AWHONN POEP FINAL EXAM
When teaching parents about grief after perinatal loss, which of the following statements is TRUE?
Grief after perinatal loss may be significant and traumatic and may last for months to years.
Lesions that are localized to the skin, eyes, or mouth.
HSV
Baby Aleah was born at 42 weeks of gestation by vacuum-assisted vaginal birth 2 hours ago. She had a vacuum-assisted delivery with Apgar scores 5/8. Which potential birth injury should baby Aleah be monitored closely for?
subgaleal hemorrhage
a baby born by vacuum assisted birth. which potential birth injury should you monitor for?
subgaleal hemorrhage
Determination of risk levels of hyperbilirubinemia treatment is currently based on the use of nomograms that compare a newborn's
TSB level & age in hours
Mrs. Barnes is 14 weeks pregnant and presents with a history of atrial fibrillation in conjunction with mitral valve stenosis. Her primary care provider has determined that she should be treated with anticoagulant therapy throughout her pregnancy. Which anticoagulant is superior in preventing clot formation but is also a known teratogen and should not be used during organogenesis?
Warfarin
Keith, a new nurse you are orienting, asks you how long blood glucose screenings need to be completed on an LGA newborn. What is your BEST response?
We will continue to check blood sugars until the newborn is 24 hours of age and the glucose is 45 mg/dL or higher.
which of the following medications may act as antagonists or decrease the actions of warfarin?
antacids, antihistamine & oral contraceptives
you have a discussion with the physician regarding your patient's increasing BP, what should be included in the documentation?
document the date, time, person spoken to & objective details discussed
Jing is a 26-year-old multiparous woman who presents for a routine prenatal visit. She says she has pain in her right lower leg. Her calf is inflamed & warm to touch. A noninvasive diagnostic tool that may be used in a pregnancy to determine DVT
doppler ultrasound testing
Implantation of the embryo outside the uterus is called
ectopic pregnancy
Hyperthermia is defined as a rectal or axillary temperature greater than 99.5 F (37.5 C). The MOST common cause of hyperthermia in the newborn is
environmental
hyperthermia is defined as a rectal or axillary temperature greater than 99.5. The most common cause of hyperthermia in the newborn is
environmental
A pregnant women who has been on anticoagulant therapy & is receiving regional anesthesia is at risk for
epidural hematoma
the most common organism responsible for urinary tract infection in pregnant women is
escherichia coli (e.coli)
Mrs. Jung is returning to work 8 weeks after the birth of her first baby. When teaching about pumping and storing breast milk, it is important to stress that the BEST method for breast milk to be thawed
in the refrigerator
All of the following are elements of good documentation EXCEPT
inclusion of nursing opinion as to causes of error.
When evaluating a neonate for sepsis the term "left shift" refers to the
increase in proportion of immature white blood cells
Jamie is a first-time mother and asks you if she must increase her calorie intake. Your BEST response would be
increased caloric intake and supplementation with vitamins and minerals is recommended for breastfeeding mothers.
You are the nurse caring for a 38-week, female newborn who was born 1 hour ago in the parking lot of the emergency room. On admission to the nursery, the newborn's axillary temperature was 97.5°F (36.4°C). You recognize that cold stress may predispose the newborn to
increased oxygen consumption & hypoxia
the primary indictor of adequate nutrition in the first week of life is
infant weight
Vaccines that are considered safe during pregnancy include
influenza, T-dap & Covid-19
you contact the DR about your suspicion of something concerning about your patient. the physician doesn't respond. you will
initiate the chain of command
you have a situation where you suspect a vaginal hematoma, when you call the physician they don't respond, you
institute the chain of communication
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.
Karen, G1P0, 34 weeks gestation with twins presents to the OB triage with complaints of severe itching on her hands and feet. Your first suspicion is that Karen may have
intrahepatic cholestasis.
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
A single oral temperature of 102.20F (390C) or greater, or an oral temperature of 100.4- 102.020F (38-38.90C) that continues when the temperature is check every 30 minutes
isolated maternal fever
Mrs. Jordan has arrived to the unit for a labor evaluation. She is 39 weeks pregnant and is complaining of continuous abdominal pain and "port wine" vaginal bleeding. She is having high frequency, low amplitude contractions and the fetal heart pattern shows minimal variability. You suspect that Mrs. Jordan may have a
placental abruption
According to the american academy of pediatrics and CDC guidelines, GBS prophylaxis is recommended in all of the following circumstances except
planned c-section with intact membranes & previous positive GBS screening
a pregnant women develops varicella-zoster virus rash 2 days before birth. whcih complications are more likely for baby
pneumonia
the most common mental health disorder affecting women in the postpartum period is
postpartum depression
The MOST common postpartum complication for mothers with higher-order multiples is
postpartum hemorrhage
which of the following is a cause of vascular permeability (noncardiogenic) pulmonary edema?
preeclampsia
Doris recently had bariatric surgery. She has an appointment at the OB clinic to speak with the provider about family planning. How long will the provider advise Doris to wait to become pregnant?
