Weekly Quizzes
Which of the following are considered positive signs of pregnancy: A) Ultrasound assessment of the fetal heart rate B) Abdominal enlargement C) A positive pregnancy test D) Nausea, vomiting and a missed menstrual period
A (Ultrasound assessment of the fetal heart rate)
You are caring for a client on her initial prenatal visit. Her LNMP is July 8th, 2020. Using Nagele's rule what is her estimated date of confinement (EDC) or Estimated date of delivery (EDD) A) 04/15/2021 B) 03/15/2021 C) 05/01/2021 D) 04/01/2021
A (04/15/2021) LNMP = 7/8/2020 Date = 8 + 7 = 15 Month = 7 - 3 = 4 Year = 20 + 1 = 21 EDD: 4/15/21 - EDD or EDC - Estimated date of delivery or estimated date of confinement (old term) - Average length of pregnancy is 280 days from 1st day of the LMP - Less than 10% of women give birth on their "due date" - Most providers use a "pregnancy wheel" to calculate EDC Naegele's rule - Method to estimate EDD - Add 7 to first day of LNMP - Subtract 3 months - Add 1 year Additional Example: LNMP = 08/08/19 Date = 08 + 7 = 15th Month = 08 - 3 = 05 Year = 19 + 1 = 20 EDD = 05/15/20
You are examining an infant born through vaginal birth. On examination of the fetal head you notice a prominent ridge on the fetal skull. The patient asks why this ridge is present. You understand that this is: A) A normal finding called overriding sutures caused by molding of skull plates to allow head to deliver vaginally B) An abnormal finding called cephalohematoma that resulted in trauma to the newborn head at delivery C) An abnormal finding called subgaleal hemorrhage as a result of a forceps or vacuum delivery D) A normal finding called caput succedaneum indicating a small buildup of fluid or edema following a long labor
A (A normal finding called overriding sutures caused by molding of skull plates to allow head to deliver vaginally) Caput or molding Is what causes "cone head" Plates allow for vaginal deliveries Molding or Cone Head Resolves quickly within a few days In terms of the head, there can be significant adaptation for infants who are born vaginally. The head can "mold" or change in shape to accommodate the maternal pelvis. If you view the infant from the side and look at the angle from the tip of the chin to the top of the head, you will often see the molded shape. The normal tone of the two fontanels should be flat. Infants born by Csection often have very round, non-molded heads (unless they labored and spent time deep in the maternal pelvis).
A client comes in with irregular uterine contractions and drainage of amniotic fluid at 32 weeks gestation. Which of the following medications is recommended for this situation? A) Betamethasone B) Gabapentin C) Clonidine D) NSAIDs
A (Betamethasone) Steroids (betamethasone) to mature fetal lungs
You are conducting an assessment on a newborn born 1 hours ago. Which of the following finding would signal the need to intervene? A) Bluish color on the lips and chest B) Heart rate of 130 beats per minute C) Temperature of 98 degrees Fahrenheit D) Bluish color on hands and feet
A (Bluish color on the lips and chest) Color - Acrocyanosis is normal in 1st 24 hours Color Acrocyanosis: Blue/purple coloring of only the HAND and the FEET (perfectly normal in the first 24 hours, everything should pink up the next day) - central cyanosis (lips and mucous membranes) is abnormal Abnormal findings: Central blue/purple coloring such as the lips
A client reports to for an initial prenatal visit at 14 weeks gestation. On assessment her Blood pressure is 180/100mhHg with protein in urine of 300mg. The nurse understand that that this is indicative of: A) Chronic hypertension B) Eclampsia C) Pre-eclampsia D) Gestational hypertension
A (Chronic hypertension) •Chronic hypertension - HTN (SBP 140 or DBP 90) present before pregnancy or b/f 20 weeks gestation - Chronic hypertension - 20 - 25% of women with chronic hypertension (140/90 > twice) will also develop preeclampsia also known as superimposed pre-eclampsia
You are educating a patient on contraceptive methods that do not contain hormones. You let her know that these include: A) Copper IUD, condoms, natural family planning B) Ring, pills and implant C) Implant, copper IUD and condoms D) Condoms, natural family planning and levonorgestrel-releasing IUD
A (Copper IUD, condoms, natural family planning)
While assess the infant you notice that as the infant breathes in, both the chest and abdomen moves upward. This is indicative of: A) Diaphragmatic breathing B) Substernal chest retractions C) Adventitious breathing D) Intercoastal chest retractions
A (Diaphragmatic breathing) Respiratory rate is a very important assessment parameter in a neonate - infants often show us they are sick by increasing their respiratory rate. The normal respiratory rate in a normal newborn is 30-60 breaths/minute. Any rate above 60 needs to be reported and re-assessed. Infants also show distress by retracting their intercostal muscles - the photo above shows intercostal retractions.
