Maternity Final 6C & 6D

Which of the following occurs during infant respiratory distress syndrome (IRDS)? 1 The pleurae produce an excessive amount of fluid, putting pressure on the baby's lungs, hindering breathing. 2 The baby is unable to keep his or her alveoli inflated between breaths because of a lack of surfactant. 3 The baby's cilia are damaged or destroyed, and only coughing can prevent mucus from accumulating in the lungs. 4 Histamine and other inflammatory chemicals cause the baby's bronchioles to constrict.

2 The baby is unable to keep his or her alveoli inflated between breaths because of a lack of surfactant.

A newborn has a strong cry and is actively moving his blue extremities when stimulated. Vital signs are P140, R48. What is his APGAR score

9 Take Apgar taken at 1 & 5 minutes

An infant with *severe meconium aspiration syndrome* is not responding to conventional treatment. Which method of treatment may be available at a level III facility for use with this infant? a. Extracorporeal membrane oxygenation (ECMO) b. Respiratory support with ventilator c. Insertion of laryngoscope and suctioning of the trachea d. Insertion of an endotracheal tube

A. Extracorporeal membrane oxygenation (ECMO) (bypass to let lungs try to heal) Severe MAS develops only in small number of newborns with *meconium below vocal cords*

A steady trickle of bright red blood from the vagina in the presence of a firm fundus suggests a.Uterine atony b.Lacerations of the genital tract c. Perineal hematoma

ANS: B Undetected lacerations will bleed slowly and continuously. Bleeding from lacerations is uncontrolled by uterine contraction. (forceps delivery increases chances of lacerations) *Per the teacher: IDENTIFY CAUSE OF BLEEDING SO WE CAN STOP IT*

A primigravida in her first trimester is Rh-negative. To prevent anti-Rh antibodies from forming, this woman would receive: a.Rh immune globulin during labor b.Intrauterine transfusions with O-negative blood c.Rh immune globulin (Rhogam) at 28 weeks and within 72 hours after the birth of an Rh-positive infant d.Rh immune globulin now and again in the last trimester

ANS: C An Rh-negative woman would receive Rh immune globulin (Rhogam) at 28 weeks of gestation and within 72 hours after the birth of an Rh-positive infant or abortion.

To provide adequate postpartum care, the nurse should be aware that postpartum depression (PPD) without psychotic features: a. Is the "baby blues" plus the woman has a visit with a counselor or psychologist b. Is more common among older Caucasian women because they have higher expectations c. Is distinguished by pervasive sadness along with mood swings d. Will disappear on its own without outside help

ANS: C PPD is characterized by an intense pervasive sadness along with labile mood swings and is more persistent than postpartum blues.

Because postpartum depression occurs in 3 to 30% of postpartal women, the prenatal nurse assesses clients for risk factors for postpartum depression during the prenatal period. Which clients would the nurse consider to be at risk for postpartum depression? Select all that apply. 1. A client who is an unmarried primipara with family support 2. A client who has previously had baby blues 3. A client who is a primipara with documented ambivalence about her pregnancy in the first trimester 4. A client who is a primipara with a history of depression and lack of a supportive relationship 5. A client who is a primipara living alone and was consistently ambivalent about pregnancy

Answer: 4, 5 Rationale: Risk factors for postpartum depression include primiparity, ambivalence about maintaining the pregnancy throughout the pregnancy, history of previous depression or bipolar illness, lack of a stable support system, lack of a stable relationship with parents or partner, poor body image, and lack of a supportive relationship with parents, especially her father as a child. Ambivalence regarding pregnancy is a normal response in the first and into the second trimester, but should be resolved by the third trimester. Postpartum blues occurs in approximately 50 to 80% of postpartum women; baby blues does not particularly indicate that a woman will develop postpartum depression

A postpartum patient is at increased risk for postpartum hemorrhage if she delivers a(n) a.5-lb, 2-oz infant with forceps b.6.5-lb infant after a 2-hour labor c.7-lb infant after an 8-hour labor d.8-lb infant after a 12-hour labor

B A rapid (precipitous) labor and delivery may cause exhaustion of the uterine muscle and prevent contraction.

