the new parents. The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The physician should be notified. Molding refers to movement of the cranial bones and has nothing to do with the infant's hips. The Ortolani maneuver is not a technique used to evaluate visual acuity in the newborn. This maneuver checks hip integrity.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern since the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: A. telling the mother not to worry since all breastfed babies have this type of stool. B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. Correct C. asking the mother what she ate at her last meal. D. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements This type of stool is the first stool that all newborns, not just breastfed babies, have. At this early age this type of stool (meconium) is typical of both bottle-fed and breastfed newborns. The mother's nutritional intake is not responsible for the appearance of meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

A woman with a history of normal blood pressures arrives at her 30 week gestation visit. Her initial BP is 146/92. She returns for a recheck the next day; BP is 142/92. On both visits, the urine protein is 2+ per dipstick. She has no systemic symptoms. What is her hypertensive classification? A. Gestational hypertension B. Preeclampsia C. Chronic hypertension D. Eclampsia

B. for bitches

When caring for a newborn, the nurse must be alert for signs of cold stress, including: A. decreased activity level B. increased respiratory rate C. hyperglycemia D. shivering

B. increased respiratory rate Infants experiencing cold stress would have an increased activity level. An increased respiratory rate is a sign of cold stress in the newborn. Hypoglycemia would occur with cold stress. Newborns are unable to shiver as a means of increasing heat production; they increase their activity level instead.

A newborn male, estimated to be 39 weeks of gestation, would exhibit: A. extended posture when at rest B. testes descended into scrotum C. abundant lanugo over his entire body D, ability to move his elbow past his sternum

B. testes descended into scrotum The newborn's good muscle tone will result in a more flexed posture when at rest. A full-term male infant will have both testes in his scrotum and rugae on his scrotum. The newborn will exhibit only a moderate amount of lanugo, usually on his shoulders and back. The newborn would have the inability to move his elbow past midline.

All statements about normal labor are true except: A. A single fetus presents by vertex B. It is completed within 8 hours C. A regular progression of contractions, effacement, dilation, and descent occurs D. No complications are involved

B: Although the amount of time varies with each woman, a normal uncomplicated labor is usually completed within 18 hours.

Vaginal examinations should be performed by the nurse under all of these circumstances except: A. An admission to the hospital at the start of labor B. When accelerations of the fetal heart rate (FHR) are noted C. On maternal perception of perineal pressure or the urge to bear down D. When membranes rupture

B: An accelerated FHR is a positive sign; variable decelerations, however, merit a vaginal examination.

After change of shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, buttocks, and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is: A. Visceral B. Referred C. Somatic D. Afterpain

B: As labor progresses the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions.

A group of fetal monitoring experts (National Institute of Child Health and Human Development, 2008) recommends that fetal heart rate (FHR) tracings demonstrate certain characteristics to be described as reassuring or normal (category I). This includes: A. Bradycardia not accompanied by baseline variability B. Early decelerations, either present or absent C. Sinusoidal pattern D. Tachycardia

B: Early decelerations, the absence of late decelerations, and the presence of accelerations indicate a normal category I tracing.

With regard to systemic analgesics administered during labor, nurses should be aware that: A. Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier B. Effects on the fetus and newborn can include decreased alertness and delayed sucking C. IM administration is preferred over IV administration D. IV patient-controlled analgesia (PCA) results in increased use of an analgesic

B: Effects depend on the specific drug given, the dosage, and the timing.

With regard to spinal and epidural (block) anesthesia, nurses should know that: A. This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births B. A high incidence of postbirth headache is seen with spinal blocks C. Epidural blocks allow the woman to move freely D. Spinal and epidural blocks are never used together

B: Headaches may be prevented or mitigated to some degree by a number of methods. An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for a spinal headache.

Nurses can help their clients by keeping them informed about the distinctive stages of labor. What description of the phases of the first stage of labor is accurate? A. Latent: mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours B. Active: moderate, regular contractions; 4 to 7 cm dilation; duration of 3 to 6 hours C. Lull: no contractions; dilation stable; duration of 20 to 60 minutes D. Transition: very strong but irregular contractions; 8 to 10 cm dilation; duration of 1 to 2 hours

B: The active phase is characterized by moderate, regular contractions; 4 to 7 cm dilation; and a duration of 3 to 6 hours.

A woman who is 39 weeks pregnant expresses fear about her impending labor and how she will manage. The nurse's best response is: A. "Don't worry about it. You'll do fine." B. "It's normal to be anxious about labor. Let's discuss what makes you afraid." C. "Labor is scary to think about, but the actual experience isn't." D. "You may have an epidural. You won't feel anything."

B: This statement allows the woman to share her concerns with the nurse and is a therapeutic communication tool.

Vitals

BP-80-90's/40/50's HR- 4th intercostal space for babies. 80-120 bpm, but 100-160 is average. RR-30-60/min Temp-36.5-37.2C. Above 97.7 (ideal above 80)F

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate?

Babies respond to sound starting at approximately 24 weeks of gestation. Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

Chorioamnionitis

Bacterial infection of the amniotic cavity, major cause of complications for mothers and newborns at any gestational age.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. Which guidance should the nurse provide?

Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy. The statement Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

b

Benefits to the mother associated with breastfeeding include all except which of the following? a. There is a decreased risk of breast cancer. b. It is an effective method of birth control. c. It increases bone density. d. It may enhance postpartum weight loss.

Petichiae

Blood vessels broken

Acrocyanosis

Blue hands and feet. Normal.

Acrocyanosis

Bluish discoloration of hands and feet is a normal finding in the first 24 hours after birth. Reassure mom that this is a normal finding

Radiation

Body heat is radiating to a cooler surface, such as a cool ceiling.

Conduction

Body heat lost to a cooler surface it is in contact with, such as placing baby on a cold table

Complete abortion/miscarriage

Body naturally aborts the baby. Mom generally aborts the baby w/ no interventions needed. Slight bleeding or mild cramping

With regard to medications, herbs, boosters, and other substances normally encountered by pregnant women, what is important for the nurse to be aware of?

Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, during which a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

A first-time mother at 18 weeks of gestation is in for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that these are Braxton Hicks contractions. What other information is important for the nurse to share?

Braxton Hicks contractions should be painless. Soon after the fourth month of gestation, uterine contractions can be felt through the abdominal wall. Braxton Hicks contractions are regular and painless and continue throughout the pregnancy. Although they are not painful, some women complain that they are annoying. This type of contraction usually ceases with walking or exercise. Braxton Hicks contractions can be mistaken for true labor; however, they do not increase in intensity, frequency, or cause cervical dilation. These contractions facilitate uterine blood flow through the intervillous spaces of the placenta and thereby promote oxygen delivery to the fetus.

S/s of placenta previa

Bright red PAINLESS bleeding during second or third trimester

The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can easily be cleared with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to: A. Avoid suctioning the nares B. Insert the compressed bulb into the center of the mouth C. Suction the mouth first D. Remove the bulb syringe from the crib when finished

C A. Incorrect: The nasal passages should be suctioned one nostril at a time. The mouth should always be suctioned first. B. Incorrect: After compression of the bulb it should be inserted into one side of the mouth. If it is inserted into the center of the mouth, the gag reflex is likely to be initiated. C. Correct: The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned. D. Incorrect: When the infant's cry no longer sounds as though it is through mucus or a bubble, suctioning can be stopped. The bulb syringe should remain in the crib so that it is easily accessible if needed again.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? A. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. B. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. C. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. D. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C A. Incorrect: With each diaper change, the penis should be washed off with warm water to remove any urine or feces. B. Incorrect: If bleeding occurs, the nurse should apply gentle pressure to the site of the bleeding with a sterile gauze square. C. Correct: This action is appropriate when caring for an infant who has had a circumcision. D. Incorrect: Yellow exudates cover the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process. The exudates should not be removed.

A woman with asthma is experiencing a postpartum hemorrhage. Which drug should be avoided when treating postpartum bleeding to avoid exacerbating asthma? a. Oxytocin (Pitocin) b. Nonsteroidal antiinflammatory drugs (NSAIDs) c. Hemabate d. Fentanyl

C Prostaglandin derivatives should not be used to treat women with asthma, because they may exacerbate symptoms. Oxytocin is the drug of choice to treat this woman's bleeding; it will not exacerbate her asthma. NSAIDs are not used to treat bleeding. Fentanyl is used to treat pain, not bleeding.

A pregnant woman follows a strict vegan diet. What dietary risks are heightened with this diet? (Select all that apply) A. Listeriosis B. Pica C. Vitamin B12 deficiciency D. Inadequate calcium intake E. Heartburn

C, D

A laboring woman has just received an epidural. Which nursing action has priority? A. Limit parenteral fluids B. Monitor for fetal tachycardia C. Monitor for maternal hypotension D. Monitor for maternal bradycardia.

C.

A woman at 9 weeks gestation experiences vaginal bleeding accompanied by cramping. The bleeding and cramping spontaneously resolve without rupture of membranes or passage of tissue. Which term best describes this situation? A. Incomplete abortion B. Complete abortion C. Threatened abortion D. Inevitable abortion

C.

A woman is experiencing back labor due to occiput posterior presentation. She complains of intense pain in her lower back. An effective relief measure would be to use: A. Pant-blow (breaths and puffs) breathing techniques B. Effleurage C. Counterpressure against the sacrum D. Conscious relaxation or guided imagery

C.

During the second and third trimesters of pregnancy, what metabolic change is expected? A. High sensitivity to insulin causes glucose to enter maternal cells quickly B. Maternal insulin crosses the placenta readily C. Insulin resistance allows glucose to be transported to the fetus after a meal D. Maternal requirements for insulin fall dramatically

C.

The primary purpose of administering magnesium sulfate to women with severe preeclampsia is to: A. Lower blood pressure. B. Relieve headache C. Prevent eclamptic seizures D. Improve placental perfusion

C.

Two hours after a meal, the target blood gluse level for a pregnant woman with diabetes is: A. 65-95 mg/dl B. 130-140 mg/dl C. 120 mg/dl or less D. There is no specified limit

C.

While providing care for the breastfeeding mother, the nurse should: A. Recommend that the woman wash her nipples with a mild soap prior to feedings B. Instruct the woman to consume an additional 1000kcal/day more than her pre-pregnancy intake C. Assist the woman to properly position the infant at the breast for feedings D. Teach the woman to wait to initiate feedings after the infant begins to cry

C.

In helping the breastfeeding mother position the baby, nurses should keep in mind that: A. the cradle position is usually preferred by mothers who had a cesarean birth. B. women with perineal pain and swelling prefer the modified cradle position. C. whatever the position used, the infant is "belly to belly" with the mother. D. while supporting the head, the mother should push gently on the occiput.

C. The infant inevitably faces the mother, belly to belly.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take? A. Encourage her to empty her bladder. B. Decrease her intravenous (IV) rate to a keep vein-open rate. C. Turn the woman to the left lateral position or place a pillow under her hip. D. No action is necessary since a decrease in the woman's blood pressure is expected.

C. Turning the woman to her left side is the best action to take in this situation since this will increase placental perfusion to the infant while waiting for the doctor's or nurse midwife's instruction. Hypotension indicated by a 20% drop from preblock level is an emergency situation and action must be taken.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. either hot or cold applications may provide relief, but they should never be used together in the same treatment. B. acupuncture can be performed by a skilled nurse with just a little training. C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited. D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

C. The woman and her partner should experiment with massage before labor to see what might work best. Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B. Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important.

Fetal engagement begins when when the largest transverse diameter of the presenting part has passed through the pelvic inlet and into the true pelvis. At what station does this occur? A. -5 B. +1 C. 0 D. +5

C. 0

Which infant would be most at-risk for developing hyperbilirubinemia? The infant who is: A. Caucasian B. Female C. 34 weeks gestation D. Feeding regularly

C. 34 weeks gestation

One minute after birth, a newborn has a heart rate of 140, a good cry, well flexed extremeties, pale blue color and grimaces with suctioning. What is the newborn's apgar score? A. 10 B. 9 C. 8 C. 7

C. 7

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed: A. Only if the newborn is in obvious distress B. Once by the obstetrician, just after the birth C. At least twice, 1 minute and 5 minutes after birth D. Every 15 minutes during the newborn's first hour after birth

C. At least twice, 1 minute and 5 minutes after birth

The nurse administers vitamin K to the newborn for what reason? A. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient. B. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. C. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. D. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

C. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract.

Which measure is least effective in helping a woman prevent postpartum depression? A. Share feelings and emotions with family members and her partner B. Recognize that emotional problems after having a baby are not unusual C. Care for the baby by herself to increase her level of self confidence and self esteem D. Ask friends or family members to take care of the abby while she sleeps or has a date with her partner

C. Care for the baby by herself to increase her level of self confidence and self esteem

In the classification of newborns by gestational age and birth weight, the appropriate for gestational age (AGA) weight would: A. Fall between the 25th and 75th percentiles for the infant's age B. Depend on the infant's length and the size of the head C. Fall between the 10th and 90th percentiles for the infant's age D. Be modified to consider intrauterine growth restriction (IUGR)

C. Fall between the 10th and 90th percentiles for the infant's age

Increased levels of unconjugated bilirubin require treatment in order to prevent: A. Hemorrhage B. Erythema toxicum C. Neurotoxicity D. Infection

C. Neurotoxicity

Following vaginal birth 2 hours ago a woman with preeclampsia is experiencing a heavy flow a a result of a boggy uterus. It is determined that she will require medication to reduce the amount of blood loss. Which medication would the nurse anticipate administering? A. Methergine (methylergonovine) D. Calcium gluconate C. Pitocin (oxytocin) D. Normodyne (labetol)

C. Pitocin (oxytocin) (as an oxytocic medication is safe an effective to use to contract the uterus and reduce blood loss because it will not increase blood pressure)

A woman is in active labor. On spontaneous rupture of her membranes, the nurse caring for this woman notices variable deceleration patterns during evaluation or the monitor tracing. When preparing to perform a vaginal examination, the nurse observes a small section of the umbilical cord protruding from the vagina. What should the nurse do next? A. Increase the IV drip rate B. Administer oxygen to the woman via mask at 8 to 10 L/minutes C. Place a sterile gloved hand into the vagina and hold the presenting part of the cord while calling for assistance D. Wrap the cord loosely with a sterile towel saturated with warm normal saline

C. Place a sterile gloved hand into the vagina and hold the presenting part of the cord while calling for assistance

A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to: A. Apply an oil-based lotion to the newborn's skin to prevent dying and cracking B. Limit the newborn's intake of milk to prevent nausea, vomiting, and diarrhea C. Place eye shields over the newborn's closed eyes D. Change the newborn's position every 4 hours

C. Place eye shields over the newborn's closed eyes

Which infant behavioral state is ideal for parent-infant bonding and interaction? A. Active sleep B. Drowsy sleep C. Quiet alert D. Active alert

C. Quiet alert

A laboring woman's temperature is elevated as a result of an upper respiratory infection. The FHR pattern that reflects maternal fever is: A. Diminished variability B. Variable declarations C. Tachycardia D. Early decelerations

C. Tachycardia (FHR increases as maternal core body temperature elevates)

The nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should: A. Instill within 15 minutes of birth for maximum effectiveness. B. Cleanse eyes from inner to outer canthus before administration. C. Apply directly over the cornea. D. Flush eyes 10 minutes after instillation to reduce irritation.

C. The newborn's eyes should be cleansed from the inner to the outer canthus before the administration of erythromycin ointment.

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home? A. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. B. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. C. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change. D. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

C. This action is appropriate when caring for an infant who has had a circumcision

Newborns are at high risk for injury if appropriate safety precautions are not implemented. Parents should be taught to: A. place the newborn on the abdomen (prone) after feeding and for sleep. B. avoid use of pacifiers. C. use a rear-facing car seat. D. use a crib with side rail slats that are no more than 3 inches apart.

C. Your baby should be in a rear-facing infant car safety seat from birth until age 2 years or until exceeding the car seat's limits for height and weight.

Vitamin K is given to the newborn to: A. reduce bilirubin levels. B. increase the production of red blood cells. C. enhance ability of blood to clot. D. stimulate the formation of surfactant

C. enhance ability of blood to clot. Vitamin K does not reduce bilirubin levels. Vitamin K does not increase the production of red blood cells. Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors. Vitamin K does not stimulate the formation of surfactant.

The nurse knows that the second stage of labor, the descent phase, has begun when: A. The amniotic membranes rupture B. The cervix cannot be felt during a vaginal examination C. The woman experiences a strong urge to bear down D. The presenting part is below the ischial spines

C: During the descent phase of the second stage of labor, the woman may experience an increase in the urge to bear down.

Fetal bradycardia is most common during: A. Maternal hyperthyroidism B. Fetal anemia C. Viral infection D. Tocolytic treatment using ritodrine

C: Fetal bradycardia can be considered a later sign of fetal hypoxia and is known to occur before fetal death. Bradycardia can result from placental transfer of drugs, viral infections such as cytomegalovirus (CMV), maternal hypothermia, and maternal hypothermia.