Normal cardiovascular changes in pregnancy include: A) Heart rate increases 10-15 bpm B) Blood pressure increases in late pregnancy C) Cardiac output decreases D) Blood volume decreases
A (Heart rate increases 10-15 bpm)
The nurse is assessing the lochia on a 1-day PP patient. The nurse notes that the lochia is red and has a foul-smelling odor. The nurse determines that this assessment finding is: A) Indicates the presence of infection B) Document this as a normal finding C) Indicates the need for increasing oral fluids D) Indicates the need for increasing ambulation
A (Indicates the presence of infection) Teach Postpartum Warning Signs NCLEX - Foul smelling lochia Endometritis - Symptoms include FOUL SMELLING LOCHIA
You are caring for a newly admitted patient with a diagnosis of hyperemesis gravidarum. Which finding is a clinical manifestation of this diagnosis? A) Ketones present in urine sample B) Hemoglobin of 10.8 C) Fasting serum glucose of 100 D) Platelets of 100,000
A (Ketones present in urine sample) Symptoms of hyperemesis •Weight loss - > 5% of pre-pregnancy weight •N&V, ptyalism, dehydration, ketosis, electrolyte imbalance •Muscle wasting and vitamin deficiencies
The goal of glycemic control in a pregnancy complicated by diabetes is: A) Maintaining maternal fasting blood sugar at 65-95mg/dl B) Avoiding maternal hypoglycemia C) Maintaining maternal fasting blood sugar at 120mg/dl or less D) Maintaining a Hemoglobin A1C of below 8.0
A (Maintaining maternal fasting blood sugar at 65-95mg/dl) •GLYCEMIC CONTROL •Goal = Fasting = 65 to 95 mg/dl •Goal = Two hours post meal = 120 or less
You are a nurse taking a history on a patient in a clinic. You keep in mind that the most important aspect of primary prevention regarding risk-reduction practices is: A) Reducing the number of partners B) Knowing one's partners C) Getting tested annually for STIs D) Treatment of sexually transmitted infections
A (Reducing the number of partners)
A nurse is examining fundal height in a pregnant woman in the third trimester. As the woman arises from her the bed she tells the nurse that she feels dizzy. The nurse explains: A) This can be due to pressure on the vena cava and the woman should lie on her left side B) This can be due to pressure on the vena cava and the woman should lie on her right side C) This can be due to pressure on the legs and the woman should lie on her back with feet D) This can be due to increased venous return from the increased circulatory volume, elevate legs.
A (This can be due to pressure on the vena cava and the woman should lie on her left side) - Placental blood flow is enhanced when the women is lying on her left side because venous return from the lower extremities is not compromised. - Supine hypotension: (aka vena caval syndrome or aortocaval syndrome) from the pressure of the enlarging uterus on the aorta and it's collateral circulation when a woman is laying on her back long - Supine hypotension syndrome (woman lying on her back)- caused by the enlarged uterus pressing on the aorta or vena cava. - Have the woman lie on her left side to reduce hypotensive effects of aortic compression and/or vena cava syndrome.
A 33-year-old client with a history of one cesarean section would like to know if she is a candidate for Vaginal Birth after Cesarean Section (VBAC). Which of the following would be a contraindication for this? (select two that apply) A) First c-section involved classical incision B) Uterine trauma and perforation that was successfully repaired C) Preterm labor D) First c-section involved pfannenstiel incision E) Maternal Age
A, B (First c-section involved classical incision, Uterine trauma and perforation that was successfully repaired) Women may also have VBAC - Vaginal delivery after Cesarean section Indicated when mothers has had only 1-2 previous C sections - no other uterine scars or history of a rupture Clinically adequate pelvis Providers immediately available for C/S No others contraindications - LGA, malpresentations, Cephalopelvic disproportion (CDP), previous classical uterine incision ■Classic incision ALWAYS has repeat C-section
As a nursing student you know that the following is true about Bacterial STIs: (select all that apply) A) Can result in adverse pregnancy outcomes B) Treatment involves antibiotics C) Should involve partner treatment D) Often exhibit no symptoms E) There is no permanent cure
A, B, C, D (Can result in adverse pregnancy outcomes, Treatment involves antibiotics, Should involve partner treatment, Often exhibit no symptoms)
The following are part of all typical initial prenatal visits at approximately 12 weeks gestation (select all that apply): A) Education about pregnancy symptoms and warning signs B) Assessment of risk of intimate partner violence C) Health history, nutritional history and family history D) Measurement of fundal height E) Lab tests, including CBC and blood type
A, B, C, E (Education about pregnancy symptoms and warning signs, Assessment of risk of intimate partner violence, Health history, nutritional history and family history, Lab tests, including CBC and blood type)
Constant support during labor has been shown to: (select all of the following that apply) A) Decrease number of cesarean deliveries B) Decrease medication use in labor C) Decrease patient satisfaction and feelings of labor D) Decrease medical interventions in labor
A, B, D (Decrease number of cesarean deliveries, Decrease medication use in labor, Decrease medical interventions in labor) Labor support is vital to the outcomes of the labor and birth experience. Nurses are present at most births in the world today and can provide this very valuable support.