Which statement by a postpartum woman indicates that further teaching is *not needed* regarding DVT formation? a. "I'll stay in bed for the first 3 days after my baby is born." b. "I'll keep my legs elevated with pillows." c. "I'll sit in my rocking chair most of the time." d. "I'll put my support stockings on every morning before rising."

D-Venous congestion begins as soon as the woman stands up. The stockings should be applied before she rises from the bed in the morning. *Risk factors for DVT:(Obesity,Age > 35,Multiparity,Smoking)* *Nursing interventions DVT:* Frequent ambulation Range of motion if unable to ambulate Avoid pillows under knees Compression stockings if varicose veins or hx of DVT

The best medicine?

LAUGHTER-STOP BEING SO SERIOUS YALL!

Neonatal abstinence syndrome may cause?

May develop neurodevelopmental and behavioral problems but we won't know effects until they about 2 years old. Remember not all infants will show signs of Neonatal abstinence syndrome

________________is a serious complication of deep vein thrombosis (DVT) and the leading cause of maternal mortality. As many as 15% to 25% of all DVTs lead to this if not recognized and treated.

Pulmonary embolism (PE)

Go to this website to test reading FHR strips http://ob-efm.com/fhm/files/quiz.php

The baseline is the average heart rate rounded to the nearest five bpm.

A nurse is caring for a client in labor. The nurse determines that the client is beginning in the 2nd stage of labor when which of the following assessments is noted? A The client begins to expel clear vaginal fluid B The contractions are regular C The membranes have ruptured D The cervix is dilated completely

*know stages of labor!* D- The cervix is dilated completely Explanation: The second stage of labor begins when the cervix is dilated completely and ends with the birth of the neonate.

The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism? 1. Candida albicans 2. Chlamydia trachomatis 3. Escherichia coli 4. Group B beta-hemolytic streptococci

4. transmission of Group B beta-hemolytic streptococci to the fetus results in respiratory distress that can rapidly lead to septic shock.

A normal uterine activity pattern in active labor is characterized by: a. Contractions every 2 to 5 minutes b. Contractions lasting about 2 minutes c. Contractions about 1 minute apart d. A contraction intensity of about 500 mm Hg with relaxation at 50 mm Hg

ANS: A Contraction frequency overall generally ranges from two to five per 10 minutes of labor, with lower frequencies during the first stage and higher frequency seen during the second stage.

A primiparous woman is to be discharged from the hospital tomorrow with her infant girl. Which behavior indicates a need for further intervention by the nurse before the woman can be discharged? a.The woman is disinterested in learning about infant care. b The woman continues to hold and cuddle her infant after she has fed her. c.The woman reads a magazine while her infant sleeps. d.The woman changes her infant's diaper and then shows the nurse the contents of the diaper.

ANS: A The client should be excited, happy, and interested or involved in infant care. A woman who is sad, tearful, or disinterested in caring for her infant may be exhibiting signs of depression or postpartum blues and require further intervention.

Which characteristic *correctly* matches the type of deceleration with its likely cause? a. Early deceleration—umbilical cord compression b. Late deceleration—uteroplacental insufficiency c. Variable deceleration—head compression

ANS: B Late deceleration is caused by uteroplacental insufficiency. Early deceleration is caused by *head compression* Early decelerations ARE GOOD & generally do not need any nursing intervention. Variable deceleration is caused by umbilical cord compression.

A primary nursing responsibility when caring for a woman experiencing an obstetric hemorrhage associated with uterine atony is to: a. Establish venous access. b. Perform fundal massage. c. Prepare the woman for surgical intervention. d. Catheterize the bladder.

ANS: B The initial management of excessive postpartum bleeding is firm massage of the uterine fundus. After uterine massage the nurse may want to catheterize the client to eliminate any bladder distention that may be preventing the uterus from contracting properly. Although establishing venous access may be a necessary intervention, the initial intervention would be fundal massage. The woman may need surgical intervention to treat her postpartum hemorrhage, but the initial nursing intervention would be to assess the uterus.