Which position would the nurse suggest for second-stage labor if the pelvic outlet needs to be increased? A. Semirecumbent . B. Sitting C. Squatting D. Side-lying

C: Kneeling or squatting moves the uterus forward and aligns the fetus with the pelvic inlet; this can facilitate the second stage of labor by increasing the pelvic outlet

Fetal circulation can be affected by many factors during labor. Accurate assessment of the laboring woman and fetus requires knowledge of these expected adaptations. Which factor will not affect fetal circulation during labor? A. Fetal position B. Uterine contractions C. Blood pressure D. Umbilical cord blood flow

C: Maternal blood pressure is likely to have a significant effect on fetal circulation.

Which description of the phases of the second stage of labor is accurate? A. Latent phase: feels sleepy, fetal station is 2+ to 4+, duration is 30 to 45 minutes B. Active phase: overwhelmingly strong contractions, Ferguson reflux activated, duration is 5 to 15 minutes C. Descent phase: significant increase in contractions, Ferguson reflux activated, average duration varies D. Transitional phase: woman "laboring down," fetal station is 0, duration is 15 minutes

C: The descent phase begins with a significant increase in contractions, the Ferguson reflex is activated, and the duration varies, depending on a number of factors. The second stage of labor has no active phase.

A nurse caring for a woman in labor understands that increased variability of the fetal heart rate might be caused by: A. Narcotics B. Barbiturates C. Methamphetamines D. Tranquilizers

C: The use of illicit drugs such as cocaine or methamphetamines might cause increased variability.

A nurse teaches a pregnant woman about the characteristics of true labor contractions. The nurse evaluates her understanding of the instructions when the woman states: A. "True labor contractions will subside when I walk around." B. "True labor contractions will cause discomfort over the top of my uterus." C. "True labor contractions will continue and get stronger even if I relax and take a shower." D. "True labor contractions will remain irregular but become stronger."

C: True labor contractions occur regularly, become stronger, last longer, and occur closer together. They may become intense during walking and continue despite comfort measures. Typically true labor contractions are felt in the lower back, radiating to the lower portion of the abdomen.

The various systems and organs of the fetus develop at different stages. Which statement is most accurate?

Cardiovascular system is the first organ system to function in the developing human. The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the sixth week. The body becomes C-shaped at 21 weeks of gestation. The gastrointestinal system is complete at 36 weeks of gestation.

How post-term pregnancy is managed:

Care is still controversial. However, because perinatal morbidity and mortality increase greatly after 42 weeks of gestation, pregnancies are usually not allowed to continue after this time. In the US, physicians usually induce at 41 weeks. An alternative approach is to initiate twice-weekly fetal testing at 41 weeks. The testing generally consists of either a BPP or Non-stress test along with an assessment of amniotic fluid volume. The woman is encouraged to assess fetal activity daily, assess for signs of labor, and keep appointments with her primary.

Preterm labor definition

Cervical changes and uterine contractions occurring between 20 0/7 and 37 weeks of gestation.

The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share?

Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term. These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream?

Chorionic villi Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

Causes of neonatal hypoglycemia

Cold and not eating enough

Cephalohematoma**

Collection of blood from ruptured blood vessels between surface of a cranial bone and periosteal membrane. DOES NOT CROSS SUTURE LINE

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

Common pregnancy-specific cause of pruritus in pregnancy; it is also termed polymorphic eruption of pregnancy and is most common in primigravidae during the third trimester

Pulmonary embolism

Complication of DVT when clot dislodges and carried to pulmonary artery where it occludes vessel and obstructs blood flow to the lungs

To reassure and educate their pregnant clients regarding changes in their blood pressure, nurses should be cognizant of what?

Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of a term pregnancy. This compression also leads to varicose veins in the legs and vulva. The tightness of a blood pressure cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as the pregnancy advances. The diastolic blood pressure first decreases and then gradually increases.

1.RN has assessed a woman who gave birth vaginally 12 hours ago. Which finding would require further assessment? a. Bright to dark red uterine discharge b. Midline episiotomy-- approximated, moderate edema, slight erythema, absence of ecchymosis c. Protrusion of abdomen with slight separation of abdominal wall muscles d. Fundus firm at 1 cm above the umbilicus and to the right of midline

D) Fundus firm at 1 cm above the umbilicus and to the right of midline Rationale: Fundus should be at midline; deviation from midline could indicate a full bladder; bright to dark red uterine discharge refers to lochia rubra; edema and erythema are common shortly after repair of a wound; decreased abdominal muscle tone and enlarged uterus result in abdominal protrusion; separation of abdominal walls, diastasis recti adbominis is common during pregnancy and the postpartum period.

When monitoring a woman in labor who has just received spinal analgesia, the nurse should report which assessment findings to the health care provider? (Select all that apply.) A. Maternal blood pressure of 108/79 B. Maternal heart rate of 98 C. Respiratory rate of 14 breaths/min D. Fetal heart rate of 100 beats/min E. Minimal variability on a fetal heart monitor

D, E After induction of the anesthetic, maternal blood pressure, pulse, and respirations and fetal heart rate and pattern must be checked and documented every 5 to 10 minutes. If signs of serious maternal hypotension (e.g., the systolic blood pressure drops to 100 mm Hg or less or the blood pressure falls 20% or more below the baseline) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given.

A woman can prevent engorgement and increase breastmilk production by: A. Wearing a well-fitting bra B. Avoiding breast massage C. Drinking large amounts of fluids D. Feeding at least 8-12 times every 24 hours

D.

Which statement is true concerning calcium intake during pregnancy? A. Supplementation of calcium is recommended for all pregnant women B. Daily recommended intake of calcium is much higher for pregnant women compared to non-pregnant women C. Bone meal supplements are recommended as a calcium source D. Dietary sources of calcium include yogurt, beans and tofu

D.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

Which statement regarding infant weaning is correct? A. Weaning should proceed from breast to bottle to cup. B. The feeding of most interest should be eliminated first. C. Abrupt weaning is easier than gradual weaning. D. Weaning can be mother or infant initiated.

D. With infant-led weaning, the infant moves at his or her own pace in omitting feedings, which leads to a gradual decrease in the mother's milk supply. Mother-led weaning means that the mother decides which feedings to drop.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements.

D. Constipation can be a problem

27 y/o Pt G1P1 assigned to you states "I won't push, I'm not ready to have this baby yet but I know when its time I will push regardless if I want to or not". What natural occurrence is the pt referring to? A. Gestational Contraction B. Quickening C. Lightening D. Ferguson Reflex

D. Ferguson Reflex

When placing a newborn under a radiant heat warmer to stabilize the temperature after birth, the nurse should: A. place the thermistor probe on the left side of the chest. B. cover the probe with a nonreflective material. C. recheck the temperature by periodically taking a rectal temperature. D. prewarm the radiant heat warmer and place the undressed newborn under it.

D. The radiant warmer should be prewarmed so the infant does not experience more cold stress.

Visually abrupt FHR decrease any time during a contraction in response to umbilical cord compression. A. Early decelerations B. Late deceleration C. Prolonged declarations D. Variable deceleration

D. Variable deceleration

A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. What finding BEST indicates that preterm labor is occurring? A. Pain in the lower back B. Irregular, mild uterine contractions are occurring every 15 minutes C. Fetal fibronectin is present in vaginal secretions D. The cervix is 90% effaced and dilated to 2 cm

D. for dicks

When weighing a newborn, the nurse should: A. leave its diaper on for comfort B. place a sterile scale paper on the scale for infection control C. keep hand on the newborn's abdomen for safety D. weigh the newborn at the same time each day for accuracy

D. weigh the newborn at the same time each day for accuracy The baby should be weighed without a diaper or clothes. Clean scale paper is acceptable; it does not need to be sterile. The nurse's hand should be above, not on, the abdomen for safety. Weighing a newborn at the same time each day allows for accurate weights.

Nurses can advise their clients that all are signs that precede labor except: A. A return of urinary frequency as a result of increased bladder pressure B. Persistent low backache from relaxed pelvic joints C. Stronger and more frequent uterine (Braxton Hicks) contractions D. A decline in energy, as the body stores up for labor

D: A surge of energy is a phenomenon that is common in the days preceding labor.

The most common cause of decreased variability in the FHR that lasts 30 minutes or less is: A. Altered cerebral blood flow B. Fetal hypoxemia C. Umbilical cord compression D. Fetal sleep cycles

D: A temporary decrease in variability can occur when the fetus is in a sleep state. These sleep states do not usually last longer than 30 minutes.

In the current practice of childbirth preparation, emphasis is placed on: A. The Dick-Read (natural) childbirth method B. The Lamaze (psychoprophylactic) method C. The Bradley (husband-coached) method D. Encouraging expectant parents to attend childbirth preparation in any or no specific method

D: Encouraging expectant parents to attend class is most important, because preparation increases a woman's confidence and thus her ability to cope with labor and birth. Gaining in popularity are Birthing from Within and Hypnobirthing.

In order to accurately assess the health of the mother accurately during labor, the nurse should be aware that: A. The woman's blood pressure increases during contractions and falls back to prelabor normal between contractions B. Use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia C. Having the woman point her toes reduces leg cramps D. The endogenous endorphins released during labor raise the woman's pain threshold and produce sedation

D: In addition, physiologic anesthesia of the perineal tissues, caused by the pressure of the presenting part, decreases the mother's perception of pain.

In a variation of rooming-in, called couplet care, the mother and infant share a room and the mother shares the care of the infant with: A. The father of the infant B. Her mother (the infant's grandmother) C. Her eldest daughter (the infant's sister) D. The nurse

D: In couplet care the mother shares a room with the newborn and shares infant care with a nurse educated in maternity and infant care. This may also be known as mother-baby care or single-room-maternity-care.

For the labor nurse, care of the expectant mother begins with any or all of these situations except: A. The onset of progressive, regular contractions B. The bloody, or pink, show C. The spontaneous rupture of membranes D. Formulation of the woman's plan of care for labor

D: Labor care begins when progressive, regular contractions begin, the blood-tinged mucoid vaginal discharge appears, or fluid is discharged from the vagina. The woman and the nurse can formulate their plan of care before labor or during treatment.

If a woman complains of back labor pain, the nurse might best suggest that she: A. Lie on her back for a while with her knees bent B. Do less walking around C. Take some deep, cleansing breaths D. Lean over a birth ball with her knees on the floor

D: The hands-and-knees position, with or without the aid of a birth ball, should help with the back pain.

With regard to what might be called the tactile approaches to comfort management, nurses should be aware that: A. Either hot or cold applications may provide relief, but they should never be used together in the same treatment B. Acupuncture can be performed by a skilled nurse with just a little training C. Hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch is limited D. Therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations

D: Therapeutic touch is a laying-on of hands technique that claims to redirect energy fields in the body.

You are evaluating the fetal monitor tracing of your client, who is in active labor. Suddenly you see the fetal heart rate (FHR) drop from its baseline of 125 down to 80. You reposition the mother, provide oxygen, increase IV fluid, and perform a vaginal exam. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should you take? A. Call for help. B. Insert a Foley catheter. C. Start oxytocin (Pitocin). D. Notify the primary health care provider immediately.

D: To relieve an FHR deceleration the nurse can reposition the mother, increase IV fluid, and provide oxygen. Also if oxytocin is infusing, it should be discontinued. If the FHR does not resolve, the primary health care provider should be notified immediately.

In documenting labor experiences, nurses should know that a uterine contraction is described according to all of these characteristics except: A. Frequency (how often contractions occur) B. Intensity (the strength of the contraction at its peak) C. Resting tone (the tension in the uterine muscle) D. Appearance (shape and height)

D: Uterine contractions are described in terms of frequency, intensity, duration, and resting tone. Appearance is not a term used to describe contractions. Duration is another characteristic of uterine contractions.

oligohydramnios

Decreased of deficient amount of amniotic fluid

During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect?

Decreased sexual drive, because of nausea and fatigue A pregnant woman usually experiences a decrease, not an increase, in libido during the first trimester. Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender, which tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity.

A womans cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate?

Defects occur between the third and fifth weeks of development. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. We dont really know when such defects occur is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of developmentin the third to fifth weeks; therefore, the statement, They usually occur in the first 2 weeks of development is inaccurate.

Post partum hemorrhage

Defined as the loss of 500ml or more of blood after vaginal birth and 1000 ml or more after cesarean birth

Placenta previa management

Delivery Method: C-section if bleeding can't be controlled

Preeclampsia (mild) without severe features:

During a prenatal visit at 30 weeks of gestation, Angela's blood pressure was 156/98; it has ranged between 142/92 and 150/90 since the 28th week of her pregnancy; her urinalysis indicated a protein level of 2+ using a dipstick; her biceps and patellar reflexes are 2+. What is her diagnosis?

Which consideration is essential for the nurse to understand regarding follow-up prenatal care visits?

During the abdominal examination, the nurse should be alert for supine hypotension. The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview portion of the follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher and a diastolic BP of 90 mm Hg or higher.

Evaporation

Example: if skin or clothes are wet, the change of liquid to vapor form causes heat loss and the wet area. Keep baby dry

hyperemesis gravidarum:

Excessive prolonged vomiting accompanied by the following: Weight loss, Electrolyte imbalance, Nutritional deficiencies, Ketonuria. It needs to be under control, can cause dehydration

Who is most likely to experience the phenomenon of someone other than the mother-to-be having pregnancy-like symptoms such as nausea and weight gain?

Expectant father An expectant fathers experiencing of his partners pregnancy-like symptoms is called the couvade syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon. She may be excited about becoming a grandmother or see her daughters pregnancy as a reminder that she is getting old. A couples teenage daughter is usually preoccupied with her own sexual development and may have difficulty accepting the overwhelming evidence of her parents sexual activity. It is the father of the pregnant woman, not the sister, who experiences these symptoms.

First intervention for Jaundice

FEEDING IS FIRST INTERVENTION Phototherapy parent edu. Untreated jaundice-->brain damage

A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse?

Fetal intestines As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

Meconium

Fetus has passed meconium before birth. Three possible reasons for passage of meconium: (1) normal physiologic function that occurs with maturity or with breech presentation (2) result of hypoxia induced peristalsis and sphincter relaxation (3) can be a sequel to umbilical cord compression-induced vagal stimulation in mature fetuses.

Which statement concerning neurologic and sensory development in the fetus is correct?

Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mothers voice. Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

Which finding in the urinalysis of a pregnant woman is considered a variation of normal?

Glycosuria Small amounts of glucose may indicate physiologic spilling. The presence of protein could indicate kidney disease or preeclampsia. Urinary tract infections are associated with bacteria in the urine. An increase in ketones indicates that the patient is exercising too strenuously or has an inadequate fluid and food intake.

Mouth

Gums and tongue pink and wet. Lips and palate intact. Sucking, rooting, gag, swallow reflexes

Chronic HTN

HTN present before pregnancy HTN persistent longer than 12 weeks postpartum

Interdependent- Letting go phase

Happens about 2 weeks after mom gets home and mom is ready to let the family help and take on that role of a new family situation

Incomplete abortion/miscarriage

Has a significant loss of blood, have to do surgical management. Might be some fetal tissue left behind. Going to have to dilate the cervix and help get the baby out

While assessing the vital signs of a pregnant woman in her third trimester, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate?

Have the patient turn to her left side, and then recheck her BP in 5 minutes. BP is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the client is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

Nursing interventions for shoulder dystocia:

Have woman move to a hands and knees position (Gaskin maneuver), a swatting position, or lateral recumbent position. Gaskin maneuver requires woman to be mobile, with no significant loss of motor function caused by regional anesthesia o Avoid fundal pressure—associated with neurologic complications

Convection

Heat is lost from body when heat is transferred from the body by the movement of air, as a result, body heat is carried away. similar to having a fan blow on baby or leaving baby in a room with a window open on a windy day

What is the primary role of the doula during labor?

Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner A doula is professionally trained to provide labor support, including physical, emotional, and informational support, to both the woman and her partner during labor and the birth. The doula does not become involved with clinical tasks.

HELLP Syndrome

Hemolysis (RBC bursting apart), Elevated liver enzyme, low platelet count, decreased Hgb and HCT, Burr cells present

A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is happy that she is pregnant and the next minute she cries for no reason. Which response by the nurse is most appropriate?

Hormone changes during pregnancy commonly result in mood swings. Explaining that hormone changes can result in mood swings is an accurate statement and the most appropriate response by the nurse. Telling the woman not to worry dismisses her concerns and is not the most appropriate response. Although the woman should be encouraged to share her feelings, asking if she has spoken to her husband about them is not the most appropriate response and does not provide her with a rationale for the psychosocial dynamics of her pregnancy. Suggesting that the woman does not want to be pregnant is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The womans responses are normal. She should be reassured about her feelings.

4

How many types of perineal lacerations are there?

