maternity exam 2

when calculating the Apgar score for a newborn, which would the nurse assess in addition to the heart rate? a. muscle tone b. amount of mucous c. degree of head lag d. depth of respirations

a. muscle tone

what assessment findings are seen in a newborn with RDS? a. nasal flaring b. bradycardia c. high temp d. tachypnea

a. nasal flaring d. tachypnea

what is the management for a newborn with group B strep infection? select all a. neurological checks b. antivirals c. chest x-ray d. anitbiotics effective against GBS

a. neurological checks d. anitbiotics effective against GBS

what is different in a postterm infants skin? select all a. no lanugo b. yellow vernix c. milia d. dry skin

a. no lanugo d. dry skin

what condition in premature infants is caused by lack of surfactant and dependent on lung compliance? a. patent ductus arteriosus b. increase in BP c. increase risk of bleeding d. patent forman ovale

a. patent ductus arteriosus

how does engorgement leas to mastitis? select all a. plugged ducts b. bacteria enter through cracked nipples c. exposing nipples to air d. breastfeeding

a. plugged ducts b. bacteria enter through cracked nipples

when does prolapse of the umbilical cord happen most often? select all a. polyhydramnios b. SGA fetus c. LGA fetus d. placenta previa

a. polyhydramnios b. SGA fetus d. placenta previa

what are adolescent complication in pregnancy? select all a. postpartum hemorrhage b. iron deficiency anemia c. chromosomal abnormalities d. depression

a. postpartum hemorrhage b. iron deficiency anemia

thrombophelibitis tends to occurs in what population? select all a. preexisting obesity b. developed PP infection c. younger than 25 d. nonsmoker

a. preexisting obesity b. developed PP infection

what factors increase the risk for urinary retention? select all a. prolonged labor b. general anesthesia c. epidural anesthesia d. perineal lacerations

a. prolonged labor c. epidural anesthesia d. perineal lacerations

where does the fluid from a fetus's lungs go when they are born? select all a. pushed out by the birth process b. absorbed by lymphatics c. removed by suctioning d. absorbed by blood vessels in the lung

a. pushed out by the birth process b. absorbed by lymphatics d. absorbed by blood vessels in the lung

what does "stripping/ sweeping" the membranes mean? a. separating membranes from lower uterine segment b. taking a sample of the membrane in the first stage c. placing medication into the cervix d. looking for infected membranes

a. separating membranes from lower uterine segment

which risk to the fetus is associated with maternal diagnosis of chorioamnionitis? select all a. sepsis b. bacteremia c. pneumonia d. cerebral palsy (CP) e. respiratory distress syndrome (RDS)

a. sepsis b. bacteremia c. pneumonia d. cerebral palsy (CP) e. respiratory distress syndrome (RDS)

what are assessment signs of abruptio placentae? select all a. sharp stabbing pain b. no pain c. macrosomnia d. heavy bleeding

a. sharp stabbing pain d. heavy bleeding

what assessment findings are seen in a newborn catagorized as SGA? select all a. skull sutures widely separated b. long length c. poor skin turgor d. immature liver

a. skull sutures widely separated c. poor skin turgor d. immature liver

which finding is indicative of abnormal newborn breathing? select all a. stridor b. mottling c. bradypnea d. nasal flaring e. expiratory grunting

a. stridor b. mottling c. bradypnea d. nasal flaring e. expiratory grunting

how do NAS/ESC babies present post birth? select all a. tachypnea b. tremors c. highpitched cry d. lethargic

a. tachypnea b. tremors c. highpitched cry

assessment of primigravida at 32 wks gestation shows a BP of 170/110, 4+ proteinuria, and edema of the face and extremities. with which complication are these findings consistent? a. eclampsia b. severe preeclampsia c. chronic HTN d. gestation HTN

b. severe preeclampsia

palcenta previa

-placenta is implanted abnormally in the lower segment of the uterus -total previa --> obstructed cervix -*most common cause of painless bleeding in the 3rd trimester* -causes the baby to be SGA dx test --> ultrasound -mom is at risk for blood reaction and hemorrhage during birth

What are the 3 P's?

-power -passage -pasenger

oligohydramnios:

-pregnancy with less than the normal amount of amniotic fluid decrease in fluid is usually caused by a bladder or renal disorder in the fetus that is interfering with voiding or poor nutrition from the mom

abruptio placentae:

-premature separation of placenta, begins to separate and bleeding occurs -*most frequent cause of prenatal death* -*stabbing sharp pain, tender on palpation, heavy bleeding* -*medical emergency* -can be caused by vasoconstriction (like from smoking) -polyhydramnios puts mom at increased risk -s/s hypovolemic shock -usually mom will have a c-section to avoid going into a DIC -put mom on her left lateral side & monitor baby with external fetal monitoring

uterine inversion:

-prolapse of the fundus and the uterus through the cervix so that the uterus turns inside out -usually occurs immediately after birth

hemophilia B

-reduced level of factor IX that cause hemorrhage in labor or spontaneous miscarriage -restoration of levels by giving FFP

GERD and hiatal hernia during pregnancy:

-reflux of acidic stomach secretions into the esophagus -hiatal hernia: portion of the stomach extends and protrudes up through the diaphragm into the esophagus treatment --> PPI

asthma during pregnancy:

-reversible airflow obstruction -the airway is inflammed and hyperactive -can reduce oxygen to the fetus and may result in preterm birth or fetal growth restrictions

incomplete miscarriage:

-spontaneous miscarriage where part of the fetus is expelled but the placenta and other parts are not

complete miscarriage :

-spontaneous miscarriage where the entire products of conception (fetus, membranes, placenta) are expelled -really heavy bleeding within 2 hrs and cells of baby are passed

Threatened miscarriage:

-spontaneous miscarriage where there is bright red spotting, slight cramping,. interventions: -monitor fetal heart sounds -hCG level is tested --> it will be low; if hCG goes up within 48 hrs mom may not be having a miscarriage

imminent miscarriage:

-spontaneous miscarriage where uterine contractions and cervical dilation occur -usually get ultrasound to see if theres a FHR -DNC may occur to shovel out remaining parts

formula feeding:

-store in a cool dry place -wash bottles every time -mix with bottled water NOT tap -baby needs to be burped after feeding

s/s PE:

-sudden sharp chest pain -tachypnea -tachycardia -orthopnea -cyanosis

episiotomy:

surgical incision of perineum to release pressure on the fetal head -incision is made with blunt tip scissors lateral episiotomy: -wont tear rectum midline: -tears more easily but has less blood loss compared to a lateral incision

cervical insufficiency (premature cervical dilation):

the cervix dilates prematurely with miscarriage making baby come out sooner than wanted -the McDonalds procedure is done --> a ring is placed on cervix trying to keep is closed (places at 12-14 wks) the ring needs to be taken out between 36 & 37 wks

what is the moro reflex? a. when the neck is turned to one side, the side extremities contract b. startle, outward then inward motion of extremities c. any object close to the eye, will cause rapid eyelid closure d. sucking motion

b. startle, outward then inward motion of extremities

what treatment is needed for newborns with esophageal atresia or tracheoesphageal fistula? a. NG tube b. surgical intervention c. congenital testing d. endoscopy

b. surgical intervention

what are s/s of mastitis? select all a. asymptomatic b. swollen c. reddened d. purulent drainage

b. swollen c. reddened

what are puerpal infection s/s? select all a. bright red lochia b. temp increase after 24 hrs c. peritonitis d. endometriosis

b. temp increase after 24 hrs c. peritonitis d. endometriosis

jaundice develops in a newborn 72 hrs after birth. how should the nurse best explain the probable cause of this jaundice to the parents? a. an allergic response to the feedings b. the physiologic destruction of RBC c. temporary bile duct obstruction commonly found in newborns d. the seepage of maternal Rh negative blood into the neonates blood stream

b. the physiologic destruction of RBC

the nurse notes that a healthy newborn is lying in the supine position with the head turned to the side with the legs and arms extended on the same and flexed on the opposite side. which reflex would the nurse document? a. moro b. babinski c. tonic neck d. palmar grasp

c. tonic neck

Pain control is an important outcome for a patient after a cesarean delivery because it impacts attaining every other outcome except: A.Adequate production of breast milk B.Prevention of pneumonia and thrombophlebitis C.Maintenance of bowel function D.Continuation of maternal-infant bonding process

A.Adequate production of breast milk

You are preparing for an induction of labor. Which of these would the nurse expect to do in preparation? A.Prepare oxytocin as prescribed using a piggyback intravenous setup. B.Teach the pregnant patient to lie on their back as much as possible during labor. C.Make sure that a fetoscope is available in the room for monitoring. D.Assure the pregnant patient that the induction process will assure a shorter than usual labor.

A.Prepare oxytocin as prescribed using a piggyback intravenous setup.

Idiopathic Thrombocytopenic Purpura (ITP)

-decreased number of platelets -not inherited, and can occur during any time of life -cause is unkown treatment --> 1-3 months of oral prednisone or platelet transfusion

UTI:

-during pregnancy there is an increase in glucose which provides an environment for bacteria to grow -can cause pyelonephritis if gone untreated (s/s tender to palpation, fever, vomiting, malaise, pain, and increased frequency of urination -if UTI is untreated during pregnancy the fetus is at risk for preterm labor -dx test --> clean catch urine sample

prolonged active phase:

-hypotonic contractions, limited pain -related to malformation of fetus or cephalopelvic disproportion -can be as long as 12 hrs

post partum hemorrhage: retained placenta

-placenta previa or abruption can be causes of this 1. fundal check (boggy) 2. check lochia 3. ultrasound to see any retained fragments treatment: -D&C or manually scraping it out -uterus will become firm quickly after treatment

breech presentation:

-types include complete, frank, and footling higher risk of: -developing dysplasia of the hip -anoxia from a prolapsed cord -traumatic injury to the after -coming head -fracture of spine or arm -dysfunctional labor -early rupture of the membranes because of the poor fit of the presenting part -meconium staining

preeclampsia WITHOUT severe features

-urine dip --> +1 or 300 mg in a 24 hr urine protein collection, or 0.3 or higher on urine protein/ creatinine ratio -needs to be done on 4 different occasions every 4 hrs for a diagnosis -1+-2+ on reagent strip test is preeclampsia without severe features -edema is moderate -weight is a large indicator of how much fluid they are retaining (any weight gain of 2Ibs in 2nd trimester or wt gain of Ib in 3rd trimester) -left side lying -very low dose of aspirin because it can cause hemorrhage at time of birth -s/s to be aware of --> wt gain, increased edema in lower extremities

Internal uterine and fetal monitoring are needed in an obese laboring patient. What assessment immediately after an amniotomy would be your primary concern? A.Checking for meconium-stained amniotic fluid B.Checking maternal blood pressure C.Recording the amount of amniotic fluid released D.Immediate monitoring of fetal heart rate

D.Immediate monitoring of fetal heart rate rationale: the amniotomy immediately places risk for prolapsed cord d/t gush of fluid and we can determine this by fetal monitoring

Assisting in the initiation of breastfeeding is a role of the nurse. When should the nurse recommend that a newborn have the initial feeding? A.After the first bath B.Once the temperature has stabilized C.After newborn labs are drawn D.Within the first 30 minutes after birth

D.Within the first 30 minutes after birth

a client had a cesarean birth 3 days ago. where would the nurse, while palpating the fundus, expect to locate the fundus?

