AWHONN PEOP
Obesity is a nationwide problem in the United States. Which of the following is considered a primary measure to help determine risk of morbidity associated with overweight and obesity? Body mass index Hip circumference Shoulder width Waist circumference
Waist circumference
A woman with a previous cesarean birth is requesting a trial of labor. Which of the following is not a contraindication to trial of labor after cesarean? Previous classical uterine incision. Inability to perform an emergency cesarean birth (e.g., physician not in-house). Two previous lower uterine segment transverse cesarean births. Previous uterine rupture.
Two previous lower uterine segment transverse cesarean births.
Couvelaire uterus is associated with which condition?
Placental abruption
A high probability of successful induction of labor is associated with a Bishop score of ≥2. ≥4. ≥6. ≥8.
≥8.
While providing care for a mother/baby couplet after a birth complicated by shoulder dystocia, monitor the mother for signs of brachial plexus injury. postpartum hemorrhage. prolapsed uterus. uterine rupture.
"WRONG" brachial plexus injury.
During the first stage of labor, the nurse administering oxytocin should assess the fetal heart rate every 5 minutes. 10 minutes. 15 minutes. 30 minutes
15 minutes.
Ideally, a woman should wait how many months after bariatric surgery to become pregnant? 4-6 8-12 12-18 18-24
18-24
Maternal cardiac output begins to increase by 5 weeks gestation and peaks at 15-20 weeks gestation. 20-25 weeks gestation. 25-30 weeks gestation. 30-35 weeks gestation.
25-30 weeks gestation.
Proteinuria may indicate worsening underlying renal disease or preeclampsia when 24-hour urine levels exceed 200 mg/dl. 300 mg/dl. 400 mg/dl. 500 mg/dl.
300 mg/dl.
In patients with chronic hypertension, elevated uric acid levels in which of the following ranges may indicate risk for superimposed preeclampsia? 2.5-4.0 mg/dl (149-238 umol/l) 3.5-5.0 mg/dl 208-297 umol/l) 4.5-6.0 mg/dl (268-357 umol/l) 5.5-7.0 mg/dl (327-416 umol/l)
4.5-6.0 mg/dl (268-357 umol/l)
Asymptomatic bacteriuria is present at the first prenatal visit for some pregnant women. If left untreated, what percentage of women with this infection are likely to develop symptomatic cystitis or pyelonephritis? 5% 40% 10% 13%
40%
Postoperative assessment guidelines recommend that vital signs, including blood pressure, pulse, and respirations, be recorded every 5 minutes for the first hour. 15 minutes for the first 2 hours. 15 minutes for the first hour, then every 30 minutes for the next hour. 30 minutes for the first 2 hours.
5 minutes for the first hour. (WRONG) 15 minutes for the first hour, then every 30 minutes for the next hour. (WRONG)
Halili has a history of mechanical valve replacement and has been on anticoagulants during pregnancy. Her medications were discontinued in labor. She had a normal spontaneous vaginal birth 2 hours ago and has just completed her recovery period. Her anticoagulant therapy should be reinitiated after birth within 6 hours 8 hours 24 hours 1 week
6 hours
Zahara is admitted at 32 weeks gestation with a headache, nausea, vomiting, epigastric pain, and malaise. She is a primiparous woman with a twin gestation pregnancy who was recently diagnosed with preeclampsia. Zahara is at risk for which autosomally inherited disorder? Acute fatty liver disease Adult respiratory distress syndrome HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome and eclampsia Lupus erythematosus
Acute fatty liver disease
Which of the following parents is least likely to experience complicated grief after a perinatal loss?
Angelique, a 25-year-old, had a stillbirth at 25 weeks gestation as a result of preterm rupture of membranes and chorioamnionitis. Present in the room today are her husband, Todd, and their 2-year-old daughter.