You are educating a new mother about safe sleep practices. Which of the following would you include in your education? Select all that apply A) Baby need to be placed on a firm mattress B) Infants need to be placed on their back C) Infant need to be placed on their abdomen to ease in breathing D) Keep toys and pillows to a minimum to avoid distracting baby E) A separate crib or box, but in the same room as the mother is recommended
A, B, E (Baby need to be placed on a firm mattress, Infants need to be placed on their back, A separate crib or box, but in the same room as the mother is recommended)
As a nursing student you know that signs of placental separation include: (select two that apply) A) Uterus becomes more globular and firm B) Uterus contract and descend into the pelvis C) Mothers has the urge to push D) Gush of blood E) Umbilical cord shortens
A, D (Uterus becomes more globular and firm, Gush of blood) Third Stages of Labor •The third stage is the delivery of the placenta - placental separation and expulsion •Physiological signs of placental separation •Uterus becomes more globular, firm, and •Uterus rises in the abdomen approaching the umbilicus •Gush of blood, •Cord lengthens •Signs of placental separation •Firmly contracted fundus •Sudden gush of blood from vagina •Lengthening of umbilical cord •With signs of separation, VERY gentle traction of cord, mother gives several pushes to expel placenta •Never pull on umbilical cord prior to signs of separation, and do not provide anything more than gentle traction •May administer oxytocin IV/IM to control bleeding with birth of infant shoulder or after birth •Promotes uterine contractions to decrease maternal bleeding The third stage begins with the delivery of the baby and ends with the complete delivery of the placenta (which patients often call the "afterbirth"). This process usually takes 5-30 minutes with an average being 15 minutes. Providers can sometimes get anxious to get the placenta removed if it does not come out spontaneously, but it is very dangerous to pull on the umbilical cord - pulling could cause a uterine inversion (and a massive hemorrhage) or a detached cord. VERY gentle traction can be used. If the placenta does not come out on its own within 30 minutes, the placenta may have to manually removed by the provider. This can cause increased infection, postpartum hemorrhage and significant discomfort. CNMs often use an upright position for a stubborn placenta, with great success.
Case Scenario : You are caring for a 17-year-old girl who reports to the clinic with history of vaginal itching, abnormal vaginal discharge, and pain when passing urine and during sex. Based on the information above which of the following diagnosis would potentially cause these symptoms. Select all that apply A) Chlamydia B) Hepatitis C C) Hepatitis B D) Secondary Syphillis E) Gonorrhea
A, E (Chlamydia, Gonorrhea)
A 25-year-old gravida 1 para 0 reports for prenatal care. She is at 5-weeks gestation and her medical history shows that she has Type 1 diabetes. Which of the following would indicate understanding of her medical therapy? A) "My current insulin needs have not changed and I don't need dose adjustment from my pre-pregnancy insulin regimen" B) "My current insulin needs have decreased, and I need dose adjustment because I am at risk of developing hypoglycemia" C) "My current insulin needs have increased, and I need dose adjustment because I am at risk of developing hyperglycemia" D) "My current insulin needs have greatly increased, and they need to double my dose to prevent severe hyperglycemia"
B ("My current insulin needs have decreased, and I need dose adjustment because I am at risk of developing hypoglycemia") In the first trimester the presence of the fetal-placental unit causes a drop in growth hormone levels, resulting in enhanced insulin sensitivity. After this period of increased sensitivity to insulin, circulating levels of human placental lactogen, placentally derived human growth hormone (GH-V), progesterone, cortisol, prolactin, and other hormones increase and contribute to decreasing insulin sensitivity in peripheral tissues such as adipocytes and skeletal muscle by interfering with insulin receptor signaling. Thus insulin needs also change throughout pregnancy 1st trimester(Week 1-13) insulin needs decrease 2nd trimester(Week 14-26) = Insulin needs increase 3rd trimester (Week 27-40) = Insulin needs greatly increase - may double or triple
You are working as an RN in a labor and delivery unit. Which of the following clients would you see first? A) A primigravida at full dilatation and head at station -1 complaining about urge to push B) A primigravida at 5cm dilatation with a report of vaginal bleeding with clots and a tense abdomen C) A multigravida in fourth stage of labor with mild bleeding and complaining of difficulties attaching infant to breast D) A multigravida at 8cm dilatation complaining about painful uterine contractions
B (A primigravida at 5cm dilatation with a report of vaginal bleeding with clots and a tense abdomen) - bleeding with clots and a tense abdomen are of highest concern (true OB emergency)
The nurse is stroking sole of foot along lateral edge and the infant toes extend while the tow flex. This reflex is called? A) Stepping reflex B) Babinski sign C) Moro reflex D) Palmar grasp reflex
B (Babinski sign) Newborn Reflexes - Babinski - sole of foot The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out. The Babinski reflex is initiated by stroking the sole of the infant's foot - the normal response is a POSITIVE Babinski - which is that all the toes hyperextend and then the big toe dorsiflexes (bows down). In most infants this reflex disappears by 18 moths of age.