3 cm below umbilicus

Gestational Trophoblastic Disease (GTD) (hydatidifrom mole)

-abnormal proliferation and then degeneration of the trophoblastic villi. villi that help the placenta grow die and turns fetus into a mass of cells (mastastisizes) -happens usually right after the 1st trimester -uterus will expand more than usual -will see really high hCG levels -a DNC is used to remove -monitor hCG levels for 3 months after to make sure levels decline

post op c-section:

-ambulate with someone present -educate on why they have a foley in -check blood labs -

sickle cell anemia:

-an abnormal form of hemoglobin that causes red cells to become rigid and sickle shaped -increased risk for clotting - is a recessive trait both parents need to have it in order for it to be passed on to the baby sickle cell crisis --> stress, trauma, dehydration, low O2, very hot or cold temperature prevention of sickle cell anemia--> fluids, calm environment, oxygen

Folic acid deficiency anemia:

-can cause a neural tube defect, miscarriage, and preterm labor -400 mg of folic acid needs to be taken during pregnancy -decrease in folic acids in moms who are taking anticonvulsants -treatment --> folic acid supplement

iron deficiency anemia:

-can cause pica -iron level under 30 -iron helps make RBC which is important for the placenta -s/s --> fatigue, resteless leg syndrome, placental insufficiency, baby will be SGA -65 g of iron needs to be taken with OJ

COVID-19 during pregnancy:

-can have higher rates of fetal morbidity and mortality for fetus infected during pregnancy -educate moms on getting vaccinated!

postpartum hemorrhage: thrombin --> coagulation

-cause by a DIC or heparin that was not stopped at an appropriate time

umbilical cord prolapse:

Risk factors: -polyhydramnios -premature rupture of membranes -placenta previa -small fetus -multiple gestations -cephalopelvic disproportion Interventions: -cover with moist sterile gauze covered in sterile saline (to prevent the cord from drying out)--> dont push back into the vagina -knee to chest position to reduce compression -oxygen via facemask 10-15 L -stop oxytocin and start tocolytic

what blood volume does a pregnant pt need to loose for hypovolemic shock? a. 10% b. 25% c. 5% d. 18%

a. 10%

how much formula is needed for an infant in 24 hrs? a. 150-200 mL/kg b. 100-200 mL/kg c. 50-90 mL/kg d. 200-500 mL/kg

a. 150-200 mL/kg

what is the peak incidence of SIDS? a. 2-4 months b. 4-6 months c. 2-4 wks d. 4-6 wks

a. 2-4 months

what is the testing threshold for gestational diabetes? a. fasting greater than 126 b. fasting greater than 220 c. nonfasting greater than 200 d. nonfasting greater than 130

a. fasting greater than 126 c. nonfasting greater than 200

what is the average birth weight for a newborn female and male? select all a. female 3.2 kg b. female 4.2 kg c. male 4.6 kg d. male 3.4 kg

a. female 3.2 kg d. male 3.4 kg

increased BF to the L side of the heart helps to close what fetal shunt? a. formen ovale b. ductus arterisous

a. formen ovale

tone assessment includes: select all a. fundal firmness b. retained placenta c. fundal height d. lochia amount

a. fundal firmness c. fundal height d. lochia amount

after birth of a newborn to a gestational diabetic, what s/s may you see? select all a. hyperbilirubinemia b. SGA c. LGA d. hypoglycemia

a. hyperbilirubinemia c. LGA d. hypoglycemia

the risk for which pregnancy complication is increased in the client with type I DM? a. hypertensive disorders of pregnancy b. placenta accreta c. increased appetite d. oligohydramnios in the 3rd trimester

a. hypertensive disorders of pregnancy

what can hyperbilirubinemia lead to? select all a. hypogylcemia b. destruction of WBC c. cardiac failure d. extreme edema

a. hypogylcemia c. cardiac failure d. extreme edema

a HCP suspects ectopic pregnancy in an adolescent and conduct further evaluation. which s/s have led the provider to suspect ectopic pregnancy? a. hypotension b. abdominal pain c. vaginal bleeding d. cervical abnormalities e. maternal systemic illness

a. hypotension b. abdominal pain c. vaginal bleeding

Amnioinfusion:

addition of sterile fluid into the uterus to supplement the amniotic fluid and reduce compression on the cord -a sterile double lumen cath is introduced through the cervix into the uterus and then attached to IV tubing -initially 250 mL of normal saline is infused

how does the baby breath after delivery?

after a deep breath o

BRUE (brief resolved unexplained event)

an infant is discovered cyanotic and limp but survive after mouth-to-mouth resuscitation from the parents

how would you confirm placement of an NGT for an infant?

aspiration of their gastric contents should look yellow/ green

when do newborns receive their first vaccinations? a. 4 months b. 2 wks c. 1 month d. 2 months

d. 2 months

when do you notice symptoms of NAS/ESC in a newborn? a. 12 hrs post birth b. 4-8 hrs post birth c. immediately d. 24-48 hrs post birth

d. 24-48 hrs post birth

around what day does breastmilk transition from colostrum to human milk? a. 1-2 b. 6-7 c. 3-8 d. 3-4

d. 3-4

preterm labor is categorized as labor prior to the end of week _________ a. 36 b. 38 c. 34 d. 37

d. 37

which part of the newborns foot is the best site to use to obtain blood for the required newborn metabolic testing? a. big toe b. foot pad c. inner sole d. outer heel

d. outer heel

disseminated intravascular coagulation (DIC):

deficiency in clotting ability caused by vascular injury -usually associated with premature separation of the placenta, missed early miscarriage, or fetal death in utero

while teaching a new mother ways to decrease the risk of infection for the newborn, which type of immunity would the nurse explain was transferred to her baby through the placenta? a. active natural b. passive natural c. active artificial d. passive artificial

b. passive natural

how do we relieve tortocollis most often? a. surgical intervention b. passive stretching and excercises c. shoulder elevation when sleeping d. neck brace

b. passive stretching and excercises

why is a multiple gestation pregnancy considered a high risk? a. postpartum hemorrhage is an expected complication b. perinatal mortality is 2-3 x more likely in multiple than in single births c. optimal psychological adjustment after a multiple birth requires 6 months d. maternal mortality is higher during the prenatal period in the setting of multiple gestation

b. perinatal mortality is 2-3 x more likely in multiple than in single births

tonic neck reflex

babies head is turned one way and extension of the limbs on the side occurs; opposite side limbs contract

extrusion reflex:

babies turn brith red because they are holding their breath to protect their airway

tronocolus:

baby will only turn their head one way because the muscles are tight on the other side

initial feeding of the infant:

bellies are the size of a pea -colostrum milk is all they need for the 1st couple of days because their belly is so small -skin to skin will help the baby and mom bond and encourage breastfeeding -many need to be fed as often as q 2.5-3 hrs -crying --> late sign of being hungry

circumcision:

best preformed on the 1st or 2nd day of life after the baby has urinated and also synthesized enough vit K to reduced the chance of faulty blood coagulation -cover penis with petroleum gauze after -they will not preform a circumcision if they dont get the vit K vaccine

what is considered a late preterm infant?

born between 34-37 wks gestation

breastfeeding infant:

breastmilk and formula has 20 kcal/oz -110-120 calories/ kg every 24 hrs to provide enough growth -theres more dat in formula than breastmilk --> linoleic acid essential fatty acid necessary for brain growth and skin integrity in infants -vit D is always supplements for babies no matter if their breastfeeding or formula fed -wetting a diaper 6-8 x a day is a good indicator for fluid intake -sleeping between feedings -no excessive crying -gaining wt

after reporting to the unit, you are assigned to the following patients. which of the patients should be evaluated first? a. a 7 wk pregnant pt who had a cervical cerclage preformed 4 hrs b. a pt diagnosed with pregnancy -induced HTN experiencing urine output 75 mL/hr, BP of 135/90, and slight proteinuria c. a pt at 5 wks gestation with suspected ectopic pregnancy complaining of shoulder and abdominal pain d. a pt in 20th wk of pregnancy suspected of having trophoblastic pregnancy

c. a pt at 5 wks gestation with suspected ectopic pregnancy complaining of shoulder and abdominal pain rationale: because ectopic pregnancy has a higher risk of causing complication

what is hydrocephalus? a. spinal cord injury b. closure of sutures prematurely c. accumulation of an excess amount of CSF in ventricles d. intraventricular hemorrhage

c. accumulation of an excess amount of CSF in ventricles

the most important reason that all pregnant patients should be assessed for the possibility of substance abuse is that: a. the is a major increase in the incidence of fetal chromosomal abnormalities b. the infant may need to be breastfed more frequently to negate the effects of the drugs c. appropriate care may be rendered to the infant after delivery d. illicit drug use may result in a postterm pregnancy

c. appropriate care may be rendered to the infant after delivery

what intervention has decreased the rate of SIDS greatly? a. smoking cessation b. apnea monitoring c. back to sleep d. car eat tests

c. back to sleep

the nurse is reviewing the lab report of a newborn whose hematocrit level is 45%. which value denotes a healthy infant? a. less than 40% b. more than 75% c. between 45% and 65% d. between 65% and 75%

c. between 45% and 65%

what do infants with ankyloglossia have trouble with? a. swallowing b. breathing c. breastfeeding d. cardiac output

c. breastfeeding

which type of isolation precautions would the postpartum nurse plan to implement for a client who has given birth by urgent c-section related to active herpes simplex virus (genitalia) following onset of labor and rupture of membranes 8 hrs ago? a. standard b. droplet c. contact d. airborne

c. contact

how is a retained placenta treated? a. embolism b. hysterectomy c. dilation and curettage d. vaginal exam

c. dilation and curettage

what fetal monitoring technique is contraindicated in patients with coagulation disorders? a. non stress tests b. external monitoring c. fetal scalp monitoring d. biophysical profile

c. fetal scalp monitoring

what does transitional stool look like? a. yellow, seedy b. brown, loose c. green, loose d. black