In which situation might the application of gentle fundal pressure be appropriate? Artificial rupture of membranes Maternal exhaustion during pushing efforts Prolonged second stage of labor Shoulder dystocia
Artificial rupture of membranes
Mrs. J. has been receiving heparin therapy and is being transitioned to warfarin in the postpartum period. Which of the following medications may act as antagonists or decrease the actions of warfarin? Antacids, antihistamines, and oral contraceptives Antacids, aspirin, and acetaminophen Aspirin, acetaminophen, and oral contraceptives Aspirin, antihistamines, and vitamin K
Aspirin, antihistamines, and vitamin K (WRONG!) Aspirin, acetaminophen, and oral contraceptives (WRONG)
Which ascending infection has been linked to a higher incidence of spontaneous preterm birth, especially one precipitated by rupture of membranes? Bacterial vaginosis Herpes simplex virus Human papillomavirus Trichomonas
Bacterial vaginosis
Which of the following types of cardiac lesions are characterized by dysfunction of the cardiac muscle, resulting in decreased cardiac output? Aortic stenosis Cardiomyopathy Mitral insufficiency Pulmonic lesions
Cardiomyopathy
Which of the following is not one of the infections in the traditional TORCH classification? Toxoplasmosis Chlamydia Rubella Herpes simplex virus
Chlamydia
A nurse has just received a client from the surgical suite following a cesarean birth. The report given reveals the client has received magnesium sulfate for management of gestational hypertension just before the emergency surgery. The nurse should monitor the client for adverse effects from the magnesium sulfate by checking which parameter? Consistency of the fundus Homans' sign Gag reflex Heart rate
Consistency of the fundus
Linnette arrives at her 16 week prenatal visit reporting worsening asthma symptoms. The fetal heart rate is 142 beats per minute and Linnette has gained 2 pounds since her previous visit 4 weeks ago. Her breath sounds include bilateral wheezes, and she has a chronic dry cough. Which of the following medications should Linnette avoid during her pregnancy? Albuterol inhalers Aminophylline Cough suppressants Steroids
Cough suppressants
Jing is a 36-year-old multiparous woman who presents for a routine prenatal visit. She says she has pain in her right lower leg. Her calf is inflamed and warm to touch. A noninvasive diagnostic tool that may be used in pregnancy to determine whether Jing has deep vein thrombosis is contrast venography. Doppler ultrasound testing. Homans' sign measurement of calf size.
Doppler ultrasound testing.
Best practice includes which of the following Allowing for a dimly lit PACU to encourage rest during the recovery period Early skin-to-skin contact initiated in the OR and continued in the PACU Moving the woman side-to-side frequently Requiring all nurses to have advanced cardiac life support training
Early skin-to-skin contact initiated in the OR and continued in the PACU
The treatment of choice recommended by the Centers for Disease Control and Prevention (CDC) for uncomplicated genital chlamydial infection in pregnant women is Erythromycin, 250 mg, orally, four times a day for 14 days. Erythromycin, 500 mg, orally, four times a day for 7 days or amoxicillin, 500 mg, orally, three times a day for 7 days. Ofloxacin, 300 mg, orally, twice a day for 7 days. Tetracycline, 250 mg, orally, four times a day for 7 days.
Erythromycin, 500 mg, orally, four times a day for 7 days or amoxicillin, 500 mg, orally, three times a day for 7 days.
The most common organism responsible for urinary tract infections in pregnant women is Escherichia coli. Klebsiella pneumoniae. Proteus. Gram-positive cocci (e.g., group B streptococci).
Escherichia coli.
When assessing the obstetric trauma patient, what does the acronym FAST stand for? Fast assessment, accurate documentation, swift care, trauma care Focused assessment with sonography for trauma Facial droop, arm weakness, speech difficulty, time to call 911 Fetal risk, act quickly, serial enzymes, total assessment
Focused assessment with sonography for trauma
A woman who is G2P2 has had a primary cesarean at 34 weeks gestation due to preeclampsia with severe features. Due to difficulty with respiratory transitioning, the newborn has been transferred to the nursery and the mother is admitted to the labor and delivery PACU. Her vital signs are as follows: 94 BPM heart rate / 144/98 mmHg blood pressure / 18 per minute respirations / 98% PaO2 on pulse oximeter / 97.6F temperature. Magnesium sulfate is infusing at 2 grams per hour, urine output is 60 ml in the past hour, and reflexes are 2+. She received neuraxial anesthesia for the cesarean. Which of the following is your primary concern? Assessment of pain level Fundal location and bleeding amount Need for antihypertensive medication Observing for the development of disseminated intravascular coagulation
Fundal location and bleeding amount
When teaching parents about grief after perinatal loss, which of the following statements is true?
Grief after perinatal loss may be significant and traumatic, and may last for months to years.
In addition to hepatitis B, which other type of hepatitis virus may also be prevented with the hepatitis B vaccine? Hepatitis A Hepatitis C Hepatitis D Hepatitis G
Hepatitis D
Which of the following is not a contraindication for magnesium sulfate administration?
