Family Health Review Material

Misoprostol (Cytotec)

May cause diarrhea, nausea, vomiting Given rectally

uterine atony

Most frequent early cause of postpartum hemorrhage

Subtract 3 months Add 7 days (Adjust year if necessary)

Nagele's Rule

Oxytocin (Pitocin)

No contraindications May cause water intoxication

- Fetal heart rate: detected by doppler at 10-12 weeks or by ultrasound examination at 5 weeks - Visualization of fetus by ultrasound - Active fetal movement palpated by examiner

Positive Signs

Breast changes, amenorrhea, nausea/vomiting, urinary frequency, fatigue, quickening

Presumptive Signs

- Goodell sign - Chadwick sign - Hegar sign - Positive pregnancy test - Ballottment - Braxton Hicks Contractions - Abdominal Enlargement

Probable Signs

Complete dilation until delivery of baby Uterine contractions: every 2-3 minutes lasting 60-75 seconds of strong intensity Increase in bloody show Mom feels urge to bear down - pushing begins Epidural will prolong this phase

Second stage

a. Late decelerations

A gravid woman, 28 weeks gestation, is admitted to the labor and delivery unit following an accident. Which of the following FHR patterns would make the nurse think that the woman might have a placental abruption? a. Late decelerations b. Early decelerations c. Variable decelerations

c. Surfactant is formed

A gravida's fundal height is noted to be at the xiphoid process. The nurse is aware that which of the following fetal changes is likely to be occurring at the same time in pregnancy? a. Lanugo covers the entire body b. Insulin is produced for the first time c. Surfactant is formed d. Respiratory movements begin

c. There is no seizure activity in the woman

A nurse administers magnesium sulfate via infusion pump to a gravid woman in labor who has severe preeclampsia. Which of the following outcomes specifically indicates that the medication is effective? a. Contractions stop b. Blood pressure returns to pre-pregnancy level c. There is no seizure activity in the woman d. Output increases

b. Dizziness and nausea

A 36-week gestation gravid lies flat on her back. Which of the following maternal symptoms would the nurse expect to observe? a. Numbness and tingling down one of her legs b. Dizziness and nausea c. Rales d. Chloasma

a. Conduction

A baby has just been admitted into the neonatal nursery. Before the newborn arrived the nurse turned on the radiant warmer so that the blankets upon which the newborn would lay would be warm. This action is done to prevent heat loss in which of the following ways? a. Conduction b. Convection c. Evaporation d. Radiation

c. She feeds her baby every 2-3 hours.

A breast-feeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective? a. She pumps her breasts after each feeding. b. She feeds her baby on each side for 5 minutes. c. She feeds her baby every 2-3 hours. d. She supplements each feeding with formula.

c. Rotate the baby's position at each feeding

A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following? a. Use a nipple shield at each breastfeeding b. Clean the nipples with soap three times a day c. Rotate the baby's position at each feeding d. Bottle feed for two days and then resume breastfeeding

c. Turn the magnesium sulfate off

A client is on magnesium sulfate for preterm labor. The nurse notes the following assessment at 8:00 am: Urine output 100 ml; 98.6F, 88, 10, 120/70; absent patellar reflexes; decreased level of consciousness. The nurse's first action should be: a. Call the health care provider b. Administer calcium gluconate c. Turn the magnesium sulfate off d. Apply oxygen per facial mask at 8-10 liters/minute

d. Report of "floaters" in vision and unrelieved headache

A client is on magnesium sulfate for severe preeclampsia. The nurse should notify the health care provider of which of the following findings? a. Urinary output less than 60 mL/hr b. Patellar and bicep reflexes of +2 c. Respiratory rate of 14 d. Report of "floaters" in vision and unrelieved headache

b. ALT, AST c. CBC d. BUN, CRE

A client presents to the labor and delivery area complaining of flu-like symptoms, nausea, and epigastric pain. Which of the following labs does the nurse anticipate being ordered? (SELECT ALL THAT APPLY) a. Electrolytes b. ALT, AST c. CBC d. BUN, CRE e. Amylase and glucose

c. Auscultate lungs

A client receiving terbutaline (Brethine) through an intravenous infusion calls out complaining of shortness of breath. The nurse's initial reaction should be: a. Nothing - this is a normal side effect of this medication. b. Call the doctor immediately. c. Auscultate lungs d. Order a chest x-ray stat.

c. Have the woman breathe into a bag

A client who is 7 cm dilated and 100% effaced is breathing at a rate of 50 breaths per minute during contractions. Immediately after a contraction, she complains of tingling in her fingers and some light-headedness. Which of the following actions should the nurse take at this time? a. Assess her blood pressure b. Turn the woman on her side c. Have the woman breathe into a bag d. Check the fetal heart rate

a. Drop significantly.

A client with type 1 diabetes mellitus gives birth. The postpartum nurse monitors the blood glucose level carefully, expecting that the client's insulin requirements in the first 24 hours after delivery will: a. Drop significantly. b. Increase significantly. c. Depend on whether the patient is breastfeeding or bottlefeeding d. Return to pre-pregnancy levels.

b. Soft crackles in the bases of the lungs

A full term neonate, Apgar 9/9, has just been admitted to the nursery after a cesarean delivery. Which of the following physiological findings would the nurse expect to see? a. Absent bowel sounds b. Soft crackles in the bases of the lungs c. Depressed Moro reflex d. Grunting with expirations

c. I will probably feel the effects of hypoglycemia within a few minutes of taking my regular insulin.