Remember not to scrape off any of the yellow exudate because thats healing, just clean it, put ointment on it, 2X2 gauze and the diaper on.

How to perform circumcision care:

A 3-year-old girls mother is 6 months pregnant. What concern is this child most likely to verbalize?

How will the baby eat? By age 3 or 4 years, children like to be told the story of their own beginning and accept it being compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it will wear. School-age children take a more clinical interest in their mothers pregnancy and may want to know How did the baby get in there? and How will it get out? Whether the childs mother will die does not tend to be the focus of her questions about the impending birth of a sibling. The babys eye color does not tend to be the focus of childrens questions about the impending birth of a sibling.

a. A cephalhematoma may occur with a spontaneous vaginal birth

How would the nurse optimally reassure the parents of an infant who develops a cephalhematoma? a. A cephalhematoma may occur with a spontaneous vaginal birth b. Happens with forceps- or vacuum assisted delivery c. It is present immediately after birth d. The blood will gradually absorb over the first year

HTN

Hydralazine and labetalol and nifedipine are effective drugs for treating what?

What represents a typical progression through the phases of a womans establishing a relationship with the fetus?

I am pregnantI am going to have a babyI am going to be a mother. The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions I am pregnant, I am going to have a baby, and I am going to be a mother sum up the progression through the three phases. In phase one, the woman views the child as part of herself and not as a separate being. This is only the first step of the progression through phases of attachment. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the childs sex and personality based on fetal activity occurs during the third phase of attachment.

Certain things that restrict the baby from growing inside: smoking, alcohol, HTN, gestational diabetes, or drugs can cause mom to have a small baby

IUGR

jaundice

If a baby has extra bruising or something traumatic happened, they are at increased risk for __________________, because their body has to break down extra RBCs and their liver can't keep up so it causes this

Dental care during pregnancy is an important component of good prenatal care. Which instruction regarding dental health should the nurse provide?

If dental treatment is necessary, then the woman will be most comfortable with it in the second trimester. The second trimester is the best time for dental treatment because the woman will be able to sit most comfortably in the dental chair. Dental care, such as brushing with a fluoride toothpaste, is especially important during pregnancy. Periodontal disease has been linked to both preterm labor and low-birth-weight (LBW) infants. Emergency dental surgery is permissible; however, the mother must clearly understand the risks and benefits. Conscious relaxation is useful and may even help the woman get through any dental appointments, but it is not a reason to avoid them.

Scheduled cesarean birth:

If labor and vaginal birth are contraindicated (e.g., complete placenta previa, active genital herpes, positive HIV status with a high viral load), birth is necessary but labor is not inducible (e.g., hypertensive status that causes a poor intrauterine environment that threatens the fetus, or this course of action has been choses by PCP and woman (e.g., repeat C-section)

Chorioamnionitis:

If this develops, labor with be induced

What is the most basic information that a nurse should be able to share with a client who asks about the process of conception?

Implantation in the endometrium occurs 6 to 10 days after conception. After implantation, the endometrium is called the decidua. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the womans reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

a. Disseminated intravascular coagulation (DIC)

In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: a. Disseminated intravascular coagulation (DIC) b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome

What does the ductus venosus do?

In fetal circulation, a blood vessel carrying oxygenated blood between the umbilical vein and the inferior vena cava bypasses the liver. It is obliterated and becomes a ligament after birth.

Which renal system adaptation is an anticipated anatomic change of pregnancy?

Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty. Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

Polydramnios

Increased of excessive amount of amniotic fluid

Pregnancy hormones prepare the vagina for stretching during labor and birth. Which change related to the pelvic viscera should the nurse share with the client?

Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester. Increased sensitivity and an increased interest in sex sometimes go together and frequently occur during the second trimester. These cervical changes make evaluation of abnormal Pap tests more difficult. Quickening is the first recognition of fetal movements by the mother. Ballottement is a technique used to palpate the fetus. The Chadwick sign appears from the 6 to 8 weeks of gestation.

Risks for Hydatidiform mole pregnancy:

Increases the risk for cancer. Highest in women over age 35 and younger than 20. The risk is even higher for women over age 45

Risk for medically indicated preterm birth

Indicated preterm births occur as a means to resolve maternal or fetal risk related to continuing pregnancy. About 25% of all preterm births are indicated bc of medical obstetric conditions that affect the mother, fetus, or both.

Endometritis

Infection of the lining of the uterus -most common postpartum infection

Ineffective endocarditis

Inflammation of the innermost lining (endocardium) of the heart caused by invasion of microorganisms. When they go to the dentist, they might have to take an antibiotic prophylactically to prevent an infection from going into their heart

First assessment (0-2hr post delivery)

Initial: Apgar, external (Symmetry!!!), chest rise/fall, abdomen (belly-breathing), neurologic (innate responses), genitourinary (pee/poo)

PDA

Is another cause of left-to-right shunt that is usually diagnosed and corrected during infancy. Possible complications of this include those of VSD as well as endocarditis and pulmonary emboli.

Post-term pregnancy definition

Is one that extends beyond the end of week 42 of gestation, or 294 days from the first day of the last menstrual period (LMP).

DIC

Issue with how blood is clotting Low platelets and wide spread bleeding Body has clotting issues → end up with low platelets and wide spread bleeding if not treated

First degree perineal laceration

Laceration extend through skin and vaginal mucous membrane but not underlying fascia and muscle

Fourth degree perineal laceration:

Laceration that extends completely through the rectal mucosa, disrupting both external and internal anal sphincters

Second degree perineal laceration

Laceration that extends through fascia and muscles of perineal body but not the anal sphincter

Third degree perineal laceration

Laceration that involves external anal sphincter

The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct?

Lactation is inhibited until the estrogen level declines after birth. Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

Tx of placental abruption:

Large 16-18 gauge IV line, indwelling catheter, vaginal birth is feasible and desirable. Corticosteroids will be given to accelerate fetal lung maturity. Induction may be initiated so long as the mother and fetus are closely monitored for any evidence of compromise. C-section should be reserved for cases fetal distress of other OB complications.

Macrosomia

Large baby

Gestational Diabetes

Larger baby (macrosomia) If you have a large baby or a really small baby, want to look at blood sugar Check blood sugars Don't want baby's BS <45 - Baby can have a BS of 45

Meconium risks:

Major risk is development of meconium aspiration syndrome. MAS causes a severe form of aspiration pneumonia that occurs most often in term or post-term infants who have passed meconium in utero.

Risk for VBAC:

Major risk is uterine rupture. Other risks include operative injury, blood transfusion, hysterectomy, endometritis, neonatal morbidity, and death.

Eye prophylaxis

Mandatory in US. Avoid gonorrheal or chlamydia infection

Which statement regarding the development of the respiratory system is a high priority for the nurse to understand?

Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infants lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

A.

Maternal signs and symptoms of preeclampsia are directly related to: A. Poor perfusion of maternal organs B. Maternal hypervolemia C. Low levels of maternal serum magnesium D. Fetal hypertension

Nursing interventions for shoulder dystocia:

McRoberts maneuver- woman's legs flexed apart, knees on her abdomen. Preferred method when woman is having epidural anesthesia. Suprapubic pressure can then be applied to the anterior shoulder in an attempt to push shoulder under symphysis pubis.

Stools

Meconium passed within 12-48 hours of life. Thick and black Not passing--> increased risk for infection

PDA interventions

Medical management is vent, ibuprofen (causes PDA to constrict), and fluid restriction Nursing management is supportive, the infant needs an NTE, o2, fluid balance, and parenteral help

A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding?

Melasma Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more common in women with a dark complexion. Melasma appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

ANS: C Methotrexate is an effective, nonsurgical treatment option for a hemodynamically stable woman whose ectopic pregnancy is unruptured and less than 4 cm in diameter. Methotrexate is not indicated or recommended as a treatment option for complete hydatidiform mole, missed abortion, and abruptio placentae.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole c. Unruptured ectopic pregnancy b. Missed abortion d. Abruptio placentae

What type of cultural concern is the most likely deterrent to many women seeking prenatal care?

Modesty A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

Monitoring in mother with placental abruption:

Monitoring: fetus is assessed for IUGR, VS (maternal and fetus), and labs

The nurse working with pregnant clients must seek to gain understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate?

Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for the mature or immature woman and for the younger or older woman. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

S/S: Deep venous thrombosis

More common during pregnancy, unilateral leg pain, calf tenderness, swelling in lower part of the body, redness and warmth positive Homan's sign may be present

Post partum hemorrhage

Most common in first hour after birth, in women with a hx, in hispanic and asian women, large or multiple fetuses, prolonged labor, use of oxytocin, and mechanically assisted deliveries Macrosomic baby, many previous births, gestation hypertension, placental abruption

Prolapsed cord

NEVER APPLY FUNDAL PRESSURE! Signs include; Drastic drop in HR, variable or prolonged deceleration during uterine contractions, women reports feeling the cord after the membranes rupture, and/or cord is seen or felt in or protruding from the vagina. Do a vaginal examination to check the position of the baby, this is an emergency and needs to be fixed or baby needs to come out immediately. DO NOT MOVE HAND

Mitral valve stenosis

Narrowing of the opening of the valve between the left atrium and the left ventricle of the heart by stiffening of the valve leaflets, which obstructs blood flow from the left atrium to the left ventricle. It is the characteristic lesion resulting from rheumatic heart disease.

A patient in her first trimester complains of nausea and vomiting. She asks, Why does this happen? What is the nurses best response?

Nausea and vomiting may be due to changes in hormones. Nausea and vomiting are believed to be caused by increased levels of hormones, decreased gastric motility, and hypoglycemia. Gastric motility decreases during pregnancy. Glucose levels decrease in the first trimester. Although gastric secretions decrease, these secretions are not the primary cause of the nausea and vomiting.

Which gastrointestinal alteration of pregnancy is a normal finding?

Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial. Normal nausea and vomiting rarely produce harmful effects and may be less likely to result in miscarriage or preterm labor. Ptyalism is excessive salivation that may be caused by a decrease in unconscious swallowing or by stimulation of the salivary glands. Pyrosis begins as early as the first trimester and intensifies through the third trimester. Increased hormone production does not lead to hyperthyroidism in pregnant women.

First period of reactivity ***(Birth-30 min)

Newborns heart rate increases to 160-180 bpm, and decreases after 30 min Respirations are irregular at 60-80 breaths/min Decrease in motor activity after a period followed by 60-100 min of sleep

A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the clients expected date of birth (EDB)?

November 21, 2015 Using the Ngeles rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete a normal pregnancy. Using the Ngeles rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB.

d. She hears a clicking or smacking sound.

Nurses should be able to teach breastfeeding mothers the signs that the infant has latched on correctly. Which statement indicates a poor latch? a. She feels a firm tugging sensation on her nipples but not pinching or pain. b. The baby sucks with cheeks rounded, not dimpled. c. The baby's jaw glides smoothly with sucking. d. She hears a clicking or smacking sound.

c. Is characterized by hemolysis, elevated liver enzymes, and low platelets

Nurses should be aware that HELLP syndrome: a. Is a mild form of preeclampsia. b. Can be diagnosed by a nurse alert to its symptoms. c. Is characterized by hemolysis, elevated liver enzymes, and low platelets. d. Is associated with preterm labor but not perinatal mortality.

c. Is characterized by hemolysis, elevated liver enzymes, and low platelets.

Nurses should be aware that HELLP syndrome: a. Is a mild form of preeclampsia. b. Can be diagnosed by a nurse alert to its symptoms. c. Is characterized by hemolysis, elevated liver enzymes, and low platelets. d. Is associated with preterm labor but not perinatal mortality.

15 minutes

Nursing Alert: A perineal pad saturated in ________ minutes or less and pooling of blood under the buttock are indications of excessive blood loss, requiring immediate assessment, intervention, and notification of the PCP.

Positive, never

Nursing Alert: After birth, Rh immune globulin is administered to all Rh negative, antibody (Coombs')- negative women who give birth to Rh______ infants. Rh immune globulin is administered to the mother intramuscularly (RhoGAM), or intravenously. It should _________ be given to an infant.

HELLP Syndrome

Nursing Alert: An extremely important point to understand is that many women with _______________ may not have signs or symptoms of severe preeclampsia. For example, although most women have hypertension, BP may be only mildly elevated in 50% of cases. Proteinuria may be absent. As a result, women with this are often misdiagnosed with a variety of other medical or surgical disorder.s

be left alone

Nursing Alert: Immediately after a seizure a woman may be very confused and can be combative. Restraints may be necessary temporally. She should not _________________________. Provide emotional support to the family and discuss with them the rationale of management and the woman's progress.

Do NOT, decreases

Nursing Alert: In assessing fetal movements it is important to remember that they are usually not present during the fetal sleep cycle and that they may be temporarily reduced if the woman is taking depressant medications, drinking alcohol, or smoking a cigarette. They __________ decrease as the woman nears term. Obesity _________________ the ability of the mother to perceive fetal movement.

Hypoglycemia, hypoglycemia

Nursing Alert: Late preterm infants are at increased risk for ____________________. They have decreased glycogen stores and lack hepatic enzymes for gluconeogenesis and glycogenolysis. Their hormonal regulation and insulin secretion are immature. The increased risk of cold stress and feeding difficulties adds to the risk for _____________.

Nose, nasal

Nursing Alert: Newborn infants are by preference _______________ breathers. The reflex response to nasal obstruction is to open the mouth to maintain an airway. This response is not present in most infants until 3 weeks after birth; therefore, cyanosis or asphyxia can occur with __________ blockage.

first voiding, 24 hours

Nursing Alert: Noting and recording the _________________ is important. An infant who has not voided by __________ hours should be assessed for adequacy of fluid intake, bladder distention, restlessness, and symptoms of pain. The pediatrician should be notified.

Capillary, cord

Nursing Alert: Only venous or _______________ blood samples can be used for newborn screening and genetic studies; _________ blood is not used for such samples

Cessation

Nursing Alert: Prepackaged formula should not be given to mothers who are breastfeeding. Such "gifts" are associated with earlier ________________ of breastfeeding.

fourth

Nursing Alert: Rectal suppositories and enemas should not be administered to women with third or _____________ degree perineal lacerations. These measures to treat constipation can be very uncomfortable and can cause hemorrhage or damage to the suture line.

24 hours, pathologic

Nursing Alert: The appearance of jaundice during the first ______ hours of life or persistence beyond the ages previously delineated usually indicates a potential ____________ process that requires further investigation.

under the mother's buttocks, between the buttocks

Nursing Alert: The nurse always check for blood ______________________ as well as on the perineal pad. Although the amount on the pineal pad may be slight, blood may flow _________________ onto the linens under the mother. When this happens, excessive bleeding can go undetected.

respiratory depression

Nursing Alert: The nurse should carefully monitor all women receiving opioids because decreased intestinal motility and ___________________ are side effects.

Hand Hygiene

Nursing Alert: ___________________ should be performed before and after touching the infant, before an invasive procedure or medication administration, after contact with potentially contaminated objects, and after removing sterile or nonsterlie gloves.

Hyperglycemia, 2, 2 hours

Nursing Alert: _____________________ is most likely to be identified in _____ hours postprandial values because blood glucose levels peak approximately ______ hours after a meal.

Methotrexate, increase

Nursing Alert: the woman on _______________ therapy who drinks alcohol and takes vitamins containing folic acid (such as prenatal vitamins) ________________ her risk of have side effects of the drug or exacerbating the ectopic rupture.

Placenta previa

Nursing care: No vaginal checks, pelvic rest/bed rest, place mom on left side lying position to increase blood supply and nutrients to baby

Which statement regarding the probable signs of pregnancy is most accurate?

Observed by the health care provider Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

Dry feet

Occurs in babies born after 42w gestation

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform?

Offer the woman and her family the opportunity to listen to the fetal heart tones. To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their babys heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit.

Apnea

Ok for less than 20 seconds. Anything more, intervene.

What is the correct term used to describe the mucous plug that forms in the endocervical canal?

Operculum The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective?

Optimal fetal circulation is achieved when I am in the side-lying position. Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously, it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, then blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compressing the vena cava. Many women find lying on their abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

Expectant management of labor

PPROM management includes fetal assessment by nonstress test and biophysical profile. The woman should be taught how to self assess her fetus with daily fetal movement counts. woman should be monitored for signs of labor, placental abruption, and development of intrauterine infection Antenatal glucocorticoids are given to women less than 32 weeks because they decrease the risk for many fetal complications and are given a 7-day course of antibiotics which prolongs the time between membrane rupture and birth, decreases chorioamnionitis and Postpartum endometritis, and can prevent sepsis, pneumonia, and intraventricular hemorrhage in the baby. Watch for signs of infection. If chorioamnionitis occurs, then labor is induced. If preterm labor occurs, then tocolytics are give to allow time for the women to be transported to a proper facility that can handle the birth of a preterm infant

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. Which intervention should the nurse recommend?

