OB L&D Exam 2
Antidote for opioid-induced respiratory depression Reverse pruritus from epidural opioid?
Naloxone HCI
What does magnesium sulfate do?
decreases the CNS
What is a FAB in L&D?
forcep assisted delivery
•systolic blood pressure greater than 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher recorded on 2 different occasions at least 4 hr apart without protein in the urine or signs of end-organ dysfunction after 20 weeks of pregnancy.
gestational hypertension
What does HELLP stand for?
hemolysis, elevated liver enzymes, low platelets
What is IFM?
internal fetal monitoring
What does a stage 3 episiotomy include?
involves your vaginal lining, vaginal tissues and extends to your anal sphincter.
How do we deal with a prolapsed cord?
it is an emergency, and is usually dealt with by emergency c-section and finding ways to relieve some of the pressure on the cord in the meantime.
What is macrosomia?
large fetus; big baby
what are moderate contractions?
last 30 to 45 seconds, though they can be shorter, and might be regular or irregular. They may be spaced around 20 minutes apart and become progressively closer together, but not necessarily in a consistent pattern.
What does a molar pregnancy look like in an ultrasound?
like great light clusters.
________________ ______________ is given to prevent preterm delivery but it can also cause some negative effects in the mother, including muscle weakness, blurred vision, headache, nausea, and vomiting
magnesium sulfate
what are the contraction strengths?
mild, moderate and strong
What is cervical insufficiency?
premature dilation of the cervix
what does cervical insufficiency cause?
preterm birth...
What is engorgement of the breasts?
process of swelling and hardening of the breast tissue d/t an increase in blood and lymph supply as a precursor to lactation
what would you monitor after giving naloxone?
respirations/ respiratory effort
What does ferning indicate?
rupture of membranes; moms water broke and she has entered labor.
how do we treat cervical insufficiency?
sew it; cerclage. to keep the cervix closed until labor.
The nurse is assisting in caring for a client in labor. Which data collection finding by the nurse places the client at risk for uterine rupture?
shoulder dystocia
The nurse assists in developing a plan of care for a multigravida client who has a history of cesarean birth. It is determined that the client is at high risk of uterine rupture. The nurse plans to monitor the client closely for which sign or symptom?
signs of shock; Tachy, hypertensive, clammy, cold.
How is a molar pregnancy treated?
sometimes a hysterectomy. She must be on birth control!! monthly betas.
what creates prolactin?
the anterior pituitary gland
What is the difference between preeclampsia and maternal HTN?
there is no protein in the urine in GHT, there is protein in urine in preeclampsia
What is polyhydramnios?
too much amniotic fluid
What does a boggy uterus indicate?
uterine atony
what is vasa previa?
when a fetal vessel overlies the cervix
When are moms screened for gestational diabetes?
•24 to 28 weeks of pregnancy.
What is considered positive for gestational diabetes?
•A positive results: 130-140 mg/dL or greater.
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia. Which of the following indicates magnesium sulfate toxicity? SATA
•A. respirations less than 12/min. •B. UO less than 30 ml/hr. •D. Decreased level of consciousness
•A patient diagnosed with preeclampsia had a severe headache, 2+ protein in the urine, hyperreflexia, and was started on magnesium sulfate. Current assessment findings include a severe headache, slurred speech, and hyporeflexia. What should the nurse do next? • •A. Reassess the patient in 1 hour. •B. Notify the charge nurse immediately. •C. Document current assessment findings. •D. Turn off the magnesium sulfate infusion.
•D. Turn off the magnesium sulfate infusion.
________________________ is decreased amniotic fluid that may be caused by fetal anomalies or premature rupture of membranes.
•Oligohydramnios
What are signs of magnesium toxicity to look out for?
•Respiratory depression < 12 •Absent reflexes •Lethargy •Slurred speech •Loss of consciousness •UO < 30 mL/hr
When is GBS screening done?
•Vaginal & rectal CX are performed at 35 to 37 weeks gestation
What is leopold's maneuver used to determine?
# of fetuses fetus presentation, lie, and attitude degree of descent of the presenting part into the pelvis location of the fetus's back to assess for fetal heart tones
what are the two types of episiotomies?
* Median (midline) and mediolateral
How is engorgement treated?
- Increase frequency of breast feeding - Hand express/pumping - Apply cold after breast feeding - Apply warm before breast feeding - Breast massage - Anti-inflammatory medications
What is subinvolution of the uterus?