A gestational diabetic client who is now being placed on insulin therapy receives education from the nurse regarding treatment for hypoglycemic episodes. Which of the following indicate that the client needs further clarification of the information? a. I will carry glucose tabs in my purse and take 2-3 of them if I experience low blood sugar. b. I can take ½ a cup of regular soda if my blood sugar falls below 65 mg/dL. c. I will probably feel the effects of hypoglycemia within a few minutes of taking my regular insulin. d. Signs of hypoglycemia include sweating, tremors, weakness, and hunger.

d. November 10

A gravid client is being seen for the first time in the clinic. She states that the first day of her LMP was February 3rd. The nurse calculates the patient's EDD as: a. January 10 b. November 1 c. August 12 d. November 10

c. Uterine atony

A woman has just delivered a macrosomic baby after a 36 hour labor. For which of the following complications should the woman be carefully monitored? a. Hypoprolactinemia b. Mastitis c. Uterine atony d. Infection

a. Daily vaginal exams

A labor nurse is caring for a client, 30 weeks gestation who was admitted for premature rupture of membranes (PROM) and is not in labor. Which of the following orders would the nurse question? a. Daily vaginal exams b. Prophylactic antibiotics c. Daily kick counts d. Administer betamethasone (Celestone) 12 mg IM daily times 2

d. Lanugo covers the body

A mother has just experienced quickening. Which of the following developmental changes would the nurse expect to occur at the same time in the woman's pregnancy? a. Fetal heart begins to beat b. Coagulations factors are synthesized in the liver c. Meconium is passed d. Lanugo covers the body

d. Rapid deliveries can cause petechiae to develop on the newborn's face

A mother, 1 day postpartum from a 2-hour labor and a quick vaginal delivery, asks the nurse why the baby's face is purple. Upon examination, the nurse notes petechiae over the scalp, forehead, and cheeks of the baby. The nurse's response should be based on which of the following? a. Petechiae are always indicative of a severe bacterial infection in the newborn. b. Petechiae are also known as normal newborn rash. c. The injury is a sign that this child has been abused. d. Rapid deliveries can cause petechiae to develop on the newborn's face

a. Term gestation, Appropriate for Gestational Age

A newborn who is assessed by the Ballard scale to be 38 weeks gestation and at the 12th percentile for gestational age will be noted as which of the following? a. Term gestation, Appropriate for Gestational Age b. Pre-term gestation, Small for Gestational Age c. Term gestation, Small for Gestational Age d. Post-term gestation, Appropriate for Gestational Age

b. Chew gum

A newly pregnant patient calls into the clinic complaining of ptyalism that is bothersome. The nurse recognizes this as ptyalism and recommends which of the following? a. Wear supportive hose b. Chew gum c. Get plenty of rest d. Use acetaminophen if approved

d. Cord compression

A nurse notes the following fetal heart rate pattern on the external fetal monitor. FHR baseline of 120-130 with V shaped decelerations to 100 noted before and after contractions. The nurse understands that this pattern is related to which of the following? a. Head compression b. Fetal movement c. Placental insufficiency d. Cord compression

b. Monitor for uterine cramping d. Monitor for vaginal bleeding e. Monitor for rupture of membranes

A patient has just undergone a cerclage procedure and is now in recovery. Which of the following interventions will the nurse include in the plan of care? (SELECT ALL THAT APPLY) a. Continuous fetal monitoring b. Monitor for uterine cramping c. Fetal kick count d. Monitor for vaginal bleeding e. Monitor for rupture of membranes

b. Urinary frequency c. Nasal stuffiness e. Nausea and vomiting

A patient is in the 10th week of her pregnancy. Which of the following symptoms would the nurse expect the client to exhibit? (SELECT ALL THAT APPLY). a. Shortness of breath b. Urinary frequency c. Nasal stuffiness d. Back pain e. Nausea and vomiting

a. Maternal vital signs b. Patellar reflexes c. Speech d. Level of consciousness

A patient is on magnesium sulfate via IV pump for pre-eclampsia. Which of the following should the nurse perform to monitor the patient for early signs of toxicity? (Select all that apply). a. Maternal vital signs b. Patellar reflexes c. Speech d. Level of consciousness e. Kernig's assessments

b. Increase caffeine intake Place patient in a semi-fowlers position c. Encourage bedrest in a quiet and dimly lit room d. Administer oral analgesics for the pain

A patient that had a cesarean section two days ago has been diagnosed with a post-dural puncture headache. The nurse understands that the following interventions should be implemented (Select all that apply). a. Decrease fluid intake b. Increase caffeine intake Place patient in a semi-fowlers position c. Encourage bedrest in a quiet and dimly lit room d. Administer oral analgesics for the pain

c. Decreased variability

A woman has just received pain medication in labor. Which of the following fetal heart responses would the nurse expect to see on the internal monitor tracing? a. Variable decelerations b. Late decelerations c. Decreased variability d. Accelerations

Late decelerations

A woman in active labor has just received an epidural. The nurse understands that that if the woman has hypotension the fetal monitor tracing would indicate which of the following? a. Early decelerations b. Late decelerations c. Accelerations d. Variable decelerations

a. Uterine atony

A woman who has an obstetric history of G6P5005 just delivered a 10 pound baby boy after a 12 hour labor. For which of the following complications should the woman be carefully monitored? a. Uterine atony b. Infection c. Mastitis d. Hypoprolactinemia

c. Monitor levels of HCG and progesterone and observe for further complications

A woman who is 10 weeks gestation presents to the Emergency room complaining of spotting and mild cramping. Upon speculum examination the cervical os is closed. The nurse anticipates that care will involve which of the following? a. No treatment will be given and no monitoring will be done b. Prescription for misoprotol (Cytotec) will be given to the woman c. Monitor levels of HCG and progesterone and observe for further complications d. Dilation and curettage will be scheduled

a. The baby's chin is resting on its chest

A woman who is in active labor is told by her obstetrician, "Your baby is in the flexed attitude." When she asks the nurse what that means, what should the nurse say? a. The baby's chin is resting on its chest b. The baby's presenting part is engaged c. The baby is in the horizontal lie d. The baby is in a breech position

c. Vaginal examination

A woman who states that she "thinks" she is in labor enters the labor suite. Which of the following assessments will provide the nurse with the most valuable information regarding the client's labor status? a. Leopold's maneuvers b. Fundal contractility c. Vaginal examination d. Fetal heart assessment

b. Moderate

The FHR baseline is 120-130 bpm. The nurse will chart the variability as which of the following? a. Absent b. Moderate c. Minimal d. Marked

4-7 cm dilation Contractions every 3-5 minutes, lasting 40-60 seconds Cervix dilates 1-1.5 cm/hour Mood is nervous/anxious or helpless Ideal time for epidural