c. green, loose

which intervention would the nurse initiate when a fetal heart patten signifying uteroplacental insufficiency occurs? a. inserting a urinary cath b. admin oxygen by means of nasal cannula c. helping the client turn to the side-lying position d. encouraging the client to pain with her next contraction

c. helping the client turn to the side-lying position

where is the placenta implanted in placenta previa? a. normal b, transverse c. lower uterus d. upper uterus

c. lower uterus

step in place reflex

hold them up and touch feet to hard surface baby should start walking in place

"late hemorrhage"

occurs between 24 hrs and 6 wks after delivery

SIDS --> sudden infant death syndrome:

peak age of incidence is 2-4 months place baby supine on a firm sleeping surface, encourage room sharing but NOT bed sharing, routine immunizations and breastfeeding causes of SIDS: -sleeping prone -viral respiraatory or botulism infection -exposure to secondhand smoke -pulmonary edema -brainstem abnormalities -HR abnormalities -decreased arousal response -lack of surfactant in alveoli -sleeping in room w/out moving air currents

palmar reflex

sensation causes closing of their hand over the object

post partum hemorrhage: tone

tone --> uterine atony *most common cause of postpartum hemorrhage * 1st step = fundal firmness (will feel "boggy" uterus) 2nd step = fundal height (using the finger breath method) 3rd step = fundal position in relationship to midline 4th step = amount of lochia (determined by pad saturation interventions: 1.oxygen and fluids 1st 2.then start oxytocin (would be for a very short duration) 3.then methylergonovine --> 0.2 IM or *IV can cuase HTN (BP must be 140/90 or lower to give this med)* 4. misoprostol 5. hemabate (prostoglandin) --> *not given if a patient has asthma* 6. bimanual compression --> HCP inserts one hand into the vagina while pushing against fundus through the abd wall 7. blood replacement 8. hysterectomy

true or false: uterine atony is the most frequent cause of PPH

true

true or false: we always caution use of oxytocin in labor in pregnant patient with cardiovascular risks

true

classic c section incision:

vertically cut through abdominal skin in the uterus (very high up on the uterus) -done is there is too much scarring in the lower uterus disadvantage: -uterus could rupture in future labors and patients are advised to not have any further vaginal births

after the 1st breath, BP decreases in the pulmonary artery, what fetal shunt does this help close? a. formen ovale b. ductus arteriousus

b. ductus arteriousus

acute bilirubin encephalopathy

the destruction of brain cells by invasion of indirect or unconjugated bili -premature neonates are more prone to getting this treatment: -phototherapy or exchange treatment is used to correct bili levels

placenta circumvallata:

the fetal side of the placenta is covered in chorion to some extent and is a cause of a fetal abnormality

how is apnea categorized? a. cessation longer than 30 sec b. cessation longer than 20 sec c. cessation longer than 40 sec d. cessation longer than 25 sec

b. cessation longer than 20 sec

which technique would the nurse employ for an obstetrical client with a foreign body airway obstruction? a. black blows b. chest thrusts c. suprapubic thrusts d. abdominal thrusts

b. chest thrusts

which is prevented by providing warm, humidified oxygen to a preterm infant? a. apnea b. cold stress c. respiratory distress d. bronchopulmonary dysplasia

b. cold stress

abortion

medically induced termination of fetus

desquamation

within 24-48 hrs the skin of most newborns begins to dry -most evident in the palms of the feet and hands

what are the 6 categories in the brazelton neonatal behavioral assessment scale?

-habituation -orientation -motor maturity -variation -self-quieting behavior -social behavior

moro reflex:

"startle reflex" fast extension and then inward flexion to "protect" themselves ; swaddling stop their startle reflex

Septic pelvic thrombophlebitis:

*medical emergency* involves the ovarian, uterine, or hypogastric veins usually following mild endometriosis or c-section s/s: -suddenly ill -high fever -chills -abdominal pain -weakness -general malaise -could

amniotic fluid embolism:

*medical emergency* -amniotic fluid gets into the bloodstream and causes an embolism after a membrane rupture or partial premature separation of the placenta s/s --> -pale color -chest pain -"impending doom" -SOB -bluish gray d/t lack of blood flow to the lungs -unconscious within minutes management: -oxygen -within minutes they will beed CPR --> may be ineffective because it doesn't relieve pulmonary constriction -death may occur after that

high risk c-sections:

- a person older than 40 has an increased risk d/t conditions like gestational diabetes, HTN, and non reassuring fetal heart tracing -an obese person has an increased work load and places greater stress on already stressed organs during surgery -secondary illnesses poses a greater risk for surgery ( cardiac dz, DM, anemia, kidney or liver dz) -a person with an already low blood volume is at greater risk d/t the amount of blood loss during a c-section

Isommunization (rhogam):

- moms blood type is negative so she needs to receive rhogam to prevent the fetus of moms next pregnancy from being rejected -has to be given *within 72* hrs of birth -will test babies blood type off of cord blood

gestational HTN:

-140/90 after 20 wks with no proteinuria and no edema -as soon as they are full term they are induced -vasospasm has the most effect on our fetus --> damages the kidneys patients who are at risk: -people of color -obesity -younger than 20 or older than 40 -multiple pregnancies -polyhydramnios -heart dz diabetes -poor nutrition and socioeconomic status

vaginal bleeding:

-ALWAYS report bleeding hypovolemic shock --> occurs when 10% of blood volume is lost (low BP, increase in HR and RR) -s/s --> pale, cool, clammy, decreased LOC -interventions --> fluids, check H&H, oxygen, FHR monitoring -fetal distress --> occurs when 25% of blood is lost

preeclampsia WITH severe features

-BP 160/110 -proteinuria --> 3+-4+ -normally kidney labs will be elevated -pitting edema is present in lower extremities -thrombocytopenia -hepatic dysfunction we may see jaundice -induction for patients over 24 wks s/s to notify HCP --> -thrombus -seizure -abdominal pain -decreased urine output diet: low sodium and high protein when patient is admitted: -seizure precautions -continuous vitals q 15 min -place foley for adequate urine output measurement -can give mag sulfate to prevent seizures (its a smooth muscle relaxant) -hydralazine --> peripheral vasodilator -labetalol --> taken every day to bring BP down -nifedipine -low dose heparin

fetal intolerance of labor:

-FHR will showing variable decelerations -absent variability -late decelerations indicate that the fetus is not tolerating labor well Interventions: R --> reposition on L lateral side O --> oxygen 10-15L A --> alert HCP D --> discontinue oxytocin and start tocolytic I --> increase IV fluids

disseminated intravascular coagulation: (DIC)

-aquirred disorder of blood clotting in which the fibrinogen level fails to below effective limits -the blood isnt able to clot -labs to monitor --> platelets, pTT, aPTT, INR -thrombin time is elevated; platelets are low obstetrical complications associated with DIC: (ie. postpartum hemorrhage, abruption, severe hypertensive disorders of pregnancy, retained stillbirth. amniotic fluid embolism, acute fatty liver)

amniotomy:

-artificial rupturing of the membranes during labor -use amnihook to rupture the membranes disadvantages: -puts fetus at risk for a cord prolapse d/t gush of fluid when membranes are ruptures --> fetus need to be monitored immediately after via external or internal

myasthenia gravis during pregnancy:

-autoimmune disorder characterized by the presence of IgGa antibody against acetylcholine receptors in striated muscles treatment: -ACTH or corticosteroid is given to strengthen nerve conduction

thalassemia:

-autosomal recessively inherited blood disorders that lead to poor hemoglobin formation and severe anemia -symptoms are developed during childhood treatment: folic acid, normal pregnancy supplements, and blood transfusions (if they are bleeding or have a low H&H)

Macorsomia babies:

-becomes a problem when the fetus size is more than 9-10 Ib -may cause uterine dysfunction during labor or at birth d/t the overstretching of myometrium -a c-section is the proposed method of birth risks for having a LGA baby vaginally: -cervical nerve palsy -fractured clavicle -hemorrhage

HELLP syndrome:

-cause is unknown, is a variation of gestational hypertensive process for the common symptoms that occur: -hemolysis leads to anemia -abnormal bleeding/ clotting (d/t low platelets) -epigastric pain (d/t elevated liver enzymes) s/s: -proteinuria -edema -nausea -increased BP -general malaise -RUQ tenderness from liver inflammation therapy: -infusion of FFP or platelets to improve platelet count -baby will be SGA -this syndrome goes away after delivery of fetus -#1 risk factors --> preeclampsia is previous pregnancy

uterine rupture:

-contractions will completely stop -fetal heart sounds will be absent -c-section needs to happen immediately or fetus will die -*immediate emergency* -there will be two distinct swelling spots on the abdomen --> one from the fetus and one from the uterus to contract and minimize bleeding -administer oxytocin to try and get the uterus contributing factors for uterine rupture: -prolonged labor -abnormal presentation -multiple gestation -unwise use of oxytocin -obstructed labor or traumatic use of forceps

Diabetes during pregnancy:

-decreased control of glucose regulation -effects fetal size, infant hypoglycemia, and increased incidence of congenital anomalies -insulin dosage needs to be increased during pregnancy fasting oral glucose test: -done at 1,2, and 3 hrs -if 2 of the hrs are 95 or above gestational diabetes is diagnosed -any fasting BG over 126 -any non fasting over 200 -testing is done at 24-28 wks High risk mom categories: -obesity -hx of having a large baby -unexplained fetal abnormalities -PCOs -over the age of 35 -family hx of gestational DM -moms BG should go back to normal within st 24 hrs -36-40 wks is the most dangerous time because thats when the fetus is drawing all the nutrients from storage at once -usually moms are on long acting insulin -don't give any fluids with dextrose cal lead to: -preeclampsia -c-section -macrosomia

RA during pregnancy:

-dz of connective tissue marked by joint inflammation ad contracture from autoimmune response -pregnant patients cannot take methotrexate for the treatment of RA --> can still take corticosteroids -joint pain symptoms may increase during pregnancy

face presentation:

-face presentation is often too large to fit through the pelvis during birth -if born in face presentation babies will present with facial edema, and may have bruising -gavage feeding may be necessary to allow them enough nutrition until they can suck effectively

scoliosis during pregnancy:

-harder to have an epidural put in because of the curvature of the spine -curvature of the spine normally diagnosed between 12-14 yrs old, if left uncorrected can progress till curvature interferes with respiration and heart function -pelvic distortion can interfere with childbirth, especially at the pelvic inlet

risks for pregnancy during adolescence:

-high risk for iron-deficiency anemia -they are not developmentally fully developed -adolescents technically have control over the baby and their own body while giving birth even tho they are a minor -increased risk for preterm birth -lower brith weight infants -partner violence is high in this population -total denial during pregnancy -cephalopelvic insufficiency with makes it hard to give a vaginal birth -high risk for hemorrhoids -they will need education on everything about the baby

ectopic pregnancy:

-implantation of zygote at a site other than uterus (usually the fallopian tubes) -sharp flank pain will occur

nasopharyngitis during pregnancy:

-increased congestion d/t increased levels of estrogen during pregnancy treatment--> rest, sleep, humidifier, warm or cool compress for sinus headache, *NO ASPRIN*

pancreatitis in pregnancy:

-inflammation of pancreas -s/s epigastric pain, nausea, vomiting, anorexia, and fever

prolonged latent phase:

-intensity of contractions is minimal -can last as long as 20 hrs (normally would last for 12) -we would give them an epidural for their pain -hypertonic contractions, painful

preterm labor:

-labor that occurs before the end of week 37 -put mom on bed rest -give tocolytic to stop labor --> is contraindicated after 48 hrs -give steroids to increase fetal lung function (24 hrs before brith ideally) -have mom do kick counts -baby will be SGA -use narcotics cautiously with preterm babies -complication of early membrane rupture --> umbilical cord prolapse precursors: -dehydration -UTI -periodontal dz (gingivitis or bad oral care) -choriomniontitis --> any sort of infection of amniotic fluid or uterus -lack of prenatal care s/s: -persistent, dull and low backache -vaginal spotting -pelvic pressure of feeling of abdominal tightening -menstrual like cramping -increased vaginal discharge -uterine contractions -intestinal cramping

pneumonia during pregnancy:

-limits the viability of oxygen from inflammation of the alveoli treatment: oxygen if needed and antibiotics -pneumonia is associated with fetal growth restriction and preterm birth d/t oxygen deficit

hyperbilirubinemia

-lysis of RBCs -Rh incompatibility -ABO incompatibility mostly forms in the 1st 72 hrs because there is an active exchange of fetal maternal blood as the placenta villi loosen and is delivered s/s: -jaundice -elevated serum bili -hepatomegaly -poor muscle tone -lethargy -poor sucking reflex treatment: -feeding --> bili is excreted through urine and stool -phototherapy --> stools are often bright green -exchange transfusion --> removes senistixed cells

s/s LGA baby:

-macrosomia -#1 cause gestational DM and obesity -hypoglycemia -poor heart function -hyperbilirubinemia -they act a lot like preterm infants

s/s SGA baby:

-main cause is fetal growth restriction -hypoglycemia -pale skin and not as elastic -less hair -wide sutures in the skull -abdomen is more sunken and not as rounded -umbilical cord can be a yellow color -high hematocrit -polycythemia -prolonged acrocynosis

von willebrand dz:

-missing coagulation factor in the blood -factor 8 is given to help in the cascade of coagulation so they dont bleed out -internal fetal monitoring is contraindicated in these clients d/t risk for bleeding

cystic fibrosis during pregnancy:

-mucous all over the body from secretion of pancreas and lungs leading to difficulty digesting fat and protein because the pancreas cannot release amylase -genetic dz -fetus is at risk for growth restriction, preterm birth, and perinatal death -PKU test on fetus tells us if they have cystic fibrosis -increased risk of gestational diabetes w/ cystic fibrosis treatment --> nebulizer, vibration vest

systemic lupus erythematosus during pregnancy:

-multisystem chronic dz of the connective tissue that occurs frequently in chromosomal females age 20-40 -frequent monitoring of creatinine, edema, BP, and urine output must be done -during labor: IV hydrocortisone is administered to adjust to stress -infants may be born with a butterfly rash, anemia, thrombocytopenia, and neonatal heart blocking (may need pace maker) lasting for up to 6 months and then fade

appendicitis during pregnancy:

-nausea, sharp peristaltic pain, sharp persistent pain in the LRQ, McBurneys point test is done to test for rebound tenderness - if appendix ruptures there is an increased risk of fecal material escaping into the fallopian tubes to the fetus -after 37 weeks patient can have c-section and appenedcotomy

prolonged deceleration phase:

-no progress in dilation for 3hrs --> complete rest of dilation -can last up to 3 hrs from the fetal head being in a posterior position -prolonged engagement -laying down and having them pull knees as far to their chest as they can will help with the labor process

polyhydramnios :

-normal amniotic fluid volume is 500 --> 1000 -too much is 2,000 mL #1 high risk for this happening --> gestational diabetes risks for baby in utero: -cord prolapse -nuchal cord management: -bed rest can cause fetal malpresentation, premature rupture of membranes, infection, preterm birth, and prolapse cord

abnormalities of the placenta:

-normal placenta weighs 500g -normal cord contains 1 vein and 2 arteries 2 vessel cord --> happens because there is an absent umbilical artery normally associated with some sort of congenital heart or kidney abnormality an unusual cord length --> could mean a premature separation of the placenta or abnormal fetal lie

shoulder dystocia:

-occurs during the second stage of labor -fetal head is born but the shoulders are too broad -force of birth can result in a fractured clavicle or brachial plexus injury for the fetus most likely to occur in: -pts w/ diabeties -LGA -post term pregnancies two procedures to complete labor after shoulder dystocia: -McRoberts and suprapubic pressure

A parent planning to bottle feed asks you which form of formula is the most economical to use. Which of the following would you include in your response? A.Prepackaged, individually prepared bottles B.The condensed type that requires water to dilute C.The powder type, which is combined with water D.The ready-to-pour liquid type

C.The powder type, which is combined with water

multiple gestation:

2nd fetus during labor is usually the problem --> increased incidence of cord entanglement and premature separation of placenta -with twins we want to hear two separate FHRs -normally twins will be SGA rebozo method: -the method of how we are trying to flip them, using hands to try and move one of the babies to a good position

placenta succenturiata:

a placenta that has one or more accessory lobes connected to the main placenta blood vessels -the small lobes may be retained after birth and can lead to postpartum hemorrhage

what is normal to occur with newborn respirations? a. at least 30 bpm, irregular b. no retractions c. normal apnea d. at least 60 bpm, rapid

a. at least 30 bpm, irregular

what are assessment findings for a postterm infant? select all a. dry, cracked skin b. long fingernails c. lots of vernix d. hypoglycemia

a. dry, cracked skin b. long fingernails d. hypoglycemia

A parent is concerned because their child has lost 8 oz 3 days after birth. Which response by the nurse is appropriate? A."Your baby needs to be checked for a viral illness." B."This is a normal and expected finding." C."Your baby is probably just dehydrated." D."You need to give your baby formula since the infant has lost weight during breastfeeding."

B."This is a normal and expected finding."

You assess that the fetus of a patient is in an occiput posterior position. You know that the labor most likely will be different from a patient whose fetus is in an anterior position in that the patient: A.Will have a shorter second stage of labor B.May experience more pronounced back pain C.May need to have an external cephalic version performed D.Probably will need to have the delivery assisted by forceps or vacuum extraction

B.May experience more pronounced back pain rationale: labor will be longer because the occiput needs to rotate to an anterior position

Newborns can become dehydrated easier than adults. This is explained by which statement? A.Newborns do not have as many fluid choices as adults. B.The large amount of body fluids are mainly extracellular fluid in a newborn. C.Adults get sick more often. D.Newborns lose more fluids through insensible water loss.

B.The large amount of body fluids are mainly extracellular fluid in a newborn.

A pregnant patient who is carrying triplets is concerned when their obstetrician suggested that they give birth by cesarean delivery. What is the most accurate statement that the nurse can make to the patient regarding this? A.Traditional labor room suites cannot accommodate the personnel needed during the birth of three infants like the operating room can. B.It is safer to know exactly when the delivery will occur so that the healthcare team will be available. C.A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation. D.Labor contractions are so powerful in a multiple gestation that a cesarean delivery is safer for the infants and birthing parent.

C.A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation.

A pregnant patient who is carrying triplets is concerned when their obstetrician suggested that they give birth by cesarean delivery. What is the most accurate statement that the nurse can make to the patient regarding this? A.Traditional labor room suites cannot accommodate the personnel needed during the birth of three infants like the operating room can. B.It is safer to know exactly when the delivery will occur so that the healthcare team will be available. C.A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation. D.Labor contractions are so powerful in a multiple gestation that a cesarean delivery is safer for the infants and birthing parent.

C.A cesarean delivery helps to prevent complications due to cord prolapse or premature placental separation. rationale: because multiple gestations are more likely to have labor complications

A parent who intends to breastfeed is advised by their sibling to use formula for the first few days until the "real" milk comes in. Which is the nurse's best response regarding this information? A.Suggest that the parent use formula to supplement for the first 2 days. B.Discuss with the parent that "real" milk will not come in if they use formula and does not nurse the baby right away. C.Discuss that colostrum is all the nutrition a baby needs the first few days of life. D.Advise the parent to disregard any suggestions by their sibling about newborn nutrition.

C.Discuss that colostrum is all the nutrition a baby needs the first few days of life.

Which of the following is the primary reason that the cesarean birth rate is so high in the United States? A.Premature labor B.Fetal malpresentation C.History of previous cesarean delivery d. labor dystocia

C.History of previous cesarean delivery

The nurse is assessing a 2-day-old newborn who is irritable, pale, and not interested in eating. Which of the following additional signs is an indicator of bacterial infection in the newborn? A.Increased white blood cells B.Increased neutrophils C.Subnormal temperature D.Cough

C.Subnormal temperature

What is the most accurate statement regarding exercise and nutrition during pregnancy for a patient with diabetes? A.Extreme exercise may cause hypoglycemia; therefore, it should be avoided. B.During the last trimester, caloric intake should be decreased to less than 1,800 calories to control fetal weight gain. C.Exercise reduces the need for insulin; therefore, beginning an exercise regimen during pregnancy is recommended. D.Ideally, dietary calorie intake should be approximately 20% from protein, 40% to 50% from carbohydrates, and up to 30% from fats.

