High Risk Maternity Level 4

The nurse is assessing a woman with Class III heart disease who is in for a prenatal visit. What would be the first recognizable sign that this client is in heart failure?

Persistent Rales in the Bases of the Lungs

Jaundice that occurs after postnatal day 1 and lasts up to 1 week

Physiologic Jaundice

A client in her fifth month of pregnancy is having a routine clinic visit. The nurse should assess the client for which common second trimester condition?

Physiological Anemia

A 40-year-old woman comes to the clinic reporting having missed her period for two months. A pregnancy test is positive. What is she and her fetus at increased risk for?

Placental Abnormalities

Poor feeding and a decrease in temperature may indicate what in a newborn?

Infection

Which Antiarrhythmic Medication is given during pregnancy

Lidocaine

A nurse is caring for a pregnant client with sickle cell anemia. What should the nursing care for the client include? Select all that apply.

-Teach the client meticulous handwashing. -Assess hydration status of the client at each visit. -Urge the client to drink 8 to 10 glasses of fluid daily.

If a pregnant mother is a carrier of Thalassemia, what intervention should you perform?

-Test the Father -Genetic testing

Which Congenital Heart Diseases will ↑ risk for Complications During Pregnancy

-Tetralogy of Fallot -Transposition of the Great arteries -Eisen-Menger's Syndrome " Should NOT become pregnant"

Women with these cardiac diseases should never get pregnant

-Uncorrected TOF, -Transposition of the great arteries, -Eisenmenger's Syndrome

What determines the Severity of Maternal Complications with Heart Disease?

-severity of Cardiac Lesion, -Functional Class, -maternal Cyanosis, -use of Anticoagulants

what is the best score you can have on the silverman-anderson chart?

0

at what level does bilirubin peak in a baby with physiologic jaundice?

10

Obesity is defined as > 30 BMI . What is the weight gain range for the Obese pt during pregnancy?

11-20 pounds

how long can a baby stay under a bili light?

12-24 hours

How long should women who have had bariatric surgery wait before becoming pregnant

12-24 months

Which HSV is more severe?

HSV 2

What causes Physiological Anemia during pregnancy?

Hemodilution (When Plasma Volume increases greater than RBC )

Iron Deficiency Anemia - What are normal Hgb / Hct levels During Pregnancy?

Hgb 9.5 HcT 28 RBC ^ 25-33% Extra Iron is needed for Hgb formation

A male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant?

His ability to void and have an erection in adulthood may be impaired and surgery is needed.

What Medications are used during pregnancy to control Pain / Inflammation in RA

Hydroxychloroquine, Glucocorticoids, NSAIDs -Know: Methotrexate IS CONTRAINDICATED during pregnancy

Which women are less likely to go into spontaneous labor, women who are overweight or underweight ?

Overweight

A decrease in Maternal BP or Blood Volume will>>>

cause blood to be shunted away from the uterus and ↓ placental perfusion

what is FINES?

feeding difficulty, inspiratory stridor, nasal flaring, expiratory grunting, sternal retractions

herniation of abdominal contents through wall defect with no peritoneal sac

gastroschisis

what bilirubin level will a baby with pathologic jaundice have?

greater than 17

What bili level is considered hyperbilirubinemia?

greater than 5

immediate goal after surgical repair of cleft lip/palate?

prevent tension

The nurse is teaching a pregnant woman with iron deficiency anemia about foods high in iron. Which foods if selected by the woman indicate a successful teaching program? Select all that apply.

raisins, broccoli, peanut butter

The Nurse is caring for an infant diagnosed with a Ventricular Septal Defect. Which assessment findings does the nurse anticipate?

A Harsh Murmur

What should we monitor in a patient with Thalassemia receiving Transfusions?

Blood Transfusions put the pt at r/o *Iron Overload

Which Drug is the Preferred Diuretic?

Furosemide

infertility treatment option that requires laparascopy and general anesthesia

GIFT

What is the Fetal at Risk for with the pregnant pt. with Asthma ?