Active Phase

a. The Glucose Challenge test is done between the 24th-28th week of gestation

An 8-week gestation patient is being seen in the clinic for her first visit. She asks the nurse when her blood sugar will be tested to make sure she is not diabetic. The nurse should tell the patient which of the following? a. The Glucose Challenge test is done between the 24th-28th week of gestation b. The Glucose Challenge test will be done at the next visit. c. The three hour Glucose Tolerance Test (OGTT) will be done at 20 weeks gestation. d. The Glucose Challenge test is performed at 36 weeks gestation.

a. Amenorrhea c. Fatigue d. Breast tenderness e. Frequent urination

An antepartum patient is informing the nurse of her symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? (SELECT ALL THAT APPLY). a. Amenorrhea b. Positive pregnancy test c. Fatigue d. Breast tenderness e. Frequent urination

1 point: HR - <100 Respiratory effort - slow, weak cry muscle tone - Some flexion grimace body pink, blue extremities

Apgar Score

Prostaglandin F2 (Hemabate)

Cannot give if asthmatic!

Methylergonovine (Methergine)

Cannot give if hypertensive or history of cardiac disease Check blood pressure and hold if >140/90!!!

retained placental fragments

Cause of late hemorrhage

increases need for oxygen - increases respiratory rate and if lasts too long - metabolic and respiratory acidosis)

Cold Stress

500 - 1,000

Defined as _______ mL of blood loss from the uterus within a 24 hour period

b. Flex the woman's thighs sharply toward her abdomen.

During a vaginal delivery, the obstetrician declares that shoulder dystocia is occurring. Which of the following actions by the nurse should be implemented? a. Administer oxytocin intravenously per order. b. Flex the woman's thighs sharply toward her abdomen. c. Apply oxygen using a tight-fitting facial mask d. Apply downward pressure on the woman's fundus.

d. Have her labor in the hands/knee position

During a vaginal examination, the nurse determines that the patient is in a LOP position. The best non-pharmacological intervention that can be done with this patient to relieve her pain is: a. Have her perform effleurage during contractions b. Allow her to labor in a tub of warm water c. Use aromatherapy in the room and play soothing music d. Have her labor in the hands/knee position

Delivery of placenta until recovery over (2 hours) Monitor fetal and maternal adaption to labor Risk: Postpartum hemorrhage

Fourth Stage

c. Sommatomatropin

The blood glucose of a client with type 1 diabetes 12 hours after delivery is 94mg/dL. The client has received no insulin since delivery. The drop in serum levels of which of the following hormones of pregnancy is responsible for the glucose level? a. Estrogen b. Human chorionic gonadatropin c. Sommatomatropin d. Progesterone

a. Prolactin

The client who has decided to breast feed her baby has just delivered her newborn baby girl and is in recovery. Which of the following maternal hormones will increase sharply postpartum in order for the production of milk to occur? a. Prolactin b. Estrogen c. Progesterone d. Human chorionic gonadotropin

Positive Signs

The examiner can see, hear, or feel the fetus (ONLY 3)

b. Massage the fundus

The first action a nurse should take when caring for a woman experiencing postpartum hemorrhage associated with uterine atony is to: a. Establish venous access b. Massage the fundus c. Call the doctor/midwife d. Catheterize the bladder

d. Positive

The nurse is administering a contraction stress test and notes the presence of late decelerations corresponding to three contractions in a ten-minute period of time. The nurse understands that the test will be read as which of the following? a. Negative b. Equivocal c. Unsatisfactory d. Positive

c. Eat dry crackers before getting out of bed.

The nurse is providing care to a woman who is experiencing nausea and vomiting in her first trimester. Which of the following would be included in the education related to alleviating this symptom? a. Drink plenty of fluids with your meals. b. Eat 3 large meals plus a bedtime snack each day. c. Eat dry crackers before getting out of bed. d. Brush your teeth first thing in the morning.

c. Nonreactive

The nurse is reviewing a non-stress test (NST) and notes the following: FHR baseline of 120-130 bpm with increase in FHR noted to 150 for 15 seconds and an increase of FHR noted to 135 for 10 seconds over a 20 minute time frame. The nurse understands that this NST will be read as: a. Reactive b. Negative c. Nonreactive d. Positive

b. A client with history of cardiac arrhythmias

Three 30-week-gestation clients are on the labor and delivery unit in preterm labor. For which of the clients should the nurse question an order for terbutaline (Brethine)? a. A client with hypothyroidism b. A client with history of cardiac arrhythmias c. A client with asthma d. A client who is pregnant with twins

c. First stage, active phase

Through vaginal examination, the nurse determines that a woman is 6cm dilated and 100% effaced with the fetus at a 0 station. The nurse reports this as: a. First stage, latent phase b. First stage, transition phase c. First stage, active phase d. Second stage, latent phase

c. Maintain the newborn's temperature above 36.5C

To reduce the risk of hypoglycemia in a full-term newborn that is appropriate for gestational age, which of the following should the nurse do? a. Encourage breastfeeding every 1 hour for the first three days. b. Feed the newborn a bottle of glucose water every 3 hours until breastfeeding well. c. Maintain the newborn's temperature above 36.5C d. Assess blood glucose levels every 3 hours for the first 12 hours of life.

d. Risk for infection related to blood loss

Which of the following is a priority nursing diagnosis for a woman, G10 6226, who is postpartum day one from a spontaneous vaginal delivery with a significant postpartum hemorrhage? a. Alteration in comfort related to afterbirth pains b. Risk for altered parenting related to grand multiparity c. Risk for sleep deprivation related to mothering role d. Risk for infection related to blood loss

VEAL CHOP CALL: 1. variability, cord, change moms position 2. early, head, acknowledge 3. acceleration, ok, love it 4. late, placenta, left side

fetal heart rate acronym

Fetal monitor is place at PMI, or on side of fetal back, closest to head. Vertex presentation - monitor placement in lower quadrants Breech presentation - monitor placement in upper quadrants

fetal monitor placement

Leopald's Maneuver's determines fetal position: 1. L or R (Location of fetal back - long edge on mothers _ side) 2. O or S (Presenting part - breech or vertex) 3. A or P (Fetal presentation - towards mother's symphysis pubis or sacrum)

fetal position

Calcium Gluconate (keep at bedside)

mag antidote

d. Between the umbilicus and the symphysis pubis

A 15-week gestation patient should have a fundal height that is palpable to the nurse at what anatomical location? a. At the level of the umbilicus b. At the xiphoid process c. Two centimeters above the umbilicus d. Between the umbilicus and the symphysis pubis

b. Do nothing as this is a normal weight loss.

