AWHONN PEOP Perinatal Final Review 2022
Mrs. Johnson is a primipara at 34 weeks gestation who has been admitted to your unit with increasing blood pressures. You have a discussion with the physician about her reports of headache and blurred vision. What actions should surround the documentation of this conversation in the medical record?
Document the date, time, person spoken to, and objective details of what was said in the medical record.
Frank
What fetal Presentation?
Occiput
What fetal Presentation?
LOP
What is the correct fetal position shown in the image?
Standards for semen analysis have been designated to maintain consistency and quality control by
World Health Organization
One of the leading causes of obstetric liability is
oxytocin administration leading to tachysystole
Interconception care should be provided to a woman
postpartum until she can no longer become pregnant
During pregnancy, maternal hepatic glucose and pancreatic insulin production increase to meet the metabolic demands of both the mother and fetus. Therefore, pregnancy is generally characterized by
postprandial hyperglycemia and hyperinsulinemia.
After ovulation, the ovarian follicle produces
progesterone
The corpus luteum produces ___________ to prepare the uterus to nurture the fertilized egg.
progesterone
A shared understanding of what is going on and what is likely to happen next is known as
situational awareness
At ovulation, the cervical mucus becomes clear and stretchy. This facilitates
sperm to pass through the cervical canal
Women with chronic diseases who want to plan a pregnancy should not
stop medications immediately
Johanna was recently diagnosed with gestational hypertension. She arrives to the outpatient clinic for an ultrasound examination at 26 weeks gestation to monitor fetal status. Ultrasound examination of the umbilical cord should show
two arteries carrying deoxygenated blood from the fetus to the placenta and one vein returning oxygenated blood from the placenta to the fetus.
The Perinatal Care Core Measures include all of the following EXCEPT
use of the NICHD nomenclature for electronic fetal monitoring.
Obese women (BMI ≥30) should gain how many pounds during pregnancy?
11-20
Healthcare providers should strive to provide preconception and interconception care to all women of childbearing age, which is generally considered to be
15-44 years of age
Average viability for male sperm within the female reproductive tract is
2-3 days
Mrs. Mavis is 38 weeks pregnant and presents to the outpatient testing unit for a nonstress test. A reactive nonstress test for a fetus at this gestational age includes two fetal heart rate increases of 15 beats per minute above the baseline lasting for 15 seconds or longer in a timeframe of
20 minutes.
For a healthy, 30-year-old woman, the chance of conception is approximately __ per cycle.
20%
A routine screening for diabetes should occur around
20-28 weeks gestation
If a mother is Rh-negative and her fetus is Rh-positive, the mother will create antibodies against the fetal cells anytime they cross the placenta. To prevent Rh isoimmunization, Rh-negative mothers are screened with a D (Rh) antibody screen and given D immune globulin (RhIG) as prophylaxis at which gestational age?
28 weeks
In nonpregnant women, obesity is defined as a body mass index (BMI) over
30
Starting at what age does female fertility decline?
32
Anticipatory guidance is an important part of preconception and interconception care because the following percentage of all pregnancies in the United States are unintended.
45%
Infertility evaluation is recommended for women less than 35 years old who have not conceived after ___ months.
6 (but I think question is incorrectly worded should be 12 months; >35 y/o is 6 months)
Implantation of a fertilized ovum occurs ______ days after ovulation.
7-10
Folic acid supplementation prior to and during pregnancy has been shown to reduce the risk of neural tube defects by at least
85%
An essential component of prenatal health assessment is the determination of the pregnant woman's vital signs. Which of the following is an expected change in vital signs during pregnancy?
A decrease in diastolic blood pressure by 10-15 mm Hg or more in the sitting and standing positions and An increase in the respiratory rate and a heighted awareness to breathe as pregnancy progresses.
Match the developmental task with the correct description.