HTN / Preeclampsia, placenta previa, Intrauterine Hemorrhage, Oligohydramnios, IUGR, preterm birth and low birth weight

Movement disorders, deafness, occulomotor impairment, dental enamel hypoplasia

Kernicterus (chronic bilirubin encephalopathy)

abdominal distention/tenderness, bloody stools, feeding intolerance, green vomiting noticed after first feeding

NEC (necrotizing enterocolitis)

What drugs used to control autoimmune disorders should be Avoided During Last Trimester?

NSAIDs

Which Medications CAN be given during pregnancy to control SLE ?

NSAIDs, Prednisone, Hydroxychloroquine (Plaquenil)

Which Legal substance can cause Vasoconstriction, Reduced Placental Blood Flow, Prematurity, and / or Abruption ?

Nicotine

What are risks to mom with MS and baby?

No Adverse Effects if uncomplicated MS.. - Assess for Balance and Visual Problems

The baby's head measured 38 cm on day 1, on day 2 it measured 40 cm. what would you expect?

PVH/IVH

A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?

Prevent aspiration by elevating the head of the bed, and insert an NG tube to low suction.

What class of drug is Contraindicated in pregnant women with asthma?

Prostaglandins All ended in "prost" -carboprost -dinoprostone -Misoprostol→ can be used w/ caution **Methylergonovine Can be used ****

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client?

Provide oxygen by oxygen hood or ventilator.

Systemic Lupus Erythematous

Pt's with SLE should AVOID pregnancy until condition is Stable for at Least 6 Months. Skin Changes: Chloasma (brown or red spots) to the Face or Red Rash. SLE effects connective tissue, may cause Placentae / Organ Malformation in Fetal.

what test result would require further monitoring in a newborn with jaundice

coom's positive

priority interventions after baby with omphalocele/gastroschisis is born

cover with wet sterile dressing, regulate temperature

The nurse is caring for an infant born to a mother who abused cocaine during her pregnancy. The nurse would likely notice that this infant:

cries when touched.

What would you see on a Fetal Monitor that would indicate fetal distress?

decels, loss of variability

disorder where intestines are pushing through the diaphragm

diaphragmatic hernia

what is the priority intervention after a baby comes back from surgical repair of cleft lip/palate?

elbow restraints

abnormal location of the urethra (opening on upper side of penis)

epispadias

congenitally interrupted esophagus

esophageal artresia

Hydramnios, Copious Frothy Bubbles, Drooling, abdominal distention, coughing, choking, cyanosis

esophageal artresia, tracheoesophageal fistula

if you hit resistance while placing OG tube, you would suspect:

esophageal artresia, tracheoesophageal fistula

which disorders usually accompany trisomy 13, 18, 21?

esophageal artresia, tracheoesophageal fistula

umbilical ring defect with evisceration of abdominal contents into external peritoneal sac

omphalocele

elevated maternal fetal alpha protein may indicate:

omphalocele/gastroschisis

It would be best to place an infant with a myelomeningocele in which position prior to surgery?

on the stomach (prone)

Risk factors- Iron Deficiency Anemia

poor diet, hemolysis, pica, multiple births, Limited Intervals between pregnancies, blood loss

Sickle Cell Risk during pregnancy

preeclampsia, eclampsia, *Miscarriage, stillbirth, IUGR, fetal distress Placenta Abruption preterm birth

Iron Deficiency Anemia ↑ risk for:

preterm delivery, perinatal mortality, *Postpartum Depression, poor mental/psychomotor performance -Hemorrhage and Infection during and after deliver.

how should you bathe a baby with bladder exstrophy?

sponge baths

what is your initial action if NEC is suspected?

stop feedings

What would you see in an infant with ROP

strabismus

how should you position an infant with bladder exstrophy?

supine

3 main assessment findings with diaphragmatic hernia

tachypnea, SOB, bowel sounds in chest

abnormal communication between trachea and esophagus

tracheoesophageal fistula

T/F: children under 4 should not be given cough medicine

true

How long will Methadone show up in an infant's system?

up to 10 days

When is PVH/IVH most common?

up to 72 hours after birth

How can you prevent/minimize risk of developing BPD or ROP?

use lowest amount possible for shortest amount of time

what is the delivery method for a baby with omphalocele?

vaginal delivery if small

what are the 3 main goals while the baby has a cleft lip/palate?

weight gain, aspiration prevention, ear infection prevention

How long after birth is zidovudine given to a baby born to an HIV positive mother?