Hyperkalemia
Methergine should not be given to a patient experiencing a postpartum hemorrhage with which of the following conditions? Renal disease Asthma Hypertension Diabetes
Hypertension
Which of the following best describes the respiratory status assessment performed in the PACU? Auscultation for adventitious sounds Evaluation of color and depth of inspiration Inspection, auscultation, and oxygen saturation Documentation of rate and rhythm
Inspection, auscultation, and oxygen saturation
Advanced maternal age, hypertension, and diabetes are risk factors associated with which type of cardiac disease in pregnancy? Acquired Congenital Hemorrhagic Ischemic
Ischemic
Which of the following is recommended thromboprophylaxis for all women having a cesarean birth? Intravenous heparin Placement of pneumatic compression devices Coumadin by mouth Doppler studies
Placement of pneumatic compression devices
Of the following scenarios, which case would not be appropriate for transport from the current facility to another? Katie is a G4P3 maternal trauma patient as result of traffic collision that occurred at 50 miles per hour. Her injuries are severe, with hemodynamic instability including respiratory and cardiac failure noted upon arrival to the scene by the first responder. Amelia, a G1P0 maternal trauma patient as a result of a domestic violence incident, has blunt trauma wounds from physical assault. Bleeding is controlled at this time with stable vital signs. Noelle is a G6P2 with significant vaginal bleeding but is alert and oriented with stable vital signs. All roads to the emergency facility are clear, so a 10-minute arrival time is expected. Mary, a G2P1 at 30 weeks gestation with multiple gestation (triplets), is experiencing severe abdominal pain with no vaginal bleeding from a fall down a flight of stairs.
Katie is a G4P3 maternal trauma patient as result of traffic collision that occurred at 50 miles per hour. Her injuries are severe, with hemodynamic instability including respiratory and cardiac failure noted upon arrival to the scene by the first responder.
Which of the following is a contraindication to the administration of regional analgesia and anesthesia? Uncontrolled type-I diabetes Treated maternal bacteremia Local infection at the site of injection Use of once-daily dose of low-molecular-weight heparin
Local infection at the site of injection
In caring for a woman who is in labor with an attempt at a vaginal birth after cesarean (VBAC), it is important to provide labor support, perform ongoing assessment of maternal and fetal status, and observe for signs of abnormal labor progress. Which intervention is usually indicated as a precaution throughout labor in VBAC patients? Hourly ultrasound scans to assess previous uterine scars Indwelling Foley catheter to prevent bladder distension Intermittent fetal and uterine monitoring Maintaining patent intravenous access
Maintaining patent intravenous access
A woman is to receive general anesthesia for an unscheduled cesarean birth. The anesthesiologist asks if she or anyone in her immediate family has had problems with general anesthesia in the past. This question is asked to screen for which of the following? Malignant hypertension Malignant hyperthermia Malignant hypothermia Malignant hypotension]'
Malignant hyperthermia
Full term newborns that are asymptomatic and born to a woman who was pretreated for GBS with penicillin may be observed in the normal newborn nursery. A limited diagnostic evaluation and antibiotic therapy is indicated in which of the following circumstances? Antibiotic prophylaxis was given less than 1 hour prior to birth. Maternal antibiotic therapy was initiated for maternal chorioamnionitis. Neonate was born at less than 37 weeks gestation. Rupture of membranes occurred 18 hours prior to birth.
Maternal antibiotic therapy was initiated for maternal chorioamnionitis.
Which feature is recommended when monitoring twin gestations to differentiate between fetal heart rates and maternal heart rate?
Maternal pulse oximetry
A G1P1 woman delivered by cesarean is now in the recovery room. She received Duramorph via intrathecal catheter. On review of orders before transfer to the postpartum unit, the nurse notes one entry that needs clarification by the physician. Which order is the source of the nurse's concern? Monitor intake and output. Maintain compression stockings until ambulatory. Maintain intravenous infusion with 1 liter of lactated Ringer's solution with 20 units Pitocin over 8 hours. Monitor respirations every 6 hours for 24 hours.
Monitor respirations every 6 hours for 24 hours.