A 2 day-old breastfeeding newborn has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? a. Notify the neonatologist of the significant weight loss. b. Do nothing as this is a normal weight loss. c. Advise the mother to bottle feed the baby at the next feeding. d. Assess the baby for hypoglycemia by testing blood glucose level.

b. Dilation and curretage

A 25-year-old client presents to the emergency department with the following: 12 weeks pregnant, vaginal bleeding, no fetal heartbeat seen on ultrasound. The nurse would expect the health care provider to write an order to prepare the client for which of the following? a. Cervical cerclage b. Dilation and curretage c. Non-stress test d. Amniocentesis

d. The woman should not become pregnant for at least 4 weeks.

A 3-day-breastfeeding client who is not immune to rubella is to receive the rubella vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine? a. The woman should pump and dump her breast milk for 1 week. b. Surgical masks must be worn by the mother when she holds the baby. c. Antibodies transported through the breast milk will protect the baby. d. The woman should not become pregnant for at least 4 weeks.

b. Assess the vagina at the introitus using a pen light

A nurse is assessing a woman who had a spontaneous vaginal delivery of a 10 lb baby boy 10 hours ago. Her fundus is firm at the umbilicus, lochia is moderate and intact perineum is slightly swollen. One hour after receiving ibuprofen, 800 mg, p.o., the woman calls out complaining that her perineal pain is now at a level of 9 out of 10 and she is having terrible pressure in her bowels. Which is the appropriate intervention the nurse should take at this time? a. Call the health care provider b. Assess the vagina at the introitus using a pen light c. Put an ice pack on the woman's perineum d. Give the patient two tablets of Percocet that has been ordered for her when her pain level is between an 8-10

b. A G2 1001 who had polyhydramnios during this pregnancy c. G4 3003 who had a placenta accreta e. G2 0100 who delivered a 4,600 gm neonate

A nurse is caring for the following laboring patients. Which patient should the nurse be prepared to monitor closely for signs of postpartum hemorrhage? (SELECT ALL THAT APPLY). a. G1 0000 who delivered a fetal demise at 29 weeks gestation b. A G2 1001 who had polyhydramnios during this pregnancy c. G4 3003 who had a placenta accreta d. G2 1001 who delivered by cesarean section e. G2 0100 who delivered a 4,600 gm neonate

b. Call the pediatrician if the cord starts to have drainage.

A nurse is providing discharge instructions to the parents of a newborn. Which of the following should be included? a. Cleanse the umbilical cord with hydrogen peroxide if it starts to smell. b. Call the pediatrician if the cord starts to have drainage. c. Place your baby on her belly for best sleeping success. d. Pull the foreskin down daily on your uncircumcised newborn.

b. Swaddle the newborn in a blanket or put the baby in a snuggle sack.

A nurse notes that a 6-hour-old neonate has purplish colored hands and feet. Which of the following actions by the nurse is appropriate? a. Place the child in an isolette. b. Swaddle the newborn in a blanket or put the baby in a snuggle sack. c. Administer oxygen. d. Apply a pulse oximeter.

b. The patient is opiate dependent.

A patient who just entered the recovery room after a cesarean section is requesting pain medication. The nurse understands that nalbuphine (Nubain) is contraindicated for this patient after noting the following: a. The patient has a history of malignant hyperthermia in her family history. b. The patient is opiate dependent. c. The patient has already received morphine in her spinal anesthesia. d. The patient has a history of vomiting with this medication.

d. Taking-In Stage

A primipara that delivered two hours ago requests that the nurse take care of the baby in the nursery so that she can get a nap. Based on this information, the nurse concluded that the woman is exhibiting signs of which of the following? a. Poor bonding b. Letting Go Stage c. Postpartum Depression d. Taking-In Stage

a. Reassure the woman this is normal.

A woman 48 hours postpartum is complaining of profuse diaphoresis at night. She has no other complaints of discomfort. Which of the following actions by the nurse is most appropriate? a. Reassure the woman this is normal. b. Take the woman's temperature. c. Advise the woman to decrease her fluid intake. d. Notify the newborn's pediatrician.

b. Chronic hypertension

A woman delivered her 10 pound infant 15 minutes ago and has started to have profuse vaginal bleeding. The physician orders methylergonovine (Methergine) 0.2 mg. IM stat. Which condition is a contraindication for this medication? a. Disseminated intravascular coagulation. b. Chronic hypertension c. Diabetes Mellitus. d. Hemorrhage.

b. The woman is about to deliver the placenta

A woman had a baby by normal spontaneous vaginal delivery a few minutes ago. The nurse notes that a gush of blood was just expelled from the vagina, the umbilical cord lengthened, and the fundus has risen in the abdomen. What should the nurse conclude? a. The woman has an internal laceration b. The woman is about to deliver the placenta c. The woman has uterine atony d. The woman is about to deliver a second baby

a. Administration of betamethasone (Celestone). b. Weekly NSTs d. Monitor for vaginal bleeding and contractions e. Monitor for non-reassuring FHR patterns

A woman has been admitted to the Labor and Delivery with a partial placental abruption at 30 weeks gestation. Which of the following interventions will likely be implemented? (Select all that apply): a. Administration of betamethasone (Celestone). b. Weekly NSTs c. Intermittent monitoring of the fetus d. Monitor for vaginal bleeding and contractions e. Monitor for non-reassuring FHR patterns

d. 60 mg/dl before dinner

A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. She shows the nurse her readings for the past few days. Which one of the following reading should the nurse tell her indicates a need for adjustment in her eating? a. 75 mg/dl before lunch b. 135 mg/dl 1 hour after lunch c. 115 mg/dl 1 hour after dinner d. 60 mg/dl before dinner

a. Contractions every one minute

A woman with severe preeclampsia at 30 weeks gestation is being induced with IV oxytocin (Pitocin). Which of the following would warrant the nurse to stop the infusion? a. Contractions every one minute b. Blood pressure of 160/110 c. Woman rates pain at a level 10 d. Fetal Heart Rate of 156 with early decelerations

d. Need for less insulin than she normally injects

A woman with type 1 diabetes is being seen for preconception counseling. The nurse should emphasize that during the first trimester the woman may experience which of the following? a. An increased risk for hyperglycemic episodes b. An increased need for insulin c. Unstable blood sugars that need to be tested every 2 hours d. Need for less insulin than she normally injects

d. Send the woman for a glucose tolerance test.