Acceptance of the pregnancy ----- The woman's adaptation to and her sense of gratification about being pregnant. Identifying with the role of mother-----The woman's ability to identify with the role of mother . Evaluating and reordering the relationships-----How well the woman adapts to her pregnancy and her view of motherhood. Establishing a relationship with the fetus and preparing for childbirth-----The woman reconciles her fantasies and concerns about who this new baby will be. Prenatal fear of loss of control and self-esteem in labor----- The woman's sense of how well she thinks she can cope with the events of labor can influence her performance in labor.
Which of the following birth outcomes may be improved by preconception and interconception care?
All of the above (Infant mortality, Preterm birth, Birth defects)
Which of the following uterine abnormalities may be surgically corrected to improve fertility?
All the above (Endometrial polyps, Myomas, Uterine septum)
Which test is the best predictor of a woman's ovarian reserve?
Antral follicle count
Caroline G1P0 at 34 weeks gestation presents to the OB triage per the recommendation of her provider. Caroline has complaints of pain and frequency with urination. Caroline states that she has never had a UTI before and asks you why she would get one now. Your best response would be
As the uterus grows, pressure displaces the ureters and bladder. Pressure on the renal system can impede urine flow thus increasing the risk for UTIs.
Edward is a new nurse working on the high-risk antepartum unit. He asks you how positioning of the pregnant woman affects cardiac output. Your best response is
Cardiac output is higher in the lateral recumbent position, lower in the sitting position, and significantly decreased in the supine position.
Match the FHR category with the correct definition.
Category I-----Predictive of normal fetal acid-base balance at the time of observation Category II-----Not predictive of abnormal fetal acid-base status Category III-----Associated with abnormal fetal acid-base status at the time of observation
You are caring for Melody, a G3 P2 at 39 weeks gestation who was admitted in active labor. The FHR characteristics are as follows: baseline 125, variability minimal, no accelerations and intermittent late decelerations. Uterine activity frequency is every 3-4 minutes, lasting 60-80 seconds, firm with palpation, and resting tone is soft. What category would this FHR pattern be considered?
Category II
Which of the following has been noted among the top three root causes of sentinel events for over 10 years?
Communication
When is the best time of the menstrual cycle to perform hysterosalpingography?
Day 7-12
Which is NOT a characteristic of ovulation in the female?
Decreased basal body temperature
You are working with nursing students on the L&D unit. One of the students recalls reading about progesterone levels affecting labor and asks if you could explain this. What is your best response?
Decreased progesterone levels allow estrogen to stimulate uterine contractility. With lowered levels of progesterone, the myometrium loses resistance as uterine contractions act on the resistance of the cervix.
Match the mechanism of labor with the correct definition.
Engagement-----occurs as the biparietal diameter of the fetal head passes through the pelvic inlet Descent-----the process of movement of the presenting part through the pelvis and depends on the intraamniotic pressure and the force exerted on the fundus by uterine contractions Flexion-----occurs when the descending fetal head meets resistance from the cervix, the pelvic wall, or the pelvic floor Internal rotation-----takes place as the fetal head continues to descend from the pelvic inlet through the midpelvis to the pelvic outlet
Amniotic fluid is produced daily by fetal
Fetal lungs and urine
All women of childbearing age should take which of the following per day to reduce the risk of neural tube defects?
Folic acid
Successful defense against malpractice claims is enhanced by which of the following?
Following national professional standards
Abby, G2P1 at 39 3/7 weeks gestation presents to the OB triage with complaints of "her water leaking". You apply the fetal monitor. Abby's vitals are as follows: BP 158/98 mm Hg, P 82 bpm, R 22 bpm, Temp 100.4°F (38°C). Abby has a positive pH paper test indicating her membranes are ruptured and her cervical examination is 3cm dilated and 70% effaced. The FHR is 165 bpm, minimal variability, and recurrent variable decelerations are present. Abby is contracting every 3-4 minutes, 60-70 seconds in duration, the contractions palpate moderate, and her resting tone is soft. What assessment findings indicate IMMEDIATE provider notification?
Hypertension, elevated temperature, and indeterminant FHR pattern
Depression, fatigue, weight gain, and difficulty concentrating may all be signs of which condition?
Hypothyroidism
Which of the following is TRUE about IVF?