If a woman is at risk for thrombus and is not ready to ambulate, nurses might intervene by doing all of these interventions except: a. Putting her in antiembolic stockings (TED hose) and/or sequential compression device (SCD) boots b. Having her flex, extend, and rotate her feet, ankles, and legs c. Having her sit in a chair d. Notifying the physician immediately if a positive Homans' sign occurs

ANS: C Sitting immobile in a chair does not help. Bed exercise and prophylactic footwear might.

When a woman is diagnosed with postpartum depression (PPD) with psychotic features, one of the main concerns is that she may: a. Have outbursts of anger b. Neglect her hygiene c. Harm her infant d. Lose interest in her husband

ANS: C Thoughts of harm to oneself or the infant are among the most serious symptoms of PPD and require immediate assessment and intervention.

Of all of the signs seen in infants with respiratory distress syndrome, which one is especially indicative of the syndrome? a. Pulse greater than 160 beats/minute b. cyanosis c. Grunting d. Substernal retractions

ANS: C All others are s/s RDS but grunting is most indicative

When caring for a postpartum woman experiencing hemorrhagic shock, the nurse recognizes that the most objective and least invasive assessment of adequate organ perfusion and oxygenation is: a.Absence of cyanosis in the buccal mucosa. b.Cool, dry skin. c.Restlessness. d.Urinary output of at least 30 mL/hr.

ANS: D Hemorrhage may result in hemorrhagic shock. Shock is an emergency situation in which the perfusion of body organs may become severely compromised and death may occur. The presence of adequate urinary output indicates adequate tissue perfusion. The assessment of the buccal mucosa for cyanosis can be subjective. The presence of cool, pale, clammy skin would be an indicative finding associated with hemorrhagic shock. Hemorrhagic shock is associated with lethargy, not restlessness. *know Hypovolemic shock (s/s Decrease blood pressure Increased respiratory rate)*

The standard of care for women who are dependent on heroin or other narcotics is ____________________ maintenance treatment (MMT).

ANS: Methadone MMT should be offered as part of a comprehensive care program that includes behavior therapy and support services. MMT has been shown to decrease opioid and other drug abuse, decrease criminal activity, improve individual functioning, and decrease the human immunodeficiency virus (HIV) rate

The home-care nurse is caring for a postpartal client and suspects the development of postpartum psychosis. Which client findings support the nurse's judgment? Select all that apply. 1. Has a history of a bipolar (manic-depressive) disorder 2. Reports voices telling her the baby is evil and must die 3. Confusion about details of delivery or when the infant fed last 4. Is tearful without an identifiable reason 5. Is calm and remains seated during the home visit

Answer: 1, 2, 3 Rationale: Postpartum psychosis usually becomes evident within three months of delivery. Delusions and hallucinations are common. The risk for suicide or infanticide is increased by the psychotic woman's distorted thoughts about herself or the baby. The psychotic woman would typically display agitation, hyperactivity, and confusion. Adjustment reaction with depressed mood, commonly known as maternal or baby blues, occurs in 50-70% of women and is characterized by feelings of fatigue, anxiety, or being overwhelmed by the new maternal role.

A newborn's mother has a history of prenatal narcotic abuse. Which interventions would be most appropriate for the infant of a substance abusing mother (ISAM) in the immediate postpartum period? Select all that apply. 1. Monitor the weight every eight hours. 2. Offer infant a pacifier. 3. Assess blood glucose levels. 4. Allow breastfeeding if alcohol is the addiction. 5. Keep the infant in high-Fowler's position.