D.Ideally, dietary calorie intake should be approximately 20% from protein, 40% to 50% from carbohydrates, and up to 30% from fats.

which characteristic would the nurse anticipate in an infant born at 32 weeks gestation? a. barely visible areola and nipples b. ear pinnae that spring back when folded c. definite creases of the infants palms and soles d. a 0 degree angle on the square window sign

a. barely visible areola and nipples rationale: breast tissue is not palpable in a newborn of less than 33 wks gestation

anemia of prematurity:

RBC formation doesnt happen till 32 wks and if they are born before that they can come out anemic -delayed cord clamping can help with getting as much blood from the placenta to the baby as possible

how do we treat pancreatitis in pregnancy ? select all a. bowel rest b. TPN c. IV hydration d. PPI

a. bowel rest c. IV hydration

if herpes in a newborn is left untreated, what will they experience? select all a. dyspnea b. HTN c. CNS damage d. jaundice

a. dyspnea c. CNS damage d. jaundice

which findings would indicate infection in a pregnant client? select all a. chills b. fever c. diarrhea d. flank pain e. burning on urination

a. chills b. fever c. diarrhea d. flank pain e. burning on urination

newborns body surface to cooler surrounding air is what kind of heat loss? a. convection b. conduction c. radiation d. evaporation

a. convection

endometriosis:

a peurperal infection -infection of the endometrium, bacteria gain access to the uterus through the vagina and enter the uterus either at the time of birth or during the postpartum period s/s --> fever around 4th day postpartum and no breast filling, loss of appetite, general malaise, uterus is painful to touch, lochia is dark brown with foul oder dx--> ultrasound to see inflammation of endometrium and culture of the organism leading to infection treatment: -antibiotic such as clindamycin -oxytocic agent such as methlergonovine -increased fluids to combat fever

all infants after weightloss period gain how many Ib per month till 6 months? a. 2 Ib b. 4 Ib c. 1 Ib d. 3 Ib

a. 2 Ib

meconium plug or illeus presents as no stool within how many hrs? a. 24-48 hrs b. 24 hrs c. 12 hrs d. 36-48 hrs

a. 24-48 hrs

preeclampsia without severe features means what? select all a. BP 140/90 or higher b. mild edema of face c. proteinuria of 1+ to 2+ d. weight gain 4+ Ib a week

a. BP 140/90 or higher b. mild edema of face c. proteinuria of 1+ to 2+

management of hydatidifrom mole is what? a. D/C trophoblast cells b. admin of fibrogen c, bed rest for 2 wks d. cervix dilation

a. D/C trophoblast cells

in pregnant CF patients what are they at higher risk for? select all a. anemia b. gestational diabetes c. gene mutation d. increased respiratory infections

a. anemia b. gestational diabetes

the nurse if differentiating between cephalhematoma and caput succedaneum. which finding is unique to caput succedaneum? a. edema that crosses the suture line b. scalp tenderness over the affected area c. edema that increases during the first day d. scalp over the area becomes ecchymosed

a. edema that crosses the suture line

what procedure can be difficult with scoliosis? a. epidural anesthesia b. fetal monitoring c. general anesthesia d. C/S

a. epidural anesthesia

a pregnant client is admitted with abdominal pain and heavy vaginal bleeding. which is the immediate nursing action? a. establish IV access b. elevate the HOB c. position the client laterally to the left d. administer IM analgesic

a. establish IV access

how do we treat hypoglycemia in newborns? select all a. glucose infusion b. calcium infusion c. frequent feeding d. continuous cardiac monitoring

a. glucose infusion c. frequent feeding

what are s/s of PP psychosis? select all a. hallucinations b. paranoia c. anticlimactic feeling d. confusion

a. hallucinations b. paranoia d. confusion

a pt whos membranes ruptured if discharged to home. which of the following points would you most likely include in their teaching plan? a. having a pt monitor their temp 2x a day b. anticipating having a vaginal examination within 24 hrs after discharge c. remaining on bed rest for the 1st 24 hrs and then resume normal activity d. hourly assessment of Homan sign

a. having a pt monitor their temp 2x a day rationale: to monitor for infection

several hrs after delivery, a new mother expresses ambivalence regarding her infant. how will the nurse promote bonding between this mother and her newborn? a. having the mother feed the infant b. removing the infant from the mothers arms if it cries c. positioning the infant so its head rests on the mothers shoulders d. encouraging the mother to sleep for 4-6 hrs before interacting with the infant

a. having the mother feed the infant

a client with a BP of 150/90, 3 + proteinuria, and edema of the hands and face is diagnosed with severe preeclampsia. which other clinical findings support this diagnosis? select all a. headache b. constipation c. abdominal pain d. vaginal bleeding e. visual disturbances

a. headache c. abdominal pain e. visual disturbances

for which complication would a client who has had a spontaneous abortion be assessed? a. hemorrhage b. dehydration c. hypertension d. subinvolution

a. hemorrhage

how will we deliver oxygen to a newborn with RDS? a. highflow pressure b. vasoconstriction methods c. oxygen tent d. lowflow pressure

a. highflow pressure

what are assessment findings of an LGA newborn? a. immature reflexes b. wide sutures and fontanel c. cephalohematoma d. birth injury

a. immature reflexes c. cephalohematoma d. birth injury

what sources can nurses use to regulate infant temp? select all a. incubator b. radiant warmer c. skin to skin d. bilirub lights

a. incubator b. radiant warmer c. skin to skin

which conditions are risk factors that may place infants at higher risk for developing jaundice? select all a. infection b. african american race c. prematurity d. breast feeding e. formula feeding f. maternal diabetes

a. infection c. prematurity d. breast feeding f. maternal diabetes

what type of anemia can lead to pica? a. iron b. sickle cell c. beta thalassemia d. folic acid

a. iron

what mineral/ vitamin should newborns have as supplements if breastfed? a. iron and vit D b. iron and calcium c. calcium and vit A

a. iron and vit D

which statement by a new mother observing her preterm infant in the neonatal intensive care nursery indicates that she has not yet begun the boding process? a. its such a tiny baby b. fo you think he'll make it? c. why does he need to be in an incubator? d. my baby looks so much like my husband

a. its such a tiny baby

what fetal assessment would be needed with oligohydramnios? select all a. kidney dz b. lung development c. brain development d. pancreatic development

a. kidney dz b. lung development

which assessment findings are suggestive of postpartum depression? select all a. lethargy b. ambivalence c. emotional lability d. increased appetite e. long periods of sleep

a. lethargy b. ambivalence c. emotional lability

a newborn erros of metabolism may present with what symptoms? select all a. lethargy b. hypotonia c. seizures d. high pitched

a. lethargy b. hypotonia c. seizures

which is a neonatal effect of maternal smoking during pregnancy? a. low birth wt b. facial abnormalities c. chronic lung problems d. hyperglycemic reactions

a. low birth wt

a breastfeeding mother experiences redness and pain in the left breast, a temp of 100.8, chills, and malaise. which condition would the nurse suspect? a. mastitis b. engorgement c. blocked milk duct d. inadequate milk production

a. mastitis

what is the second line of medication treatment of PPH? a. methylergonovine b. oxytocin c. misoprostol d. carboprost

a. methylergonovine

a 26 yr old client at 29 wks gestation has gained 8 Ibs in 2 wks; her BP has increased from 128/74 Hg to 150/90; and she has developed 1 + proteinuria on the dipstick. which condition do these signs suggest? a. mild preeclampsia b. severe preeclampsia c. chronic HTN d. gestational HTN

a. mild preeclampsia

which factor will increase the risk for uterine atony in a postpartum client? a. multiple gestation b. gestational anemia c. hypertonic contractions d. group B strep

a. multiple gestation because it thins the uterine wall by overstreching

why would a patient have a c-section? select all a. multiple gestation b. failure to progress c. cephalopelvic disproportion d. breech presentation

a. multiple gestation b. failure to progress c. cephalopelvic disproportion d. breech presentation

which information would the nurse include in the discharge teaching of a postpartum client? a. the prenatal kegel tightening exercises should be continued b. a bowel movement may not occur for up to a week after birth c. the episiotomy sutures will be removed at the first postpartum visit d. a postpartum checkup should be scheduled as soon as menses return

a. the prenatal kegel tightening exercises should be continued

treating hydrocephalus with a shunt, what education needs to be provided to parents? select all a. the shunt will need to be replaced as child grows b. fluid drains into the peritoneum c. ICP is normal d. monitor for infection

a. the shunt will need to be replaced as child grows b. fluid drains into the peritoneum d. monitor for infection

which information would the nurse give a pregnant client about having a chorionic villus sampling (CVS)? a. the test can result to spontaneous abortion b. the results are not as accurate c. the information it provides is inadequate d. it must be done with the use of laparoscopic surgery

a. the test can result to spontaneous abortion

which test is used to confirm breech presentation? a. ultrasound b. fetal scalp pH c. amniocentesis d. digital pelvemetry

a. ultrasound

a client at 36 wks gestation has a BP of 140/90. which additional sign of preeclampsia would the nurse assess for? a. urine dipstick postive for protein b. mild ankle edema c. episode of dizziness on arising d. wt gain of 2 Ib in 2 wks

a. urine dipstick postive for protein

when are lacerations most likely to occur? select all a. use of instruments b. SGA c. LGA d. precipitate births

a. use of instruments c. LGA d. precipitate births

why is it important for the nurse to encourage a client with preeclampsia to lie in the left lateral recumbent position? a. uterine and kidney perfusion are maximized, and compression of the major vessels is relieved b. intra-abdominal pressure on the iliac veins is maximized, and there is increased blood flow to the pelvic area c. aortic compression is maximized, thereby decreasing uterine arterial pressure and increase uterine blood flow d. hemoconcentration is maximized, thereby reducing blood volume an cardiac output and increasing placental perfusion

a. uterine and kidney perfusion are maximized, and compression of the major vessels is relieved

initial treatment of PPH is what? a. uterine massage b. hysterectomy c. curettage d. gauze packing

a. uterine massage

for a posterior positioned fetus, what intervention is needed? select all a. void q 2 hrs b. cervical ripening c. rotation methods d. counterpressure

a. void q 2 hrs c. rotation methods

the nurse is preparing to discharge a 3 day old infant who weighed 7 Ib at birth. which finding should be reported immediately to the HCP? a. wt of 6 Ib 4 oz b. hemoglobin of 16.2 g/dL c. 3 wet diapers over the last 12 hrs d. total serum bilirubin if 10 mg/dL

a. wt of 6 Ib 4 oz

urinary retention: postpartum

after birth bladder sensation for voiding is decreased because of bladder edema and caused by the pressure of birth -if mom continues to have urinary retention foley cath the patient -catheter should be left in for 24 hrs then we would let them try to void on their own --> if they dont void within 6 hrs we are concerned

which statement by a patient who is 8 wks pregnant and has cardiac dz would you most likely follow up closely? a. "I have been really constipated for the last few weeks" b. "I have gained 4 Ib during the last week, but im not eating more than before" c. "i have not felt any fetal movement as of yet" d. I have has episodes in the morning when I have almost thrown up"

b. "I have gained 4 Ib during the last week, but im not eating more than before"

when does postpartum blues occur? a. 1-5 days b. 1-10 days c. 2 wks d. 4 wks

b. 1-10 days

postpartum how long until mothers BG normalizes? a. 12 hrs b. 24 hrs c. 2 hrs d. 8 hrs

b. 24 hrs

what can cause hyperbiliruibinemia? select all a. hypoglycemia b. ABO incompatability c. Rh incompatability d. secondary pathology