The nurse is performing a Leopold's maneuver and pelvic assessment. The figure below indicates the findings. What is the position and presentation of the fetus? A) Face Presentation, Right Occiput Anterior (ROA) B) Cephalic presentation, Left Occiput anterior (LOA) C) Cephalic presentation, Right Occiput Anterior (ROA) D) Brow Presentation, Left Occiput anterior (LOA)
B (Cephalic presentation, Left Occiput anterior (LOA)) Fetal Presentation Cephalic (head down) is most common The most common way for a baby to "present" is to be head (cephalic) down. In this photo the fetus presents in either Left Occipital Anterior (LOA) cephalic presentation or could also be considered Left Occipital Transverse (LOT) cephalic presentation. More than 95% of babies are born head down - physics favors this position as the head is the heaviest part of the baby. The head is also "moldable" as the cranial bones can actually "mold" or move to accommodate the trip through the maternal pelvis. Remember from A&P class that the occipital bone is on the back of the head, the mentum is the chin (on the mandible bone), acromion process is the shoulder, and the sacrum is the buttock. Anterior is towards the front or the front side, posterior is towards the back or facing back, transverse is sideways. The left and the right refer to where that presenting bone is nearest or facing to the side of the women's body.
You are caring for a client on her initial visit. During interview she mentions that she got pregnant in 2010 and the pregnancy ended at 12 weeks; her second pregnancy was in 2012 and she delivered at 36 weeks and child is alive; her other pregnancy was twins delivered at 34 weeks gestations and both are alive; and she is currently pregnant. Calculate her GTPAL A) G-4, T-0, P-3, A-1, L-3 B) G-4, T-0, P-2, A-1, L-3 C) G-4, T-1, P-2, A-1, L-3 D) G-5, T-0, P-3, A-1, L-3
B (G-4, T-0, P-2, A-1, L-3) G: A total of 4 pregnancies including the current pregnancy. Third pregnancy was twins, this is still considered a total of ONE pregnancy. T: 0 term pregnancies (full term is considered pregnancies carried to 37 weeks or greater) P: 2 preterm pregnancies (second pregnancy and third pregnancy are considered preterm due to delivery/number of pregnancies carried between 20 and 36.6 weeks) A: 1 abortion, first pregnancy is considered a spontaneous abortion because it is prior to 20 weeks, the pregnancy ended at 12 weeks. There was no delivery therefore it would not be considered preterm. Instead, this pregnancy would be considered a miscarriage or a spontaneous abortion. L: A total of 3 living children (One child alive from second pregnancy, along with two children alive from the third pregnancy) Gravidity and Parity NCLEX Five-Digit System - Gravidity = G (pregnancy) - Parity = P (T-P-A-L) - Full term (37 week or <) - Preterm (>20-36 6/7 weeks) - Abortions- either therapeutic or spontaneous (<20 weeks) - Living Children (total living)
When is urinary frequency most common during pregnancy? A) First and second trimester B) The first and third trimester C) The second and third trimester D) The third trimester only
B (The first and third trimester) Urinary Tract Changes Functional Changes •Frequency increased from pressure of uterus in first trimester, it decreases in second trimester when uterus becomes abdominal organ and reappears in 3rd trimester when the presenting part descends on against the bladder. This contributes to reduced bladder capacity, hyperemia, and bladder irritation •Side lying increases renal perfusion and urine output
You are caring for a patient who has just been diagnosed with HELLP syndrome. You would expect to see the following findings in her lab results: A) Elevated WBCs B) Low platelets (<100,000) C) Elevated hemoglobin level (>12.0) D) Decreased liver enzymes (AST and ALT)
B (Low platelets (<100,000)) HELLP SYNDROME •H: hemolysis (Hg/Hct decrease) •EL: elevated liver enzymes (elevated AST & ALT) •LP: low platelets (platelets decrease < 100,000) •Can occur without overt preeclampsia •Subjective symptoms in HELLP •Generalized malaise (90%) •Epigastric pain (65%) •Nausea and vomiting (30-50%) •Headache (31%) •Treatment-Only "cure" is delivery of infant
As a nursing student you understand the following intervention would be contraindicated in a client with severe pain of left leg and Deep Vein Thrombosis: A) Administer prescribed anticoagulant therapy and analgesics B) Massage the affected area to promote muscle relaxation C) Elevation of the affected leg and use of compression stocking D) Encouraging bed rest
B (Massage the affected area to promote muscle relaxation) No palpation/rubbing area - may dislodge clot
You are caring for a client with postpartum hemorrhage from uterine atony. which of the following would be a priority nursing diagnosis. A) Notify their provider B) Massage the uterine fundus and express clots C) Start an IV infusion of 1L Ringers lactate with 10-40 units of Oxytocin D) Administer oxygen 10L via mask
B (Massage the uterine fundus and express clots) Postpartum hemorrhage Uterine Atony Inability for uterus to contract - Ensure bladder is empty - Monitor uterine contractility and FH - Fundal massage and express clots - Monitor vital signs - Maintain or initiate IV fluids - Oxygen 2-3L /min - Treat other causes i.e. retained placenta INTERVENE - Fundal massage (Massage the uterus until firm) - IV access/fluids - Medications - Notify provider
Which of the following psychological responses would characteristic of puerperal psychosis? A) Fatigue after birth B) Mother is restless and say that she sees ghosts trying to steal her baby C) Excessive weepiness and feeling of inadequacy on day 1 postpartum D) Mood swings, anxiety, and insomnia on day 7 postpartum
B (Mother is restless and say that she sees ghosts trying to steal her baby) Postpartum psychosis - 0.1-0.2% of new mothers - Usually in 1st 2 weeks - Sx = Auditory & visual hallucinations, delusions, paranoia, delirium, impulsivity, obsessive concerns about baby Treatment: - Aggressive - hospitalization - Therapy; possible ECT - Medication - Antipsychotics - Risperidone, aripiprazole
Your patient is 39 weeks pregnant and has called the clinic to ask if she might be in labor. The following signs indicate that she is likely in true labor: A) Bloody show B) Regular contractions that have been getting stronger and closer together C) Cervical effacement D) Contractions that get stronger or less strong depending on maternal movement
B (Regular contractions that have been getting stronger and closer together) Here is a list of how we determine if labor is "true" (dilation is occurring) or "false" (minimal or no dilation). This is a question that often appears on ATI or NCLEX - they want you to know how to counsel a patient about whether or not she is in labor. If the mother is unsure, have her drink a glass or two of water and rest for 30min. If the contractions stop, they were Braxton hicks and not true labor. If the contractions continue and become stronger after a period of time, they are likely true contractions. Also, if a woman is less than 38 weeks gestation and is contracting regularly, she should be assessed for preterm labor.