4-6 weeks

at what gestational age does imperforate anus develop

5-7 weeks

How would you position a newborn at risk for PVH/IVH

Flexed contained position (fetal position)

What does a ground glass pattern on a newborn's CXR indicate?

amniotic fluid in the lungs

How would the Nurse Manage Care for the Pregnant women with Tetralogy of Fallot ?

Bed Rest after 20 weeks with a Pulmonary Artery catheter

What causes Cardiac Workload changes Immediate Postpartum period?

Blood Loss and Diuresis (lots of Urine)

What Food / Drinks Interfere with Iron absorption and should be avoided?

Caffeine, (Tea) Chocolate, High Fiber foods, Milk

Serum Ferritin will be at what level in Iron-deficiency Anemia?

<100

Cocaine stays how long to in adults and infants?

Adults: 24-48 hours, Infants 72-96 hours

How much Higher is a Pregnant woman's HR on Average?

20 BPM

At what gestational age is an HIV positive mother scheduled for c-section?

38 weeks

At what age is a cleft palate usually repaired

9 months

What is a Nursing Diagnosis for the CVD pt.. ?

Activity Intolerance

How would the Nurse Manage Care for the Pregnant women with Ventricular Septal Defect (VSD) ?

Rest with Limited Activity If Symptomatic

T/F: BP is relatively unaffected by labor

TRUE

How would the Nurse advise Women who develop Peripartum Cardiomyopathy during Pregnancy?

Advise NOT to attempt another pregnancy

What is the leading substance abuse cause of Intellectual Disability

Alcohol Use during pregnancy

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best?

"I understand your concern because as many as 50% of babies can develop jaundice."

The nurse is assessing a toddler at a well-child visit and notes the following: small in stature, appears mildly developmentally delayed; short eyelid folds; and the nose is flat. Which advice should the nurse prioritize to the mother in response to her questions about having another baby?

"It's a good idea to stop drinking alcohol 3 months before trying to get pregnant."

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer?

"The antibodies may be those transferred across the placenta; the baby may not develop AIDS."

What is the daily recommended amount of iron supplementation during pregnancy?

30 mg/day

An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breast-feed the baby during the postoperative phase. What is the best response by the nurse?

"You will not be able to breast-feed immediately after, but you can pump and feed the child with a cup."

What is the greatest risk factor for many of the Acquired Conditions during pregnancy?

**Advanced Maternal Age ↑ risk of acquired conditions: HTN, DM, HYPERLIPIDEMIA. MI could happen during pregnancy ex: CAD, etc

What are Expected s/s of Iron Deficiency Anemia in the pregnant women?

*Fatigue, *HA, *Restless Leg Syndrome, *Pica (bizarre eating behaviors)

Systemic Lupus Erythematous / SLE Management During Labor

*Hydration *Oxygen *Pain meds -Encourage Rest -Post-op: Ted-hose

Iron Supplement Recommendations

*Take w/ Vitamin C-foods and Stool Softener.* S/E of Iron: Nausea, Constipation - Vitamin C promotes Iron absorption

By what Percentage does the Blood Volume Increase during pregnancy?

30-50%

What is the maximum amount of caffeine a pregnant woman should consume daily?

300 mg

To many sickled cells in the placenta put the Maternal pt. at r/o ?

-*Placenta Abruption -Miscarriage

What is the expected treatment for a Pregnant woman with Atrial Septal Defect (ASD)

-AV Nodal Blockers -May Require Cardioversion

How would the Nurse Manage Care for the Pregnant Women with Mitral Stenosis

-Activity Restriction (Stabilize HR,) -Sodium Reduction, and -Bed Rest If Severe

What are expected S/S of Sickle Cell in Pregnancy ?

-Anorexia -Dyspnea -Malaise

Name 3 conditions pregnant women with Heart Disease at risk for?

-HF -Arrhythmia -Stroke

At what point during pregnancy can an HIV positive mother resume her usual drug regimen?