Involves ovarian stimulation
Which of the following is NOT a component of the risk reduction strategy known as closed loop communication?
Is only used in emergency patient care situations
Which statement is most accurate about asthma during pregnancy?
It is safer for a pregnant woman to be treated with asthma medications than to have associated symptoms and exacerbated asthma.
What is the best way to confirm the diagnosis of endometriosis?
Laparoscopy
Which two medications frequently used in the perinatal setting are identified as high-risk medications by the Institute for Safe Medication Practices (ISMP)?
Magnesium sulfate and oxytocin
During the proliferative phase of the menstrual cycle, which is NOT true?
Menstruation occurs
Yearly objectives developed by The Joint Commission that focus on problems in healthcare safety are known as
National Patient Safety Goals
Methylmercury may be found in certain fishes and can adversely affect which fetal system?
Neurologic
Which is NOT true about ovarian hyperstimulation syndrome?
Not an assisted reproductive technologies (ART) risk
Match the fetal lie with correct definition.
Oblique-----occurs less frequently and usually converts to a different fetal lie during labor Transverse-----occurs when the long axis of the fetus is at a right angle, or perpendicular, to that of the mother Longitudinal-----occurs when the long axis of the fetus is parallel to the long axis of the mother
Women who are underweight may have difficulty conceiving due to which of the following conditions?
Oligo-ovulation
Which is NOT a symptom of polycystic ovarian syndrome?
Painful periods
In the early menstrual cycle phase, which gland sends a signal telling the ovaries to prepare to release an egg?
Pituitary
Profound reproductive and endocrine changes occur throughout pregnancy. Which of the following statements is true about progesterone?
Progesterone supports and maintains implantation of the developing embryo in early pregnancy.
A tool used to screen for IPV is
RADAR
Sofia has arrived to your unit for a labor evaluation. She is 37 weeks pregnant and has been complaining of excessive fatigue. Which of the following is a normal physiologic response to the expanding blood volume during pregnancy?
Red blood cell (RBC) production increases to accommodate the expanding blood volume and White blood cell (WBC) production increases due to the changes in estrogen and cortisol.
Which of the following is TRUE about GIFT?
Requires laparoscopy
Which tool is used when an adverse event has occurred to identify variations in performance that led to the outcome?
Root cause analysis
Authoritative statements of the duties that all registered nurses, regardless of role, population, or specialty are expected to perform competently are defined
Standards of Care
Some foods are considered unsafe during pregnancy, and women may choose to avoid them during the preconception period. Undercooked meat and unwashed fruits and vegetables may expose women to which organism?
Toxoplasma gondii
Abigail a G5P4 at 38 5/7 weeks gestation presents to the L&D unit in active labor. Her cervical examination reveals that she is 5 cm dilated and 80% effaced with the fetal head at a -1 station. Abigail has a history of opioid use and is currently on a methadone treatment. She is requesting an epidural for pain relieve. What is your best response?
We can use nonpharmacologic interventions until the anesthesia provider arrives to insert the epidural.
You are caring for Sonya, G1P0 at 40 weeks gestation who was admitted in active labor. Sonya's membranes spontaneously ruptured 30 minutes ago. You are orientating a new nurse and he asks you how often Sonya's vital signs should be taken. What is your best response?
We should take Sonya's pulse, respirations, and blood pressure at least every 4 hours and take her temperature every hour.
Complete
What fetal Presentation?
Footling
What fetal Presentation?
Maria, a 21 year old, G1P0 at 39 2/7 weeks gestation presents to the OB triage with complaints of contractions. You apply the fetal monitor and perform a cervical examination. The cervical examination revealed that Maria is 1 cm dilated and 50% effaced. Maria stated that her cervical examination two days ago at her doctors appointment was the same. Maria asks you what signs to look for to know if she is in labor. What is your best response? (Select all that apply.)
You may experience pain that begins in your lower back and gradually sweep around to your lower abdomen and You may feel like the baby has dropped down in the pelvis. This is referred to as lightening.