A woman's glucose challenge test results are 155 mg/dL. Which of the following actions, as ordered by the Health Care Provider, is appropriate? a. Teach the woman how to inject herself with insulin. b. Notify the woman of the normal results. c. Provide the woman with oral hypoglycemic agents. d. Send the woman for a glucose tolerance test.

b. The client will deliver after 38 weeks gestation

A woman, G4 P0030 at 12 weeks gestation has just been admitted to the labor and delivery suite for a cerclage procedure. Which of the following long-term outcomes is appropriate for this client? a. The client will gain less than 25 pounds during the pregnancy b. The client will deliver after 38 weeks gestation c. The client will have normal blood glucose levels throughout the pregnancy d. The client will deliver a baby that is appropriate for gestational age.

a. 25-hour old newborn who has not voided yet.

Four newborns are in the newborn nursery, none of whom are crying or in distress. Which of the babies should the nurse report to the neonatologist? a. 25-hour old newborn who has not voided yet. b. 2-day old newborn who is breathing irregularly at a rate of 50. c. 2-day old newborn who is excreting a milky discharge from both nipples. d. 16-hour old newborn who has a blood sugar of 50.

d. The neonate with nasal flaring.

Four newborns were admitted into the neonatal nursery 1 hours ago. They are all sleeping under radiant warmers. Which of the babies should the nurse ask the neonatologist to evaluate? a. The neonate with a temperature of 36.5 C and weight of 3,000 grams b. The neonate with white spots on the bridge of the nose. c. The neonate with a bruise-like spot on his buttocks. d. The neonate with nasal flaring.

a. LSP and -1 station

During a vaginal examination, the nurse palpates fetal buttocks that are facing the left posterior and are 1 cm above the ischial spines. Which of the following is consistent with this assessment? a. LSP and -1 station b. LOP and -1 station c. LMP and +1 station d. LSP and +1 station

Probable Signs

HCP can see, but observation could be a result of other conditions

b. Hypotension

Immediately following administration of an epidural anesthesia, the nurse must monitor the mother for which of the following? a. Severe headache b. Hypotension c. Increase in bladder retention d. Fetal heart accelerations

0-3 cm dilation with little fetal descent Contractions every 15-30 minutes, lasting 15-30 seconds Increase to decrease Contractions every 5-7 minutes, lasting 30-40 seconds Mood is eagar, patient talks through contractions Woman stays home during latent phase

Latent Phase

a. Pain medication and sedation

The labor and delivery nurse is reviewing the chart of a client in labor and notes that the client has been 2-3 cm for the last 7 hours despite painful and frequent contractions. The nurse is concerned and calls the health care provider expecting an order for which of the following? a. Pain medication and sedation b. Have the Resident perform an amniotomy c. Get the operating room ready for a cesarean section d. Send the woman home and tell her to come back in the morning

d. "No, this is normal and is known as the postpartal "baby blues".

The new mom is tearful and wonders if this is a sign of postpartum depression? The nurse correctly answers: a. "Yes, being tearful in the hospital on postpartum day 3 is one of the signs of postpartum depression." b. "No, but it is unusual for you to be so emotional so quickly." c. "I will get the doctor to order you an antidepressant." d. "No, this is normal and is known as the postpartal "baby blues".

c. methylergonovine (Methergine)

The nurse admits a full-term woman to the labor and delivery unit who is 7cm-90%-+2. She has a history of asthma since childhood and a history of postpartum hemorrhage in the last pregnancy. He makes sure that which of the following medications are available at the delivery? a. terbutaline (Brethine) b. prostaglandin F2 (Hemabate) c. methylergonovine (Methergine) d. betamethasone (Celestone)

c. Betamethasone (Celestone) 12mg IM

The nurse admits a pregnant woman into the Labor and Delivery room with PPROM at 28 weeks gestation not in labor. The nurse understands that which of the following medications will be administered as a PRIORITY? a. Antibiotics b. Magnesium Sulfate loading dose c. Betamethasone (Celestone) 12mg IM d. nifedipine (Procardia)

b. History of previous cesarean sections 5 years ago and 3 years ago

The nurse becomes concerned when noting which of the following past obstetric histories of a woman who plans to have a vaginal delivery after a cesarean section? a. Documented low transverse incision on the uterus b. History of previous cesarean sections 5 years ago and 3 years ago c. History of a cesarean section 3 years ago d. History of vaginal birth less than 18 months ago

c. The client has been hyperglycemic for the last 3 months and normoglycemic today.

The nurse caring for a pregnant patient with type 2 diabetes mellitus notes that the client's glycosylated hemoglobin (HgbA1c), result was 10% today and the fasting blood glucose result was 80 mg/dL. Which of the following interpretations by the nurse is correct is relation to this data? a. The client has been hyperglycemic for the last 3 months and is hyperglycemic today. b. The client has been normoglycemic for the last 3 months and normoglycemic today. c. The client has been hyperglycemic for the last 3 months and normoglycemic today. d. The client has been normoglycemic for the last 3 months and hyperglycemic today

b. Patient's fundus is boggy.