- a delay of the uterus returning to normal after birth -should be 1 cm/day
What is a boggy uterus?
- a term used to describe a soft fundus indicating retention or placental fragments. - The uterus will feel soft and squishy upon palpation.
What are the 5 P's of labor?
-Passageway (The pelvis and soft tissues) -Passengers (The fetus and placenta) -Powers (Contractions) -Position of mother (standing, walking, side-lying, squatting, on hands and knees) -Psyche (psychological response)
What is the dilation range for the latent Phase:?
0-3 cms
What are the four steps of leopold's manuever?
1. start at the fundus of the uterus and palpate for the fetus's head or buttocks. 2. locate smooth contour of back or irregular small parts. 3. Gently grasp lower portion of uterus between thumb and fingers to feel for head or buttocks, 4. Turn towards woman's feet, and feel for cephalic prominence. If cephalic prominence is on same side as smooth back, then it's extended.
What is considered gestational hypertension?
140/90 on 2 separate occasions 4 hours apart.
The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia. Select all that apply. 1.) Proteinuria 2.)Hypertension 3.)Low-grade fever 4.)Generalized edema 5). Increased pulse rate 6.)Increased respiratory rate
1.) Proteinuria 2.)Hypertension
The nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Which interventions should the nurse include in planning nursing care for this client? Select all that apply.
1.)Assess blood pressure. 2.)Check the urine for protein. 3.)Assess deep tendon reflexes. 5.)Teach the importance of keeping track of a daily weight.
A 39 week pregnant patient is in labor. The patient has preeclampsia. The patient is receiving IV Magnesium Sulfate. Which finding below indicates Magnesium Sulfate toxicity and requires you to notify the physician? A. Deep tendon reflex 4+ B. Respiratory rate of 13 breaths per minute C. Urinary output of 600 mL over 12 hours D. Clonus presenting in the lower extremities E. Patient reports flushing or feeling hot
E. The nurse should monitor for Magnesium Sulfate toxicity.
_______________________ ____________________ is characterized by unusually acute nausea and vomiting. •Associated with increased levels of hCG. •Defined as N/V that is prolonged past 12 weeks of gestation.
Hyperemesis gravidarum (HG)
Which of the following physical findings would lead the nurse to suspect that a client with severe pre-eclampsia has developed HELLP syndrome? Select all that apply. 1. +3 pitting edema. 2. Petechiae. 3. Jaundice. 4. +4 deep tendon reflexes. 5. Elevated specific gravity.
2 and 3 are correct.
the maternity nurse prepares the client for which techniques are commonly used to relieve shoulder dystocia? 1.Leopold's maneuver 2.McRoberts' maneuver 3.Placing the client in the lithotomy position 4.Positioning the client laterally on her left side
2.McRoberts' maneuver The McRoberts maneuver is used to relieve shoulder dystocia. It is described as the woman flexing her thighs sharply against her abdomen to straighten the pelvic curve. This procedure will assist the fetus to move past the pelvic curve of the woman.
A miscarriage, also known as a spontaneous abortion or spontaneous pregnancy loss, occurs before ___ weeks gestation.
20
•An AFI of __to __ cm is abnormal.
20 to 25
Which of the following situations would most likely warrant contact with a physician for further orders for care or treatment? A. A patient has a 3rd-degree perineal laceration after delivery B. A patient has lost 100 mL of blood with delivery C. A patient has a boggy uterus that does not firm with massage D. A patient is having rectal pain
C. A patient has a boggy uterus that does not firm with massage
A patient with high bp during labor has been given magnesium sulfate IV. In addition to regulation of bp, which of the following results would the nurse expect to see after administration of this medication? A. cool, pale skin B. Constipation C. Muscle weakness D. Neck pain
C. Muscle weakness
Which of the following laboratory values should the nurse report to the physician as being consistent with the diagnosis of HELLP syndrome? 1. Hematocrit 48%. 2. Potassium 5.5 mEq/L. 3. Platelets 75,000. 4. Sodium 130 mEq/L.
3. Low platelets are consistent with the diagnosis of HELLP syndrome.
The nurse concludes that both clotting and bleeding occur during disseminated intravascular coagulation (DIC) due to which process? A. Tissue damage from bleeding uses up clotting factors quicker than they can be replaced. B. Activation of intrinsic pathways results in release of excess clotting factors. C. Only clotting occurs during DIC, as clotting factors are replaced and available to prevent excess bleeding. D. Excess release of thrombin uses up clotting factors quicker than they can be replaced.