Which of the following is a common complication following maternal trauma? Chorioamnionitis Anaphylactoid syndrome of pregnancy Placental abruption Maternal anemia
Placental abruption
A pregnant woman presents with a rash 2 days before giving birth to a full term infant. The rash is determined to be caused by the varicella-zoster virus. Which complication will the newborn most likely experience? CNS defects Limb anomalies Cutaneous scarring Pneumonia
Pneumonia
Women undergoing induction of labor are at an increased risk for which of the following? Postpartum hemorrhage Umbilical cord prolapse Longer second stage of labor Fetus in occiput posterior position
Postpartum hemorrhage
Which of the following is a cause of vascular permeability (noncardiogenic) pulmonary edema? Beta-mimetic therapy Hypertension Congestive heart failure Preeclampsia
Preeclampsia
Amniotic band syndrome is associated with what complication in pregnancy?
Preterm premature rupture of membranes
During which phase of the pathophysiologic process of disseminated intravascular coagulopathy (DIC) do platelets adhere to the surface of the exposed collagen, bind to platelet receptors, and attach to the damaged tissue creating a platelet plug?
Primary hemostasis
The normal decline in systemic vascular resistance that occurs in pregnancy may become problematic for women with cardiac lesions or cardiac diseases. Which describes a shunt reversal that involves unoxygenated blood delivered into the systemic circulation? Intraabdominal shunt Intraventricular Left-to-right shunt Right-to-left shunt
Right-to-left shunt
Joe and Sarah have arrived for a prenatal visit and an ultrasound. When the ultrasound shows the fetus does not have a heartbeat, the father yells at the physician to look again or to have someone else read the ultrasound. He then storms out of the room. What phase of grief is the father experiencing?
Searching and yearning
Ricardo and Maria have just been told that their 12-week fetus does not have a heartbeat. Maria stares blankly at the window and does not respond. What phase of grief is she experiencing?
Shock and numbness
Marielle has been admitted to the intensive care unit with worsening pulmonary edema after being treated for preterm labor. She is wearing a Venturi mask with 40% oxygen for worsening blood gases. The primary care physician suspects acute respiratory distress syndrome. Which medications should be avoided while Marielle is in critical condition? Morphine sulfate Furosemide Hydralazine Terbutaline
Terbutaline
Side effects of prostaglandin administration may include nausea, vomiting, diarrhea, and uterine tachysystole. Which medication should be readily available to treat tachysystole? Magnesium sulfate, 4 g, IVP Magnesium sulfate, 4 g, piggyback over 20 minutes Terbutaline, 0.50 mg, IM Terbutaline, 0.25 mg, SC
Terbutaline, 0.25 mg, SC
Which of the following statements is false regarding the subsequent pregnancy after a perinatal loss?
The sense of threat mothers experience is based on the mother's appraisal of the pregnancy, not necessarily on actual medical risk. (WRONG) Subsequent pregnancy is usually experienced with a greater sense of threat, guarded emotions, and feelings of stress that remain elevated throughout the subsequent pregnancy. (WRONG)
Which of the following statements regarding baptism is true?
There is disagreement in some Christian religions regarding baptism of a stillborn or miscarried baby.
Mrs. Barnes is 14 weeks pregnant and presents with a history of atrial fibrillation in conjunction with mitral valve stenosis. Her primary care provider has determined that she should be treated with anticoagulant therapy throughout her pregnancy. Which anticoagulant is superior in preventing clot formation but is also a known teratogen and should not be used during organogenesis? Low-dose aspirin Low-molecular-weight heparin Low-molecular-weight heparin Warfarin
Warfarin
Many women with HIV-1 infection become pregnant. Pre-exposure prophylaxis with antiretroviral medications may help decrease transmission to the fetus. Which of the following combinations is not preferred for women receiving initial antiretroviral therapy? Atazanavir and ritonavir Darunavir and ritonavir Abacavir and lamivudine Zidovudine and stavudine
Zidovudine and stavudine
RhD-negative women may be sensitized with fetal blood during any bleeding episode in the antepartum period. If a Kleihauer-Betke test determines greater than 15 ml of fetal blood in the maternal circulation, it is important to recognize that
a 300-mg Rh immunoglobulin dose may not be sufficient to prevent sensitization.
Universal vaccination and prenatal testing for hepatitis B have decreased the incidence of acute hepatitis infections in newborns. Infants born to hepatitis B surface-antigen (HBsAg)-positive mothers should receive the first dose of hepatitis vaccine within 12 hours of birth with a dose of hepatitis B immunoglobulin (HBIG) administered concurrently at a different site. a dose of hepatitis B immunoglobulin (HBIG) administered by 2 weeks of age. the second dose administered at 1 week of age, and the third dose by 2 months of age. the second dose administered 2 months later, and the third dose administered by 12¬-18 months of age.
a dose of hepatitis B immunoglobulin (HBIG) administered concurrently at a different site.