You are providing care to a client with pre-eclampsia on Magnesium sulfate. Which of the following finding would cause concern? A) Urine output of 50ml/hr B) Respiratory rate of 11/min C) Protein is urine of 2g/24hr D) Serum levels of Mag Sulfate of 6mEq/L
B (Respiratory rate of 11/min) MAGNESIUM SULFATE - A "HIGH-ALERT" MEDICATION NCLEX •ASSESS for: RR = (< 12/min), Serum levels (higher than 7 mEq/L), Decreased LOC, Muscle weakness, Decreased urine output (< 30 ml/hour), Decreased deep tendon reflexes
You are caring for a client who has just been diagnosed with Shoulder dystocia. You are alone in the room. Which of the following is a priority action to take? A) Turn patient onto her left side and call for help B) Stay calm and quickly call for help C) Call for help and document your observations D) Help woman into position that facilitate birth of shoulder
B (Stay calm and quickly call for help) True OB emergencies = Shoulder dystocia (DO NOT LEAVE PATIENT ALONE IN THE ROOM CALL FOR ASSISTANCE) SHOULDER DYSTOCIA - Head delivers but the anterior shoulder gets stuck (this shoulder is closer to mom's pelvis) Risks: once the head delivers, lack of oxygenation of the baby KNOW THE FIRST TWO MOST COMMON INTERVENTIONS (MRoberts maneuver and Suprapubic pressure) McRoberts Maneuver (cannot do by yourself, need additional staff in the room present) FUNDAL PRESSURE IS NOT ADVISED (DO NOT PUSH AT THE TOP WE ARE ONLY GOING TO PUSH AT THE PUBIC BONE)
A primary risk of Pitocin (oxytocin) is: A) Early decelerations B) Tachysystole C) An increased rate of c-section D) Prolonged labor
B (Tachysystole) Induction Methods - Oxytocin (Pitocin) ■Oxytocin (Pitocin)- IV medication given to induce uterine contractions, may be used to augment labor ■Do NOT give oxytocin <4 hours after administration of Misoprostol ■Risk: hyperstimulation of uterus (leading to decreased rest b/w contractions, decreased placental perfusion & non-reassuring fetal status), Maternal HTN, uterine rupture, placental abruption, rapid labor/birth, decreased placental function, fetal hypoxia, fetal bradycardia, hyperbilirubinemia, trauma from rapid birth -Tachysystole is excessive uterine activity and is described as more than 5 contractions in a 10-minute segment averaged over a 30-minute period. -Tachysystole can be the result of both spontaneous and induced labor patterns
The resident has just told your patient that her baby's head is at zero station - she asks what that means so you will tell her that: A) The baby's head is ready to be born - as the head is now engaged B) The baby's head is at the ischial spines - this is the smallest part of the pelvis C) The baby's head is above the ischial spines - this is the largest part of the pelvis D) The baby's head is below the ischial spines - this is the smallest part of the pelvis
B (The baby's head is at the ischial spines - this is the smallest part of the pelvis) PASSAGEWAY •Bony pelvis: •Station-Level of presenting part (-5cm to +5cm) •Soft tissues: •Lower uterine segment, cervix, and pelvic floor muscles
You are admitting a patient to L&D and she tells you that she thinks that her "water broke." Which of the following findings would indicate that the fluid is amniotic fluid? A) The fluid is clear, pale yellow and has an acidic pH of 5.0 B) The fluid is clear, pale yellow and has an alkaline pH of 7.0 C) The patient reports that she has been "leaking" fluid for the past 8 hours D) The fluid is blood tinged and has an acidic pH of 6.0
B (The fluid is clear, pale yellow and has an alkaline pH of 7.0) Assessment of Amniotic Fluid NCLEX •Labor is initiated by SROM in 10% of women at term •Difficult for pt to determine if ROM occurs •Membranes may only "leak" and not fully rupture •Women at term may have minor incontinence •Assessment of fluid on admission •Normal amniotic fluid is clear, odorless, pale, straw colored and may have flecks of vernix, lanugo •Two tests to assess for amniotic fluid •NITRAZINE pH test - AF is alkaline (6.5-7.5) urine is acidic (5-6) •FERNING TEST - When examined under a microscope - AF will "fern" and create a "frondlike crystalline pattern" In about 10% of women, labor is initiated when the amniotic sac (water bag) ruptures. For other women, the bag of waters breaks or ruptures sometime during labor. When the bag does break (rupture), it can be difficult to determine - especially if it does not rupture with a big "gush." Women sometimes think they may have been incontinent, so do not think they are leaking amniotic fluid. The way that we can determine if the fluid leaking is amniotic fluid (or urine) is to assess the fluid color (amniotic fluid is clear/straw/odorless) and also its pH. The pH of amniotic fluid is more alkaline - it is 6.5-7.5. We have special test strips called "Nitrazine" strips - and they tell us if the fluid is more alkaline. Amniotic fluid also looks very characteristic under a microscope on a slide (see above photo) - it "ferns" in a very specific way. So we do keep microscopes in labor and delivery for assessing fluid.