12-24 months after the bariatric surgery
While inspecting the patency of the anus, it is important to note the passage of stool. Most newborns will pass meconium within the first
12-48 hours
Pregnant woman who have undiagnosed and untreated hypothyroidism are at risk for
preeclampsia, placental abruption, and stillbirth.
Lakisha is a 24-year-old primipara who delivered a 6 lb 2 oz (2,778 gram) male infant 24 hours ago. During your postpartum assessment, Lakisha asks when her uterus will no longer be so prominent in her abdomen. You discuss that the top of her uterus should no longer be felt after about
2 weeks
the postpartum uterus will no longer be felt after about
2 weeks
all of the following may predispose a pregnant woman to disseminated intravascular coagulopathy (DIC) except
preterm labor
One of the MOST common and well documented risk factors for preterm labor is
previous history of preterm birth
You are responsible for teaching a class to a group of mothers. One mother has asked how soon she should begin to use birth control after birth. It is important to discuss that in non-lactating women, ovulation may occur as early as
27 days
After birth, cardiac output usually remains elevated for 48 hours and then decreases rapidly during the first two weeks. Cardiac output returns to pre-pregnant values within
3 weeks
Proteinuria may indicate worsening underlying renal disease or preeclampsia when 24-hour urine levels exceed
300 mg/dL
the late preterm infant population is currently defined as babies who are born between
34 & 36 weeks
The late preterm infant population is currently defined as babies who are born between
34 and 36 completed weeks of gestation.
In contrast to term newborns, bilirubin levels in late preterm infants typically peak at
5-10 days of life
After birth, blood loss is typically evaluated by the primary care physician or midwife who delivered the baby. Normal blood loss for a vaginal birth is less than or equal to
500 mL
normal blood loss for a vaginal birth is less than or equal to
500 mL
Halili has a history of mechanical valve replacement and has been on anticoagulants during pregnancy. Her medications were discontinued in labor. She had a normal spontaneous vaginal birth 2 hours ago and has just completed her recovery period. Her anticoagulant therapy should be reinitiated after birth within
6 hours
A newborn is born after a difficult birth and meets the criteria for therapeutic hypothermia. Cooling the newborn must begin within
6 hours of birth
You are caring for a mother who is Rh negative and her infant is Rh positive. To prevent sensitization, it is important to administer Rh immune globulin (Rhogam) within how many hours after birth?
72 hours
You are caring for a mother who is rh-negative and her infant is rh-positive. To prevent sensitization, it is important to administer Rhogam within how many hours after birth?
72 hours
Risk factors for placenta previa include
previous uterine surgery, smoking, and hypertension.
during which phase of the patho process of DIC do platlets adhere to the surface?
primary hemostasis
You are asked to explain the use of CPAP to a new nurse. You explain CPAP is used for the following circumstance:
A newborn moderate symptoms of respiratory distress syndrome
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
Which of the following breastfeeding positions is MOST useful for the mother recovering from a cesarean birth?
Allow the mother to choose the method and position that works best for her and for the newborn.
Mrs. Jones has been receiving heparin therapy and is being transitioned to warfarin in the postpartum period. Which of the following medications may act as antagonists or decrease the actions of warfarin?
Antacids, antihistamines, and oral contraceptives
Roberta, a 29 year-old, G3P2, arrives in the OB triage. Her significant other Jose reported Roberta's complaints of severe heartburn. He shared that the pain started after they had lunch. You noticed Roberta was not speaking for herself. What would your next course of action be?
Ask Roberta what her preferred spoken language is and provide an interpreter as needed.
You are orienting Stacy in the newborn nursery. After plotting the newborns weight, length, and head circumference on the growth chart, you document the newborn is asymmetric IUGR. Stacy asks you to explain asymmetric IUGR. What is your BEST response?
Asymmetric IUGR occurs when the body weight and length fall below the 10th percentile on the newborn growth chart. The head and abdominal circumference both fall within normal range.
Blindness, conjunctivitis, pharyngitis, arthritis, and in rare cases, life-threatening neonatal sepsis
Gonorrhea infection
Karen is being treated for trichomoniasis and is prescribed a single 2 gram dose of oral metronidazole. What should you include in the education to Karen. (Select all that apply.)
Avoid alcohol or vinegar products because they may cause nausea, vomiting, or cramping// Avoid sexual intercourse for at least two weeks to allow the tissues to heal// Continue to avoid alcohol for at least 24 hours after you take the metronidazole // You will need to return in three months for retesting.
You are caring for Tish, a 32 year-old G4P3 who was admitted to the antepartum unit with gestational hypertension. Antihypertensive therapy was initiated four hours ago. Tish current vital signs are BP 144/92 mm Hg, heart rate 122 bpm, respirations 22 bpm, temperature 98.9°F. Given Tish's current vital signs, what could potentially be happening?