Risk of neonatal transmission for herpes simplex virus is highest for those women who acquire a new herpetic lesion and infection near the time of delivery. acquire a new herpetic lesion in the first trimester of pregnancy. have herpetic lesions around their mouth in the first few days after birth. have herpetic lesions on their genitals and symptoms present throughout pregnancy.
acquire a new herpetic lesion and infection near the time of delivery.
Marlene is a 26-year-old primipara who is 10 weeks pregnant and has a history of obesity and smoking. She is complaining of bleeding over the past 24 hours. Her primary care physician has confirmed a loss of her pregnancy. While reviewing her follow up instructions, you should
ask Marlene how she is doing and then listen to her responses.
When working with a family who had a term stillbirth
ask to take multiple photographs of the infant with different family members.
Lori has a history of congenital cardiac disease. She is being moved to a telemetry unit for cardiac monitoring after the delivery of her 24-week stillborn infant. The most common assessment that the nurses who do not work on perinatal units may fail to address is
bleeding and lochia. (WRONG) emotional grief (wrong)
During the intrapartum and postpartum periods, it is important to ensure homeostasis and oxygenation in women with cardiac disease. The recommended method of pain control for labor and birth for such women is breathing and relaxation. epidural anesthesia. general anesthesia. intravenous narcotics.
breathing and relaxation. (WRONG) Intravenous narcotics (WRONG)
When working with a family who has had a stillbirth at term, you should
collect mementos and offer them to the family prior to discharge.
The most common causes of neonatal death include
congenital abnormalities and preterm birth
A primary cause of hearing loss in the newborn is congenital rubella. congenital toxoplasmosis. cytomegalovirus. group B streptococcus (GBS) sepsis.
cytomegalovirus
Treating hypertension with vasodilating agents during pregnancy may be associated with decreased uteroplacental blood flow. increased maternal weight gain. increased uteroplacental blood flow. preterm birth.
decreased uteroplacental blood flow.
Svetlana has a history of Marfan syndrome and has arrived for an office visit for preconception counseling. Her primary care provider has ordered laboratory work and an echocardiogram to help determine the potential childbearing options. The prognosis for maternal outcomes in pregnancies of women with Marfan syndrome is related to degree of aortic root dilation. degree of pulmonary hypertension. presence of cardiac dysrhythmias. presence of hypervolemia during pregnancy.
degree of aortic root dilation.
Romelia's labor was induced at 32 weeks gestation after a third-trimester fetal loss. Her blood pressure has remained high after delivery. Her Muslim culture supports wrapping the deceased newborn in a seamless white sheet and having a burial within 24 hours. Romelia is requesting an early discharge to be at the burial. You should
discuss concerns with the physician and family and individualize her discharge plan to include appropriate outpatient monitoring and follow-up.
Implantation of the embryo outside the uterus is called
ectopic pregnancy
Flying Sparrow, a 25-year-old Native American woman, delivered a stillborn infant at term after a cord accident. She has been stoic since the delivery and refuses to see the baby. You should
encourage the family to view the baby when the mother is ready to see him. (Wrong) bring the baby to her room and leave him in a crib in the corner. (WRONG)
A pregnant woman who has been on anticoagulant therapy and is receiving regional anesthesia is at risk for aneurysm rupture. epidural hematoma. postpartum migraine headaches. subdural hematoma.
epidural hematoma.
The initial nonpharmacologic intervention for postpartum hemorrhage caused by involution failure consists of external or bimanual uterine massage. insertion of an indwelling Foley catheter. pulse oximetry and cardiac monitoring. reverse Trendelenburg position.
external or bimanual uterine massage.
Ms. Linghu arrived at the obstetric care unit for a labor evaluation. She is 28 weeks gestation and is complaining of a lower back ache and cramping. The physician has asked for assistance in obtaining a sample to assess for fetal fibronectin (fFN). Which statement about fFN is most accurate?
fFN is a strong predictor or marker for identification of preterm labor associated with infection.