14 weeks

Heroin stays how long in adults and infants system?

24 hours, 24-48 hours

men who will be undergoing semen analysis should abstain from sex for how long before providing sample?

24-48 hours (Sample should be tested in 1 to 2 hours)

At what point in pregnancy / postpartum period is the woman Most at risk for complications from heart disease?

28-32 weeks and up to 48 hours postpartum (r/t bleeding)

Education: RA does not adversely affect pregnancy but occasionally returns at:

3-4 Months Postpartum

Assessment Cardiac- Priority

ALWAYS look for s/s decompensation SOB Dyspnea Cyanosis FACE AND HAND EDEMA = problem JVD ↑ RR Palpitations chest pain w/ exertion or syncope ↑ fatigue wet cough

What interventions should be avoided in pregnant women with HSV or HIV?

AROM, FSE, vacuum/forceps

Which HSV drug is started at 36 weeks or during active outbreaks in pregnant women ?

Acyclovir

interventions required for a pregnant woman with cardiac disease during labor

Arterial Line, Epidural, Forceps/Vacuum- (reduce the workload of contractions during labor)

A nurse is caring for a pregnant client with heart disease in a labor unit. Which intervention is most important in the first 48 hours postpartum?

Assessing for Cardiac Decompensation

Name 2 Preferred BP Meds used in Pregnancy

BB-Propranolol CCB-Nifedipine *NO ACE INHIBITORS* "No Lisinopril"

A young mother has tested positive for HIV. When discussing the situation with the client, the nurse should advise the mother that she should avoid which activity?

Breastfeeding

Which Inhalers are recommended during pregnancy ?

Budesonide Albuterol Salmeterol

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?

Cephalhematoma

Which Illegal substance can cause Vasoconstriction, Gestational HTN, abruption, CNS defects, "Snow Baby Syndrome

Cocaine

Method of choice for monitoring for PVH/IVH

Cranial US

If breathing effort increases in a newborn, temperature will ____

Decrease

Is a baby born to an HIV positive mother more likely to contract HIV during pregnancy or during delivery?

Delivery

Thalassemia Management

Depends on severity -Blood Transfusions -Genetic counseling

Polyhydramnios on US may indicate that the baby will have:

Diaphragmatic Hernia

The client with Alpha Thalassemia ask why it is NOT recommended she take exogenous iron?

This form of Anemia does NOT respond to Iron Supplements

True or False: RDS is caused by a lack of alveolar surfactant.

True

T/F: A pregnant mother with Sickle cell can have morphine

True; if not close to delivery

Which drugs are Contraindicated (category x) In Pregnancy?

Warfarin, Methotrexate

At what point do women with MS experience an increase in symptoms/relapse?

Within first 3 months postpartum

What drug is given during labor when the mother is HIV positive?

Zidovudine

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hemoglobin

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?

abdomen appearing red and shiny

which drug classes are used to control MS during pregnancy?

anti-inflammatories, immunosuppressants, immunologics

Anemia-assessment questions

any fatigue, weakness, malaise, anorexia or frequent infections/colds?

where on the growth chart would a baby with failure to thrive fall?

below 3rd percentile

Risk factors for PVH/IVH

birth weight less than 1,500 grams/less than 35 weeks, rapid deliveries

What are Distinctive Characteristics of FAS Fetal Alcohol Syndrome?

growth restriction, craniofacial structure abnormalities, CNS dysfunction Facial: Epicanthal Folds, Low Nasal Bridge, Short Palpebral Fissues, Short Nose, Ear abnormalities, This Upper Lip, Receding Jaw, Smooth Philtrum

What will CXR show on a newborn with MAS

hyper-aeration with atelectasis

What will a CXR show in an infant with RDS?

hypo-aeration, under expansion, ground glass pattern

Absence of anal opening, no meconium passage, s/s of intestinal obstruction

imperforate anus

what would you suspect if a newborn hasn't passed first stool in 24 hours?

imperforate anus

on what side does diaphragmatic hernia usually occur?

left side

A nurse is caring for a client with CVD who has just delivered. What nursing intervention should the nurse perform when caring for this client? SATA

-Assess for Shortness of Breath -Moist Cough -Edema (note any pitting) -and Auscultate Heart Sounds for abnormalities

What are Post-Partum S/S of Decompensation in the Pregnant Cardiac pt?