Because of the tachycardia, Tish may be experiencing decreased cardiac output and pulmonary edema.
All pregnant women should receive education regarding careful handling of potentially infected items such as diapers, dirty clothing, and toys; avoiding putting a child's pacifier in her mouth; avoiding sharing food and utensils; and washing hands frequently to avoid which infection?
Cytomegalovirus
Clinical signs of velamentous insertion of the cord include
FHR bradycardia
You are demonstrating newborn care in a discharge teaching class to a group of new mothers. In your discussion of Sudden Infant Death Syndrome (SIDS), it is important that you emphasize proper sleeping conditions. Which of the following constitutes a safe sleeping environment for a newborn infant?
Firm mattress free of loose bedding and stuffed toys
When assessing the obstetric trauma patient, what does the acronym FAST stand for?
Focused assessment with sonography for trauma
You are providing couplet care for Linda and her newborn. Linda is a diabetic mother who gave birth yesterday. She asks you why her baby would be a risk for blood sugar problems. What is your BEST response?
Following birth, your supply of glucose to your baby is rapidly diminished. However, the increased level of insulin remains, resulting in a potential for your baby's blood sugar to be lower than normal.
Successful defense against malpractice claims is enhanced by which of the following?
Following national professional standards.
When is it appropriate to start a sepsis protocol?
For women with a mean arterial pressure < 65 mm Hg
Eye prophylaxis with a single-use dose of sterile ophthalmic ointment containing 0.5% erythromycin is usually administered within the first hour of birth to prevent which of the following conditions?
Gonococcal opthalmia neonatorum
You are walking past Elizabeth's room when you overhear the nurse, Margaret, say "I am very concerned for you Elizabeth." After Margaret leaves the room, you ask her to speak privately to provide her feedback regarding what you overheard. Your feedback should include
I overheard what you said to Elizabeth about being concerned for her. I would like to suggest a more empathetic approach by saying "I can see how upset you are. I will provide you with a list of support groups that may be helpful after you leave the hospital."
Lori has a history of congenital cardiac disease. She is being moved to a telemetry unit for cardiac monitoring after the birth of her 24-week stillborn infant. The nurse caring for Lori asks you what education she needs to provide Lori regarding normal postpartum assessment findings. Your BEST response should be
It is important for Lori to understand that her milk will come in. We need to educate Lori to avoid breast and nipple stimulation by wearing a supportive bra or sports bra. In addition, she can apply cold packs to the breast for comfort and take pain medication as prescribed by the provider when needed.
You are caring for Lauren who gave birth to a 36-week stillborn baby girl. Terri, a new nurse that you are orienting, asks you what tips you have regarding mementos and photography. Your best response is
It is important to ascertain the parents' wishes regarding photography and cutting a lock of hair as some cultures or religious traditions do not embrace this practice.
Mrs. Lang is concerned that breastfeeding is not going well because her newborn has lost weight since birth. What is your BEST response?
It is normal for babies to lose up to 7% of their birth weight after birth. We will continue to monitor the baby's weight.
Which of the following conditions may predispose a newborn to meconium aspiration syndrome?
Maternal hypertension
You are caring for Mrs. Henderson, G2 P2 had a vaginal birth three hours ago. The nursing student obtained Mrs Henderson's vital signs and reported the following: heart rate of 124 bpm, respirations 24, temperature of 97.8°F, and blood pressure 92/62. The nursing student also commented that Mrs. Henderson appeared "agitated." Given the vital sign assessment that you received from the nursing student, what should you consider?
Mrs Henderson may be experiencing a postpartum hemorrhage and will need immediate further examination.
Yearly objectives developed by The Joint Commission that focus on problems in healthcare safety are known as
National patient safety goals
A new nurse asks you why it is important to check a glucose level for a newborn that is being ruled out for sepsis. Your BEST response would be?
Newborns that are sick tend to have higher metabolic rates which leads to a depletion of available glucose and oxygen.
Mona, a 22 year-old, G2P1 with a history of asthma, was admitted to the antepartum unit with preeclampsia. The provider ordered Labetalol 10mg IV. What is your next course of action?
Notify the provider that Mona has a history of asthma and request a different antihypertensive.
Andrea, a 25 year old G1P0 at 39 5/7 weeks gestation was admitted at 1020 for spontaneous rupture of membranes. Andrea stated that she thinks her "water broke" around 2030 the night before. Her cervical examination at that time was 3/80/0 with greenish fluid noted on the exam glove. Andrea's prenatal record indicated she was positive GBS so PCN G was initiated. Andrea received an epidural for pain relieve around 1130. Andrea's cervix was examined hourly by the OB Resident. Her labor progressed as anticipated and she gave birth to a male newborn at 1630 with Apgar of 7 and 9. What factors would place Andrea at risk for an intraamniotic infection? Select the best answer.
Nulliparity, prolonged rupture of membranes, meconium-stained fluid, multiple cervical examinations, and GBS
Sarah asks you if using a pacifier is bad since she is breastfeeding her baby. What is your BEST response?