Althea arrived at the obstetric unit for a labor evaluation at 39 weeks gestation. She reports decreased fetal movement for the past 24 hours. Her biophysical profile is 2/8. The decision is made to perform a cesarean delivery. The most common reason for a cesarean birth is failure to progress or abnormal fetal heart patterns. polyhydramnios with single gestation fetus. preterm labor with prolonged rupture of membranes. twins or higher gestation pregnancy.
failure to progress or abnormal fetal heart patterns.
All of the following are possible side effects of oxytocin administration except nausea and vomiting. fetal hyperglycemia. tachysystole of the uterus. water intoxication.
fetal hyperglycemia.
Current recommendations for antenatal glucocorticoid administration for acceleration of fetal lung maturation is appropriate
for women at 23-36 6/7 weeks gestation at risk for preterm birth within 7 days.
An intervention that may cause further impaction of the fetal shoulder in a delivery with shoulder dystocia is fundal pressure. Gaskin maneuver. McRoberts maneuver. suprapubic pressure.
fundal pressure.
Alexandra is 21-year-old primigravida at 10 weeks of gestation. She has arrived for her first prenatal visit. She is 5' 3" tall, and her prepregnant weight is 245 lbs. In your prenatal discussion about optimal weight gain during her pregnancy, it is important to stress that Alexandra should gain 10-15 lbs to accommodate the growing placenta and fetus. gain 25-35 lbs to accommodate the growing placenta and fetus. lose weight during pregnancy to decrease the risk of potential complications. maintain her current weight throughout the pregnancy.
gain 10-15 lbs to accommodate the growing placenta and fetus.
Common sites of neonatal gonorrheal infection include all of the following except conjunctiva. genitals. meninges. joints.
genitals.
Your patient, Irene, calls a nurse to her bedside describing spontaneous rupture of membranes. As the sheets are pulled back, a loop of umbilical cord is noted protruding from her vagina. All of the following are appropriate interventions for umbilical cord prolapse except covering the cord with a moistened gauze. calling for immediate assistance. gently placing the umbilical cord back into the vagina. placing the patient in Trendelenburg position to relieve compression on the cord.
gently placing the umbilical cord back into the vagina.
Women who had rapid HIV testing during labor that yielded a positive result should begin antiretroviral therapy only in the immediate postpartum period. be monitored closely with an intrauterine pressure catheter and internal fetal scalp electrode. be scheduled for an immediate cesarean birth. have a follow-up test in the postpartum period to confirm the diagnosis.
have a follow-up test in the postpartum period to confirm the diagnosis.
The longer the third stage of labor lasts, the more at risk the woman is for exhaustion. fourth-degree laceration. hemorrhage. uterine rupture.
hemorrhage.
Janice is a 42-year-old, obese primiparous woman who is in early labor. She has a history of obesity and uncontrolled glucose levels during the third trimester of pregnancy. Uncontrolled abnormal glucose levels in pregnancy may also be associated with hypertension, macrosomia, and polyhydramnios. hypertension, preterm birth, and oligohydramnios. hypotension, postterm birth, and oligohydramnios. hypotension, preterm birth, and polyhydramnios.
hypertension, macrosomia, and polyhydramnios.
The period of time during labor and birth when the greatest cardiac stress associated with the highest cardiac output occurs is the early first stage of labor. immediate postpartum period. late first stage (transition) of labor. second stage of labor with fetal descent.
immediate postpartum period.
The term used to describe gender differences in how perinatal loss is experienced by each parent is
incongruent grief
Cardiac output in the immediate postpartum period is decreased. increased. only of concern with a history of cardiac disease. not affected during the recovery period.
increased
The initial signs of hemorrhagic shock in a postpartum woman include decreasing blood pressure and respiratory rate. decreasing heart rate and cool clammy skin. increasing heart rate and oliguria. increasing heart rate and respiratory rate.
increasing heart rate and respiratory rate.
You are the primary preceptor of a new nurse on your unit. You are scheduled to care for a 28-year-old primiparous woman who will be arriving for preinduction prostaglandin insertion this evening. The new nurse and you sit down to review the medical record and establish a plan of care. The patient's prepregnant weight was 380 lbs. In your discussion about risks associated with obesity in pregnancy, it is important to emphasize that obese women are more prone to induction of labor, postterm pregnancy, and gestational diabetes. induction of labor, preterm pregnancy, and gestational diabetes. prolonged labor, postterm pregnancy, and type I diabetes. prolonged labor, preterm pregnancy, and type I diabetes.
induction of labor, postterm pregnancy, and gestational diabetes.