b. ABO incompatability c. Rh incompatability

what type of hepatitis are spread across the placenta? select all a. A b. B c. C d. D

b. B c. C

what are important interventions in labor for patients with sickle cell anemia? a. increased room temp b. IV fluids c. oxygen administration d. pain management

b. IV fluids c. oxygen administration d. pain management

how can hydrocephalus be diagnosed? select all a. lumbar puncture b. MRI c. transillumination d. skull x-ray

b. MRI c. transillumination d. skull x-ray

following a multiple pregnancy birth, what is the pt at risk for? a. hyperemesis b. PP bleeding c. PP seizures d. hypertension

b. PP bleeding

what interventions are needed with a prolonged latent phase caused by hypertonic contractions? select all a. increasing oxytocin b. adequate hydration c. ultrasound d. providing rest

b. adequate hydration d. providing rest

what is the management for meconium aspiration? select all a. IVF b. antibiotic therapy c. surfactant d. oxygen admin

b. antibiotic therapy c. surfactant d. oxygen admin

before forceps are applied what must happen? select all a. trial of pushing b. bladder is empty c. cervix fully dilated d. membranes ruptures

b. bladder is empty c. cervix fully dilated d. membranes ruptures

what is a common cause of dysfunctional labor? a. starting epidural too quickly b. cephalopelvic disproportion c. prolonged first stage of labor d. oxytocin

b. cephalopelvic disproportion

the nurse applies fetal and uterine monitors to the abdomen of a client in active labor. when the client has contractions, the nurse notes a 15 beat/min deceleration of the FHR below the baseline lasting 15 min. which is the next nursing action? a. calling the primary HCP b. changing the maternal position c. obtaining the maternal BP d. preparing the environment for an immediate birth

b. changing the maternal position rationale: fetus is responding to partial cord compression

what are assessment findings in a preterm infant? select all a. pink at birth b. covered in vernix caseosa c. ruddy skin d. small fontanels

b. covered in vernix caseosa c. ruddy skin d. small fontanels

a nurse determines that a newborn us suffering from respiratory distress. which visible signs confirm this assessment? select all a. crackles b. cyanosis c. wheezing d. tachypnea e. retractions

b. cyanosis d. tachypnea e. retractions

15 yr old pt is 6 months pregnant when first coming for prenatal care. the patient states that. "i had no idea I was pregnant." what is the most probable rationale for the patients statement? a. ignorance of the signs of pregnancy b. denial of the pregnancy c. low intelligence level d. lack of visible pregnancy signs

b. denial of the pregnancy

if you are giving seizure medications to pregnant patients, what intervention should be done? a. check antibodies b. drug levels c. also give antacid d. check neuro status

b. drug levels

which would the nurse ask the postpartum client to do before assessing her uterine fundus? a. drink fluids b. empty her bladder c. preform valsalva maneuver d. assume the semi-fowler position

b. empty her bladder

which would be included in the plan of care for an obstetrical client who has been taking carbamazepine throughout the first trimester of pregnancy? a. evaluation for fetal hydramnios b. evaluation for a neural tube defect c. evaluation for cardiac malformation d. chromosomal assessment for down syndrome

b. evaluation for a neural tube defect

which major group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula? a. amino acids b. gamma globulins c. essential electrolytes d. complex carbs

b. gamma globulins

what assessment findings are present in a newborn with hydrocephalus? select all a. sutures closed b. hyperactive reflexes c. high -pitched cry d. fontanelles widen

b. hyperactive reflexes c. high -pitched cry d. fontanelles widen

what is the last resort if PPH is not controlled? a. blood replacement b. hysterectomy c. bimanual compression d. debridement

b. hysterectomy

what interventions should a nurse taking care of a PPH do? select all a. position head of bed elevated b. insert a foley cath c. administer 10 L via facemask d. straight cath

b. insert a foley cath c. administer 10 L via facemask

what is the most common method of OC cervical ripening? a. sweeping of membranes b. insertion of prostaglandin c. hygroscopic suppositories d. administration of oxytocin

b. insertion of prostaglandin

what affect does an increase in maternal BP have on the fetus? a. increase in accelerations b. insufficient blood supply c. LGA d. increased oxygen delivery

b. insufficient blood supply

Where is Vit K synthesized? select all a. liver b. intestinal flora c. bone marrow d. muscle

b. intestinal flora c. bone marrow

what is the most common cause of SGA? a. gestational diabetes b. intrauterine growth restriction c. mother with seizure disorder d. medications

b. intrauterine growth restriction

the nurse is assessing a new mother at a health care facility. which symptom would the nurse identify as a symptom of postpartum blues? a. frantic energy b. mild irritability c. hallucinations d. unwillingness to sleep

b. mild irritability s/s also include tearfulness, rapid mood fluctuations, and anxiety

what treatment is most common doe newborns with NAS/ESC? select all a. no pacifier b. morphine administration if needed c. NG tube for feeds d. incubation period in NICU

b. morphine administration if needed c. NG tube for feeds

which combination of maternal and infant blood type would be an indication for admin of Rho (D) immune globin (RhoGAM) to the postpartum client? a. mother A + and infant O + b. mother O - and infant O + c. Mother AB - and infant B- d. mother B + and infant B -

b. mother O - and infant O +

why is a multiple gestation pregnancy considered a high risk? a. postpartum hemorrhage b. perinatal mortality is 2-3x more likely in multiple than single births c. optimal psychological adjustment after multiple birth requires 6 months -1 yr d. maternal mortality is higher during the prenatal period in the setting of multiple gestation

b. perinatal mortality is 2-3x more likely in multiple than single births

what assessments will the nurse see with a trauma related PPH? select all a. forcept delivery b. perineal lacerations c. perineal hematoma d. retained placenta

b. perineal lacerations c. perineal hematoma

what is the therapeutic management for hyperbilirubinemia? select all a. twin transfusion b. phototherapy c. increase feeding frequency d. bone marrow aspiration

b. phototherapy c. increase feeding frequency

why does bleeding occur in placenta previa? select all a. placenta hemorrhages b. placenta cant stretch to accommodate c. preterm labor d. cervix dilates

b. placenta cant stretch to accommodate d. cervix dilates

women who become pregnant for the 1st time at a later reproductive age (35+) are at risk for which complications? select all a. seizures b. preterm labor c. multiple gestation d. chromosomal abnormalities e. bleeding in the 1st trimester

b. preterm labor c. multiple gestation d. chromosomal abnormalities e. bleeding in the 1st trimester

preeclampsia with severe features has symptoms of what? select all a. mild nonpitting edema b. proteinuria 3+ to 4+ c. BP 160/110 d. elevated serum creatinine

b. proteinuria 3+ to 4+ c. BP 160/110 d. elevated serum creatinine

why do we delay cord clamping in preterm infants? select all a. encourage fetal circulation to continue b. reduce development of anemia c. increase maternal antibodies d. allow as much blood to enter from placenta

b. reduce development of anemia d. allow as much blood to enter from placenta

which is the most important parameter for the nurse to monitor during the first 24hrs after the birth of an infant at 36 wks gestation? a. duration of cry b. respiratory distress c. frequency of voiding d. poor nutritional intake

b. respiratory distress

what causes transient tachypnea? a. breech position b. retained fluid in lungs c. low oxygen d. administration of glucocorticosteroids

b. retained fluid in lungs

why does peritonitis cause future fertilitty problems? a. hemorrhage b. scarring and adhesions in pertoneum c. separation of fallopian tubes d. antibiotic scaring

b. scarring and adhesions in pertoneum

which statements by the nurse while teaching students about viable pregnancy related to preterm labor? select all a. a premature baby has good cognitive development b. the treatment for preterm labor include bed rest and hydration c. preterm labor before the 20th week is indicative of a nonviable fetus d. it is not desirable to intervene and stop the delivery in the case of preterm labor e. preterm labor refers to uterine contractions progressing to delivery before the 27th week of pregnancy

b. the treatment for preterm labor include bed rest and hydration c. preterm labor before the 20th week is indicative of a nonviable fetus

what are hemangiomas? a. difference of color from one side of the body to the other b. vascular tumors of the skin c. hemolyzed RBCs d. palor

b. vascular tumors of the skin

what will the umbilical cord stump look like after birth? a. red, wet b. white, gelatinous c. clear, moist d. pale, exudate

b. white, gelatinous

what is considered an early preterm infant?

born prior to 34 wks and after 24 wks

breastmilk and formula for term newborns should be how many kcal? a. 22 b. 24 c. 20 d. 19

c. 20

between which weeks of gestation would a client with type I DM expect to increase her insulin dosage? a. 10th and 12th weeks of gestation b. 18th and 22nd weeks of gestation c. 24th and 28th weeks of gestation d. 36th and 40th weeks of gestation

c. 24th and 28th weeks of gestation beginning of third trimester insulin needs to be increased because of an increase in maternal resistance to insulin

what weight is categorized as macrosomnia? a. 6 kg b. 4.8 kg c. 4.5 kg d. 5.5 kg

c. 4.5 kg

the nurse in the newborn nursery is monitoring an infant for jaundice related to ABO incompatibility. which blood type does the mother usually have to cause this incompatibility? a. A b. AB c. O d. AB

c. O

a client measuring at 18 wks gestation visits the prenatal clinic stating that she is still very nauseated and vomits frequently. physical examination reveals a brown vaginal discharge and blood pressure of 148/90. there are absent fetal heart sounds. which condition does the nurse suspect? a. dehydration b. choriocarcinoma c. hydatifrom mole d. threatened abortion

c. hydatifrom mole

after an incomplete abortion, a client asks the nurse to tell her again what is is meant by an "incomplete abortion." which response by the nurse is appropriate? a. i dont think you should focus on this anymore b. its when the fetus dues but is retained in the uterus for at least 2 months c. its when parts of the pregnancy tissue are expelled and parts remain in the uterus d. it think its best for you to ask your primary HCP for the answer to that question

c. its when parts of the pregnancy tissue are expelled and parts remain in the uterus

a pregnant client w/ a hx of preterm labor is at home on bed rest. which instruction would be included in this clients teaching plan? a. place blocks under the foot of the bed b. sit upright with several pi;;owes behind the back c. lie on the side with the head raised on a small pillow d. assume the knee-chest position at regular intervals throughout the day

c. lie on the side with the head raised on a small pillow -keeps pressure of the fetal head off the cervix

why should the use of baby powder be avoided on an infant? a. skin irritation b. skin infection c. lung irritation d. respiratory infection

c. lung irritation

what medication do we give to treat eclampsia? a. oxytocin b. potassium sulfate c. mag sulfate d. corticosteroids