Pacifiers may have a protective effect that can reduce the incidence of SIDs, however, it is recommended to delay the use until breastfeeding is well established.
Marlene, a new nurse working on the unit, asks you to explain perinatal palliative care. What is your BEST response?
Perinatal palliative care is a family centered approach that enhances maternity care with emotional, sociocultural, and spiritual support for parents who are continuing a pregnancy affected by a life-limiting fetal condition.
An acquired condition in pregnancy where the heart muscle becomes enlarged, thick, or rigid leading to a decrease in contractility is called
Peripartum cardiomyopathy.
Samantha, a G2P2 with a DVT, has been receiving Heparin therapy. You notice on the MAR that the 2pm dose of Heparin was given twice. What medication would be given to reverse the effects of Heparin?
Protamine sulfate via slow IV push
Which of the following statements regarding baptism is TRUE?
Regardless of what religion or culture, ask the couple about all of their preferences.
Joe and Sarah have arrived for a prenatal visit and an ultrasound. When the ultrasound showed the fetus did not have a heartbeat, the father yelled at the physician to look again or to have someone else read the ultrasound. He then storms out of the room. What phase of grief is the father experiencing?
Searching and yearning
Which of the following parents is MOST likely to experience complicated grief after a perinatal loss?
Shontelle experienced a stillbirth at term, and is alone in her room. Her family lives far away, and she and her husband are in the process of divorcing.
Lorna, a 22 year old, presenting to the clinic for her annual examination. Lorna and her husband are planning to start a family. She shares that her friend was newly diagnosed with HPV. Lorna asks you how she would know if she had HPV. Your best response would be
Signs & symptoms of HPV are asymptomatic causing no clinical issues.
You are caring for Carla, a 23 year old G1P0 who is being induced for post dates. Carla has a history of herpes simplex virus but no active lesions at this time. The fetal heart rate (FHR) is very difficult to trace. You have to consistently adjust the ultrasound to obtain the FHR. One of the nursing students on the unit asks why you don't place a fetal scalp electrode. Your best response is
The application of a fetal scalp electrode is not generally recommended for women with active lesions or a history of HSV infection because it can cause a local neonatal infection.
Linda, G2P1, 39 weeks gestation is admitted in active labor. Linda has a BMI of 40. While preparing the room for imminent birth, you bring in ergonomic equipment to assist with positioning and transferring Linda. The family asks what the equipment is for. Your best response would be?
The equipment is used to assist with patient positioning and transfers.
Karen, a 34 year-old G2P1, was admitted with pulmonary edema. She is on continuous fetal monitoring. What do you expected with the fetal heart rate tracing?
The fetal heart rate may manifest as an increasing fetal heart rate baseline, decreasing heart rate variability, and late decelerations.
Universal vaccination and prenatal testing for hepatitis B have decreased the incidence of acute hepatitis infections in newborns. Neonates born to hepatitis B surface-antigen (HBsAg)-positive mothers should receive
The first dose of hepatitis B vaccine within 12 hours after birth and a dose of hepatitis B immunoglobulin (HBIG) administered at a different site.
The fetal circulatory system is supported by the placenta. The umbilical cord, which is comprised of two arteries and one vein, carries blood to and from the fetus. Identify the correct statement about the umbilical cord below.
The umbilical vein carries oxygenated blood from the placenta to the fetus.
Tonya is a new nurse that you are training in the OB clinic. You are reviewing what assessment is needed for the next patient visit with Amanda, G1P1, postpartum 6 week follow-up appointment. Amanda has been very concerned with her weight and wanted to speak with the provider about her next steps. The provider asked you to obtain Amanda's waist circumference. Tonya seemed a little confused by this. What is your best explanation?
There is a direct relationship between waist circumference and abdominal fat and can be used to determine the risk of morbidity associated with being overweight.
Sandy, a new nurse to the L&D unit, asks you why the provider ordered a 24-hour urine for protein when you have the supplies needed on the unit to perform a urine dip stick for protein. Your best response is?
There is potential for a high false-positive when performing a urine dipstick for protein.
A new mother is very concerned and asks you about the 'red marks' on the newborn's eyelids. She noticed that they get darker when the newborn cries. What is your BEST response?
They are common birthmarks called nevus simplex or stork bites that blanch with pressure and become pinker with crying.
Neonatal complications are typically limited to the consequences of prematurity and/or low birth weight.
Trichomoniasis
Mrs. Joseph delivered a healthy, male newborn yesterday. She and her partner are discussing the benefits and risks of circumcision. Which of the following statements about neonatal circumcision is correct?
When the decision is made to proceed with circumcision, analgesia and anesthesia should be provided.