The nurse knows that effacement refers to A) The softening of the cervix in preparation for labor and delivery B) Thinning of the cervix as is drawn upward from the uterine side walls C) The discomfort that begins in the back and radiates around to the abdomen D) Dilatation of the cervical os as the uterus contracts and retracts pulling on the cervix
B (Thinning of the cervix as is drawn upward from the uterine side walls) Effacement- enzymes such as collagenase and elastase break down the collagen fibers of the cervix causing it to thin and draw up into the sides of the uterus causing ripening and effacement The cervix (or bottom on the uterus) must efface (thin out) and dilate (open) in order for the baby to come out. This is a nice graphic of how effacement and dilation increase throughout labor.
The day after birth of her baby, a mother tells the nurse that she has been urinating excessively. What is the nurse's response? A) You probably have a UTI, I will obtain a urine sample B) This is a normal response to eliminate extra extracellular fluid from the pregnancy C) This may be an early sign of postpartum pre-eclampsia D) You will need to cut back on your fluid intake
B (This is a normal response to eliminate extra extracellular fluid from the pregnancy) Postpartum chills and diaphoresis - Present immediately after birth - Diaphoresis is as a result of elimination of excess fluid and waste products via the skin - woman may wake up drenched with perspiration.
You are caring for a client with cord prolapse. Which of the following interventions would he suitable for this case? (select three that apply) A) Try and see if the cord can be replaced back into the cervix gently B) Administer oxygen 10L via mask C) Position the client in supine position for adequate gaseous exchange D) Glove examining hand and quickly insert two finger in vagina and push presenting part upward E) Position the client in extreme Trendelenberg
B, D, E (Administer oxygen 10L via mask, Glove examining hand and quickly insert two finger in vagina and push presenting part upward, Position the client in extreme Trendelenberg) Umbilical Cord Prolapse (Rare) -Umbilical cord prolapse (emergency!!!!!) ■Occurs when the cord lies below the presenting part of the fetus, causing compression of the cord ■May be visible or hidden - estimated in 1% of less of labors -Cord may be seen - or palpated in vagina with rupture of membranes, may see decelerations in fetal heart tones -Cord should not be touched or manipulated, may cause vasospasm & compression ■Risk factors -Malpresentation (breech, footling, transverse lie), unengaged presenting part, polyhydramnios, preterm or small fetus, SROM or amniotomy, long cord ■Prolonged compression may result in CNS damage or fetal death - Treatment includes relieving the pressure on the umbilical cord
You are caring for a client in immediate postpartum period with heavy bright vaginal bleeding and clots. On abdominal assessment the bladder is empty and uterus in firm, midline, and halfway between symphysis pubis and umbilicus. What should the nurse consider the most likely cause of this hemorrhage? A) Superficial lacerations B) Normal bleeding associated with birth C) Cervical tear or deep lacerations D) Uterine atony
C (Cervical tear or deep lacerations) Postpartum hemorrhage Immediate / early/ primary PPH - Occurs within 24 hours of birth - Very common - Common causes include uterine atony, lacerations, retained fragments, or uterine inversion
A client with type 2 diabetes at 20 weeks gestation complains that they feel nauseous and excessive thirst. On assessment the client is confused and respirations are shallow at rapid at 35 breaths per minute with a sweet fruity scented breath. The nurse identifies that these signs and symptoms are indicative of? A) Urinary tract infection B) Hypoglycemia C) Diabetic ketoacidosis D) Hyperemesis gravidarum
C (Diabetic ketoacidosis) •HYPERGLYCEMIA (insufficient insulin DKA) •Sx - Thirst, nausea, vomiting, fatigue, poor vision, headache •Interventions - Check BS, give insulin, re-check BS - may need IV fluids or insulin in ER, contact provider
A mother is changing a diaper of her 2-hour female infant notices thick greenish stool on the diapers. What is the best response to the mother? A) Green colored stool called meconium is a sign a hypoxia in the infant and needs to be investigated B) Green meconium is the sign of rapid gastrointestinal motility C) Greening colored stool called meconium is normal and should change to yellowish over time D) You infant may need to be examined for possibility of hepatic system problems
C (Greening colored stool called meconium is normal and should change to yellowish over time) Stools - Change over the first 2-3 days - Meconium - First stool - thick, tarry green/black - by 24 hours of life - Transitional - 2-3rd day; green/brown, less sticky - Milk - 3rd-4th day; yellow/gold and soft in breastfed infant; pale yellow/light brown and odorous in formula fed infant
As a nursing student you understand the consequence of persistent posterior positions in labor include? A) Precipitate labor B) Reduced pain sensation C) Labor dystocia D) Shorter second stage of labor