D. Excess release of thrombin uses up clotting factors quicker than they can be replaced.
•Condition that indicates there has been a complication of pregnancy.
Intrauterine Growth Restriction (IUGR)
It's best for a woman to get antibiotics for GBS at least __- hours before delivery.
4
How is internal fetal monitoring done?
It is a spiral that goes inside the baby's head. the mother must already be ruptured to use this method. She should be 2 to 3 CM dilated for this.
A 26-week-gestation woman is diagnosed with severe pre-eclampsia with HELLP syndrome. The nurse will assess for which of the following signs/symptoms? 1. Low serum creatinine. 2. High serum protein. 3. Bloody stools. 4. Epigastric pain
4. Epigastric pain is associated with the liver involvement of HELLP syndrome.
Risks of amniotic fluid volume disorders include which of the following? • A. Preterm delivery B. Umbilical cord prolapse C. Variable decelerations in the fetal heart rate D. All of the above
D. all of the above
Your patient with preeclampsia is started on Magnesium Sulfate. The nurse knows to have what medication on standby?
D: The antidote for Magnesium Sulfate is Calcium Gluconate. The nurse should have this on hand in case Magnesium toxicity occurs.
What does DIC mean?
Disseminated Intravascular Coagulation (most serious complication of shock/ often fatal). refers to bleeding out...
Majority of miscarriages occur between weeks __and __ and are thought to be the result of chromosomal abnormalities.
5 and 8
what is a uterine rupture?
A condition in which the uterus tears open exposing fetus and uterine contents to the peritoneum. the uterus opens up.
What does a first degree episiotomy include?
A small tear that involves just the lining of your vagina.
What does a second degree episiotomy include?
A tear that extends through the lining of your vagina to the underlying vaginal tissue. Most episiotomies are second-degree.
Fetal tachycardia is most common during: A. Maternal fever B. Umbilical cord prolapse C. Regional anesthesia D. MgSO4 administration
A. Maternal fever Correct: Fetal tachycardia can be considered an early sign of fetal hypoxemia and can also result from maternal or fetal infection.
•Premature separation of the placenta from the uterus either a partial or complete detachment occurs after 20 weeks
Abruptio Placentae:
Methergine or pitocin is prescribed for a woman to treat PP hemorrhage. Before administration of these medications, the priority nursing assessment is to check the: A) Amount of lochia B) Blood pressure C) Deep tendon reflexes D) Uterine tone
B) Blood pressure; They cause continuous uterine contractions and may elevate blood pressure. A priority nursing intervention is to check blood pressure. The physician should be notified if hypertension is present.
Which of the following physiological responses is considered normal in the early postpartum period? A) Urinary urgency and dysuria B) Rapid diuresis C) Decrease in blood pressure D) Increase motility of the GI system
B) Rapid diuresis... Rationale: In the early PP period, there's an increase in the glomerular filtration rate and a drop in the progesterone levels, which result in rapid diuresis.
On the first following delivery, the physician ordered a hemoglobin level for the patient; the result was 9.9 g/dL. The physician did not list any other orders in the patient's chart since that time. Which response of the nurse is most appropriate> A. call the physician and ask if he wants a blood transfusion for the patient B. ask the physician about the hemoglobin level when he comes in for rounds C. Contact the laboratory and ask them to repeat the test D. continue to monitor the patient and document the result
B. ask the physician about the hemoglobin level when he comes in for rounds; Hemoglobin 9.9g/dL is on the lower side for a woman, but not quite an emergency. The nurse should still ask the doctor about the concerns.
What blood sugar values are considered to be gestational diabetes?
BS 130-140
Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: A) Return to pre pregnant weight is usually achieved by the end of the postpartum period B) Fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3 pound weight loss C) The expected weight loss immediately after birth averages about 11 to 13 pounds D) Lactation will inhibit weight loss since caloric intake must increase to support milk production
C) The expected weight loss immediately after birth averages about 11 to 13 pounds. Weight loss from diuresis, diaphoresis, and bleeding is about 9 pounds. Weight loss continues during breast feeding..