Answer: 1, 2, 3, 4 (number 4-WOW, so sad) Rationale: Infants experiencing neonatal abstinence syndrome (NAS) have needs immediately after birth that change as the hours pass. These infants need frequent weights as intake may be diminished due to withdrawal symptoms. It may be helpful to the infant to be offered opportunity for nonnutritive sucking, such as with a pacifier to soothe and quiet the infant. These infants are at high risk for glucose abnormalities, making glucose monitoring important. Breastfeeding is allowed if the mother is addicted to alcohol but she must not breastfeed after alcohol ingestion. It is unnecessary to keep the infant in high-Fowler's position

The nurse should monitor which postpartum clients who are at high risk for thrombophlebitis? Select all that apply. 1. A client who had a cesarean delivery 2. A client of normal pre-pregnant weight 3. A client who has five children 4. A client who smokes cigarettes 5. A client who kept active during pregnancy

Answer: 1, 3, 4 Rationale: The postpartal woman is prone to develop superficial thrombophlebitis from increased clotting factors, increased number and adhesiveness of platelets during the postpartal period. Numerous factors place clients at risk. Among the most common are cesarean deliveries, lack of mobility, obesity, cigarette smoking, previous history, trauma such as leg stirrups during birth, varicosities, diabetic mothers, multiparas, and anemia.

A baby's mother is HIV-positive. Which intervention is most important for the nurse to include when planning care for this newborn? 1. Encourage the mother to breastfeed. 2. Administer zidovudine (AZT) after delivery. 3. Cuddle the baby as much as possible. 4. Place the baby's crib in a quiet corner of the nursery.

Answer: 2 Rationale: Administering zidovudine (AZT) to the mother prenatally and intrapartally, as well as to the infant immediately after delivery, decreases the prenatal risk of transmission of HIV by 60-70%. Breastfeeding is contraindicated in an HIV-positive mother because the virus can be passed through breast milk. *Baby is given AZT first 6 months*

If the nurse suspects a uterine infection in the post-partum client, the nurse should make which priority assessment? 1. Pulse and blood pressure 2. Odor of the lochia 3. Episiotomy site 4. The abdomen for distention

Answer: 2 Rationale: An abnormal or foul odor of the lochia indicates infection in the uterus *(metritis)* The vital signs may be affected by an infection, but that is not definitive enough to suspect a uterine infection. A distended abdomen usually indicates a problem with gas, perhaps a paralytic ileus. Inspection of the episiotomy site would not provide information regarding a uterine infection.

The nurse would take which action as part of nursing care of the infant experiencing neonatal abstinence syndrome? 1. Place stuffed animals and mobiles in the crib to provide visual stimulation. 2. Position the baby's crib in a quiet corner of the nursery. 3. Avoid the use of pacifiers. 4. Avoid holding the baby.

Answer: 2 Rationale: Neonatal abstinence syndrome, or drug withdrawal, causes hyperstimulation of the neonate's nervous system. Nursing interventions should focus on decreasing environmental and sensory stimulation during the withdrawal period. Pacifiers allow for nonnutritive sucking by the infant

A newborn is admitted with a diagnosis of transient tachypnea of the newborn (TTN). When planning nursing care for this baby, what nursing goal should the nurse formulate? 1. Promote adequate quantity of surfactant. 2. Promote absorption of fetal lung fluid by administering O2 3. Assist in removal of meconium from airway. 4. Stimulate respirations.

Answer: 2 Rationale: Transient tachypnea of the newborn (TTN) is caused by delayed absorption of fetal lung fluid. Nursing care is focused on supporting oxygenation needs to allow the newborn's body to reabsorb the fluid. Inadequate surfactant is related to prematurity and respiratory distress syndrome. TTN causes tachypnea so stimulating respirations is not appropriate. TTN occurs in babies born by C-section and who are premature. It is thought to be due in part to the lack of thoracic compression that occurs with vaginal delivery. The respiratory rate is typically elevated. It clears rapidly, usually within 1-4 days.

The nurse is admitting a neonate two hours after delivery. Which assessment data should the nurse be concerned about? Select all that apply. 1. Hands and feet blue with otherwise pink color 2. Bilateral nasal flaring 3. Minimal response to verbal stimulation 4. Apical heart rate 140-156 5. Chest retractions 6.Cyanosis

Answer: 2, 5, 6 Rationale: Nasal flaring, cyanosis and chest retractions could be signs of respiratory distress and require immediate intervention. Blue hands and feet, a minimal response to verbal stimulation and apical heart rate of 140-156 are normal findings for a neonate at two hours of age. *Teacher wants us to know respiratory most common complication in premature infants* A finding indicating RDS would be an x-ray "white out" means no gas exchange

A woman who delivered three weeks ago calls the postpartum unit with breastfeeding questions. She wants to know if she can continue to breastfeed while she has the flu. She states that she feels achy all over and has chills and a fever of 103°F. What other question is important for the nurse to ask? 1. "Have you been sleeping well?" 2. "Are you still experiencing vaginal flow?" 3. "Do you have any reddened areas or tenderness on your breasts, or unusual breast discharge?" 4. "Do you have any swelling in your legs or visual disturbances?"