Pelvic rock exercises Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Stretching and other exercises to relieve back pain should be performed several times a day. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain.

IUGR, follow up, dx= <10% EFW (estimated fetal weight) on growth US: Common problems that affect SGA (small for gestational age) infants

Perinatal asphyxia, meconium aspiration, hypoglycemia, polycythemia, temperature instability.

PDA

Persistent opening between the two major blood vessels leading from the heart. Should close shortly after birth.

Placenta previa

Placenta implanted in lower uterine segment near or over internal cervical os Degree to which the internal cervical os is covered by placenta used to classify three types Don't do a vaginal check, do an ultrasound to see where the placenta is lying

c

Postpartum fatigue (PPF) is more than just feeling tired; it is a complex phenomenon affected by a combination of physiologic, psychologic, and situational variables. Which of these is not a contributing factor to PPF? a. Long labor or cesarean birth b. Infant care demands c. Social isolation due to lack of visitors d. Anemia or infection

Heparin

Pregnant women with cardiac issues, you can give _________________ versus Warfarin or anything else, have to be aware of medications that will cross the placenta

Amniocentesis

Prenatal diagnostic test that provides direct access to the fetal circulation during the second and third trimesters.

Management of a prolapsed cord

Pressure on the cord can be relieved by putting on a sterile gloved hand into the vagina. Two fingers are used. One finger is on either side of the cord or both fingers on one side, exert upward pressure against the presenting part to relieve compression. DO NOT MOVE YOUR HAND! if cord is coming out of the vagina, DO NOT put it back in. Instead wrap loosely in a towel dunked in sterile, warm normal saline solution. Administer oxygen to the woman by a nonrebreather mask at 8-10 L until birth start IV fluids continue to monitor fetus HR by internal fetal scalp electrode continuously prepare for vaginal birth if cervix is fully dilated a C-section if it is not

Vitamin K

Prevention of hemorrhagic disease

Risk factors for preeclampsia

Primigravidity in woman <19 or >40 years of age First pregnancy with a new partner History of preeclampsia Pregnancy-onset snoring African descent Multifetal gestation, maternal infection/inflammation in current pregnancy, pre existing medical or genetic conditions

What is the correct term for a woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability?

Primipara A primipara is a woman who has completed one pregnancy with a viable fetus. To help remember the terms: gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. Therefore, a primigravida is a woman pregnant for the first time; a multipara is a woman who has completed two or more pregnancies with a viable fetus; and a nulligravida is a woman who has never been pregnant.

A Correct: Bleeding needs to be evaluated at every diaper change. If bleeding occurs, gentle pressure should be applied with a sterile gauze square. If the bleeding does not stop, the primary health care provider should be notified. B Incorrect: The baby should void after the circumcision prior to discharge. He is expected to void six to eight times within 24 hours. C Incorrect: The penis should be cleansed with plain water and petroleum applied. Soap should not be used until the circumcision is healed at 5 or 6 days after the procedure. D Incorrect: This is normal and will remain for 2 to 3 days. The parents should not attempt to remove this exudate. Redness, swelling, or discharge indicates infection, and the physician should be notified.

Prior to discharging a male infant who has just been circumcised, the nurse must evaluate that the parents understand the instructions for care at home. The nurse is reassured when the parents report which of the following? a. They will check for bleeding with every diaper change. b. The baby is expected to void at least four times in 24 hours. c. Soap and water should be used to clean the penis. d. They will notify the provider if a yellow exudate develops and covers the head of the penis.

Which hormone is essential for maintaining pregnancy?

Progesterone Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

Preclampsia

Protein in urine indicates what diagnosis for a pregnant mother?

Preclampsia lab profile

Protein is found in the urine

Causes of placental abruption:

Risk factor: Maternal hypertension is a primary risk factor, but also cocaine, blunt external abdominal trauma from MVAs

Risk for preterm birth, medically indicated preterm birth

Risk factors: -Hx of preterm birth - Current multifetal pregnancy -Cervical or uterine abnormalities - Bleeding after the first trimester of pregnancy - Low or high maternal BMI - Non-white race (especially non-hispanic Black) - Low socioeconomic & educational status - Living with chronic stress - Intimate partner violence, lack of social support - Smoking/ Substance abuse - Physically demanding working conditions

IUGR

Risk factors: Lack of oxygen like smoking, disease process of the mother; gestational diabetes, anemia, environmental factors; drug use, oligohydramnios, environmental factors Pre-rupturing of membranes does not effect this

When temp goes down.....

Risk for metabolic acidosis, which happens easily if cold and untreated!

Which statement regarding the structure and function of the placenta is correct?

Secretes both estrogen and progesterone As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

Eclampsia

Seizures, HTN, protein in urine If mom seizes, don't put anything in mom's mouth, and nurse should stay with mom

Postpartum blues

Sets around day 4-5, peaks on day 5- mom will cry for no reason, have ups and downs- generally goes away on its own Occurs on taking-hold phase Should go away in few days or a week Sad, anxious, or overwhelmed feelings Crying spells Loss of appetite Difficulty sleeping

Post-partum blues (baby blues)

Sets in after 4-5 days, women will cry for no reason. Have some ups and downs because they go through feelings of euphoria stage at the hospital and then they go home and they're tired and their hormones are shifting and become emotional. Typically go away after about 10 days, if they don't then they need to be assessed further for something else

Severe preeclampsia (with severe features)

Shawn is primigravida at 28 weeks of gestation. Her BP has risen to 160/110 and higher. Proteinuria is at 3+. She has been complaining of a headache and states that she needs to wear sunglasses even indoors because light hurts her eyes. She reports that she has been using two pillows at night instead of one to breath more easily when she sleeps. What is her diagnosis?

Which behavior indicates that a woman is seeking safe passage for herself and her infant?

She keeps all prenatal appointments. The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly eating, carefully driving, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect?

She will have increased lordosis. An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus?

Slightly above the symphysis pubis In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

Dx of a prolapsed cord

Sometimes it can be seen directly after rupture of membranes. The fluid will wash over the cord in front of the presenting part. symptoms of this are vaginal bleeding, abnormal fetal heart rate (bradycardia, absent or minimal variability and variable or prolonged decelerations), inadequate uterine relaxation

Risk for preterm birth

Spontaneous preterm births occur following an early initiation of the labor process in the apparent absence of maternal or fetal illness and make up nearly 75% of all preterm births in developed countries. Conditions such as preterm labor with intact membranes and preterm labor with PROM often result in preterm birth.

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth?

Striae gravidarum Striae gravidarum, or stretch marks, reflect a separation within the underlying connective tissue of the skin. They usually fade after birth, although they never completely disappear. An epulis is a red, raised nodule on the gums that easily bleeds; it disappears or shrinks after giving birth. Chloasma, or the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead, especially in dark-complexioned pregnant women. Chloasma usually fades after the birth. Telangiectasia, or vascular spiders, are tiny, star-shaped or branchlike, slightly raised, pulsating end-arterioles usually found on the neck, thorax, face, and arms. They occur as a result of elevated levels of circulating estrogen and usually disappear after birth.

Post-partum depression

Symptoms can range from mild to severe pervasive sadness and labile mood swings, with women having good days and bad days. Father can also experience this. Screening for this should be performed on both of the parents. This can go undetected because new parents generally do not voluntarily admit to this kind of emotional distress out of embarrassment, guilt, or fear.

Second period of reactivity (4-8 h PP)

Tachycardia and tachypnea occur, meconium passes (newborns first poop!) Increased muscle tone, changes in skin color, mucous production (coughing up a lot of gunk from being in utero). A lot of bonding and feeding

Which time-based description of a stage of development in pregnancy is correct?

Termpregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdateor postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

Why might it be more difficult to diagnose appendicitis during pregnancy?

The appendix is displaced upward and laterally, high and to the right. The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurneys point and is not displaced in a downward direction.

A woman who is 16 weeks pregnant asks the nurse, Is it possible to tell by ultrasound if the baby is a boy or girl yet? What is the best answer?

The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan. Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

Gastroschisis

The baby's intestines are found outside of the baby's body, exiting through a hole beside the belly button. Is the herniation of the bowel through a defect in the abdominal wall to the right of the umbilical cord.

What is important for the nurse to recognize regarding the new father and his acceptance of the pregnancy and preparation for childbirth?

The father goes through three phases of acceptance of his own. A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. During the last 2 months of the pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant fathers ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

30 minutes - 1 hour.

The first period of reactivity happens _________. It is the most alertness for the baby right after baby is born.

14 days

The fundus will go down 1 centimeter per day, after ______ days the fundus should be non palpable

c. HELLP syndrome. HELLP syndrome is a laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). Eclampsia is determined by the presence of seizures. DIC is a potential complication associated with HELLP syndrome. Idiopathic thrombocytopenia is the presence of low platelets of unknown cause and is not associated with preeclampsia.

The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the Pitocin infusion, the nurse reviews the woman's latest laboratory test findings, which reveal a platelet count of 90,000, an elevated aspartate transaminase (AST) level, and a falling hematocrit. The nurse notifies the physician because the laboratory results are indicative of: a. Eclampsia. b. Disseminated intravascular coagulation (DIC). c. HELLP syndrome. d. Idiopathic thrombocytopenia.

b. Intense abdominal pain.

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. Bleeding. c. Uterine activity. b. Intense abdominal pain. d. Cramping.

B

The nurse is assessing a newborn at 5 hours of age and finds a soft mass over the infant's occiput. The soft mass crosses the suture line. The nurse documents this finding as which of the following? a. Subgaleal hemorrhage b. Caput succedaneum c. Cephalhematoma d. Hydrocephalus

b. Caput succedaneum

The nurse is assessing a newborn at 5 hours of age and finds a soft mass over the infant's occiput. The soft mass crosses the suture line. The nurse documents this finding as which of the following? a. Subgaleal hemorrhage b. Caput succedaneum c. Cephalhematoma d. Hydrocephalus

During the initial visit with a client who is beginning prenatal care, which action should be the highest priority for the nurse?

The nurse should be alert to the appearance of potential parenting problems, such as depression or lack of family support. Besides these potential problems, the nurse needs to be alert to the womans attitude toward keeping regular health care appointments. If the client lacks insurance, then the nurse may be able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants, and Children [WIC]; Medicaid). The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. The nurse must be sensitive to special problems; he or she should inquire because discovering individual needs is important. A client with a chronic or handicapping condition might forget to mention it because she has adapted to it. Obtaining information on drug use is important and can be confidentially done. Actual testing for drug use requires the clients consent.

b. "The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult."

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

A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, How does my baby get air inside my uterus? What is the correct response by the nurse?

The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream. The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a womans blood system; rather, blood and gas transport occur through the placenta.

c

The primary purpose of administering magnesium sulfate to women with severe preeclampsia is to: A. Lower blood pressure. B. Relieve headache C. Prevent eclamptic seizures D. Improve placental perfusion

Unplanned C-Section:

The psychosocial outcomes of unplanned or emergency cesarean birth are usually more pronounced and negative when compared with the outcomes associated with a scheduled or planned cesarean birth. Women and their families experience abrupt changes in their expectations for birth, postpartum care, ad the care of the new baby at home. This may be an extremely traumatic experience for all. The woman may approach the procedure tired and discouraged after an ineffective and difficult labor.

involution

The return of the uterus to a non pregnant state after birth. This process begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle.

Preeclampsia

This can happen up to 6 weeks after the baby is born Protein in urine, HTN S/S- stomach pain, N/V, swelling in hands and feet, headaches, vision changes, SOB

Postpartum depression

This happens further out... takes weeks to show up Begin any time in the first year- last longer and more severe Thoughts of harming self and baby No interest in baby

Premature Preterm Rupture of Membranes (PPROM)

This is managed before 32 weeks is usually managed expectantly because the risks to the fetus and infant associated with preterm birth are considered to be greater than the risks of infection. Women will be hospitalized in order to prolong the pregnancy and allow for more fetal development, unless there is intrauterine infection, significant vaginal bleeding, placental abruption, preterm labor, or fetal compromise occur

Magnesium sulfate

This is the drug of choice in the prevention and treatment seizure activity caused by severe preeclampsia or eclampsia. It is almost always administered IV as a secondary infusion

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client?

This respiratory change is normal in pregnancy and caused by an elevated level of estrogen. Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

C. Involution period

Time between birth of the newborn and return of the reproductive organs to non pregnant state? a. Lochia period b. Mini-tri c. Involution period d. Puerperium (fourth stage)

The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise?

To determine whether the nipple is everted or inverted Sometimes known as the pinch test, this exercise is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples, nor is it not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose?

To protect the mother and fetus during pregnancy Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the evil eye may be specific to one particular culture; however, it is not the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind cultural rituals.

Cardiac output increases from 30% to 50% by the 32nd week of pregnancy. What is the rationale for this change?

To provide adequate perfusion of the placenta The primary function of increased vascular volume is to transport oxygen and nutrients to the fetus via the placenta. Renal plasma flow increases during pregnancy. Assisting with pulling metabolic wastes from the fetus for maternal excretion is one purpose of the increased vascular volume.

What is the primary role of the nonpregnant partner during pregnancy?

To support and nurture the pregnant woman The partners primary role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. Although financial support is important, it is not the partners primary role in pregnancy. Protecting the pregnant woman from old wives tales is not the partners role. The womans partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy.

Babinski***

Toes fan out as nurse brushes tip of thumb upward on bottom on foot

Cervical insufficiency dx:

Transvaginal ultrasound, pelvic exam, lab tests, cervical funneling

Hemabate Methergine Pitocin Fundal massage

Treatment medications for PPH (postpartum hemorrhage):

According to the Gate Control Theory, applying a stimulus during labor such as heat, cold or pressure can block transmission of pain sensations to the brain. True False

True

A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide?

Tub bathing is permitted even in late pregnancy unless membranes have ruptured. The primary danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

Which statement regarding multifetal pregnancy is incorrect?

Twin pregnancies come to term with the same frequency as single pregnancies. Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

Chorioamnionitis Tx:

Tx: prompt treatment with broad spectrum IV antibiotics and birth of the fetus are necessary. Ampicillin or penicillin and gentamicin most often used treat chorio during labor. After C-section, and antibiotic that covers anaerobic organisms, such as clindamycin or metronidazole, should be added. Also use prophylactic antibiotic tx for women who are GBS positive.

Tetrology of Fallot

Type of cyanotic congenital heart defect that results in an abnormal opening between the ventricles, pulmonary stenosis, overriding aorta, and right ventricular hypertrophy

Von Willebrand Dx

Type of hemophilia, most common of all hereditary bleeding disorders. Results from a deficiency or defect in the blood clotting protein vWF. Symptoms include recurrent bleeding episodes such as nosebleeds or after tooth extraction

Number of voids...

Typically matches the number of days old of the newborn

S/s of ectopic pregnancy:

Typically s/s occur 6 to 8 weeks after the last normal menstrual period The three most classic symptoms are the following: Abdominal pain Delayed menses Abnormal vaginal bleeding (spotting)

a. Infant is dusky and turns cyanotic when crying

Under which circumstance should the nurse immediately alert the pediatric provider? a. Infant is dusky and turns cyanotic when crying b. Acrocyanosis is present 1 hour after childbirth c. The infant's blood glucose level is 45 mg/dl d. The infant goes into a deep sleep 1 hour after childbirth

L/S Ratio

Used to determine fetal lung maturity When LS ratio is 2:1 an infants lungs are considered mature. Use amniocentesis to see if lungs are mature or not

Chorioamnionitis Dx:

Usually dx by clinical findings of maternal fever, maternal and fetal tachycardia, uterine tenderness, and foul odor of amniotic fluid.

Risk for VBAC:

Uterine scar separates, uterine rupture hysterectomy surgical incisions infant death neuro complications

Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider?

Vaginal bleeding Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it is not usually an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be taught that urinary frequency is normal.

A new mother asks the nurse about the white substance covering her infant. How should the nurse explain the purpose of vernix caseosa?

Vernix caseosa protects the fetal skin from the amniotic fluid. Prolonged exposure to the amniotic fluid during the fetal period could result in the breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system was dependent on nutritional intake of the mother. The amnion was the inner membrane that surrounded the fetus and was not involved in the oxygen and nutrient exchange. The amniotic fluid helped maintain fetal temperature.

Which development related to the integumentary system is correct?

Very fine hairs called lanugo appear at 12 weeks of gestation. Very fine hairs, called lanugo appear first at 12 weeks of gestational age on the fetus eyebrows and upper lip. By 20 weeks of gestation, lanugo covers the entire body. By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow. By 28 weeks of gestation, the scalp hair is longer than these fine hairs, which is thin and may disappear by term. Fingernails and toenails develop from thickened epidermis, beginning during the 10th week. Fingernails reach the fingertips at 32 weeks of gestation, and the toenails reach the toe tips at 36 weeks of gestation.

Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings?

Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract. Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

d. respiratory rate of <25/min Normal RR is between 30-60/min

What is an abnormal finding in an assessment for a newborn? a. blood sugar of 45 b. HR of 160 c. dark green stool d. respiratory rate of <25/min

The mouth because when you touch the nose, they naturally makes them reflex and gasp in their mouth and if they have any fluids in their mouth they can aspirate that

What is suctioned first, the nose or the mouth?

a. Abdominal with synchronous chest movements

What is the predominate pattern of newborn's breathing? a. Abdominal with synchronous chest movements b. Chest breathing with nasal flaring c. Deep with a regular rhythm

Stop the magnesium and give Calcium gluconate or calcium chloride

What is the reversal for magnesium sulfate?

On their back

What is the safest way for a newborn to sleep?

ANS: C Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Bleeding time of 10 minutes b. Thrombocytopenia c. Presence of fibrin split products d. Hyperfibrinogenemia

Methotrexate

What medication is given to tx an ectopic pregnancy?

b. Total placenta previa In total placenta previa, the placenta completely covers the cervical os. The fetus would die if a vaginal delivery occurred. If the mother has stable vital signs and the fetus is alive, a vaginal delivery can be attempted in cases of partial abruptio placentae. If the fetus has died, a vaginal delivery is preferred. The most common ectopic pregnancy is a tubal pregnancy, which is usually detected and treated in the first trimester. Labor can be safely induced if the eclampsia is under control.

Which maternal condition always necessitates delivery by cesarean section? a. Partial abruptio placentae c. Ectopic pregnancy b. Total placenta previa d. Eclampsia

c. A woman who has had multiple children

Which mom would be most likely to experience strong contractions after delivery? a. A woman who experienced oligohydramnios b. A woman who is bottle-feeding her infant c. A woman who has had multiple children d. A woman whose infant weighed 5 pounds

a

Which vital sign deviates from the normal reading as a result of puerperal sepsis? a. Temperature b. Respirations c. Blood pressure (BP) d. Pulse

F. Pre-rupturing of membranes. Rationale: It might impact the birth weight of the baby at that point, but the baby is growing great up until her pre-rupturing of membranes. Example: Baby is growing great up until 35 weeks because the mother has pre-rupturing of her membranes. It may cause her to have the baby at like 5 pounds, but the baby won't have IUGR, but the baby will be born at a typical gestational age at 35 weeks. However, if the mom was a smoker and gave birth at 38 weeks and the baby was 5 pounds, that would be something that would make that baby grow small inside uterine.

Which would not be a restrictive factor in IUGR: a. Oligohydramnios b. Drug use c. Environmental factors d. Smoking f. Pre-rupturing of membranes

Pre-rupturing of membranes. Rationale: It might impact the birth weight of the baby at that point, but the baby is growing great up until her pre-rupturing of membranes. Example: Baby is growing great up until 35 weeks because the mother has pre-rupturing of her membranes. It may cause her to have the baby at like 5 pounds, but the baby won't have IUGR, but the baby will be born at a typical gestational age at 35 weeks. However, if the mom was a smoker and gave birth at 38 weeks and the baby was 5 pounds, that would be something that would make that baby grow small inside uterine.

Which would not be a restrictive factor in IUGR: a. Oligohydramnios b. Drug use c. Environmental factors d. Smoking f. Pre-rupturing of membranes

Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide?

While working or traveling in a car or on an airplane, women should arrange to walk around at least every hour or so. Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurses best answer?

Within the next month, you should start to feel fluttering sensations. Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, you should have felt the baby move by now is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient?

Womans increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

Which client might be well advised to continue condom use during intercourse throughout her pregnancy?

Women at risk for acquiring or transmitting STIs The objective of safer sex is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and then to her fetus, condom use is recommended throughout the pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice safer sex behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. The client should be educated as to what may place both herself and her fetus at risk. Any pregnant woman can develop candidiasis, which is an infection not related to condom use.

What should the nurse be cognizant of concerning the clients reordering of personal relationships during pregnancy?

Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father of the child. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings to one another. The second trimester is the time when a womans sense of well-being, along with certain physical changes, increases her desire for sex. Sexual desire is down in the first and third trimesters.

b

Women with hyperemesis gravidarum: a. Are a majority, because 80% of all pregnant women suffer from it at some time b.Have vomiting severe and persistent enough to cause weight loss, dehydration, and electrolyte imbalance c.Need IV fluid and nutrition for most of their pregnancy d. Often inspire similar, milder symptoms in their male partners and mothers

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of the exercise on the fetus. Which guidance should the nurse provide?

You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month. Typically, running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

A woman who is 8 months pregnant asks the nurse, Does my baby have any antibodies to fight infection? What is the most appropriate response by the nurse?

Your baby has IgG and IgM. During the third trimester, IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester. IgA immunoglobulins are not produced by the baby. Therefore, by the third trimester, the fetus has both IgG and IgM. Breastfeeding supplies the newborn infant with IgA.

Marked diuresis

__________________________, decreased bladder sensitivity, and overdistention of the bladder can lead to problems with urinary elimination. If they're not losing that water weight, have to assess what's going on and why they aren't losing it.

Miscarriage (spontaneous abortion)

a pregnancy that ends as a result of natural causes before 20 weeks of gestation

A woman gave birth to 7lb 6oz girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500ml. When assessing the woman's vitals signs the nurse is concerned to see: a. Temperature 37.9 C, heart rate 120, respirations 20, blood pressure 90/50 b. Temperature 37.4 C, heart rate 88, respirations 36, blood pressure 126/68 c.Temperature 38.0 C, heart rate 80, respirations 16, blood pressure 110/80 d. Temperature 36.8 C, heart rate 60, respirations 18, blood pressure 140/90

a. Temperature 37.9 C, heart rate 120, respirations 20, blood pressure 90/50 Rationale: An EBL of 1500 ml with tachycardia and hypotension suggest hypovolemia caused by excessive blood loss.

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

a. Ultrasound for placental location

The nurse recognizes that a nonstress test (NST) in which two or more fetal heart rate (FHR) accelerations of 15 beats/min or more occur with fetal movement in a 20-minute period is: a. Reactive b. Positive c. Nonreactive d. Negative

a. reactive

Which condition, not uncommon in pregnancy, is likely to require careful medical assessment during the puerperium? a. Varicosities of the legs b. Carpal tunnel syndrome c. Periodic numbness and tingling of the fingers d. Headaches

d. Headaches Rationale: Headaches in the postpartum period can have a number of causes, some of which deserve medical attention. Periodic numbness of the fingers usually disappears after birth unless carrying the baby aggravates the condition.

A new father states, "I know nothing about babies," but he seems to be interested in learning. This is an ideal opportunity for the nurse to: a. Continue to observe his interaction with the newborn. b. Tell him when he does something wrong. c. Show no concern, as he will learn on his own. d. Include him in teaching sessions.

d. Include him in teaching sessions.

A 30-year-old multiparous woman has a boy who is 2 ½ years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home." Which suggestion would best help this woman alleviate sibling rivalry? a. Tell the older child that he is a big boy now and should love his new sister. b. Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn. c. Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him. d. Realize that the regression in habits and behaviors in the older child is a typical reactions and that he needs extra love and attention at this time.

d. Realize that the regression in habits and behaviors in the older child is a typical reactions and that he needs extra love and attention at this time.

A nurse is observing a family. The mother is holding the baby she delivered less than 24 hours ago. Her husband is watching his wife and asking questions about newborn care. The 4-year-old brother is punching his mother on the back. The nurse should: a. Report the incident to the social services department. b. Advise the parents that the toddler needs to be reprimanded. c. Report to oncoming staff that the mother is probably not a good disciplinarian. d. Realize that this is a normal family adjusting to family change.

d. Realize that this is a normal family adjusting to family change.

To provide optimum care for the postpartum woman, the nurse understands that the most common causes of subinvolution are: a. Postpartum hemorrhage and infection b. Multiple gestation and postpartum hemorrhage c. Uterine tetany and overproduction of oxytocin d. Retained placental fragments and infection

d. Retained placental fragments and infection Rationale: Subinvolution is failure of the uterus to return to a nonpregnant state. The most common causes of subinvolution are retained placental fragments and infection. Subinvolution may be caused by infection and result in hemorrhage.

Suppression of uterine activity medications interventions for preterm labor:

▪ (tocolytics) are given to arrest labor after uterine contractions and cervical change have happened. These do not reduce the rate of preterm births but delay the birth long enough for the mother to be transferred to a hospital and to be given corticosteroids to reach maximum benefit to reduce neonatal morbidity ▪ Most common is mag sulfate. It depresses the CNS so assess respirations, deep tendon reflexes, and LOC to identify if the mag levels are too high. Less side effects than beta adrenergic agonists ▪ Nifedipine is a calcium channel blocker that suppresses contractions. ▪ beta adrenergic agonist (ritodrine and terbutaline) have side effects like tachycardia and hyperglycemia. Contraindicated in those with heart disease, preeclampsia, diabetes, or hyperthyroidism. ●Terbutaline relaxes uterine smooth muscle and is used often ▪off-label meds such as those drugs that treat asthma, HTN, or are anti inflammatories suppress preterm labor

Interventions to promote fetal lung maturity for preterm birth

▪ Give antenatal glucocorticoids IM injection to mom in order to accelerate fetal lung maturity by stimulating fetal surfactant production. ▪ All women between 24 - 34 weeks who are at risk for preterm within 7 days should receive this. Benefit begins within 24 hours of the injection

Prevention interventions for preterm labor:

▪ Primary prevention such as education, preconception counseling, especially if there is a hx of preterm birth. ▪ smoking cessation ▪ administration of prophylactic progesterone

Chorioamnionitis risks:

▪ Women with this can develop bacteremia, at risk for dysfunctional labor, which could mean they need a C-section, which puts them at risk for a pelvic abscess or wound infection. ▪ Neonatal risks include pneumonia, bacteremia, and sepsis. Death more likely to occur in preterm infants than in term infants.

Lifestyle modifications for preterm labor

▪ activity restriction ▪ restriction of sex ▪ home care for those at risk for preterm babies

Causes of RDS:

▪ diabetic mother ▪ rapid delivery ▪ occurs in infants whose lungs have not yet fully developed. ▪ mainly caused by a lack of a slippery substance in the lungs called surfactant. This substance helps the lungs fill with air and keeps the air sacs from deflating. Surfactant is present when the lungs are fully developed.

Interventions for SGA (small for gestational age) infants

▪ keep warm & prevent cold stress ▪ maintain airway ▪ oral feedings ▪ nursing support = same as preterm babies

Management of inevitable preterm birth:

▪ magnesium sulfate is given to reduce or prevent neonatal neurologic morbidity (cerebral palsy). This is given to those who are at least 24 weeks but less than 32 weeks at the time birth is expected to occur. ▪ breech position is common in preterm and small babies can be born through a partially dilated cervix. ▪ a resuscitation materials should be present at the birth

Pitocin

▪ stimulates contractions and aids in milk let-down. ▪ goal is to produce contractions of normal intensity and frequency using the lowest dose possible. It can also control postpartum bleeding. ▪ possible maternal problems are placental abruption, uterine rupture, unnecessary C-sections due to abnormal fetal heart rate patterns, postpartum hemorrhage, hyponatremia, uterine tachysystole, and infection ▪ possible fetal problems are hypoxemia and acidosis which results in abnormal heart rate ▪ monitor respirations, pulse and BP every 30-60 mins and with every dose change ▪ assess fetal status and contraction pattern every 15 minutes and with every dose change and every 5 minutes during the second stage of labor ▪ usually the med can be either decreased or discontinued when the membranes rupture or in the active first stage of labor

Early recognition interventions for preterm labor:

▪ transfer mother before birth to hospital that can handle preterm ▪ giving antibiotics during labor to prevent neonatal group B streptococci infection ▪ give glucocorticoids to mom in labor in order to prevent or reduce neonatal mortality or morbidity from problems such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis ▪ give mag sulfate to women birthing before 32 weeks to reduce the incidence of cerebral palsy in infants ▪ should assess for signs of preterm labor at each prenatal visit

Preeclampsia lab profile

-hemoglobin/hematocrit may increase -pt/ptt unchanged (NOT AN INDICATOR) -BUN increased -platelets under 1,000 -uric acid greater than 5.9

Nurse the baby is she's breastfeeding, if mom is not breast feeding then bind the breasts

A new mom is dealing with engorgement, as a nurse what do you recommend her to do?

All pregnant women should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause. A. Severe vomiting in early pregnancy B. Epigastric pain in late pregnancy C. Severe backache and flank pain D. Decreased fetal movement E. Glycosuria 1. Fetal jeopardy or intrauterine fetal death 2. Kidney infection or stones 3. Gestational diabetes 4. Hyperemesis gravidarum 5. Hypertension, preeclampsia

1. D (Fetal jeopardy or intrauterine fetal death= Decreased fetal movement) 2. C (Kidney infection or stones= Severe backache and flank pain) 3. E (Gestational diabetes= Glycosuria) 4. A (Hyperemesis gravidarum= Severe vomiting in early pregnancy) 5. B (Hypertension, preeclampsia= Epigastric pain in late pregnancy) Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy.

a. Acrocyanosis

A new mother states that her infant must be cold because the baby's hands and feet are blue: a. Acrocyanosis b. Erythema toxic neonatorum c. Harlequin sign d. Vernix caseosa

d. Placental abruption. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption. Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.

11. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. Eclamptic seizure. c. Placenta previa. b. Rupture of the uterus. d. Placental abruption.

Awake HR

120-140bpm

Oxytocic:

classification of medication that stimulates the uterus to contract (a uterotonic)

Hydatidiform mole (molar pregnancy)

A noncancerous tumor that develops in the uterus as a result of a nonviable pregnancy. There may or may not be an embryo or placental tissue present. If there is an embryo, it unfortunately won't be able to survive

A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time?

24 hours Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

b. Intense abdominal pain.

24. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. Bleeding. c. Uterine activity. b. Intense abdominal pain. d. Cramping.

At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at todays visit?

28 These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs?

2:1 The L/S ratio indicates a 2:1 ratio of lecithin to sphingomyelin, which is an indicator of fetal lung maturity and occurs at approximately the middle of the third trimester. L/S ratios of 1.4:1, 1.8:1, and 1:1 each indicate immaturity of the fetal lungs.

A womans obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system?

4-1-2-0-4 Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this womans gravidity and parity. The numbers reflect the womans gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L signifies the number of children born who are currently living; the woman has four children. 3-1-1-1-3 is an incorrect calculation of this womans gravidity and parity; 3-0-3-0-3 is an incorrect calculation of this womans gravidity and parity; and 4-2-1-0-3 is an incorrect calculation of this womans gravidity and parity.

a. Administration of blood

5. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? a. Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d.Administration of steroids

In most healthy newborns, blood glucose levels stabilize at _________ mg/dL during the first hours after birth:

50 to 60 In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. A blood sugar level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life, the blood glucose levels should be approximately 60 to 70 mg/dL.

To provide optimal prenatal care, a blood pressure reading should be obtained at every prenatal visit. Calculating the mean arterial pressure (MAP) can increase the value of this diagnostic finding. MAP readings for a pregnant woman at term are 90+ = 5.8 mm Hg. The nurse has just obtained a BP of 106/70 mm Hg on a 37-week primiparous client. The formula for the MAP reading is (systolic + [2 diastolic]) 3. The MAP reading for this client is _____ mm Hg.

82 (106 + [2 70]) 3 (106 + 140) 3 246 3 = 82 mm Hg The MAP can also be thought of as the mean of the blood pressure present in arterial circulation.

b. Ultrasound for placental location The presence of painless bleeding should always alert the health care team to the possibility of placenta previa. Don't do a vaginal check, do an ultrasound to see where the placenta is lying

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

d. Biorhythmicity

A baby soothed by being held in a position in which the newborn can hear the mother's heartbeat? a. Entrainment b. Reciprocity c. Synchrony d. Biorhythmicity

Jaundice

A baby who has a hemorrhage (trauma), such as bruising on the face because of trauma or got pulled out so they have the vacuumed head (Caput succedaneum) that has extra RBCs... They have extra blood pooling, the liver has to break down those RBCs, so what is this baby at an increased risk for?

c. Breastfeeds her infant every 2 hours.

A breastfeeding woman develops engorged breasts at 3 days' postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman: a. Skips feedings to let her sore breasts rest. b. Avoids using a breast pump. c. Breastfeeds her infant every 2 hours. d. Reduces her fluid intake for 24 hours.

Fetal Fibronectin test -what is it used for?

A diagnostic test for preterm labor. fFN is a glycoprotein glue usually found in plasma and produced during fetal life. Normally appears in cervical and vaginal secretions early in pregnancy and then again in late pregnancy. Test is performed by collecting fluid from the woman's vagina using a swab during a speculum examination. Presence of fFN during late second and early third tri may be related to placental inflammation, which is thought to be a cause of spontaneous preterm labor. Often the test is used to predict who will NOT go into preterm labor because preterm labor is very unlikely to occur in women with a negative result

b. Worsening disease and impending convulsion. Headache and visual disturbances are caused by increased cerebral edema. Epigastric pain indicates distention of the hepatic capsules and often warns that a convulsion is imminent. These are danger signs showing increased cerebral edema and impending convulsion and should be treated immediately. The patient has not been started on magnesium sulfate treatment yet. Also, these are not anticipated effects of the medication.