C (Labor dystocia) •Continuous labor support to decrease pain •Longer labors, pitocin augmentation, posterior presentations, supine positions, arrest of labor & other complications may create additional physiologic pain in labor Here is a graphic about the fetal position. Another way of looking at the presentation: The baby will also have his head tilted a certain way - either toward the maternal back or the maternal abdomen. The head can also be further turned toward the right or left side of the mother. We label these positions as R or L (right or left) and O, M, A, S (Occiput, Mentum, Acromion process, Sacrum) and then A, T, OR P (anterior, transverse, or posterior). So a fetal head position might be recorded on a maternal chart as "ROA" - Right occiput anterior (photo on top left). Babies in an anterior position are facing the maternal back - their spines face up toward the maternal abdomen. Babies in a posterior position are facing the maternal abdomen - their spines are against the maternal spine. The posterior head position is also called "persistent occiput posterior". The posterior position is more uncommon - but when present , it can contribute to what we call "back labor" or posterior labor - which can cause significant back pain in the mother. Mother's with a baby in a posterior position often complain more about back pain than contraction pain! 1st letter- R or L (location of presenting part on R or L of maternal pelvis) 2nd letter- O, M, A, or S (specific presenting part - occiput, mentum, shoulder or sacrum) 3rd letter- A or P (location of presenting part in anterior or posterior pelvis)
You are caring for a mother 14 hours after birth. The nurse understands that the uterus should be: A) Midline, firm, and halfway between the symphysis pubis and umbilicus B) Midline, firm, and at the level of the symphysis pubis C) Midline, firm, and at the level of the umbilicus D) Slightly pushed to the side, boggy, and halfway between the symphysis pubis and umbilicus
C (Midline, firm, and at the level of the umbilicus) - Midline location of fundus is normal finding The uterus should be firm, midline, at the umbilicus, small to moderate lochia (bleeding). There should not be any clots (especially larger than a golf ball), there should be no gush of blood when palpating (especially if it continues to bleed, if gushing-start to massage, if continues to bleed call for assistance and hemorrhage cart). A boggy (mushy) uterus indicates atony and should be massaged by nurse. The uterus should become firm and there should be not gushing of blood or clots. If you should need to massage a uterus to firm you should keep a closer eye on this patient for possible hemorrhage. - Immediately after birth it should be the size of a large grapefruit and the top of the fundus should be midline midway between the symphysis pubis and umbilicus - Within 6-12 hours later the fundus rises to the level of the umbilicus - but it should remain midline and firm. If it rises above the umbilicus and it feels boggy suspect the risk of postpartum hemorrhage - The fundus should reduce in size at least 1 cm a day (I finger breadth) - it should descent into pelvis by 10th day and by 6 to 8 weeks it weight 60 grams
You are caring for a mother who reports to the emergency room at 26 weeks gestation with history of vaginal bleeding and severe abdominal pain. On examination you observe dark red blood and clots, and her abdomen feels tense. What is the most likely diagnosis? A) Miscarriage B) Ectopic pregnancy C) Placental abruption D) Placenta Previa
C (Placental abruption) Placental abruption- placenta separates from uterine wall, deprives baby of oxygen, maternal hemorrhage PREECLAMPSIA FETAL RISKS include Placental abruption which is catastrophic & can be fatal to fetus. PREECLAMPSIA MATERNAL RISKS: •Placental abruption Placental Abruption NCLEX - Bleeding = Dark red (70-80%) - Abdominal tenderness/pain = Present - abdomen is "boardlike" - Signs of shock = Common if severe - Coagulopathy = DIC if severe
You are educating a patient on hormonal contraception. You let her know that combined hormonal contraceptives, which prevent ovulation from occurring, come in the following forms: A) IUD, patch and pills B) IUD, implant and patch C) Ring, patch and pills D) Ring, patch and IUD
C (Ring, patch and pills)
You are caring for a patient who is 37 weeks pregnant. You are concerned about the risk of preeclampsia when the patient tells you she is having: A) Edema in her feet and ankles B) Fatigue C) Scotoma (blind spots in her vision) D) A history of headaches at 14-18 weeks gestation
C (Scotoma (blind spots in her vision)) SEVERE PREECLAMPSIA •Subjective: epigastric pain (liver enlargement or failure), headache (can be mild -> severe), visual disturbances (scotoma, blurring), SOB, dyspnea (pulmonary edema)
The labor nurse is called to the bedside. The patient reports the urge to bear down with contractions. On assessment the cervical exam is 9/100/+1 station. What stage of labor is this person in? A) Stage 2 B) Stage 1: Active C) Stage 1: Transitional D) Stage 1: Latent
C (Stage 1: Transitional) FIRST STAGE OF LABOR •Transition phase: 8 to 10 cm dilation of cervix
You are caring for a patient who is 24 weeks pregnant. She is concerned about a recent dark pigmented color change in the form of a vertical line that goes from above the umbilicus to the top of the pubis. The best thing to tell her is: A) This is not a normal finding in pregnancy and she should be referred to a dermatologist B) This is called chloasma - it is normal in pregnancy C) This is called linea nigra and is normal in pregnancy D) This is normal in pregnancy but is often accompanied by itching and hives