The most common pregnancy complication primary care obstetric providers treat is bleeding. infection. multiple gestation. preterm labor.
infection.
Geneva is a 24-year-old primigravida in active labor and has a history of weight reduction surgery 12 months prior to conceiving. She has worked closely with the healthcare team throughout her pregnancy to ensure adequate weight gain to support both maternal and fetal needs. Her cervix is 6 cm dilated and 80 percent effaced. She has been managing contraction pain with breathing exercises and relaxation techniques. She suddenly complains of severe abdominal pain, nausea, and vomiting and has a fever. Because of her history, you suspect that she may have gastroenteritis intestinal obstruction. placental abruption. pulmonary embolus.
intestinal obstruction.
Mrs. Madison has arrived at her prenatal visit at 36 weeks gestation. She has gestational diabetes, and her glucose levels have been controlled by diet alone. She documented several high glucose values over the past week. It is important to discuss that prolonging pregnancy beyond 38 weeks in women with diabetes may result in fetal cardiomegaly. demise. hyperbilirubinemia. macrosomia.
macrosomia.
An ova that is fertilized by one sperm and then divides into two zygotes results in
monozygotic gestation.
The risk of perinatal transmission of HIV can be reduced with antiretroviral treatment. Identification in the preconception period is essential. Which of the following statements about HIV screening in pregnancy is most accurate? Pregnant women are routinely screened for HIV with all prenatal laboratory testing. must be given the option to opt out of routine HIV testing. must provide written consent for HIV screening. should be offered HIV screening in each trimester.
must be given the option to opt out of routine HIV testing.
Michelle states the she feels the urge to push. A cervical examination reveals that Michelle is 9 centimeters dilated with the presenting part at -1 station. Michelle should assume a squatting position to allow her to push more effectively. not push at this time because pushing may cause her cervix to swell. turn onto her left side, which will decrease her urge to push. when she feels the urge to push allow her to bear down with each urge.
not push at this time because pushing may cause her cervix to swell.
The initial drug of choice for excessive bleeding in the postpartum period is Methergine, IM. oxytocin, IV. prostaglandin, PR. terbutaline, SC.
oxytocin, IV.
Classic signs of placenta previa are
painless, bright red bleeding.
A primary and routine role of the circulating registered nurse during a cesarean birth includes completing a newborn and maternal assessment prior to leaving the operating room. documenting the fetal heart rate every 5 minutes until birth. performing needle and sponge counts with the scrub person. performing resuscitation and stabilization of the newborn infant after delivery.
performing needle and sponge counts with the scrub person.
The level of care provided when a patient is emerging from a surgical procedure requiring anesthesia or sedation is referred to as phase 1. phase 2. postanesthesia phase. recovery phase.
phase 1
Painless, bright red vaginal bleeding at 28 weeks of gestation is most likely caused by
placenta previa.
Mrs. Jordan has arrived to the unit for a labor evaluation. She is 39 weeks pregnant and is complaining of continuous abdominal pain. She is having high frequency, low amplitude contractions and the fetal heart pattern shows minimal variability. You suspect that Mrs. Jordan may have a
placental abruption.
Measures to prevent hypothermia may include all of the following except limiting skin exposure. maintaining room temperature at 72 degrees Fahrenheit. placing warm blankets on the woman. warming fluids before infusion.
placing warm blankets on the woman.(WRONG) warming fluids before infusion. (WRONG)
According to the American Academy of Pediatrics (AAP) and CDC guidelines, GBS prophylaxis is recommended in all of the following circumstances except GBS bacteruria in current pregnancy. planned cesarean birth with intact membranes and previous positive GBS screen. previous history of multiple preterm births. negative GBS screen in current pregnancy with previous infant with known GBS infection.
planned cesarean birth with intact membranes and previous positive GBS screen.
The most common postpartum complication for mothers with higher-order multiples is
postpartum hemorrhage.
Intensive nursing and medical management in women with pregestational diabetes should begin in the immediate postpartum period. preconception period. second trimester of pregnancy. third trimester of pregnancy.
preconception period.
Pregnant woman who have undiagnosed and untreated hypothyroidism are at risk for chronic hypertension and malabsorption syndromes. congestive heart failure, miscarriage, and infection. preeclampsia, placental abruption, and stillbirth. preterm labor, low-birth-weight infants, and hypoglycemia.
preeclampsia, placental abruption, and stillbirth.