Universal vaccination and prenatal testing for hepatitis B have decreased the incidence of acute hepatitis infections in newborns. Infants born to hepatitis B positive mothers should receive the first dose of hepatitis vaccine within 12 hours of
a dose of hepatitis b immunoglobulin HBIG administered concurrently at a different site
which infant is most at risk for hypothermia
a newborn with neurologic deficits
a WBC count of 22,000 ina postpartum patient may be indicative of
a normal postpartum physiologic process
Lei presents to her primary care physician complaining of fatigue 10 days after having a spontaneous vaginal birth of twins. Her physician has ordered some lab work. Her white blood count value of 22,000/mm3 may be indicative of
a normal postpartum physiologic process.
Position statements are recommendations for
a pathway of action regarding a particular issue
Jennifer is admitted at 32 weeks gestation with a headache, nausea, vomiting, epigastric pain, and malaise. She is a primiparous woman with a twin gestation pregnancy who was recently diagnosed with preeclampsia. Jennifer is at risk for which autosomally inherited disorder?
acute fatty liver disease
Unrecognized and untreated endometritis in the postpartum period may progress
acute salpingitis
During fetal life, the foramen ovale
allows blood to directly enter the left atrium from the right atrium.
An intrauterine condition in which rings of amniotic membranes lead to constriction resulting in malformation or amputation of the extremities is
amniotic band syndrome
Anna, G2P1 at 30 weeks gestation presented to the OB triage after a motor vehicle accident. You are helping the primary nurses and she asks you to place the fetal monitor while she is assessing Anna. After leaving the room, you ask the nurse why it was so important to place the fetal monitor in this situation. What would the nurse's best response be?
any condition, such as trauma, that causes a reduction in perfusion to the uterus is poorly tolerated by the fetus
Rhonda, a 25-year-old Native American woman, gave birth a stillborn infant at term after a cord accident. She has been stoic since the birth and refuses to see the baby. You should:
ascertain Rhonda's wishes regarding the family seeing the baby and if she agrees, provide a separate room for the family to see the baby.
When working with a family who had a term stillbirth the nurse should
ascertain the parents' wishes regarding any culture or religious beliefs and support their wishes.
Upon entering the woman's room to review discharge instructions, you find her staring at her baby and crying. The MOST appropriate action for the nurse is to
ask the woman why she is crying.
Last evening Katelyn gave birth to a healthy baby girl, weighing 7 lbs 1 oz (3,203 g). Her newborn nursed well immediately after delivery. She has not had a second successful breastfeeding in 4 hours despite repeated attempts. You should
assess the newborn's sleep cycles and hunger cues.
Janice is a 42-year-old, obese primiparous woman who is in early labor. She has a history of obesity and uncontrolled glucose levels during the third trimester of pregnancy. Uncontrolled abnormal glucose levels in pregnancy may also be associated with (Select all that apply.)
birth defects, stillbirth, and macrosomia, prematurity, small for gestational age, and shoulder dystocia.
which of the following cardiac lesions are characterized by dysfunction of the cardiac muscle with decreased cardiac output
cardiomyopathy
Baby Lourdes was born 4 hours ago at 42 weeks of gestation by vacuum-assisted delivery. On your initial newborn examination, you document an edematous, bruised lesion on the right anterior scalp where the vacuum was applied. This lesion has clearly demarcated edges and does not cross the suture line. This is BEST described as a
cephalohematoma
You are the primary preceptor of a new nurse on your unit. You are scheduled to care for a 28-year-old primiparous woman who will be arriving for preinduction prostaglandin insertion this evening. The new nurse and you sit down to review the medical record and establish a plan of care. The patient's prepregnant weight was 380 lbs. In your discussion about risks associated with obesity in pregnancy, it is important to emphasize that obese women are more prone to
cesarean birth, endometritis, cardiac dysfunction, wound dehiscence, depression, gestational diabetes mellitus, preeclampsia, termination of breastfeeding
which of the following has been noted among the top three root causes of sentinel events for over 10 years?
communication
Jing is a 36-year-old multiparous woman who presents for a routine prenatal visit says she has pain in her right lower leg. Her calf is inflamed and warm to touch. A noninvasive diagnostic tool that may be used in pregnancy to determine whether Jing has deep vein thrombosis is
compression ultrasonography
Which of the following complications may predispose a pregnant woman to disseminated intravascular coagulopathy (DIC). (Select all that apply.)
concealed placental abruption, intrauterine fetal demise, preeclampsia
Based on a positive amniotic fluid test result or placental pathology that indicates the confirmed presence of placental infection or inflammation
confirmed IAI
The MOST common causes of neonatal death include
congenital abnormalities and preterm birth
the most common cause of neonatal death includes
congenital anomalies & preterm birth
a primary cause of hearing loss in the newborn is
cytomegalovirus
Placental function begins to decrease toward the end of pregnancy, which may result in
decreased blood flow and fetal hypoxia.
which of the following signs may be seen in a newborn with a pneumothroax?
decreased breath sounds on one side, grunting & cyanosis, & hypotension (all of the above)
Primary causes of jaundice in late preterm infants
decreased life of fetal hemoglobin and diminished bilirubin conjugation.