The nurse has received an order for an early discharge for a patient that delivered a few hours ago. The assessment that is most concerning over an early discharge is: a. Patient expresses lack of confidence with infant bathing. b. Patient's fundus is boggy. c. Patient has moderate amount rubra lochia. d. Patient has perineal redness and edema

c. Dark brown vaginal bleeding

Which of the following findings should the nurse expect when assessing a client, 8 weeks gestation, with gestational trophoblastic disease (hydatidiform mole)? a. Protracted pain b. Variable fetal heart decelerations c. Dark brown vaginal bleeding d. Severe headaches

a. The client uses her peri-bottle each time she goes to the bathroom to void/stool. b. The client applies a fresh peri-pad after each void/stool d. The client washes her hand after the procedure.

The nurse has taught a newly admitted patient to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? (SELECT ALL THAT APPLY). a. The client uses her peri-bottle each time she goes to the bathroom to void/stool. b. The client applies a fresh peri-pad after each void/stool c. The client wipes from back to front after voiding. d. The client washes her hand after the procedure. e. The woman mixes warm tap water with hydrogen peroxide in the peri-bottle.

b. Intermittently apply ice packs to the axillae and breast regions.

The nurse in the obstetric clinic received a telephone call from a bottle-feeding mother of a 4 day old baby girl. The client stated that her breasts are firm, red, and very shiny. Which of the following is the best action for the nurse to advise the client to perform? a. Apply lanolin to her breasts and nipples every 3 hours. b. Intermittently apply ice packs to the axillae and breast regions. c. Manually express all milk in the breasts every 3 hours. d. Ask the primary health care provider to order a pill to stop milk production.

d. Her cervix has dilated from 2 to 4 cm.

The nurse is assessing a client who states "I think I am in labor." Which of the following findings would positively confirm the client's belief? a. She is contracting every 2 minutes b. Her membranes have ruptured c. The fetal head is engaged d. Her cervix has dilated from 2 to 4 cm.

b. Turn the patient to her left side

The nurse is assessing a fetal monitor tracing and notes that the FHR baseline is 140-150 bpm with decreases to 120 bpm noted beginning after the contraction begins with return to baseline after the contraction ends. The nurse's first action should be which of the following? a. Document the findings b. Turn the patient to her left side c. Call the health care provider d. Turn the mainline intravenous fluid rate up

c. Intercostal retractions

The nurse is assessing a newborn on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? a. Caput Succeddaneum b. Mongolian Spot c. Intercostal retractions d. Milia

d. Fundus at the level of the umbilicus, lochia rubra

The nurse is assessing a woman who delivered 12 hours earlier. Which of the following findings would the nurse expect to find at this point? a. Fundus 1 cm above the umbilicus, lochia rubra b. Fundus 2 cm below the umbilicus, lochia rubra c. Fundus 2 cm above the umbilicus, lochia rubra d. Fundus at the level of the umbilicus, lochia rubra

a. Baseline of 140 - 150 with decelerations to 120 noted beginning with the contraction and returning to baseline by the end of the contraction.

The nurse is assessing the fetal monitor tracings of a patient in labor. Which of the following heart rate patterns would the nurse interpret as normal during the transitional phase of stage one? a. Baseline of 140 - 150 with decelerations to 120 noted beginning with the contraction and returning to baseline by the end of the contraction. b. Baseline of 140-150 with decelerations to 120 noted after the start of the contraction with return to baseline after the end of the contraction. c. Baseline of 140-145 with V-shaped decelerations to 120 bpm unrelated to contractions. d. Baseleine of 140-141 with decelerations to 105 noted after the start of the contracton and returning to baseline after the end of the contraction.

a. G4P3 breastfeeding mom

The nurse is assigned to care for 4 new mothers on the postpartum floor. The nurse knows that the patient who is most likely to have the most painful after-birth pains is: a. G4P3 breastfeeding mom b. G1P0 bottle-feeding mom c. G1P0 who delivered a 5lb 6oz baby d. G1P0 who delivered 5 lb. twin boys and is bottle feeding

c. Applying oxygen per face mask at 8-10 L/min

The nurse is caring for a patient in labor when repetitive late decelerations are noted on the external fetal monitor. The nurse's action after turning the patient to her left side should be: a. Applying oxygen per nasal cannula b. Increase the mainline IV c. Applying oxygen per face mask at 8-10 L/min d. Turn the patient to her right side after 5 minutes on the left side

b. Pad the client's bed rails and headboard

The nurse is caring for a patient who has severe preeclampsia. Which of the following is an important action for the nurse to perform in anticipation of potential eclampsia? a. Check urine for ketones b. Pad the client's bed rails and headboard c. Provide auditory and visual stimulation d. Place the bed in high Fowler position

a. PKU b. Cystic Fibrosis d. Hypothyroidism e. Sickle Cell Disease

The nurse is discussing the neonatal blood screening test with a new mother. The nurse should tell the patients that her newborn will be tested for which of the following? (SELECT ALL THAT APPLY) a. PKU b. Cystic Fibrosis c. Cerebral Palsy d. Hypothyroidism e. Sickle Cell Disease

c. progesterone

The nurse is explaining the hormones of pregnancy to the nursing students and states that which of the following is responsible for maintaining the pregnancy? a. estrogen b. human chorionic gonadotropin c. progesterone d. oxytocin

d. nifedipine (Procardia)

The nurse is getting ready to discharge a patient to home who was admitted for preterm labor that was halted by the use of Magnesium Sulfate. The nurse understands that which of the following medications will now be used to prevent another episode of preterm labor? a. methylergonoavine (Methergine) b. Betamethasone (Celestone) c. Antibiotics Therapy d. nifedipine (Procardia)

a. Baseline rate of 110-160 bpm b. Moderate variability d. Early decelerations are present or absent e. Accelerations are either present or absent

The nurse is instructing a new staff nurse on reassuring FHR patterns. Which of the following information should be included? (SELECT ALL THAT APPLY) a. Baseline rate of 110-160 bpm b. Moderate variability c. Variable decelerations are present d. Early decelerations are present or absent e. Accelerations are either present or absent

d. Administer dose of hydralazine (Apresoline) IV push

The nurse is performing hourly assessments on the client who is being treated with magnesium sulfate for severe hypertension. The assessment at 0800 includes: B/P 190/114, pulse 88, respirations 14, reflexes +3, output 30mL, severe headache, nausea, lungs clear to auscultation, denies visual disturbances, and RUQ pain. Based on this assessment, the nurse anticipates that the health care provider will order which of the following as the priority intervention? a. Repeat the magnesium sulfate bolus b. Administer calcium gluconate c. Apply oxygen per non-rebreather mask at 10 L/min d. Administer dose of hydralazine (Apresoline) IV push

c. Flushing, sweating, and irritability.