A patient with pregnancy-induced hypertension is admitted complaining of pounding headache, visual changes, and epigastric pain. Nursing care is based on the knowledge that these signs are an indication of: a. Anxiety due to hospitalization. b. Worsening disease and impending convulsion. c. Effects of magnesium sulfate. d. Gastrointestinal upset

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

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

Placental abruption

A serious pregnancy complication in which there is detachment of part or all of placenta from implantation site after 20 weeks of gestation

With regard to primary and secondary powers, the maternity nurse should understand that: A. Primary powers are responsible for effacement and dilation of the cervix B. Effacement generally is well ahead of dilation in women giving birth for the first time; they are more together in subsequent pregnancies C. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation D. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs

A: The primary powers are responsible for dilation and effacement; secondary powers are concerned with expulsion of the fetus.

When managing the care of a woman in the second stage of labor, the nurse uses various measures to enhance the progress of fetal descent. These measures include: A. Encouraging the woman to try various upright positions, including squatting and standing B. Telling the woman to start pushing as soon as her cervix is fully dilated C. Continuing an epidural anesthetic so that pain is reduced and the woman can relax D. Coaching the woman to use sustained, 10- to 15-second, closed-glottis bearing-down efforts with each contraction

A: Upright positions and squatting may enhance the progress of fetal descent.

16. The nurse caring for pregnant women must be aware that the most common medical complication of pregnancy is: a. Hypertension. c. Hemorrhagic complications. b. Hyperemesis gravidarum. d. Infections.

ANS: A Preeclampsia and eclampsia are two noted deadly forms of hypertension. A large percentage of pregnant women will have nausea and vomiting, but a relatively few have the severe form called hyperemesis gravidarum. Hemorrhagic complications are the second most common medical complication of pregnancy; hypertension is the most common.

A client at 39 weeks of gestation has been admitted for an external version. Which intervention would the nurse anticipate the provider to order? a. Tocolytic drug b. Contraction stress test (CST) c. Local anesthetic d. Foley catheter

ANS: A A tocolytic drug will relax the uterus before and during the version, thus making manipulation easier. CST is used to determine the fetal response to stress. A local anesthetic is not used with external version. Although the bladder should be emptied, catheterization is not necessary.

33. Spontaneous termination of a pregnancy is considered to be an abortion if: a. The pregnancy is less than 20 weeks. b. The fetus weighs less than 1000 g. c. The products of conception are passed intact. d. No evidence exists of intrauterine infection.

ANS: A An abortion is the termination of pregnancy before the age of viability (20 weeks). The weight of the fetus is not considered because some older fetuses may have a low birth weight. A spontaneous abortion may be complete or incomplete. A spontaneous abortion may be caused by many problems, one being intrauterine infection.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg intramuscular (IM) doses of betamethasone. What is the purpose of this pharmacologic intervention? a. To stimulate fetal surfactant production b. To reduce maternal and fetal tachycardia associated with ritodrine administration c. To suppress uterine contractions d. To maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy

ANS: A Antenatal glucocorticoids administered as IM injections to the mother accelerate fetal lung maturity. Propranolol (Inderal) is given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate is given to reverse the respiratory depressive effects of magnesium sulfate therapy.

37. The priority nursing intervention when admitting a pregnant woman who has experienced a bleeding episode in late pregnancy is to: a. Assess fetal heart rate (FHR) and maternal vital signs b. Perform a venipuncture for hemoglobin and hematocrit levels c. Place clean disposable pads to collect any drainage d. Monitor uterine contractions

ANS: A Assessment of the FHR and maternal vital signs will assist the nurse in determining the degree of the blood loss and its effect on the mother and fetus. The most important assessment is to check mother/fetal well-being. The blood levels can be obtained later. It is important to assess future bleeding; however, the top priority remains mother/fetal well-being. Monitoring uterine contractions is important but not the top priority.

5. In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? a. Administration of blood b. Preparation of the client for invasive hemodynamic monitoring c. Restriction of intravascular fluids d. Administration of steroids

ANS: A Primary medical management in all cases of DIC involves correction of the underlying cause, volume replacement, blood component therapy, optimization of oxygenation and perfusion status, and continued reassessment of laboratory parameters. Central monitoring would not be ordered initially in a client with DIC because this can contribute to more areas of bleeding. Management of DIC would include volume replacement, not volume restriction. Steroids are not indicated for the management of DIC.

35. Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (Select all that apply): a. Unwrapping the infant. b. Changing the diaper. c. Talking to the infant. d. Slapping the infant's hands and feet. e. Applying a cold towel to the infant's abdomen.

ANS: A, B, C Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant. Slapping the infant's hand and feet and applying a cold towel to the infant's abdomen are not appropriate. The parent can rub the infant's hands or feet to wake the infant. Applying a cold towel to the infant's abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant's face to wake the infant.

15. What nursing diagnosis would be the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to the fetus related to uteroplacental insufficiency b. Risk for eclampsia c. Risk for deficient fluid volume related to increased sodium retention secondary to administration of MgSO4 d. Risk for increased cardiac output related to use of antihypertensive drugs

ANS: A Risk for injury to the fetus related to uteroplacental insufficiency is the most appropriate nursing diagnosis for this client scenario. Other diagnoses include Risk to fetus related to preterm birth and abruptio placentae. Eclampsia is a medical, not a nursing, diagnosis. There would be a risk for excess, not deficient, fluid volume related to increased sodium retention. There would be a risk for decreased, not increased, cardiac output related to the use of antihypertensive drugs.

4. In caring for an immediate postpartum client, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder: a. Disseminated intravascular coagulation (DIC) b. Amniotic fluid embolism (AFE) c. Hemorrhage d. HELLP syndrome

ANS: A The diagnosis of DIC is made according to clinical findings and laboratory markers. Physical examination reveals unusual bleeding. Petechiae may appear around a blood pressure cuff on the woman's arm. Excessive bleeding may occur from the site of slight trauma such as venipuncture sites. These symptoms are not associated with AFE, nor is AFE a bleeding disorder. Hemorrhage occurs for a variety of reasons in the postpartum client. These symptoms are associated with DIC. Hemorrhage would be a finding associated with DIC and is not a clotting disorder in and of itself. HELLP is not a clotting disorder, but it may contribute to the clotting disorder DIC.

A pregnant woman's amniotic membranes have ruptured. A prolapsed umbilical cord is suspected. What intervention would be the nurse's highest priority? a. Placing the woman in the knee-chest position b. Covering the cord in sterile gauze soaked in saline c. Preparing the woman for a cesarean birth d. Starting oxygen by face mask

ANS: A The woman is assisted into a modified Sims position, Trendelenburg position, or the knee-chest position in which gravity keeps the pressure of the presenting part off the cord. Although covering the cord in sterile gauze soaked saline, preparing the woman for a cesarean, and starting oxygen by face mark are appropriate nursing interventions in the event of a prolapsed cord, the intervention of top priority would be positioning the mother to relieve cord compression.

What are the complications and risks associated with cesarean births? (Select all that apply.) a. Pulmonary edema b. Wound dehiscence c. Hemorrhage d. Urinary tract infections e. Fetal injuries

ANS: A, B, C, D, E Pulmonary edema, wound dehiscence, hemorrhage, urinary tract infections, and fetal injuries are possible complications and risks associated with cesarean births.

36. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion (Select all that apply)? a. Breast tenderness b. Warmth in the breast c. An area of redness on the breast often resembling the shape of a pie wedge d. A small white blister on the tip of the nipple e. Fever and flulike symptoms

ANS: A, B, C, E Breast tenderness, breast warmth, breast redness, and fever and flulike symptoms are commonly associated with mastitis and should be included in the nurse's discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in women who have a plugged milk duct.

45. The reported incidence of ectopic pregnancy in the United States has risen steadily over the past 2 decades. Causes include the increase in STDs accompanied by tubal infection and damage. The popularity of contraceptive devices such as the IUD has also increased the risk for ectopic pregnancy. The nurse who suspects that a patient has early signs of ectopic pregnancy should be observing her for symptoms such as (Select all that apply): a. Pelvic pain b. Abdominal pain c. Unanticipated heavy bleeding d. Vaginal spotting or light bleeding e. Missed period

ANS: A, B, D, E A missed period or spotting can easily be mistaken by the patient as early signs of pregnancy. More subtle signs depend on exactly where the implantation occurs. The nurse must be thorough in her assessment because pain is not a normal symptom of early pregnancy. As the fallopian tube tears open and the embryo is expelled, the patient often exhibits severe pain accompanied by intraabdominal hemorrhage. This may progress to hypovolemic shock with minimal or even no external bleeding. In about half of women, shoulder and neck pain results from irritation of the diaphragm from the hemorrhage.

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

ANS: B A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression from magnesium toxicity. Because magnesium sulfate is a central nervous system depressant, the client will most likely become sedated when the infusion is initiated. Deep tendon reflexes of 2 and absent ankle clonus are normal findings.

3. What laboratory marker is indicative of disseminated intravascular coagulation (DIC)? a. Bleeding time of 10 minutes c. Thrombocytopenia b. Presence of fibrin split products d. Hyperfibrinogenemia

ANS: B Degradation of fibrin leads to the accumulation of fibrin split products in the blood. Bleeding time in DIC is normal. Low platelets may occur with but are not indicative of DIC because they may result from other coagulopathies. Hypofibrinogenemia would occur with DIC.

23. The breastfeeding mother should be taught a safe method to remove the breast from the baby's mouth. Which suggestion by the nurse is most appropriate? a. Slowly remove the breast from the baby's mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infant's mouth. c. A popping sound occurs when the breast is correctly removed from the infant's mouth. d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.

ANS: B Inserting a finger into the corner of the baby's mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in "chewing" on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the baby's mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

2. A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. The nurse can explain to him that beginning solid foods before 4 to 6 months may: a. Decrease the infant's intake of sufficient calories. b. Lead to early cessation of breastfeeding. c. Help the infant sleep through the night. d. Limit the infant's growth.

ANS: B Introduction of solid foods before the infant is 4 to 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

34. An abortion in which the fetus dies but is retained within the uterus is called a(n): a. Inevitable abortion c. Incomplete abortion b. Missed abortion d. Threatened abortion

ANS: B Missed abortion refers to retention of a dead fetus in the uterus. An inevitable abortion means that the cervix is dilating with the contractions. An incomplete abortion means that not all of the products of conception were expelled. With a threatened abortion the woman has cramping and bleeding but not cervical dilation.

24. The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. Bleeding. c. Uterine activity. b. Intense abdominal pain. d. Cramping.

ANS: B Pain is absent with placenta previa and may be agonizing with abruptio placentae. Bleeding may be present in varying degrees for both placental conditions. Uterine activity and cramping may be present with both placental conditions.

Eclampsia

AT 32 weeks of gestation,Maria--- with hypertension since 28 weeks, hyperactive deep tendon reflexes (DTRs) with clonus, and proteinuria of 4+ --- has a convulsion. What is her diagnosis?

Cervical insufficiency

An incompetent cervix, occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.

Steady pressure applied against the laboring woman's sacrum by the nurse or coach using the fist or heel of the hand or a firm object (e.g. tennis ball); it is especially helpful during back labor. A. Cross pressure B. Counter pressure C. Holding pressure D. Steady pressure

B. Counter pressure

1. A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until her infant is crying frantically. On the basis of this information, this woman should feed her infant about every 2.5 to 3 hours when she: a. Waves her arms in the air. c. Has hiccups. b. Makes sucking motions. d. Stretches her legs out straight.

ANS: B Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues. Waving the arms in the air, hiccupping, and stretching the legs out straight are not typical feeding-readiness cues.

Which nursing intervention is paramount when providing care to a client with preterm labor who has received terbutaline? a. Assess deep tendon reflexes (DTRs). b. Assess for dyspnea and crackles. c. Assess for bradycardia. d. Assess for hypoglycemia.

ANS: B Terbutaline is a beta2-adrenergic agonist that affects the mother's cardiopulmonary and metabolic systems. Signs of cardiopulmonary decompensation include adventitious breath sounds and dyspnea. An assessment for dyspnea and crackles is important for the nurse to perform if the woman is taking magnesium sulfate. Assessing DTRs does not address the possible respiratory side effects of using terbutaline. Since terbutaline is a beta2-adrenergic agonist, it can lead to hyperglycemia, not hypoglycemia. Beta2-adrenergic agonist drugs cause tachycardia, not bradycardia.

20. The process whereby parents awaken the infant to feed every 3 hours during the day and at least every 4 hours at night is: a. Known as demand feeding. b. Necessary during the first 24 to 48 hours after birth. c. Used to set up the supply-meets-demand system. d. A way to control cluster feeding.

ANS: B The parents do this to make sure that the infant has at least eight feedings in 24 hours. Demand feeding is when the infant determines the frequency of feedings; this is appropriate once the infant is feeding well and gaining weight. The supply-meets-demand system is a milk production system that occurs naturally. Cluster feeding is not a problem if the baby has eight feedings in 24 hours.

Fetal breathing movement, fetal body movement, fetal tone, non-stress test, and amniotic fluid volume

Biophysical profiling test includes assessment of five variables, namely:

n planning for home care of a woman with preterm labor, which concern should the nurse need to address? a. Nursing assessments are different from those performed in the hospital setting. b. Restricted activity and medications are necessary to prevent a recurrence of preterm labor. c. Prolonged bed rest may cause negative physiologic effects. d. Home health care providers are necessary.

ANS: C Prolonged bed rest may cause adverse effects such as weight loss, loss of appetite, muscle wasting, weakness, bone demineralization, decreased cardiac output, risk for thrombophlebitis, alteration in bowel functions, sleep disturbance, and prolonged postpartum recovery. Nursing assessments differ somewhat from those performed in the acute care setting, but this concern does not need to be addressed. Restricted activity and medications may prevent preterm labor but not in all women. In addition, the plan of care is individualized to meet the needs of each client. Many women receive home health nurse visits, but care is individualized for each woman.

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

ANS: C Proteinuria is defined as a concentration of 1+ or greater via dipstick measurement. A dipstick value of 3+ should alert the nurse that additional testing or assessment should be made. Generally, hypertension is defined as a BP of 140/90 or an increase in systolic pressure of 30 mm Hg or in diastolic pressure of 15 mm Hg. Preeclampsia may be manifested as a rapid weight gain of more than 2 kg in 1 week. Edema occurs in many normal pregnancies and in women with preeclampsia. Therefore, the presence of edema is no longer considered diagnostic of preeclampsia.

25. Which type of formula is not diluted before being administered to an infant? a. Powdered c. Ready-to-use b. Concentrated d. Modified cow's milk

ANS: C Ready-to-use formula can be poured directly from the can into baby's bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cow's milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

The nurse is teaching a client with preterm premature rupture of membranes (PPROM) regarding self-care activities. Which activities should the nurse include in her teaching? a. Report a temperature higher than 40° C. b. Tampons are safe to use to absorb the leaking amniotic fluid. c. Do not engage in sexual activity. d. Taking frequent tub baths is safe.

ANS: C Sexual activity should be avoided because it may induce preterm labor. A temperature higher than 38° C should be reported. To prevent the risk of infection, tub baths should be avoided and nothing should be inserted into the vagina. Further, foul-smelling vaginal fluid, which may be a sign of infection, should be reported.

Which substance used during pregnancy causes vasoconstriction and decreased placental perfusion, resulting in maternal and neonatal complications? a. Alcohol b. Caffeine c. Tobacco d. Chocolate

ANS: C Smoking in pregnancy is known to cause a decrease in placental perfusion and is the cause of low-birth-weight infants. Prenatal alcohol exposure is the single greatest preventable cause of mental retardation. Alcohol use during pregnancy can cause high blood pressure, miscarriage, premature birth, stillbirth, and anemia. Caffeine may interfere with certain medications and worsen arrhythmias. Chocolate, particularly dark chocolate, contains caffeine that may interfere with certain medications.

30. Which condition would not be classified as a bleeding disorder in late pregnancy? a. Placenta previa. c. Spontaneous abortion. b. Abruptio placentae. d. Cord insertion.

ANS: C Spontaneous abortion is another name for miscarriage; by definition it occurs early in pregnancy. Placenta previa is a cause of bleeding disorders in later pregnancy. Abruptio placentae is a cause of bleeding disorders in later pregnancy. Cord insertion is a cause of bleeding disorders in later pregnancy.