All of the following complications may predispose a pregnant woman to disseminated intravascular coagulopathy (DIC) except
preterm labor.
One of the most common and well documented risk factors for preterm labor is
previous history of preterm birth.
Risk factors for placenta previa include
previous uterine surgery, smoking, and hypertension.
Pregnant women who have had weight reduction surgery should avoid the routine 50-g glucose load testing for gestational diabetes at 28 weeks gestation to prevent diabetic ketoacidosis. dumping syndrome. prolonged hyperglycemia. prolonged hypoglycemia.
prolonged hyperglycemia. WRONG prolonged hypoglycemia. WRONG
The drug of choice to reverse the effects of anticoagulant therapy is calcium gluconate via slow IV push. low-molecular-weight heparin via slow IV push. Narcan via slow IV push. protamine sulfate via slow IV push.
protamine sulfate via slow IV push.
One of the best ways to help parents who are living with grief is to
provide them with a list of community resources and support groups.
You are caring for a mother/baby couplet. Approximately 40 hours ago, Melinda, a 32-year-old primiparous woman, had an urgent cesarean birth after a prolonged second stage of labor during which she had a Category-III abnormal fetal heart tracing. Melinda has been weepy and has not wanted to get out of bed. She describes symptoms of dyspnea, abdominal pain, and chest pain. Her vital signs are blood pressure of 84/56 while lying down, pulse of 118 beats per minute, and respirations of 26 breaths per minute. Melinda is displaying symptoms of anxiety. cardiomyopathy. preeclampsia. pulmonary embolus.
pulmonary embolus.
A woman with higher-order multiples is at risk for all of the following except
pyelonephritis.
When assessing a pregnant woman with rheumatic heart disease at 28 weeks gestation, you must be alert for signs of cardiac decompensation. A sign of cardiac decompensation is continuous wet cough. rapid, irregular, weak pulse. supine hypertension. widened pulse pressure.
rapid, irregular, weak pulse.
The goals of nursing and medical management of hemorrhage include all of the following except identification and management of the source of bleeding. re-establishment of maternal hemodynamic stability. restoration of circulating fluid volume. separation of the mother newborn couplet until stabilization.
separation of the mother newborn couplet until stabilization.
A dermatome is an area of skin supplied by a single spinal nerve. Assessment of dermatome level helps establish sympathetic and motor levels of the neuraxial blockade caused by anesthesia. The RN knows that a woman is recovering from neuraxial anesthesia when her sensory awareness is resolved on one side. she demonstrates sensory awareness to an alcohol wipe but not a blunt needle prick. the dermatome level is moving upward. she can lift both legs off of the bed.
she demonstrates sensory awareness to an alcohol wipe but not a blunt needle prick. (WRONG) her sensory awareness is resolved on one side. (WRONG)
The loss of a pregnancy prior to 20 weeks gestation or delivery of a fetus weighing less than 500 grams is called a/an
spontaneous abortion
Which position may be helpful to facilitate rotation for a fetus that is in the occiput posterior position? Standing Semi-Fowler's Squatting High Fowler's
squatting
A rapid assessment of maternal status is completed immediately on arrival prior to the anesthesiologist provider leaving the PACU. If the mother is stable, the RN accepts the transfer and assumes care of the mother. In situations in which the mother is not stable the nurse should expect that the anesthesia provider is immediately available by pager or phone. the anesthesia provider may release responsibility to the nurse as long as the mother remains in the PACU. the anesthesia provider will remain with the mother until stable, and then the nurse accepts the responsibility of the mother. the obstetrician can assume care if the anesthesia provider is not available.
the anesthesia provider will remain with the mother until stable, and then the nurse accepts the responsibility of the mother.
A cerclage placed in women with documented shortened cervical length by ultrasound examination is called a(n)
therapeutic cerclage.
Vaginal birth is the preferred method of delivery for most women with cardiac disease. One indication for cesarean birth may be presence of bicuspid aortic valve without stenosis. presence of Marfan syndrome with normal aortic size. presence of mitral valve prolapse with audible murmur. use of warfarin therapy within 2 weeks of delivery.
use of warfarin therapy within 2 weeks of delivery.
The cardiac lesions that may be more likely to present for the first time in pregnancy because of increased demands on the heart are complex lesions. lesions of the aorta. shunt lesions. valvular lesions.
valvular lesions.