The nurse is preparing to administer intravenous MgSO4 (magnesium sulfate) to a multipara who has been admitted for pre-term labor. What are the initial side effects that are expected to occur with the bolus dose that the nurse should explain to the patient? a. Hypotension, decreased respirations. b. Hyporeflexia and flaccid paralysis. c. Flushing, sweating, and irritability. d. Tinnitus and diarrhea

c. Contractions are no longer

The nurse is titrating the maintenance dose of the Magnesium Sulfate infusion following the initial bolus dose to stop preterm labor. The nurse will continue to increase the infusion rate until which of the following assessments is noted? a. Decrease of blood pressure to 120/80 mm Hg b. Respiratory rate of 10 breaths/minute c. Contractions are no longer present d. Loss of patellar reflexes

c. Increase mainline IV d. Turn off oxytocin (Pitocin) e. Turn mother to her left side

The nurse notes a prolonged deceleration of the FHR to 80 bpm and begins intrauterine resuscitation. Which of the following steps are included in this intervention? (SELECT ALL THAT APPLY). a. Provide oxygen per nasal cannula at 2L/min b. Place mom on her back with a wedge under her right hip c. Increase mainline IV d. Turn off oxytocin (Pitocin) e. Turn mother to her left side

8

The nurse notes that a newborn who is 1 minute old, exhibits the following characteristics: heart rate 108 bpm, strong cry, pink body with blue hands and feet, and some flexion. What does the nurse determine the Apgar score to be? 6 7 8 9

a. Acceleration

The nurse notes that the fetal heart rate baseline is 120-130 with an increase in FHR to 145 bpm lasting 15 seconds. The nurse would chart this change in baseline as which of the following? a. Acceleration b. Early deceleration c. Variable deceleration d. Late deceleration

a. Marked

The nurse notes that the fetal heart rate is 140-170 bpm and charts that the variability is which of the following? a. Marked b. Minimal c. Absent d. Moderate

b. Fetal heart rate via Doppler

The nurse notes the following findings in a 14-week-gestation patient. Which of the findings would be considered a positive sign of pregnancy? a. Positive pregnancy test b. Fetal heart rate via Doppler c. Positive Chadwicks sign d. Ballottment

d. Client is 33 weeks gestation

The nurse questions an order for indomethacin (Indocin) based on which of the following assessment findings? a. Client has polyhydramnios b. Client is contracting every 5 minutes at 29 weeks gestation c. Cervical examination: 2cm - 50% - -3 d. Client is 33 weeks gestation

c. Knowledge deficit r/t lack of parenting experience

The nurse receives the following report on a newly delivered client: 21 years of age; married; G1P1001; Spontaneous vaginal delivery with no episiotomy or lacerations; vitals: 99.0F, 88, 16, 120/70; fundus firm at umbilicus with moderate rubra lochia; ambulated to the bathroom to void 4 times; breastfeeding every two hours. Which of the following nursing diagnoses should the nurse include in this client's care plan? a. Fluid volume deficit r/t excess blood loss b. Impaired skin integrity r/t vaginal delivery c. Knowledge deficit r/t lack of parenting experience d. Impaired urinary elimination r/t excessive output

a. ibuprofen (Motrin)

The nurse understands that the best choice of pain medication that should be administered to the client having uterine cramping following a miscarriage would be which of the following? a. ibuprofen (Motrin) b. acetaminophen (Tylenol) c. morphine sulfate d. hydrocodone with acetaminophen (Norco)

a. Monitor the uterine resting tone

The patient in labor is having multiple deep variable decelerations down to 60-70 bpm. The health care provider has ordered an amnioinfusion. The nurse understands that the primary intervention is to: a. Monitor the uterine resting tone b. Monitor for accelerations c. Cool the intravenous fluid prior to infusion d. Administer the infusion per gravity

c. To check for genetic abnormalities

The patient is scheduled for an amniocentesis at 16 weeks gestation. The nurse understands that this is being done for which of the following reasons? a. To check lung maturity b. To determine the sex of the fetus c. To check for genetic abnormalities d. To determine EDD

d. Mother is A negative blood type and Indirect Coombs is negative.

The patient who is 28 weeks gestation will receive Rhogam at this visit if which of the following conditions are present? a. Mother is B negative blood type and the Indirect Coombs is positive. b. Mother is A positive blood type and the Indirect Coombs is negative. c. Mother is A negative blood type and Father is B positive blood type. d. Mother is A negative blood type and Indirect Coombs is negative.

Birth until delivery of placenta Contractions continue into third stage of labor Risk: placental separation

Third Stage

Contractions every 2-3 minutes, lasting 60-90 seconds Mood is angry, restless Transition phase is the shortest, most intense phase of labor Early decelerations often occur during Transition phase

Transition

c. Formation of a hematoma.

Upon assessing a new admission to the nursery, the nurse notes that there is a bulge on the newborn's skull that does not cross suture lines and is located on the right parietal bone. The nurse understands that this bulge is a result of which of the following? a. Molding of the baby's skull so that the head could fit through the pelvis. b. Swelling of the tissues of the baby's head from pressure of her pushing. c. Formation of a hematoma. d. The position of the baby during the last trimester of pregnancy.

b. Assess bladder

Upon examination, a nurse notes that a woman is 10 cm dilated, 100% effaced, and -3 station. Which of the following actions should the nurse perform first based on this assessment? a. Encourage the woman to push b. Assess bladder c. Move the client into a supine position with legs in stirrups d. Provide firm fundal pressure

a. Facial expression b. Breathing pattern e. Cry

Using the Neonatal Infant Pain Scale (NIPS), a nurse is assessing the pain response of a newborn who has just had a circumcision. The nurse is assessing a change in which of the following signs/symptoms? (SELECT ALL THAT APPLY) a. Facial expression b. Breathing pattern c. Temperature d. Heart rate e. Cry

d. Fundal assessment

What is the most important assessment in the immediate postpartum period for the nurse to make? a. Maternal vital signs b. Breast feeding potential c. Bladder assessment d. Fundal assessment