17. Nurses should be aware that HELLP syndrome: a. Is a mild form of preeclampsia. b. Can be diagnosed by a nurse alert to its symptoms. c. Is characterized by hemolysis, elevated liver enzymes, and low platelets. d. Is associated with preterm labor but not perinatal mortality.

ANS: C The acronym HELLP stands for hemolysis (H), elevated liver enzymes (EL), and low platelets (LP). HELLP syndrome is a variant of severe preeclampsia. HELLP syndrome is difficult to identify because the symptoms often are not obvious. It must be diagnosed in the laboratory. Preterm labor is greatly increased, and so is perinatal mortality.

35. A placenta previa in which the placental edge just reaches the internal os is more commonly known as: a. Total c. Complete b. Partial d. Marginal

ANS: D A placenta previa that does not cover any part of the cervix is termed marginal. With a total placenta previa, the placenta completely covers the os. When the patient experiences a partial placenta previa, the lower border of the placenta is within 3 cm of the internal cervical os but does not completely cover the os. A complete placenta previa is termed total. The placenta completely covers the internal cervical os.

4. A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who: a. Sleeps for 6 hours at a time between feedings. b. Has at least one breast milk stool every 24 hours. c. Gains 1 to 2 ounces per week. d. Has at least six to eight wet diapers per day.

ANS: D After day 4, when the mother's milk comes in, the infant should have six to eight wet diapers every 24 hours. Sleeping for 6 hours between feedings is not an indication of whether the infant is breastfeeding well. Typically infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster fed. The infant should have a minimum of three bowel movements in a 24-hour period. Breastfed infants typically gain 15 to 30 g/day.

13. Your patient has been receiving magnesium sulfate for 20 hours for treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings would you expect to observe/assess in this client? a. Absence of uterine bleeding in the postpartum period b. A fundus firm below the level of the umbilicus c. Scant lochia flow d. A boggy uterus with heavy lochia flow

ANS: D Because of the tocolytic effects of magnesium sulfate, this patient most likely would have a boggy uterus with increased amounts of bleeding and a heavy lochia flow in the postpartum period.

29. As related to the care of the patient with miscarriage, nurses should be aware that: a. It is a natural pregnancy loss before labor begins. b. It occurs in fewer than 5% of all clinically recognized pregnancies. c. It often can be attributed to careless maternal behavior such as poor nutrition or excessive exercise. d. If it occurs before the twelfth week of pregnancy, it may manifest only as moderate discomfort and blood loss.

ANS: D Before the sixth week the only evidence may be a heavy menstrual flow. After the twelfth week more severe pain, similar to that of labor, is likely. Miscarriage is a natural pregnancy loss, but by definition it occurs before 20 weeks of gestation, before the fetus is viable. Miscarriages occur in approximately 10% to 15% of all clinically recognized pregnancies. Miscarriage can be caused by a number of disorders or illnesses outside of the mother's control or knowledge.

18. Nurses should be aware that chronic hypertension: a. Is defined as hypertension that begins during pregnancy and lasts for the duration of pregnancy. b. Is considered severe when the systolic blood pressure (BP) is greater than 140 mm Hg or the diastolic BP is greater than 90 mm Hg. c. Is general hypertension plus proteinuria. d. Can occur independently of or simultaneously with gestational hypertension.

ANS: D Hypertension is present before pregnancy or diagnosed before 20 weeks of gestation and persists longer than 6 weeks postpartum. The range for hypertension is systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg. It becomes severe with a diastolic BP of 110 mm Hg or higher. Proteinuria is an excessive concentration of protein in the urine. It is a complication of hypertension, not a defining characteristic.

Thalassemia

Anemia in which an insufficient amount of hemoglobin is produced to fill red blood cells; it is a hereditary disorder

Risks of post-term pregnancy

Another complication: abnormal fetal growth. Macrosomia occurs most often, increased risk of operative birth and shoulder dystocia.

41. A 32-year-old primigravida is admitted with a diagnosis of ectopic pregnancy. Nursing care is based on the knowledge that: a. Bed rest and analgesics are the recommended treatment. b. She will be unable to conceive in the future. c. A D&C will be performed to remove the products of conception. d. Hemorrhage is the major concern.

ANS: D Severe bleeding occurs if the fallopian tube ruptures. The recommended treatment is to remove the pregnancy before rupture in order to prevent hemorrhaging. If the tube must be removed, the woman's fertility will decrease; however, she will not be infertile.

As part of the discharge teaching, the nurse can prepare the mother for her upcoming adjustment to her new role by instructing her regarding self-care activities to help prevent PPD. Which statement regarding this condition ismost helpful for the client? a. Stay home, and avoid outside activities to ensure adequate rest. b. Be certain that you are the only caregiver for your baby to facilitate infant attachment. c. Keep your feelings of sadness and adjustment to your new role to yourself. d. Realize that PPD is a common occurrence that affects many women.

ANS: D Should the new mother experience symptoms of the baby blues, it is important that she be aware that these symptoms are nothing to be ashamed of. As many as 10% to 15% of new mothers experience similar symptoms. Although obtaining enough rest is important for the mother, she should not distance herself from her family and friends. Her spouse or partner can communicate the best visiting times to enable the new mother to obtain adequate rest. It is also important that she not isolate herself at home by herself during this time of role adjustment. Even if breastfeeding, other family members can participate in the infant's care. If depression occurs, then the symptoms will often interfere with mothering functions; therefore, family support is essential. The new mother should share her feelings with someone else and avoid overcommitting herself or feel as though she has to besuperwoman. A telephone call to the hospital "warm line" may provide reassurance with lactation issues and other infant care questions. Should symptoms continue, a referral to a professional therapist may be necessary.

Management of a prolapsed cord

Another person can place a rolled towel under the woman's right hip The woman may also be assisted into a position such hands and knees or knees to chest. Here, gravity keeps the pressure of the presenting part of the cord. Call for assistance. do not leave the woman alone have someone notify primary dr.

Some of the embryos intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system?

Abdomen is too small to contain all the organs while they are developing. The abdominal contents grow more rapidly than the abdominal cavity; therefore, part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.

Ideal temp

Above 97.7 (numbers only slightly above 97.7- start worrying and monitoring closely) NORMAL: 98 or above! Below 97.7- Start intervention to warm.

Ideally, when should prenatal care begin?

After the first missed menstrual period Prenatal care should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prenatal care before missing the first menstrual period is too early. It is unlikely the woman is even aware of the pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning prenatal care after the third missed menstrual period is too late. The woman will have completed the first trimester by that time.

Fontanels

Anterior AND posterior-must have for proper growth of skull Most important** assessment: Are they present?? Overriding sutures- edges of cranial bones edges should not be connected General symmetric shape

Tx of DVT:

Anticoagulants, heparin · Rest with elevated leg · Elastic compression stockings · Coumadin (Warfarin)

A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the womans last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result?

Anticonvulsant medications may cause the false-positive test result. Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

Preterm birth definition

Any birth that occurs before the completion of 37 weeks of pregnancy (<37 0/7 weeks of gestation)

"Eyes and thighs"

Areas you typically administer medications or vitamins within first 2 hr after delivery

Weight loss

Avoid, avoid, avoid. OK is loss is less than 10% -dehydration? -feeding problems?

What will the newborn experiencing cold stress exhibit? Select all that apply. A. Hyperglycemia B. Increased respiratory rate and oxygen consumption C. Metabolic acidosis D. Hyperbilirubinemia E. Shivering

B, C, D

Which test is performed to determine if membranes are ruptured? A. Urine analysis B. Fern test C. Leopold maneuvers D. AROM

B: In many instances a sterile speculum examination and a Nitrazine (pH) and fern test are performed to confirm that fluid seepage is indeed amniotic fluid.

Concerning the third stage of labor, nurses should be aware that: A. The placenta eventually detaches itself from a flaccid uterus B. The duration of the third stage may be as short as 3 to 5 minutes C. It is important that the dark, roughened maternal surface of the placenta appear before the shiny fetal surface D. The major risk for women during the third stage is a rapid heart rate

B: The third stage of labor lasts from birth of the fetus until the placenta is delivered. The duration may be as short as 3 to 5 minutes, although up to 1 hour is considered within normal limits.

A cold baby is a...?

Bad baby!!

What is the PRIORITY teaching tip the nurse should provide about bottle-feeding? A. Infants may stool with each feeding in the first weeks. B. Feed newborn at least every 3 to 4 hours. C. Hold infant semiupright while feeding. D. Some infants take longer to feed than others.

C. Airway is priority. The infant might inhale formula or choke on any that was spit up.

A pregnant woman at 32 weeks gestation comes to the emergency department because she has begun experiencing bright red vaginal bleeding. She reports that she has no pain. The admission nurse suspects that the woman is experiencing: A. Abruptio placentae B. Disseminated intravascular coagulation C. Placenta previa D. Preterm labor

C. Placenta previa

Evidence-based care practices designed to support normal labor and birth recommend which practice during the immediate newborn period? A. The healthy newborn should be taken to the nursery for a complete assessment. B. After drying, the infant should be given to the mother wrapped in a receiving blanket. C. Encourage skin-to-skin contact of mother and baby. D. The father or support person should be encouraged to hold the infant while awaiting delivery of the placenta.

C: The unwrapped infant should be placed on the woman's bare chest or abdomen, then covered with a warm blanket. Skin-to-skin contact keeps the newborn warm, prevents neonatal infection, enhances physiologic adjustment to extrauterine life, and fosters early breastfeeding.

Jaundice

Caused by buildup of bilirubin. Yellowing

Signs of Respiratory Distress:

Clinical symptoms can occur immediately after birth or 6 hour later. Look for signs of distress S/S: crackles, poor air exchange, pallor, the use of accessory muscles, and apnea. The treatment is supportive. Ventilation, oxygenation, and surfactant can be applied.

Complications of a C-Section:

Complications include aspiration, hemorrhage, atelectasis, endometritis, abdominal wound dehiscence or infection, urinary tract infection, injuries to the bladder or bowel, and complications related to anesthesia.

Don't get it wet and to let it fall off, sponge bath the baby, no lotions because it dries the baby's skin out

Cord Care:

As part of their teaching function at discharge, nurses should tell parents that the baby's respiration should be protected by all of the following procedures except: A. Prevent exposure to people with upper respiratory tract infections B. Keep the infant away from secondhand smoke C. Avoid loose bedding, water beds, and beanbag chairs D. Don't let the infant sleep on his or her back

D A. Incorrect: Infants are vulnerable to respiratory infections; infected people must be kept away. B. Incorrect: Secondhand smoke can damage lungs. C. Incorrect: Infants can suffocate in loose bedding and furniture that can trap them. D. Correct: The infant should be laid down to sleep on his or her back for better breathing and to prevent sudden infant death syndrome. Infants are vulnerable to respiratory infections; infected people must be kept away. Secondhand smoke can damage lungs. Infants can suffocate in loose bedding and furniture that can trap them.

Another common pregnancy-specific condition is pruritic urticarial papules and plaques of pregnancy (PUPPP). A client asks the nurse why she has developed this condition and what can be done. What is the nurse's bestresponse? a. PUPPP is associated with decreased maternal weight gain. b. The rate of hypertension decreases with PUPPP. c. This common pregnancy-specific condition is associated with a poor fetal outcome. d. The goal of therapy is to relieve discomfort.

D PUPPP is associated with increased maternal weight gain, increased rate of twin gestation, and hypertension. It is not, however, associated with poor maternal or fetal outcomes. The goal of therapy is simply to relieve discomfort. Antipruritic topical medications, topical steroids, and antihistamines usually provide relief. PUPPP usually resolves before childbirth or shortly thereafter.

A laboring woman receives an opioid analgesic for pain, then unexpectedly delivers 45 minutes later. Which medication should be readily available at the time of delivery? A. Vitamin K B. Ephedrine C. Nubain D. Narcan

D.

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should: A. Notify the woman's physician B. Tell the woman to slow the pace of her breathing C. Administer oxygen via a mask or nasal cannula D. Help her breathe into a paper bag

D: This woman is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. The woman can also breathe into her cupped hands if no paper bag is available.

Which statement best describes the rationale for the physiologic anemia that occurs during pregnancy?

Dilution of hemoglobin concentration occurs in pregnancy with physiologic anemia. When blood volume expansion is more pronounced and occurs earlier than the increase in red blood cells, the woman has physiologic anemia, which is the result of the dilution of hemoglobin concentration rather than inadequate hemoglobin. An inadequate intake of iron may lead to true anemia. The production of erythrocytes increases during pregnancy.

Epilepsy

Disorder of the brain that causes recurrent seizures; it is the most common major neurologic disorder accompanying pregnancy

Hemabate

Don't give this medication to asthma patients

Methergine

Don't give this medication to patients with HTN

Apgar

Done at 1-5 minutes. Rarely see a perfect 10. Respiratory rate and Heart rate are usually great, Newborn usually loses points in skin color and reflex irritability. (Acrocyanosis is common, reflex: grimace (only 1 point) common)

Which condition is likely to be identified by the quadruple marker screen?

Down syndrome The maternal serum level marker of alpha-fetoprotein is used to screen for Down syndrome, trisomy 18, neural tube defects, and other chromosomal anomalies. The quadruple-marker screen will not detect diaphragmatic hernia. Additional testing, such as ultrasonography, is required to diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified during an ultrasound examination. The quadruple-marker screen will not detect anencephaly.

Caput Succedaneum**

Edementous area on scalp, usually from long labor with sustained pressure on head against cervix, causes local blood vessels to rupture and slows venous return. CROSSES SUTURE LINE

A young mom just delivered and isn't bonding with her baby, what are some ways to educate this mom?

Educate on different ways of noticing cues of the baby, how to recognize hunger cues/cries, having her demonstrate a bath

Nursing interventions Post C-section:

Ensure adequate pain relief and rest. Daily care includes perineal care, breast care, and routine hygienic care. Woman may shower after original dressing is removed. Foley catheter usually taken out on first day as well. Woman is encouraged to be out of bed and ambulating several times each day after catheter is removed. Use of ted hose or SCD boots to remain in use when woman is in bed, may be removed when she is ambulating.

DIC

Eventually the patient will end up with low platelets and wide spread bleeding if this complication is not caught, due to the body having a decreased clotting factor as a result of low platelets.

Feeding

Every 2-3 hours: 10-12 feedings/day. Sit up while feeding- decrease risk of ear infections and aspiration

Newborns undergoing painful procedures should be swaddled tightly with legs extended and close together. True False

False

Top 3 interventions for all newborns

Feed, warm, airway

Lanuga

Fine hair

Musculoskeletal findings

Flexed position, limited extension. Legs-limited extension Hips-look for symmetry of gluteal folds Feet-flat sole, dry, flaky skin

a

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. What should the nurse do? a. Assist the woman with initiating breastfeeding and remain with her as long as necessary. b. Recognize this as behavior of the taking-hold stage. c. Record the behavior as ineffective maternal-newborn attachment. Move the baby back to the nursery, reassuring the woman that her rest is a priority at this time.

Pruritus gravidarum

Generalized itching during pregnancy without the presence of a rash; it is often limited to the abdomen and is usually caused by skin distention and development of striae

Umbilical cord care

Goal- prevent/decrease risk of infection and hemorrhage. Soap and water. Falls off 10-14 days.

hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true?

Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome. Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

S/S of preeclampsia

History of malaise Influenza-like symptoms Epigastric or right upper quadrant abdominal pain Symptoms worsen at night and improve during the daytime

Stepping

Hold baby over ground- baby will pretend to walk

Palmar grasp

Holding things

Tell her that it's normal because extra fluid gets push into places and things become more swollen, it is a normal finding that will go away

If mom is worried because her newborn son's scrotum is swollen, what should you tell her?

A woman arrives at the clinic for a pregnancy test. The first day of her LMP was September 10, 2014. Her expected date of birth (EDB) is __________.

June 17, 2015 Using the Ngeles rule, June 17, 2015, is the correct EDB. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of September 10, 2014: September 10, 2014 3 months = June 10, 2014 + 7 days = June 17, 2014 + 1 year = June 17, 2015.

Interventions to keep infant warm

Keep covered Knit cap Utilize radiant warmer Keep dry Avoid placing of cold surfaces Avoid drafts

Tonic neck

Looks like baby is holding sword. Head should face the "sword-holding" arm, while other arm is flexed

Newborn rash

Looks like pimples

Late preterm infant

Lots of risks r/t physiological immaturity Often the size and weight of term infant.. Respiratory distress, temp instability, hyperbilibirubinemia(jaundice).

Tx for hypertensive disorders

Low-dose aspirin (60 to 80 mg) may help certain high risk women, anti-hypertensive for severe HTN, mag sulfate for seizure prevention

Complications of placenta previa

Major complication is hemorrhage, fetal death (caused by preterm birth) stillbirth, malpresentation, fetal anemia, intrauterine growth restriction (IUGR), fetal distress due to low oxygen supply. Shock and death of the mother if the bleeding is excessive. infection and formation of blood clots. Blood loss requiring transfusion.