C (This is called linea nigra and is normal in pregnancy) •Dark line from umbilicus to symphysis (normal skin change during pregnancy)
As a nursing student you know that the following is true about Viral STIs: (select all that apply) A) Are easy to detect based on obvious symptoms B) Are cured with antibiotics C) Often exhibit no symptoms D) They are chronic E) Should involve partner treatment
C, D, E (Often exhibit no symptoms, They are chronic, Should involve partner treatment)
A primigravida reports to the clinic at 37 weeks gestation . She explains that she has been experienced pressure on the diaphragm and shortness of breath in the past week, but she was told that everything was okay. She explains that her chest feels lighter and breathing has improved, but she occasionally feels sharp pain in the pelvis that comes suddenly and goes. All other findings are normal. Which of the following would be the most appropriate explanation of this condition? A) "This is caused by increased oxygen demands due to growing fetus" B) "This is a result of physiological anemia due to increased blood volume" C) "Your body demands have increased with the increased body weight due to the enlarged uterus" D) "This is called lightening as the fetus descends into the pelvic cavity"
D ("This is called lightening as the fetus descends into the pelvic cavity") - "Lightening" - fundus may decrease as fetus moves down and engages into the pelvis ("baby dropped")
Case Scenario : You are caring for a 17-year-old girl who reports to the clinic with history of vaginal itching, abnormal vaginal discharge, and pain when passing urine and during sex. What would be the first thing that the provider should? A) Conduct a vaginal exam to assess discharge and presence of sores B) Collect a urine and vaginal swab for a NAAT test C) Educate the client about sex practices D) Ask history about sexual partners
D (Ask history about sexual partners)
A nurse is preparing to perform a fundal assessment on a postpartum client. The initial nursing action in performing this assessment is which of the following? A) Ask the client to lie flat on her back with the knees and legs flat and straight. B) Massage the fundus gently before determining the level of the fundus. C) Ask the client to turn on her side D) Ask the mother to urinate and empty her bladder
D (Ask the mother to urinate and empty her bladder) FIRST ACTION IS TO EMPTY OUT THE BLADDER
Which of the following would be a contraindication for a vacuum extraction? A) Cervix at 10cm dilatation B) Pre-eclampsia C) Head at station 0 D) Breech presentation
D (Breech presentation) Vacuum Assisted Delivery ■Indications -Maternal exhaustion, fetal distress in second stage -Contraindicated before 34 weeks gestation Forceps Assisted Delivery ■Indications -Prolonged second stage, fetal distress, abnormal presentations as in breech, arrest of rotation
A nurse is conducting an assessment and while holding the babies face with her hand the baby turns to the side and catches the nurses finger in his/her mouth. Which reflex is this? A) Babinski reflex B) Moro reflex C) Suckling reflex D) Rooting reflex
D (Rooting reflex) Newborn Reflexes - Rooting - turn to open mouth and search for food with touch of lip/mouth/cheek
You have been assigned to administer Vitamin K to an infant. The mother asks why this injection is necessary. Which of the following responses provide accurate information for main reason we give vitamin K to infants A) Vitamin K is a group of vitamins that are responsible for promoting uptake of other newborn immunizations B) Vitamin K is a group of vitamins that are responsible for infant growth and development C) Vitamin K is a group of vitamins that are responsible for boosting the immune system preventing infection D) Vitamin K is a group of vitamins that are responsible for coagulation reducing the risk of bleeding
D (Vitamin K is a group of vitamins that are responsible for coagulation reducing the risk of bleeding) Newborn Procedures - Vitamin K - IM (once) in thigh to initiate clotting factors Newborn IM injections NLCEX •Vitamin K - 1st 2 hours •Use vastus lateralis muscle and correct landmarks to avoid nerves and blood vessels in thigh •25 gauge 5/8 inch needle is appropriate size for IM in a neonate Most newborns get two IM injections in the first 24 hours of life. The first is a Vitamin K injection and the second is often a Hepatitis B injection, It is very important to know the correct landmarks for newborn injections. An IM injection is given to a newborn with a SQ needle - usually a 25 gauge 5/8 inch needle will be an IM needle in a newborn - the thinnest needle possible will avoid damage to the small newborn muscle mass. . The area of choice is the vastus lateralis muscle in the upper outer thigh area. The gluteal muscle is very small and poorly developed in a newborn - it is also very close to the sciatic nerve. The deltoid does not have adequate muscle mass.
When providing education to a patient regarding treatment of Chlamydia, an important piece of education is: A) You can have sex immediately after you complete taking the entire dose of medication B) You can continue to have sex during treatment without risk of spreading the infection C) You can resume unprotected sex at any time after diagnosis D) Wait at least 7 days after completing treatment to resume unprotected sex as you can still pass on infection
D (Wait at least 7 days after completing treatment to resume unprotected sex as you can still pass on infection)