Presumptive Signs

What the woman feels

LLQ

When performing Leopold's maneuvers, the nurse notes that the fetus is in the left occiput anterior position (LOA). Which is the best position for the nurse to place the fetal heart rate monitor? LUQ RLQ RUQ LLQ

b. Painless vaginal bleeding

Which finding should the nurse expect when assessing a client with placenta previa? a. Severe abdominal pain b. Painless vaginal bleeding c. Cullen's sign d. Uterine tenderness with vaginal bleeding

a. Maternal pulse of 122 bpm c. Maternal blood pressure 88/56 d. Audible rales

Which of the following assessments would cause the nurse to hold the scheduled dose of terbutaline (Brethine)? (SELECT ALL THAT APPLY). a. Maternal pulse of 122 bpm b. FHR of 170 bpm c. Maternal blood pressure 88/56 d. Audible rales e. Absence of contractions in the last hour

b. The client will use her peri-bottle after every void throughout hospitalization. d. The client will report that lochia is not foul-smelling throughout hospitalization. e. The client will have a normal temperature within 24 hours of delivery.

Which of the following nursing outcomes related to the nursing diagnosis, "Risk for intrauterine infection related to vaginal delivery" should be included in the plan of care? (SELECT ALL THAT APPLY). a. The client changes her peri-pad at least once a day throughout hospitalization. b. The client will use her peri-bottle after every void throughout hospitalization. c. The client will drink sufficient quantities of fluid throughout hospitalization. d. The client will report that lochia is not foul-smelling throughout hospitalization. e. The client will have a normal temperature within 24 hours of delivery.

a. Blood pressure of 162/112 b. Fetus with IUGR d. Greater than +3 proteinuria

Which of the following physical findings would lead the nurse to suspect that a client was experiencing severe pre-eclampsia? (SELECT ALL THAT APPLY). a. Blood pressure of 162/112 b. Fetus with IUGR c. Output of 2000ml in a 24 hour period d. Greater than +3 proteinuria e. Blood pressure of 140/90

a. 4 cm 80% 0 c. 6cm 90% +1 d. 2cm 90% +1

Which of the following vaginal examination results demonstrate that the fetus is engaged? (Select all that apply) a. 4 cm 80% 0 b. 9 cm 100% -2 c. 6cm 90% +1 d. 2cm 90% +1 e. 8cm 90% -1

a. Prepregnancy blood pressure (BP) 100/60 and third trimester 140/90

Which of the following vital sign changes should the nurse highlight for a pregnant women's obstetrician? a. Prepregnancy blood pressure (BP) 100/60 and third trimester 140/90 b. Prepregnancy respiratory rate (RR) 16 rpm and third trimester RR 20 rpm c. Prepregnancy heart rate (HR) 76 bpm and third trimester 88 bpm d. Prepregnancy temperature (T) of 98.6 F and third trimester T 99.0 F

LSA

While performing Leopold's maneuvers on a woman in labor, the nurse palpates a hard round mass in the fundus, a long flat object on the mother's left side, small irregular objects on the mother's right side, and a soft round mass above the symphysis. Which of the following positions is consistent with these findings? ROA LSA LSP ROP

Hot flushes, sweating, N/V, drowsiness, blurred vision, lethargy dizziness - most noticeable during bolus (too fast) and Pulmonary edema

adverse effects of mag

Lethargy, Hypotonia, Respiratory depression

mag neonate implications

Chadwick sign

bluish coloration of the mucous membranes of the cervix, vagina, and vulva (6th week)

hourly maternal assessment

mag nursing responsibilities

Routine serum levels drawn Therapeutic level: 4-7.5 mEq/

mag therapeutic range

Convection Nurse's Role: Increase room temperature

flow of heat from body to air (room temp)

Evaporation Nurses Role: Dry immediately after birth or bath

loss by being wet - liquid changes to vapor (born "wet" at birth and after baths)

Radiation Nurse's Role: Keep crib away from open windows/doors

loss from body to cooler surface not in direct contact (crib by window - open doors)

Conduction Nurse's Role: Turn radiant heater on

loss of body to cooler surface area (put on cold blankets, cold exam table)

CNS depressant and relaxes smooth muscles (uterus)

mag action

40 grams mixed in 1000 ml IV solution Piggybacked to mainline - administered per pump! Loading dose: 4-6 grams/20 minutes Maintenance dose: 1-4 grams/hr

mag dose/route

decreased variability and CNS depression

mag fetal implications

stop contractions

mag in preterm labor

seizure prevention

mag in severe preeclampsia

1. Oxytocin (Pitocin): No contraindications, May cause water intoxication 2. Methylergonovine (Methergine): Cannot give if hypertensive or history of cardiac disease, Check blood pressure and hold if >140/90!!! 3. Prostaglandin F2 (Hemabate): Cannot give if asthmatic 4. Misoprostol (Cytotec): May cause diarrhea, nausea, vomiting, Given rectally

postpartum medications

Ballottment

rebounding of the fetus against the examiner's fingers on palpation

Hegar sign

softening and thinning of the lower uterine segment; 6th week

Goodell sign

softening of the cervix; 2nd month

1. Massage 2. Palpate Bladder - Empty Bladder 3. Administer medications (Pitocin) 4. Administer medications 5. Determine blood loss (check underneath!): Weigh perineal pads: 1gm = 1mL 6. Closely monitor vital signs: Will NOT see change in vitals until after 40% of blood volume has been lost Intravenous access needed 7. Oxygen 8. Physician or Nurse mid-wife may attempt bimanual massage 9. Sonogram 10. Uterine cavity explored/packed 11. Prostaglandin administration 12. Blood replacement 13. Hysterectomy - Last resort only (Rare)

therapeutic management of hemorrhage

Loss of deep tendon reflexes Respiratory rate less than 10-12/min Altered level of consciousness Slurred speech Complaints of being too warm

toxic levels of mag result in...