Treating hypertension with vasodilating agents during pregnancy may be associated with
decreased uteroplacental blood flow.
Cindy, a 25 year-old, G1P0 is scheduled for induction of labor next week. She is taking LMWH. Part of her preoperative instructions should include
discontinuing the LMWH 24 hours prior to induction of labor.
Romelia's labor was induced at 32 weeks gestation after a third-trimester fetal loss. Her blood pressure has remained high after birth. Her Muslim culture supports wrapping the deceased newborn in a seamless white sheet and having a burial within 24 hours. Romelia is requesting an early discharge to be at the burial. You should
discuss concerns with the physician and family and individualize her discharge plan to include appropriate outpatient monitoring and follow-up.
Ms. Linghu arrived at the obstetric care unit for a labor evaluation. She is 28 weeks gestation and is complaining of a lower back ache and cramping. The physician has asked for assistance in obtaining a sample to assess for fetal fibronectin (fFN). Which statement about fFN is MOST accurate?
fFN is a strong predictor or marker for identification of preterm labor.
the newborns mother has a history of type 1 diabetes, infant is macrosomic. there is a risk of hypoglycemia because
fetal overproduction of insulin
Francesca is a 34-year-old primipara with a history of type-I diabetes. She was delivered by primary cesarean birth for macrosomia. She gave birth to a male newborn weighing 12 lbs 4 oz (5,557 g). You recognize that the newborn may be at risk for hypoglycemia secondary to
fetal-neonatal overproduction of insulin
you are teaching a new mother about proper sleeping conditions to prevent SIDS. what is a safe sleeping environement?
firm mattress free of loose beeding & stuffed toys
Current recommendations for antenatal glucocorticoid administration for acceleration of fetal lung maturation is appropriate
for women at 24 0/7-33 6/7 weeks gestation at risk for preterm birth within 7 days.
Alexandra is 21-year-old primigravida at 10 weeks of gestation. She has arrived for her first prenatal visit. She is 5' 3" tall, and her prepregnant weight is 245 lbs and her BMI is 45. In your prenatal discussion about optimal weight gain during her pregnancy,it is important to stress that Alexandra should
gain 11-20 lbs to accommodate the growing placenta & fetus
Because of the decreased lower esophageal sphincter tone of pregnancy and increasing mechanical pressure due to the rapidly growing uterus in the women pregnant with multiples, she is at risk for
gastroesophageal reflux.
common sites of neonatal gonorrheal infection include all of the following except
genitals
Antimicrobial ophthalmic prophylaxis given to the neonate soon after birth is recommended for which STI?
gonorrhea
One of the MOST common causes of early on-set neonatal sepsis is
group b strep infection
a woman who has rapid HIV testing during labor with a positive result should
have a follow up test in the postpartum period to confirm the diagnosis
which type of hepatitis may be prevented with the hepatitis B vaccine?
hepatitis D
Although most women are able to breastfeed if they choose, there are important instances in which breastfeeding is contraindicated. Which of the following is NOT a contraindication to breastfeeding?
hepatitis c infection
Mrs. Johnson has described that her newborn has been crying constantly since his circumcision this morning. When you arrive at her room, you find the newborn crying in his crib. Which of the following nonpharmacologic interventions can you teach Mrs. Johnson to help console her newborn?
holding & rocking
what is a nonpharmacologic intervention that you can use to help console a baby after their circumcision?
holding & rocking
Which of the following is NOT a contraindication for magnesium sulfate administration?
hyperkalemia
infants with hypothermia may also experience ____ related to increased glucose utilization
hypoglycemia
rom the nurse's station you can hear Karen's newborn crying. When you enter the room, you notice that Karen is also crying and curled up in her bed. When you ask her if she needs any assistance Karen responds by saying "I can't get her to stop crying. I am a horrible mother." What is your BEST response?
it can be frustrating when your baby cries; you did the right thing by placing her in the crib & then taking a moment for yourself
Swiss cheese is often used as the paradigm for explaining medical error. In this model, the holes in the cheese represent
latent weakness
While teaching Karin about her newborn's umbilical cord, it is important to stress that routine cord care consists of
leaving the cord exposed to air and observing for redness, drainage, and/or odor.
A pregnant woman presents with a rash two days before giving birth to a full term neonate. The rash is determined to be caused by the varicella-zoster virus. Which complications will the newborn most likely experience?
life-threatening disseminated disease
Mrs. Madison has arrived at her prenatal visit at 36 weeks gestation. She has gestational diabetes, and her glucose levels have been controlled by diet alone. She documented several high glucose values over the past week. It is important to discuss that prolonging pregnancy beyond 38 weeks in women with diabetes may result in fetal
macrosomia
prolonging pregnancy beyond 38 weeks in a women with diabetes may result in fetal
macrosomia
the institute of safe medication practice has identified which 2 meds as high risk in the perinatal setting?
magnesium & oxytocin
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 & oxytocin
a limited diagnostic evaluation on an infant is indicated in which circumstance?
maternal antibiotic therapy was initiated for maternal chorioamnionitis
Which feature is recommended when monitoring twin gestations to differentiate between fetal heart rates and maternal heart rate?
maternal pulse oximetry
An ova that is fertilized by one sperm and then divides into two zygotes results in
monozygotic gestation.