-Cough Dyspnea -Edema -Palpitations -Crackles to lung bases

What expected changes to the Respiratory System in Pregnancy will the Nurse expect to see?

-Diaphragmatic Elevation Decreases causing a decrease in residual in capacity. -O2 Consumption and BMR ↑ = Faster RR (Remember If Mom can't get O2 / Baby can't get O2)

When caring for a pregnant woman with cardiac problems, the nurse must be alert for signs and symptoms of Cardiac Decompensation (congestive heart failure), which include? SATA

-Dyspnea -Crackles -Irregular weak pulse. Rationale: Signs of Cardiac Decompensation to congestive heart failure include crackles in the lungs from fluid, difficulty breathing, and weak pulse from heart exhaustion. The heart rate would not be regular, and a cough would NOT be dry. The heart rate would increase rather than decrease.

Management of Sickle Cell Anemia

-Fluids, Oxygen -blood transfusion if severe anemia -analgesics x pain -antibiotics for infection -*Postpartum: Anti-embolism Stockings

Thalassemia (type of Hereditary Anemia)

-Inherited Defect -Inability to produce hemoglobin (alpha or beta)

Interventions for a woman with Asthma During Labor

-Oxygen Saturation (Pulse Ox), -Epidural Analgesia (pain mgm) to ↓ stress (Can trigger an Acute Attack)

What are 5 Risks to Fetus when mom has Heart Disease?

-Premature birth -Growth Restriction / Low Birth Weight -Intraventricular hemorrhage -Respiratory Distress Syndrome -Death

Sickle Cell Crisis Prevention

-Prevent Dehydration (8-10 glasses of water daily) -Avoid Infections (hand washing) -Avoid Extreme Temps, cigarette smoke/alcohol

What are Indicators of Sickle Cell Crisis ?

-Severe Abd Pain -Muscle spasm Leg Pain, Joint Pain -Stiff Neck N/V Seizures

at what age is a cleft lip usually repaired?

3/4 months

At what gestational age is there usually a sufficient amount of surfactant produced?

31 weeks

what is the mortality rate of newborns with infections if left untreated?

50%

A preterm newborn in the neonatal intensive care unit (NICU) has been diagnosed with periventricular-intraventricular hemorrhage (PVH-IVH). Which nursing action would be a priority in the plan of care for this newborn?

Avoiding lifting the lower extremities above the midline.

At what point during pregnancy is an Asthma Attack RARE ?

During the last month - Greatest Risk of Attack is between 24-36 Weeks

Chronic lung disease in newborns with lung injury that requires continued 02 after initial 28 days of life

BPD (Bronchopulmonary Dysplasia)

Possible causes include surfactant deficiency, pulmonary edema, lung immaturity, barotrauma, FVO

BPD (Bronchopulmonary Dysplasia)

Children with this disorder will have frequent colds in winter and increased risk for asthma

BPD (bronchopulmonary dysplasia)

Development of these two disorders is linked to sustained high 02 use

BPD, ROP

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

Blood Stools

A pregnant woman with sickle cell anemia is very concerned her infant will also develop the disease and questions the nurse about that possibility. Which is the best response from the nurse?

Both Parents have to carry the trait.

Functional Classification System Heart failure

Class I: No s/s; No Limitations Class II: s/s Dyspnea w/ ↑ Activity (going up stairs, chest pain) = Light Activity (allow rest periods) Class III: s/s Fatigue, Palpitations w/ Normal Activity (bedrest during pregnancy) Class IV: s/s at rest w/ ANY activity→ should NOT really get pregnant = bed rest, C-section, Put on O2

When should the Nurse expect complications Sickle Cell Anemia ?

Complications can happen at ANY Time during pregnancy.

How is Exogenous Surfactant given to a newborn?

ET tube

Reasons why a pregnant woman would avoid prenatal care

Drug use, Domestic Abuse

A premature infant develops Respiratory Distress Syndrome. With this condition, circulatory impairment is likely to occur because with increased lung tension, the:

Ductus Arteriosus Remains Open.