Answer: 3 Rationale: Mastitis most frequently occurs at two to four weeks after delivery with initial *flu-like symptoms* plus breast tenderness and redness. The client may be describing symptoms of a breast infection. Sleep, lochia, and edema with visual disturbances are not associated with breast problems. *Signs/Symptoms* "flu-like" Fever /Chills Unilateral breast pain Redness and inflammation Tender axillary lymph nodes

A new mother with mastitis is concerned about breastfeeding while she has an active infection. How should the nurse respond to the client's concern? 1. The infant is protected from infection by immunoglobulins in the breast milk. 2. The infant is not susceptible to the organisms that cause mastitis. 3. The organisms that cause mastitis are not passed in the milk. 4. The organisms will be inactivated by gastric acid.

Answer: 3 Rationale: The organisms are localized in breast tissue and are not excreted in the breast milk. *Management &Nursing Interventions* Antibiotic therapy (safe for baby) Application of heat/ice Analgesics *Prevention is Key* -Teach proper latch-on, prevent nipple fissures -Teach good asepsis, hand washing

Which sign of thrombophlebitis should the nurse instruct the postpartal client to look for when at home after discharge from the hospital? 1. Muscle soreness in her legs after exercise 2. Enlarging varicose veins in her legs 3. Localized posterior leg tenderness, heat, and swelling 4. New areas of ecchymosis

Answer: 3 Rationale: These are classic signs of thrombophlebitis that appear at the site of inflammation; the other signs listed are not. *Signs/Symptoms* Pain + Homan's sign Warmth and redness at site Stiffness Leg may be pale and cool (milk-leg)

Which woman is at *greatest risk* for early postpartum hemorrhage? a.A primiparous woman being prepared for an emergency cesarean birth for fetal distress b. A primigravida in spontaneous labor with preterm twins c. A multiparous woman with an 8-hour labor d. A woman with preeclampsia on magnesium sulfate whose labor is being induced

D Magnesium sulfate administration during labor poses a risk for PPH. Magnesium acts as a smooth muscle relaxant, thereby contributing to uterine relaxation and atony.

If nonsurgical tx for *late postpartum hemorrhage* is ineffective, which surgical procedure would the nurse expect to be performed?

D&C allows examination of the uterine contents and removal of any retained placental fragments or blood clots.

S/SPostmaturity in an infant SATA Excessive vernix caseosa covering the skin Meconium aspiration hypoglycemia Cracked, peeling skin lethargy respiratory distress syndrome

Meconium aspiration, hypoglycemia, and cracked,dry &peeling skin are consistent with a postmature infant. "KNOW POSTMATURE Increased risk for meconium aspiration* Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome would be consistent with a very premature infant *The post mature infant would most likely have longer hair and decreased amounts of subcutaneous fat*

Neonatal abstinence syndrome (NAS) is the term used to describe the symptoms associated with drug withdrawal in the neonate, what would the pharmacologic treatment be?

Medications of choice are morphine, phenobarbital, diazepam, or diluted opium, therapy is based on moms addiction. *Drug therapy may be necessary in 50-60% of infants to wean slowly and gradually, can't tolerate "cold turkey"*

What would nurse expect when 24 hour postpartum assessment reveals a fever, elevated pulse, chills, anorexia, fatigue, pelvic pain, uterine tenderness or *foul-smelling* profuse lochia?

Metritis (infection of uterus) Aka endometritis *Nursing interventions:* Fowler's position to promote drainage of lochia IV antibiotics Antipyretics