Which of the following circumstances is most likely to cause uterine atony and lead to PP hemorrhage? A) Hypertension B) Cervical and vaginal tears C) Urine retention D) Endometritis
C) Urine retention
Which of the following patients would be at high risk of developing pre-eclampsia? Select all that apply. A. A patient who is pregnant with her 3rd child B. A patient who is married C. A patient who is 40 yrs old D. A patient who is overweight E. A patient who is pregnant with twins
C, D, E
Which of the patients described should the nurse see first? A. 20 yr old patient who just had her first baby and doesn't know how to breastfeed B. 27 yr old diabetic patient who delivered her second child yesterday and needs her morning dose of insulin C. 24 yr old patient who has had a large amount of lochia and has developed a hematoma on her perineum D. 30 yr old patient who needs to take a shower and eat breakfast before the physician comes to dismiss her
C. 24 yr old patient who has had a large amount of lochia and has developed a hematoma on her perineum
What electrolytes are affected in pregnancy?
Na elevated, K lowered
What is a molar pregnancy (hydatidiform mole)?
Occurs when only the trophoblast layers of the embryo proliferate and not the epiblast and as a result no embryo develops
•Occurs when the placenta implants on in the lower segment of the uterus near or over the cervical os.
Placenta Previa:
Spontaneous rupture of membranes 1 hr or more prior to the onset of true labor ROM for some signals labor
Premature Rupture of membranes- PROM
•Spontaneous PROM after 20 weeks of gestation and prior to 37 weeks gestation
Preterm Premature ROM-PPROM
1. The nurse knows that preeclampsia tends to occur during what time in a pregnancy? A. before 20 weeks B. in the third trimester and postpartum C. after 20 weeks D. in the first and second trimester
The answer is C. Preeclampsia tends to occur AFTER 20 weeks gestation.
7. Your patient is 36 weeks pregnant with severe preeclampsia. The physician has ordered lab work to assess for HELLP Syndrome. Which findings on the patient's lab results correlate with HELLP Syndrome? A. Hemoglobin 12 g/dL B. Platelets 90,000 μL C. ALT 100 IU/L D. AST 90 IU/L E. Glucose 350 mg/dL F. Abnormal RBC peripheral smear
The answers are: B, C, D, and F.
what is considered colostrum?
The first breast milk comes in the first 24 to 48 hours after birth.
What does a stage 4 episiotomy include?
The tear affects the vaginal lining, vaginal tissues, anal sphincter and rectum. The most severe type of tear with the most complications.
What are mild contractions?
They usually come every five to 15 minutes and last 60 to 90 seconds.
As a nurse to prepare the client, what do you ask your patient to do before performing leopold's maneuver?
To empty her bladder, Then lie on her back with her knees flexed and feet on the bed Place a small towel or something under their hip to avoid the uterus to compress major vessels causing supine hypotension syndrome
how will we see a prolapsed umbilical cord?
We will see variables on the strip that signify cord compression.
What is a prolapsed umbilical cord?
When the umbilical cord presents first and gets squeezed between the vaginal wall and the baby's head.
What is shoulder dystocia?
Where the baby's shoulder gets caught on the pubis during delivery, obstructing it. Obstetric emergency as *umbilical cord is compressed* in vagina
Can a mom be cured of gestational diabetes?`
Yes, once she has the baby, she can be cured.
What is prolactin?
a hormone released from the anterior pituitary gland that stimulates milk production after childbirth.
what may need to happen for a uterine rupture?
a hysterectomy
How is a ferning test performed ?
a sterile swab is used to collect a specimen of mom's fluids and the sample is observed under a microscope to look for ferning.
what is an episiotomy?what is s
a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.
Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: a. spina bifida. b. intrauterine growth restriction c. diabetes mellitus. d. Down syndrome.
b. intrauterine growth restriction (IUGR)
The patient's medical record states that she tested positive for group B Streptococcus infection. which of the following precautions should be given in this situation? A. the patient should receive antibiotics at this time b. the patient should be given antibiotics during labor c. the fetus should receive antibiotics as a prenatal infusion d. there is no treatment necessary
b. the patient should be given antibiotics during labor
Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing: a. uterine prolapse b.rectocele c. cystocele d. vesicovaginal fistula
c. cystocele; cystocele occurs when the supportive tissue between a woman's bladder and vaginal wall weaken and stretch allowing the bladder to bulge into the vagina. - aka: ANTERIOR PROLAPSE
Antidote for magnesium sulfate toxicity is?
calcium gluconate
what is liquid gold?
colostrum