Which Drug is the Preferred Anticoagulant?

Enoxaparin *(Remember No Warfarin)*

What is the most important thing the nurse can do for a teenage mom?

Ensure she has support

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?

Esophageal Atresia

When caring for a neonate with a diagnosed tracheoesophageal fistula preoperatively, which symptoms are anticipated? Select all that apply.

Excessive drooling, Cyanosis, Elevated heart rate, Frothing

What does the Clomiphene Citrate test look for?

FSH levels (Assesses a Woman's Ovarian Reserve) >15 indicates she is unlikely to conceive with her own eggs.

T/F: All Corticosteroids for Asthma during pregnancy are to be given PO

False (Inhaled is Preferred) - *Budesonide* -Albuterol -Salmeterol are recommended during Pregnancy.

The Nurse is educating the client on what foods that are High in Iron. Which is a correct response by the client?

I can eat -Dried Fruits, Whole Grains, Green Leafy Vegetables, Meats, Peanut Butter, Tofu and Iron-Fortified Cereal

A newborn has not passed any stools in the first 24 hours after birth, and his abdomen is becoming distended. The nurse recognizes that which condition could explain such findings?

Imperforate Anus

How will the Nurse Manage the Iron Deficiency Anemia pt?

Iron Supplements, Nutrition (avoid tea, coffee, chocolate, high fiber) Eat dried fruit, whole grain, green leafy, meat, peanut butter, iron-fortified cereal Monitor Labs - Low H&H, Low Iron (<30), Ferritin < 100 Stool softeners

The nurse is assessing a mother who just delivered a 7 lb (3136 g) baby via cesarean delivery. Which assessment finding should the nurse prioritize if the mother has a history of controlled atrial fibrillation?

Jugular Distention

How would the Nurse Educate the Pregnant pt CVD ?

Lay on your Left Side, Stay away from Salt and consume a High Fiber Diet

Barrel-Shaped chest, PROLONGED tachypnea, increasing respiratory distress, retractions, grunting, and cyanosis

MAS (meconium aspiration syndrome)

Beta Thalassemia

Major Form- (gene from both parents) Most common Can be Severe-Pregnancy is NOT recommended ***

Which Illegal substance can cause Anemia, inadequate weight gain, Hyperactive Startle Reflex, Tremors, prematurity

Marijuana

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of Atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?

Meconium Aspiration Syndrome

Which Drug CAN be given to pregnant women with Asthma who are at Risk for Postpartum Hemorrhage

Methylergonovine

Alpha Thalassemia

Minor Form -No S/S -Mild Anemia - *Do NOT Prescribe Iron Suppliments

Which Prostaglandin can be given WITH CAUTION to a pregnant woman with Asthma ?

Misoprostol

The nurse is planning care for a newborn with a cleft lip and palate scheduled for surgery in a few weeks. For which health need will the nurse focus when planning this patient's care?

Nutritional support

A nurse caring for a pregnant client suspected substance use during pregnancy. What is the priority nursing intervention for this client?

Obtain a urine specimen for a drug screening.

The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly?

On the dorsal end of the penis

Which substances can cause Withdrawal, abruption, preterm labor, PROM, Perinatal Asphyxia, malnutrition, newborn Sepsis

Opiates, Narcotics / Heroin

What is the First Test that will be done to assess Ovarian Function ?

Ovulation Predictor Kit - (At Home Test) Women are Most Likely to take a Urinary Pregnancy Test First.

The nurse is caring for a neonate that is small for gestational age due to intrauterine growth restriction. Which is the most common cause?

Oxygen and Nutrient deficiency prior to birth

Which test dentifies genetic abnormalities in embryos created through IVF ?

PGD (Preimplantation genetic diagnosis)

what is usually The First Sign of Esophageal Artresia / Tracheoesophageal Fistula?

Polyhydramnios

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side

A woman is pregnant and has asthma. Her primary care provider has told her to continue taking Prednisone during pregnancy, but she is concerned the drug may be teratogenic. What advice would be best to give her regarding this?