c. mag sulfate

the nurse teaches a new mother how to position her newborn during feedings. which is the best way to evaluate if the teaching was effective? a. develop basic teaching plan b. ask the mother is she understands c. observe the mother feeding the infant d. determine the mothers readiness to learn

c. observe the mother feeding the infant

how is twin to twin transfusion identified? a. increase in both twins hemoglobin b. mothers abd circumference is abnormal c. one twin is larger in sonogram d. testing in the 3rd trimester

c. one twin is larger in sonogram

which is suspected when a client at 37 wks gestation experiences a sudden sharp pain in her abdomen with a period of fetal hyperactivity followed by fundal tenderness and a small amt. of dark red bleeding? a. true labor b. placenta previa c. partial abruptio placentae d. abdominal muscular injury

c. partial abruptio placentae

which cardiac dz has the lowest risk for maternal mortality? a. endocarditis b. aortic stenosis c. patent duct arteriosus d. pulmonary HTN

c. patent duct arteriosus

what is a treatment option for separation of the symphysis pubis? select all a. c-section b. continued breastfeeding c. pelvic floor therapy d. kegel exercises

c. pelvic floor therapy d. kegel exercises

which factor contraindicates sexual intercourse during pregnancy? a. fetal tachycardia b. presence of leukorrhea c. premature rupture of membranes d. imminence of the estimated date of birth

c. premature rupture of membranes

what are preamature infants at risk for based on lack of sufficient lung surfactant? a. sepsis b. hypoglycemia c. respiratory distress syndrome d. hemorrhage

c. respiratory distress syndrome

which intervention will be delayed until the newborn is 36-48 hrs old? a. vitamin K injection b. test for blood glucose level c. screening for phenylketonuria d. testing for necrotizing enterocolitis

c. screening for phenylketonuria

what increases the risk of venous thromboembolic disease in pregnancy? a. episiotomy b. keto diet c. stasis d. hypercoagulation

c. stasis d. hypercoagulation

with complete uterine rupture what happens to contractions? a. late decelerations b. no change c. stop completely d. variable decelerations

c. stop completely

when planning care for a patient with type 1 DM, which change in insulin requirements would the nurse anticipate on the 1st postpartum day? a. slow decrease b. rapid increase c. sudden decrease d. gradual increase

c. sudden decrease

what is treatment for meningocele? a. lumbar puncture b. hydrocephalus shunt c. surgery to replace meninges and close skin d. PT/OT

c. surgery to replace meninges and close skin

how is caput succedaneum/ cpehalohematome treated? a. breastfeeding b. bilirubin treatment c. time will reduce both d. evacuation of blood

c. time will reduce both

which T's are included in postpartum hemorrhage? select all a. tocolytic b. tetany c. tone d. trauma

c. tone d. trauma

placenta accreta:

deep attachment of the placenta to the uterine myometrium causing the placenta to not loosen to be delivered -can cause a hemorrhage -most need a hysterectomy and treatment with methotrexate to kill the remaining tissue

precipitate labor:

cervical dilation that occurs at a rate of 5cm or more per hr in a primipara or 10cm or more per hr in a multipara -happens when uterine contractions are so strong that the mom gives birth with only a few rapidly occurring contractions -creates a risk for the fetus because a subdural hemorrhage may occur from the rapid release of pressure on the head

apnea:

cessation in respirations lasting longer than 20 sec, sometimes accompanied by bradycardia or cyanosis -gentle tactile stimulation is used to cause the baby to breath again -infants with frequent episodes may be placed on a CPAP or ventilator -hypogylcemic babies and hyperbili babies are at a higher risk for having this

chronic renal disease:

compromised kidneys may not produce erythropoietin and glycoprotein necessary for RBC formation which can cause severe anemia -GFR increases during pregnancy, but creatinine can be low -if greater than 2.0 patients are advised not to get pregnant because of it poses high risk of damage to the already impaired kidneys -if dialysis is needed progesterone needs to be supplemented because its being filtered out of the blood -if using corticosteroids for a form of treatment --> glucose levels need to be checked

COPD during pregnancy:

constriction of the airway r.t long term smoking -limits amount of oxygen to the fetus and may result in preterm birth or fetal growth restriction (SGA) -may need oxygen or c-section during labor d/t SOB from pushing -oxygen needs to be monitored during labor treatment --> corticosteroids (labs to check are glucose)

how quickly is rhogam given after birth? a. 48 hrs b. 96 hrs c. 24 hrs d. 72 hrs

d. 72 hrs

what is a contraindication of administration of methylergonovine? a. seizure disorder b. nausea c. asthma d. HTN

d. HTN

what maneuver is used to help a shoulder presentation? a. McBurneys b. C/S c. McSymph d. McRoberts

d. McRoberts

what is a common cause of PP depression? a. multiple gestation b. support from family c. good self worth d. PTSD from birth

d. PTSD from birth

a client in 36 wks gestation presents with severe abdominal pain, heavy vaginal bleeding, a drop in BP, and an increased pulse rate. which complication of pregnancy is suggested by these s/s? a. hydatidifrom mole b. vena cava syndrome c. marginal placenta previa d. aburptio placentae

d. aburptio placentae

which preexisitng condition is an indication for a cesarean birth? a. gonorrhea b. chlamydia c. chronic hepatitis d. active genital herpes

d. active genital herpes

which additional nursing care is needed for the postpartum client after a cesarean birth that may not be necessary following vaginal birth? a, encouraging early ambulation b. assessing the fundus gently but firmly c. checking vital signs for evidence of shock d. administering the prescribed pain meds in scheduled intervals

d. administering the prescribed pain meds in scheduled intervals

when can you preform the metabolic screening test? a. two weeks post birth b. after feeding for 72 hrs c. any time within the first month d. after feeding for 24 hrs

d. after feeding for 24 hrs

what can esophageal atresia or tracheosophageal fistula lead to? a. growth restriction b. oliohydramnios c. postterm birth d. aspiration

d. aspiration

which assessment would the nurse include in the plan of care for a postpartum client with large, painful varicose veins? a. monitoring daily clotting times b. assessing for peripheral pulses c. monitoring daily hemoglobin values d. assessing for signs of thrombophlebitis

d. assessing for signs of thrombophlebitis

which maternal complications are associated with precipitous labor and birth? a. HTN b. hypoglycemia c. chilling and shivering d. bleeding and infection

d. bleeding and infection

although the newborn was just cleaned and examined, the mother notes a red rash consisting of small papules on the face, chest, and back of the newborn. which condition would the nurse recognize? a. harlequin sign b, vernix caseosa c. nevus flammeus d. erythema toxicum

d. erythema toxicum rationale: - erythema toxicum is a benign, generalized, transient rash that is a reaction to the new environment, it disappears a short time after birth

the nurse admits a client with severe preeclampsia to the high-risk prenatal unit. which is the next intervention after the vital signs have been obtained? a. calling the primary health care provider b. checking the clients reflexes c. determining the clients blood type d. establishing and IV line

d. establishing and IV line

which reason would the nurse provide to a new mother about neonatal wt loss in the 1st 3 days of life? a. an allergy to formula b. a hypoglycemic response c. ineffective feeding techniques d. excretion of accumulated excess fluids

d. excretion of accumulated excess fluids

after 20 wks a BP of 140/90 should be considered what? a. preeclampsia b, eclampsia c. severe features d. gestational HTN

d. gestational HTN

which is a GI manifestation of infection in the newborn> a. lethargy b. irritability c. nasal flaring d. glucose instability

d. glucose instability

a full term infant who is LGA should be monitored for which risk? a. hypotension b. hypothermia c. hypocalcemia d. hypoglycemia

d. hypoglycemia

what do you need to monitor for in the early hours of life? a. hyperglycemia b. hypotension c. HTN d. hypoglycemia

d. hypoglycemia

which finding is indicative of hypothermia in a newborn infant? a. seizures b. diaphoresis c. flushed skin d. hypoglycemia

d. hypoglycemia

for which complication would the nurse closely monitor a client with a diagnosis of abruptio placentae? a. cerebral hemorrhage b. pulmonary edema c. impeding seizures d. hypovolemic shock

d. hypovolemic shock

what causes relaxation of a fetus rectal sphincter? a. gestational diabetes b. polyuria in fetus c. tachycardia d. hypoxia leading to vagus reflex

d. hypoxia leading to vagus reflex

which would absence of the babinski reflex indicate during a newborn assessment? a. hypoxia during labor b. neurological injury during birth c. hyperrflexia of the muscular system d. immaturity of the CNS

d. immaturity of the CNS

if newborn is in NICU what should be assessed each time when speaking with parents? a. understanding of carseat b. risk of maltreatment c. adaptation of siblings d. knowledge regarding childs condition and development

d. knowledge regarding childs condition and development

what abnormality has the meninges protruding through the vertebrae, spinal cord and usually ends at the point of protrusion? a. anenephaly b. meningocyle c. encephalocele d. meningomyelocele

d. meningomyelocele

which client is at increased risk for postpartum hemorrhage? a. one who breast-feeds in the birthing room b. one who receives a pudendal block for the birth c. one whose third stage lasts less than 10 min d. one who gives birth to an infant weighing 9 Ib 8 oz

d. one who gives birth to an infant weighing 9 Ib 8 oz

which sign would the nurse expect in a client with placenta previa? a. painful vaginal bleeding in the 1st trimester b. painful vaginal bleeding in the 3rd trimester c. painless vaginal bleeding in the first trimester d. painless vaginal bleeding in the 3rd trimester

d. painless vaginal bleeding in the 3rd trimester

on the 3rd postpartum day after cesarean birth a client tells the nurse that her breasts feel warm, tender, and firm. the skin is shiny and taut. which condition would the nurse suspect as the cause of the clients breast discomfort? a. oversupply of milk b. mastitis c. bilateral plugged ducts d. physiological engorgement

d. physiological engorgement

which action would the nurse take when a lab report indicates that a postpartum client being prepared for discharge has a WBC of 16,000? a. check with the nurse manager to see whether the client may go home b. reassess the client for signs of infection by taking her vitals c. delay the clients discharge until the HCP has conducted complete examination d. place the report in the clients records because this is an expected postpartum finding

d. place the report in the clients records because this is an expected postpartum finding

what amniotic fluid abnormality can develop with gestational diabetes? a. abruption b. oligohydramnios c. previa d. polyhydramnios

d. polyhydramnios

if a pregnant pt which chronic renal disease is getting dialysis what medication do you need to give? a. corticosteroids b. antibiotics c. antihypertensives d. progesterone

d. progesterone

what is the 1st step to establish breastfeeding? a. pumping to increase b. bathing infant prior to bath c. supporting breast d. skin to skin