The risk of perinatal transmission of HIV can be reduced with antiretroviral treatment. Identification in the preconception period is essential. Which of the following statements about HIV screening in pregnancy is most accurate? pregnant women:
must be given the option to opt out of routine HIV testing
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
Which type of white blood cell migrates to the walls of blood vessels to attack bacteria through chemotaxis and phagocytosis?
neutrophils
Which of the following is a contraindication for magnesium sulfate administration?
nifedipine
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.
normalization of deviance
your patients physician is pushing to induce her labor at 38 weeks in spite of AWHONN recommendations. this is known as
normalization of deviance
Kimberly is a full-term newborn born at 8:40 am to a diabetic mother. Her mother is planning to feed her with formula. Prior to her third feeding at 1:30 p.m., Kimberly's blood sugar was 31 mg/dl (1.7 mmol/L). She tolerated 1⁄4 oz. of formula. One hour after feeding, Kimberly's blood sugar was 30 mg/dl (1.6 mmol/L). The next intervention is to
notify the primary care provider immediately and anticipate an order for intravenous (IV) fluids containing a dextrose solution.
Karen gave birth to a 22-week gestation stillborn baby boy. She has had many visitors and her significant other has been very supportive. Despite this, Karen has not been responsive and appears to be numb. One of the best ways to help Karen is to
notify the provider of your findings and provide Karen with a list of community resources and support groups.
Team training is an effective risk management strategy because it
outlines effective communication tools and techniques.
Which two hormones MOST affect milk synthesis and milk ejection?
oxytocin & prolactin
Classic signs of placenta previa are
painless bright red bleeding
Jaundice that typically appears within the first 24 hours of life, with rapidly rising serum bilirubin levels, and is usually caused by an underlying disease process, such as sepsis or hemolysis is called
pathological jaundice
One of the metabolic disorders that results from a deficiency in a liver enzyme that may cause progressive developmental delays, severe intellectual disability, seizures, and autistic-like behavior is
phenlketonuria
Couvelaire uterus is associated with what condition?
placental abruption
authoritative statements that describe a competent level of nursing practice through assessment, diagnosis, outcome identification, planning, implementation & evaluation are defined as
standards of care
You are caring for a mother/baby couplet. Approximately 40 hours ago, Melinda, a 32- year-old primiparous woman, had an urgent cesarean birth after a prolonged second stage of labor during which she had a Category-III abnormal fetal heart tracing. Melinda has been weepy and has not wanted to get out of bed. She describes symptoms of dyspnea and chest pain. Her vital signs are blood pressure of 84/56 while lying down, pulse of 122 beats per minute, and respirations of 26 breaths per minute. Melinda is displaying symptoms of
pulmonary embolism
your patient has symptoms of dyspnea, abdominal pain, & chest pain, VS are BP 84/56, P 118. & RR 26- symptoms of?
pulmonary embolus
Cami, a G1P0 at 26 weeks gestation, presents to the OB triage with complaints of fever, chills, flank pain and tenderness, urinary frequency or urgency, hematuria, and dysuria. Based on your training, what do you think she might have?
pyelonephritis
a women with higher-order multiples is at risk for all of the following except
pyelonephritis
Mariel gave birth to a 10 lb 12 oz (4,876 gram) male infant 3 hours ago. She had a 2 midline episiotomy with labial swelling and bruising. She was medicated with Ibuprofen 800 mg 2 hours ago. She is complaining of perineal pain. The MOST effective intervention at this time is to
reapply ice packs to her perineum
after vaginal delivery your patient is complaining of perineal pain. she was given ibuprofen 2 hours ago. best intervention is to
reapply ice park to her perineum
An unsuccessful repair of a 4th degree laceration after a precipitous vaginal birth of a 12-pound infant may result in a
rectovaginal fistula
Mrs. Kirkland has arrived for her routine postpartum visit 6 weeks after the birth of her first infant. During her examination, Mrs. Kirkland describes that intercourse is uncomfortable. Her pelvic exam is unremarkable. You discuss that intercourse may be painful due to vaginal dryness which is caused by
reduced estrogen levels
Olivia, a 32 year-old, G3P2 with a history of cardiac disease, is being admitted for labor. Given her history, what is the recommended method of pain control?
regional anesthesia
Cecelia was born at 42-week gestation with meconium stained amniotic fluid after a prolonged second stage of labor. She is floppy, apneic, and has a heart rate of 60 beats per minute. The first action in caring for Cecelia is to
reposition the head and begin positive pressure ventilation.