Prednisone is considered safe in the doses prescribed by her care provider.

Autoimmune Disease in Pregnancy SLE, RA, MS

Prevent Pregnancy when disease is Active -Plan Conception between Flares and Continue Meds during pregnancy

breathing disorder resulting from lung immaturity and lack of surfactant

RDS (Respiratory Distress Syndrome)

If a baby is not responding to 02 and being warmed, what would you expect?

RDS (respiratory distress syndrome)

what disorder can result from prematurity, deficient surfactant, c-section in the absence of labor, male gender, and DM?

RDS (respiratory distress syndrome)

Rapid growth of retinal blood vessels in a premature infant

ROP (retinopathy of prematurity)

what is the usual cause of pathologic jaundice?

Rh and ABO incompatibilities

Why do we see complications of sickle cell anemia in pregnancy?

Secondary effects r/t hormonal modifications will cause Hypercoagulable State and ^ Risk for infection

CNS depression, newborn withdrawal, Maternal Seizures during labor, Newborn Abstinence Syndrome, delayed lung maturity

Sedatives (Xanax, Ambien)

The nurse is caring for a pregnant client who is in her 30th Week gestation and has Congenital Heart Disease. Which of the following should the nurse recognize as a symptom of Cardiac Decompensation with this client?

Swelling of the Face and Hands

What is Secondary Infertility ?

The Inability to conceive After Previous Pregnancy

How would the Nurse Manage Care for the Pregnant women with Patent Ductus Arteriosus (PDA) or corrected TOF

The Pt will Have minimal problems if it was corrected surgically in childhood

An infant is born with an omphalocele. Which explanation by the nurse is the best description of the feeding plan for the infant?

The infant will be fed by TPN to supply nutrients and keep the bowel from filling with air or stool.

lethargy, poor feeding/tone/moro reflex, high-pitched cry, increased CNS failure

acute bilirubin encephalopathy

Meconium drug screening will show any drugs used during pregnancy after what gestational age?

after 24 weeks

what would you see on KUB of an infant with NEC

air in abdominal wall, dilated bowel loops

what is the usual cause of physiologic jaundice?

breastfeeding

What is the delivery method for a baby with gastroschisis?

c-section

how is a baby with failure to thrive identified?

weight loss, poor feeding, 3-5 percentile

Who is at highest risk for developing BPD?

wimpy white boys

tremors, seizures, Hyperactivity, hypertonic muscles, shrill cry, frequent yawning/sneezing, skin mottling, loose/watery stools, projectile vomiting

NAS Newborn Abstinence Syndrome

If you hear a Systolic Ejection Murmur in a newborn what do you suspect?

PPHN (Persistent Pulmonary HTN of the newborn)

Fetus with s/s of HF, persistent hypoxemia, tachypnea, cyanosis, grunting, retractions

PPHN (persistent pulmonary HTN of the newborn)

The Nurse recognizes that Unilateral Arm Flapping in an infant is a sign of:

Seizures

What's expected lab findings would the Nurse expect to see in diagnosing Iron-deficiency anemia?

Serum Iron less than 30 mcg/dl -Low Hgb / Hct, and Low Serum Ferritin <100

A 32 weeks' gestation newborn is admitted to the neonatal intensive care unit. The assessment reveals a pale dyspneic newborn with marked tremors, a bulging anterior fontanel, and a high-pitched cry. What diagnosis best correlates with the assessment findings?

Periventricular-Intraventricular Hemorrhage

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position.

A pregnant client has a history of Asthma. After reviewing the possible medications that may be prescribed during her pregnancy to control her asthma, the nurse determines additional teaching is needed when the client identifies which drug as being used?

Misoprostol

When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications?

Morphine

Marked pulmonary HTN that causes right to left shunting of blood and hypoxemia

PPHN (persistent pulmonary HTN of the newborn)

Unexplained drop in hct, pallor, poor perfusion, seizures, shrill cry, lethargy, hypotonia

PVH/IVH

What Type of Symptoms might you see in pregnant women with Heart Disease?

Palpitations, SOB with exertion, Occasional chest pain

Jaundice that manifests in first 24 hours of life

Pathologic Jaundice