During the 2nd trimester of pregnancy, a woman may choose to have a serum alpha-fetoprotein (AFP) level drawn. An AFP is a screening tool for which
a low level may be associated with Down's syndrome and other chromosomal abnormalities.
Position statements are recommendations for
a pathway of action regarding a particular issue
A patient safety event, unrelated to the natural course of the underlying illness, that reaches a patient and results in death, permanent harm, or severe temporary harm with intervention required to sustain life is an example of
a sentinel event
Cultural sensitivity means that the healthcare provider is
alert and considerate of others' views
Preconception care includes maximizing health
all of the above (between pregnancies, during pregnancies, and throughout life)
Women over the age of 35 have an increased risk of
all of the above (cesarean birth, miscarriage and stillbirth, pregnancy-related complications)
Obesity can result in
all of the above (ovulatory dysfunction, altered oocyte and endometrial functions, lower birth rates)
Pregnancy outcomes associated with ART include
all the above (early pregnancy loss, multiple gestation pregnancy, preterm birth)
A baseline FHR is defined as
an approximate mean FHR rounded to increments of 5 bpm during a 10-minute segment, excluding accelerations, and decelerations, and periods of marked variability.
The first "a" in RADAR stands for
ask directly, in a kind, nonjudgmental way
Nadia has arrived for a routine annual physical examination. She does not maintain eye contact and provides only brief responses to questions during the physical assessment systems review. Upon physical examination, you notice bruises on her breasts, upper thighs, and genitals. Nadia begins to cry and states that her husband beats her. Your first action should be to
assess Nadia's safety and ask if she has a safety plan
No amount of alcohol is safe during pregnancy. Fetal alcohol spectrum disorders include
central nervous system abnormalities
Access to care may be limited by all factors except lack of
contraception
The best way for a woman with a regular menstrual cycle to predict ovulation is to record the first day of the LMP and
count backward 14 days
Mrs. McKenzie has arrived for a routine prenatal visit. She is 34 weeks pregnant and is complaining of heartburn and constipation. Her vital signs, fetal heart rate, and deep tendon reflexes are normal. You recognize that her complaints may be due to a/an
decrease in gastric smooth muscle tone and motility caused by increasing maternal hormones.
The innermost layer of the uterus is called the
endometrium
Fertilization occurs in the
fallopian tube
Increasing maternal and paternal age have been shown to influence the risk of
genetic abnormalities
All of the following are elements of good documentation EXCEPT
inclusion of nursing opinion as to causes of error
Smoking increases the risk of
increase in spontaneous abortion
You are a nurse on the mother/baby unit caring for a woman who is 12 hours postpartum from an operative vaginal delivery with midline episiotomy. The woman has severe rectal pain and reports inability to urinate. You suspect a vaginal hematoma and call her physician to request an evaluation. The physician does not respond. Under these circumstances it is appropriate to
institute the chain of communication
The MOST common form of ART for a woman with cervical factor infertility is
intrauterine insemination (IUI)
FHR variability is defined as
irregular fluctuations in a 10-minute window excluding FHR accelerations and decelerations that represent the fetal sympathetic and parasympathetic nervous systems reactivity.
Swiss cheese is often used as the paradigm for explaining medical error. In this model, the holes in the cheese represent
latent weaknesses
In health care, an unplanned event that did NOT result in injury, illness, or damage but had the potential to do so is referred to as a
near miss
You are assigned to a patient who is at 38 weeks and 6 days gestation. She is being admitted for an elective induction of labor because her husband is going on an extended business trip in 2 days and he wants to be present for the delivery. The hospital has no policy regarding elective induction, but you know that the AWHONN "Go the Full 40" campaign doesn't support early elective induction. You approach the physician with your concerns. He responds that he's been doing this for 30 years and has never had a bad outcome from an elective induction at this gestation. This scenario is an example of
normalization of deviance
You are reviewing Jamie's prenatal record prior to her arrival for induction of labor. You notice that she had an ultrasound last week and her maximum vertical pocket was 1.75 and her AFI was 4.5. Given these results, you assume she is being induced for
oligohydramnios
Team training is an effective risk management strategy because it
outlines effective communication tools and techniques