Mario is a 2-hour-old neonate who was born at 41 weeks gestation with meconium stained amniotic fluid. He presented floppy and apneic and he required 2 minutes of bag/mask ventilation on 100% oxygen. He was weaned to room air by 10 minutes of age. Currently, Mario has tachypnea, mild grunting, and retractions. His arterial blood gas levels are: pH: 7.15, pCO2: 63, HCO3: 21. Which of the following is a correct interpretation of these blood gas results?
respiratory acidosis
Lola is a 24-year-old Caucasian primipara who has arrived at the labor and birth unit with excessive, bright red, vaginal bleeding. She is 36 5/7 weeks' pregnant and has a known placenta previa. She has a history of poorly controlled type I diabetes. After an evaluation, her primary care provider has determined that Lola needs to have a primary cesarean birth. Her neonate is MOST at risk for
respiratory distress syndrome
in a postpartum patient diaphoresis occurs in the first few days after birth due to
restoration of pre-pregnancy fluid volume
Joleen is a 32-year-old primiparous woman who delivered a female infant 24 hours ago. She is complaining of having to change her gown frequently due to sweating. You explain that diaphoresis occurs in the first few days after birth due to
restoration of pre-pregnancy fluid volume.
Which tool is used when an adverse event has occurred to identify variations in performance that led to the outcome?
root cause analysis
which tool is used when an adverse event has occurred to identify variations in performance that led to the outcome?
root cause analysis
Amniotic band syndrome is associated with what complication in pregnancy?
rupture of membranes
Full term newborns that are asymptomatic & born to a woman who was pretreated for GBS with penicillin may be observed in the normal newborn nursery. A limited diagnostic evaluation & antibiotic therapy is indicated in which of the following circumstances?
rupture of membranes occurred 18 hours prior to birth
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
sentinel event
a patient safety event, unrelated to the underlying illness, that reaches a patient, results in death, perm or severe temp harm is
sentinel event
Ricardo and Maria have just been told that their 12-week fetus does not have a heartbeat. Maria stares blankly at the window and does not respond. What phase of grief is she experiencing?
shock & numbness
A shared understanding of what is going on & what is likely to happen next is known as
situational awareness
a shared understanding of what is going on & what is likely to happen next is known as
situational awareness
the loss of pregnancy prior to 20 weeks gestation or delivery of a fetus weighing less than 500 grams is called a
spontaneous abortion
Tatiana is a 24-year-old homeless woman who presents to the labor and delivery unit in active labor with no history of prenatal care. She gives birth precipitously within 10 minutes after her arrival. The neonate's Apgar scores are 2 at 1 minute of life, 5 at 5 minutes of life, and 7 at 10 minutes of life, and the neonate falls in the small for gestational age category on the neonatal growth chart. At 12 hours of age, the neonate is tachypneic, jittery, hypertonic, high-pitched cry, and inconsolable. It is important to screen this neonate for
substance exposure
Based on clinical findings which include maternal intrapartum fever and one or more of the suspected following: maternal leukocytosis, purulent cervical discharge, or fetal tachycardia
suspected IAI
Clinical signs and symptoms may include an edematous "barber's pole" umbilical cord with stripes of red, light blue, and chalky white
syphilis
Mrs. Rowe is a 28-year-old multiparous woman who delivered a 7lb 9oz (3,430 gram) male infant 1 hour ago. Both the mother and the infant are in stable condition after the uncomplicated vaginal birth. While caring for Mrs. Rowe and her infant at this time, you would expect her to be in which of the following maternal adjustment phases?
taking-in
Tammy, a 32 year-old, G2P1 with chronic hypertension, is being seen in the OB triage with complaints of an unrelieved headache after taking acetaminophen. The provider order labs including uric acid. The uric acid result was 4.5-6.0 mg/dL.
tammy may have superimposed preeclampsia
blood sugar screening for a late preterm infant should continue prior to every feeding until the newborn
the newborn is at least 24 hours old & plasma glucose is at least 45
The full term newborn cardiovascular assessment includes auscultation, inspection, and palpation. The point of maximal impulse is usually palpable and can be auscultated in the
third to fourth intercostal space and left of the midclavicular line.
A cerclage placed in women with documented shortened cervical length by ultrasound examination is called
ultrasound indicated cerclage
Gabriella was born by operative vaginal birth after a prolonged second stage of labor. She presented as floppy and apneic, and required bag/mask ventilation and fluid resuscitation in the delivery room. Her Apgar scores were 3 at 1 minute of life, 5 at 5 minutes of life, and 8 at 10 minutes of life. The pediatrician has requested that a cord blood sample be sent to the lab. To document the most accurate acid-base status at the time of delivery, this blood sample should be drawn from the
umbilical artery
You are preparing to give your postpartum patient Rh immune globulin. Prior to administering this medication, you should
verify that the mother is Rh negative and Coombs negative.
Obesity is a nationwide problem in the US. Which of the following is considered a primary measure to help determine risk of morbidity & obesity?
waist circumference