Toxicity of magnesium sulfate

Mild symptoms: lethargy, muscle weakness, decreased or absent DTRs, double vision, and slurred speech Increasing symptoms: maternal hypotension, bradycardia, bradypnea, and cardiac arrest. Blood can be drawn to precisely determine the serum level if mild or severe is suspected

Symptoms of Resp. distress

Nasal flaring, intercostal/subcostal retractions. *Grunting and out of range vitals indicate inadequate O2 supply to tissues

Venix Caseosa

Natural lubricant from amnion

Biophysical profile, ultrasound, electronic fetal monitoring.

Noninvasive dynamic assessment of the fetus and its environment that is based on acute and chronic markers of fetal disease. It uses both real-time __________________ and external ________________.

A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurses best response?

Normal pregnancy is 10 lunar months. Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of 28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of gestation.

an open airway, preventing heat loss, and promoting parent-infant interaction

Nursing care immediately after birth includes maintaining what 3 things:

S/S of placental abruption:

Painful bleeding or hardening of the abdomen, vaginal bleeding, belly pain, and back pain in the last 12 weeks of pregnancy, fetal distress, or premature labor

Gestational hypertension

Patient has an increase in systolic BP from 130 up to 150. What is the diagnosis?

Eclampsia

Patient has elevated BP, proteinuria and seizure activity. What is the diagnosis?

Preeclampsia

Patient has elevated BP, proteinuria, and swelling. What is the diagnosis?

HELLP syndrome

Patients lab show elevated liver enzymes and low platelets, what is the diagnosis?

Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia?

Pica Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

Risks of post-term pregnancy

Placenta begins to age after 43-44 weeks of gestation. Placenta cannot adequately oxygenate the fetus. Decreased amniotic fluid, oligohydramnios causes potential for cord compression and resulting hypoxemia. Increased chance of meconium aspiration.

Milia

Raised white spots on nose-don't pick at them. They go away.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parents class. Which aspect of their birth plan should be considered potentially unrealistic and require further discussion with the nurse?

Regardless of the circumstances, we do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage. Because monitoring is essential to assess fetal well-being, fetal monitoring is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long as labor is normally progressing. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the womans sister as her coach with her husband nearby is an acceptable request for a laboring woman. Using breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.

What kind of fetal anomalies are most often associated with oligohydramnios?

Renal An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

Risks of post-term pregnancy

Risks: increase risk for perineal injury related to fetal macrosomia, risk for hemorrhage and infection, interventions such as induction of labor with prostaglandins or oxytocin, forceps or vacuum-assisted birth, and cesarean birth are more likely to be necessary. Woman may experience fatigue, physical discomfort, and psychological reactions such as depression, frustration, and feelings of inadequacy until she passes her estimated date of birth

Chorioamnionitis risks:

Risks: risk factors associated with a long labor, such as prolonged membrane rupture, multiple vaginal examinations, and use of internal FHR and contraction monitoring modes. Also risk factors: young maternal age, low socioeconomic status, nulliparity, and preexisting conditions of the lower genital tract.

Stomach

Round, soft, bowel sounds, liver palpable

Post partum hemorrhage S/S:

S/S: soaking a pad in an hour, if you go from light to heavy flow,

hallucinations

Seeing or hearing things that are not there Feelings of confusion Rapid mood swings Trying to hurt self or baby

Ears

Startle response, alert to high pitched voices

Moro

Startle- Arms go up in air

Eyes

Symmetry, tears (scant? absent?), follow objects, clear

Hydatidiform mole tx:

TX: Suction Dilation & Curettage (D&C): Surgical removal of the lining of the womb (uterus) by scraping and scooping

During the physical examination of a client beginning prenatal care, which initial action is most important for the nurse to perform?

The client should empty her bladder before the pelvic examination. The nurse should instruct the client to empty her bladder. An empty bladder facilitates the examination and also provides an opportunity to obtain a urine sample for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

Preterm labor definition

The diagnosis of this is based on three major criteria: - Gestational age between 20 and 37 weeks - Uterine activity (contractions) - Progressive cervical chance (effacement of 80%, or cervical dilation of 2 cm or greater)

An expectant couple attending childbirth classes have questions regarding multiple births since twins run in the family. What information regarding multiple births is important for the nurse to share?

Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

Patient Ductus Arteriosus (PDA)

Type of congenital heart defect that involves failure of the ductus arteriosus to close; it results in a left-to-right shunt

Post partum hemorrhage

Vital sign changes- increased HR decreased BP

Monitor these things while giving mag sulfate

Vital signs, DTRs, level of consciousness

The liver

What organ breakdown the RBCs and gets rid of bilirubin?

Color:pallid, cyanotic, or pink Reflex irritability:response to suctioning of the nares or nasopharynx Muscle tone:degree of flexion and movement of the extremities Respiratory effort:observed movement of the chest wall Heart rate:auscultation with a stethoscope or palpation of the umbilical cord

What 5 things are being assessed to determine the Apgar score?

The baby's blood sugar, we don't want it to get lower than 45

What do we want to monitor in the baby if the mother had gestational diabetes?

c. stay with her

What do you do if a mother seizes? a. put something in her mouth b. leave her c. stay with her

Patent ductus arterious

What does PDA stand for

A. apical heart rate of 90 beats/min, slightly irregular, when awake and active The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. A harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn.

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? A. apical heart rate of 90 beats/min, slightly irregular, when awake and active B. Acrocyanosis C. Harlequin color sign D. Weight loss representing 5% of the newborn's birth weight

Implement skin to skin and breast feeding, and and interaction and bonding during this time because after this time period the baby will go into hours of restful sleep because they just went through a traumatic event getting squeezed out

What's the most important things to implement during the first period of reactivity for the baby:

Gestational Diabetes

When a woman has this _______________________, she is at risk for having a large baby and could have a potentially hard time delivering that baby.

In the first 30-60 seconds after birth if the babies hr is under 100, gasping, or has apnea

When would you begin PPV (positive pressure ventilation)?

C. Periodic numbers and tingling of the fingers

Which condition is likely to require careful medical assessment during the puerperium? a. Varicosities of the legs b. Carpal tunnel syndrome c. Periodic numbers and tingling of the fingers d. Headaches

b. prolactin

Which hormone stay elevated after delivery: a. estrogen b. prolactin c. progesterone d. human placental lactogen

6

Within _____ weeks after birth, the physiologic changes induced by pregnancy have reverted to their normal state.

A woman asks the nurse, What protects my babys umbilical cord from being squashed while the babys inside of me? What is the nurses best response?

Your babys umbilical cord is surrounded by connective tissue called Whartons jelly, which prevents compression of the blood vessels. Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Whartons jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

COOMBS

_____________ screening test for Rh incompatibility by examining the serum of Rh-negative women for Rh antibodies.

Non-stress test

______________ test based on the fact that a healthy awake fetus with an intact central nervous system produces characteristic heart rate patterns in response to its own movements, uterine contractions, or stimulation.

CVS, 10 and 13; MSAFP, unconjugated estriol, and HCG, age

_____________________ test used to screen for down syndrome. It is performed between __________ and __________ weeks of gestation. The levels of three markers, namely: ________________, _____________, __________, in combination with maternal ____________________ are used to determine risk.

MSAFP, 15 and 17

_______________________ test used as a screening tool for rural tube defects in pregnancy. The test is ideally performed between _______________ and _____________ weeks of gestation.

A nurse preforms an Apgar on a preterm newborn 3 minutes after birth. Her heart rate is 98bpm, respirations are 32 per minute and irregular, and her body is pink with blue extremities. She has some movement and flexion, and grimaces in response to stimulation. 1. What is the newborns Apgar score? 2. What nursing interventions are a priority at this time? (select all that apply)

a. 6 b. 5 c. 3 d. 7 (answer- B) a. Take the newborns blood pressure b. Clear airway of secretions c. Continue monitoring heart rate and repirations d. Alert the doctor as this requires emergency surgery e.. Assess newborn for respiratory distress (answer- B, C, E)

Meconium staining:

appearance of fetal intestinal contents in the amniotic fluid, giving it a greenish color

Fundal pressure:

application of a gentle yet steady force with hands pressed against the uterus

Amniotomy:

artificial rupture of membranes

8. Other early sensual contacts between infant and mother involve sound and smell. Nurses should be aware that, despite what folk wisdom may say: a. High-pitched voices irritate newborns. b. Infants can learn to distinguish their mother's voice from others soon after birth. c. All babies in the hospital smell alike. d. A mother's breast milk has no distinctive odor.

b. Infants can learn to distinguish their mother's voice from others soon after birth.

Approximately 10% to 15% of all clinically recognized pregnancies end in miscarriage. Possible causes of early miscarriages include all of the following except: a. Systemic disorders b. Infections c. Endocrine imbalance d. Chromosomal abnormalities

b. Infections

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: a. Foster and active role in the baby's care b. Provide time for the mother to reflect on the events of her labor and delivery c. Recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now d. Promote maternal independence by encouraging her to meet her own hygiene and comfort needs

b. Provide time for the mother to reflect on the events of her labor and delivery

The nurse observes that a 15-year-old mother seems to ignore her newborn. A strategy that the nurse can use to facilitate mother-infant attachment in this mother is to: a. Tell the mother she must pay attention to her infant. b. Show the mother how the infant initiates interaction and pays attention to her. c. Demonstrate for the mother different positions for holding her infant while feeding. d. Arrange for the mother to watch a video on parent-infant interaction.

b. Show the mother how the infant initiates interaction and pays attention to her.

A woman expresses a need to review her labor and birth experience with the nurse who cared for her while in labor. This behavior is most characteristic of which phase of maternal postpartum adjustment? a. Taking-hold (dependent-independent phase) b. Taking-in (dependent phase) c. Letting-go (interdependent phase) d. Postpartum blues (baby blues)

b. Taking-in (dependent phase) Rationale: This happens in the first 1 to 2 days of recovery following birth.

Rooting reflex

brush side of face-baby head turns towards that side (nipple)

Ring of Fire:

burning sensation of acute pain as vagina stretches and crowning occurs

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. Cramping. b. Uterine activity. c. Intense abdominal pain. d. Bleeding.

c. Intense abdominal pain.

Methotrexate is recommended as part of the treatment plan for which obstetric complication? a. Complete hydatidiform mole b. Missed abortion c. Unruptured ectopic pregnancy d. Abruptio placentae

c. Unruptured ectopic pregnancy

Tx of Pulmonary embolism

continuous IV heparin is used until symptoms have resolved then followed by heparin or oral or subQ anticoagulant therapy for up to 6 months

Nuchal cord:

cord encircles the fetal neck

Childbirth may result injuries to the vagina and uterus. Pelvic floor exercises, also known as Kegel exercises, will help to strengthen the perineal muscles and encourage healing. The nurse knows that the client understands the correct process for completing these conditioning exercises when she reports: a. "I contract my thighs, buttocks, and abdomen." b. "I do 10 of these exercises every day." c. "I stand while practicing this new exercise routine." d. "I pretend that I am trying to stop the flow of urine midstream."

d. "I pretend that I am trying to stop the flow of urine midstream."

In caring for the woman with disseminated intravascular coagulation (DIC), what order should the nurse anticipate? a. Preparation of the client for invasive hemodynamic monitoring b. Restriction of intravascular fluids c. Administration of steroids d. Administration of blood

d. Administration of blood

After they are born, a crying infant may be soothed by being held in a position in which the newborn can hear the mother's heartbeat. This phenomenon is known as: a. Entrainment. b. Reciprocity. c. Synchrony. d. Biorhythmicity.

d. Biorhythmicity.

After giving birth to a health infant boy, a primiparous woman, age 16, is admitted to the postpartum unit. An appropriate nursing diagnosis for her at this time is "Risk for Impaired Parenting" related to deficient knowledge of newborn care. In planning for the woman's discharge, what should the nurse be certain to include in the plan of care? a. Tell the woman how to feed and bather her infant. b. Give the woman written information on bathing her infant. c. Advise the woman that all mothers instinctively know how to care for their infants. d. Provide time for the woman to bather her infant after she views and infant bath demonstration

d. Provide time for the woman to bather her infant after she views and infant bath demonstration Rationale: Having the mother demonstrate infant care is a valuable method of assessing the client's understanding of her newly acquired knowledge, especially in this age-group because she may inadvertently neglect her child.

5. The interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state is called the: a. Involutionary period because of what happens to the uterus b. Lochia period because of the nature of the vaginal discharge c. Mini-tri period because it lasts only 3 to 6 weeks d. Puerperium, or fourth trimester of pregnancy

d. Puerperium, or fourth trimester of pregnancy Rationale: The puerperium, also called the fourth trimester or the postpartum period of pregnancy, lasts about 3 to 6 weeks. Involution marks the end of the puerperium, or the fourth trimester of pregnancy.

Shultz mechanism:

expulsion of placenta with fetal side emerging first

Duncan mechanism:

expulsion of placenta with maternal surface emerging first

Ferning:

frondlike crystalline pattern created by amniotic fluid when it is placed on a glass slide

Episiotomy:

incision into perineum to enlarge the vaginal outlet

Risks for an elective cesarean birth

longer hospital stay for the woman, increased risk of respiratory problems for the baby, greater complications in subsequent pregnancies, including uterine rupture and placental implantation problems. Cesarean birth on request should not be performed unless it is 100% certain that woman has reached 39 weeks gestation.

Superficial Venous thrombosis

involvement of superficial saphenous venous system

Deep venous thrombosis

involvement varies but can extend from the foot to the iliofemoral region, occurs in lower extremities

Neonatal respiratory distress syndrome (RDS)

is a lung disorder often seen in premature babies. The condition makes it hard for the baby to breathe. Baby may need to be put on a vent.

Ectopic pregnancy

is a significant cause of maternal morbidity and mortality.

Active pursuit of labor

is recommended for mothers who experience preterm PROM between 34-36 weeks. Conservative management at this stage prolongs pregnancy by only a few days which increases the risk of chorioamnionitis by a lot. Also, if lung maturity can be documented, women with PPROM at 32-33 weeks may be recommended for immediate birth because of the increases risk for complications with expectant management

Mongolion spots

macular areas of blueish-black pigmentation on dorsal area and butt- common in dark-skinned newborns

Open-glottis pushing:

method of breathing during bearing-down efforts characterized by a strong expiratory grunt or groan

Leopold maneuvers:

method used to palpate fetus through abdomen

Symptoms of PDA:

murmur, tachycardia, tachypnea, crackles, bounding peripheral pulses, hepatomegaly, metabolic acidosis, hypercapnia, possible cardiomegaly and pulmonary edema

Nose

nostrils open to air flow, slight flattering after birth, midline

Ferguson reflex:

occurs when pressure of presenting part against pelvic floor stretch receptors result in a woman's perception of an urge to bear down

Crowning:

occurs when the widest part of the head (biparietal diameter) distends the vulva just before birth

The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will:

result in a macrocosmic fetus. Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

Elective cesarean birth:

primary cesarean birth without medical or obstetric indication. Reasons: fear of pain during labor and birth, mistaken idea that surgery will prevent future problems with pelvic support, bladder and bowel incontinence, or sexual dysfunction. Also chosen due to traumatic vaginal birth or convenience.

Valsalva maneuver:

prolonged holding of breath while bearing down (closed-glottis pushing)

Induction- meds used

prostaglandins : -cytotec: higher risk for uterine tachysystole with abnormal fetal heart rate and a passage of meconium into the amniotic fluid -cervidil: easy removal if there is an adverse reaction such as tachysystole. Advantages of these is the decreased use of oxytocin required for induction Pitocin

Prolapse of umbilical cord:

protrusion of umbilical cord in advance of the presenting part

Modified Ritgen maneuver:

technique used to control birth of fetal head and protect perineal musculature

Discharge teaching

temp repsirations feeding schedule elimination positioning and holding rashes clothes safety (car seats) bathing cord care/skin care infant follow-up (3 days!) Immunizations-schedules cardiopulmonary resuscitation

Quad screen

test adds an additional marker called inhibit A to increase the accuracy of screening for Down syndrome in women more than 35 years of age.

Non-stress test

test based on the fact that a healthy awake fetus with an intact central nervous system produces characteristic heart rate patterns in response to its own movements, uterine contractions, or stimulation.

Nitrazine test:

test to determine if membranes have ruptured by assessing pH of the fluid

Ectopic pregnancy

the fertilized ovum is implanted outside the uterine cavity; also called "tubal pregnancies," typically in a Fallopian tube

Prolapsed cord

when the cord lies below the presenting part of the fetus and delivered first. More common with breech or transverse position, the cord is long (more than 100 cm), or an unengaged presenting part. Also the cord may prolapse when the amniotic fluid bursts and the presenting part is high

Tx of SVT:

· Analgesia (NSAID) · Rest with elevation of leg · Elastic compression stockings · Heat

S/S: Superficial Venous thrombosis

· Pain and tenderness in lower extremity · Warmth, redness, enlarged, hardened vein over clot