d. skin to skin

A pt who is severely hearing impaired is concerned that they will not wake at night when their newborn cries. which of the following would you suggest? a. sleeping with the newborn in bed with them so they can hear the baby b. feeding the baby cereal at bedtime so they will not wake at night c. telling the patient that if the newborn wakes and cries but is not fed, the newborn will not continue to wake at night d. sleeping with their arm or leg on the crib so they can feel the vibration of the infants crying or buying and sound -sensitive device that will flash a bright light when a loud noise is detected

d. sleeping with their arm or leg on the crib so they can feel the vibration of the infants crying or buying and sound -sensitive device that will flash a bright light when a loud noise is detected

which sign in the newborn infant would reflect an apgar score of 1 in the category of respiration? a. good cry b. grimace c. absent respiration d. slow, weak cry

d. slow, weak cry

what comobidity may an infant with an imperforate anus have? a. CNS disorder b. respiratory disorder c. cardiac disorder d. spinal cord disorder

d. spinal cord disorder

after receiving a diagnosis of placenta previa, the client asks the nurse what this means. which is an appropriate response? a. it premature separation of a normally implanted placenta b. your placenta isnt implanted securely in place on the uterine wall c. you have premature aging of a placenta that is implanted in your uterine fundus d. the placenta is implanted in the lower uterine segment, and it is covering part or all of the cervical opening

d. the placenta is implanted in the lower uterine segment, and it is covering part or all of the cervical opening

cramping and vagina; spotting at 12 wks gestation with an audible fetal heart rate and a closed cervix is characteristic of which problem? a. missed abortion b. inevitable abortion c. incomplete abortion d. threatened abortion

d. threatened abortion --> because the cervix is closed

which would the nurse expect to observe in a healthy newborns cord vessels? a. two vessels: one vein and one artery b. three vessels: two veins and one artery c. four vessels: two veins and two arteries d. three vessels: one vein and two arteries

d. three vessels: one vein and two arteries

which intervention ordered for a client with cephalopelvic disproportion would the nurse question? a. maintain NPO status b. start a peripheral IV of normal saline c. record fetal heart tones q 15 min d. tritrate oxytocin infusion per protocol

d. tritrate oxytocin infusion per protocol

what does gestational diabetes increase your risk for? a. type I DM b. obesity c. graves dz d. type II DM

d. type II DM

what is a nuchal cord? a. twisting of the umbilical cord b. increased thickness of the umbilical cord c. shorter length umbilical cord d. umbilical cord passes 360 degrees around fetal neck

d. umbilical cord passes 360 degrees around fetal neck

how should a preamature infant idealy be fed? a. with formula b. gavage c. NPO with IVF d. with breastmilk

d. with breastmilk

a pregnant patient at 37 wks gestation comes into the emergency department with heavy bleeding and begins to show signs of hypovolemic shock. As an intervention, you would: a. place the pt flat in bed on their back b. preform a vaginal exam to determine the extent of the bleeding c. gain IV access using a 27 G needle d. withhold oral fluid

d. withhold oral fluid rationale: they might need to have a c-section

respiratory distress syndrome:

d/t the lack of surfactant which helps keep alveoli from collapsing on expiration s/s low body temp, nasal flaring, grunting, central cyanosis on room air, tachypnea, retractions -can lead to hypoxia and respiratory acidosis dx: based on s/s and chest x ray will have a hazy lung field treatment: -surfactant replacement --> newborn should be placed in an elevated position -oxygen -ventilator

witchs milk

engorged breasts of the infant with a little milk production; happens d/t the moms hormones no matter the sex

true or false: it is suggested a classic incision c-section patient have a vaginal birth in the future

false

true or false: a mother should not breastfeed when mother has mastitis

false

blink reflex

going to close to the face or eye baby will blink

C- section:

ideal to have it done 39 weeks and beyond -500 -1,000 mL of blood loss with a c-section -need a foley placed to ensure adequate bladder emptying -interferes with organ functioning and circulatory functioning -towel is placed under R hip to move gastric contents away indications: -cephalopelvic disproportion -breech presentation -multiple gestation -failure of labor to progress -placenta previa -placenta abruptio things we need to make sure are done before procedure: -anesthesia consent -type and screen for blood -NPP status before hand -epidural or general (in emergency situations) before hand

meconium aspiration:

if hypoxia occurs a vagal reflex is stimulated resulting in relaxation of the rectal sphincter releasing meconium into the amniotic fluid aspiraiton can cause the ductus arteriousus to remain open and compromises cardiac efficiency meconium aspiration can cause: -tachypnea -retractions -grunting - cyanosis -coarse bronchial lung sounds management: -amnioinfusion -oxygen and positive pressure ventilation -antibiotics for pneumonia -monitor temp for infection

harlen quinn sign:

immature blood circulation in a newborn who has been lying on their side appears red of the dependant side of the body as if a line has been drawn down the center of their body

subinovulation:

incomplete return of the uterus to its prepregnant size and shape treatment: -oral methylergonovine 0.2 mg 4x a day to improve uterine tone and complete involution

powers:

ineffective uterine force contractions don't line up treatment: oxytocin hypotonic contractions: more frequent contractions, resting tone of uterus is very low, cervix doesn't dilate easily hypertonic contractions: more frequent contractions, resting phase isnt present, muscle doesn't relax during contraction, will see decels in FHR, long 1st stage of labor uncoordinated contractions: no similarity in contractions, low resting tone, blood supply to placenta decreases, might need a c-section if we cant get contractions in a rhythmic pattern

mastitis:

infection of the breast mat occur as early as the 7th postpartum day or not until the baby is weeks or months old *primary cause --> milk stasis* -breast milk contains glucose making it a good environment for bacteria to grow -check breasts for pain or streaking redness s/s: occurs within 1 week --> a couple months -tenderness -warmth -massage breasts -continue to breastfeed -use good hand washing techniques -lanolin for cracked nipples treatment: -oral antibiotics --> can continue to take these during breastfeeding except for sulfa antibiotics (gets better within 2-3 days)

Peritonitis:

infection of the peritoneal cavity, usually occurring as an extension of endometriosis *one of the leading causes of death in postpartum infection period* -infection spreads from the uterus through the lymphatic system or directly through the fallopian tubes or uterine wall to peritoneal cavity -often accompanied by a paralytic ileus (requires insertion of a nasogastric tube to prevent vomiting and to res the bowel) s/s: -rigid abdomen -abdominal pain -high fever -rapid pulse -vomiting -appearance of being acutely ill

femoral thrombophlebitis:

inflammation at site of thrombophlebitis accompanied by arterial spasm which diminishes arterial circulation in the leg as well s/s: unilateral localized symptoms -redness -swelling -warmth -hard inflamed vessel in affected leg treatment: -anticoagulants and ambulation -heparin --> check pTT, aPTT, INR (can continue this while breastfeeding) with heparin there will be an increased amount of lochia and oozing from episiotomy

thrombophlebitis:

inflammation with the formation of blood clots either: superficial vein disease (SVD) or deep vein thrombosis (DVT) why it occurs: -fibrinogen level is still elevated from pregnancy which increases blood clotting -dilation of lower extremity veins is still present as a result of the pressure from fetal head during pregnancy -use of stirrups during pregnancy

post partum hemorrhage: trauma

lacerations types: -episiotomy -natural tear of vagina -tears within the uterus occurs most often with: - precipitous birth --> pushing the baby out too fast -breech birth --> because its a very wide part of the baby being pushed out -LGA babies -forcep or vacumm use -primigravida pregnancies 4th degree laceration is the most severe and mom may have trouble pooping --> give stool softeners and pain medication vulvar hematoma: -trauma inside -can occur at the site of episiotomy or laceration -will appear red and purplish (like a bruise) management --> sitz bath, ice, peri bottle

post term pregnancy:

later than 40 wks 2 weeks beyond term poses a danger to the fetus: -meconium aspiration -macrosomia --> big baby -variable decelerations in FHR from cord compression if labor hasn't begun by 41 wks a non stress test or biophysical profile may be done to document the state of placental perfusion and the amount of amniotic fluid present -prostaglandin gel or misoprostol applied to vagina to initiate cervical ripening followed by an oxytocin infusion to start the labor process

s/s post term infant:

live born infant after the 41st week of pregnancy -dry cracked skin -leathery skin d/t the lack of fluid and absence of vernix -loss of fat and muscle -hypoglycemic -low circulating plasma level -hematocrit may be elevated -meconium will be present in the amniotic fluid -well developed reflexes, more tone, and more alertness

what is considered a preterm infant?

live born infant born before 37 wks gestation

hepatitis during pregnancy:

liver disease occurs from the invasion of hep A, B, C, or D -C & B can be crossed through the placenta - c-section is advised to minimize risks during birth

milia

looks like baby acne but it is immature clogged sebaceous glands

low lying transverse incision c-section:

low lying bikini line incision above symphysis pubis -the most common type of c-section incision -contracts minimally with labor so they can have a vaginal birth for future pregnancies if they choose -decreased uterine infections compared to classic incision -less likely to cause any GI muscle complications disadvantage: -takes longer to preform

babinski reflex:

making a J on the bottom of the foot with your finger the infants toes will spread apart like a fan

seizure disorders during pregnancy:

need to be carefully managed during pregnancy because anoxia that could be caused by severe seizures could deprive oxygen from the fetus -check therapeutic drug levels if they take seizure meds during pregnancy -seizure meds arent normally safe during pregnancy but the risks and benefits are weighed of taking them

transverse lie:

occurs in pendulous abdomens, uterine fibroid tumors that obstruct the lower uterine segment, contraction of the pelvic brim and polyhydramnios

eclampsia

occurs when preeclampsia if left undiagnosed and can be fatal -seizures --> tonic clonic -after seizure they will go into post ictal state lasting 1-2 hrs (monitor vitals and HR) -as soon as mom is stabilized after a seizure the baby needs to come out -edema after birth needs to be diuresed and could take up to 48 hrs to 6 wks -pt education includes teaching mom to take their blood pressure daily to determine when they can come off of the BP meds

"early hemorrhage"

occurs within 1st 24 hrs after delivery -blood loss of 500 mL following vaginal birth -blood loss of 1,000 mL or more or 10% decrease in hematocrit after c-section

what does a dimple on a babies bum indicate?

possible neural tube defects

gestational diabetes

pregnancy can cause insulin resistance -the pancreas cant respond to the increased insulin requirements coupled with increased insulin resistance from hormone increases 1st trimester --> insulin decreases 2nd & 3rd trimester--> insulin resistance occurs when hormones increase right after delivery --> hormones and insulin requirements decrease

persistent patent ductus arteriosus

premature newborns lack surfactant so its more difficult for them to move blood from the pulmonary artery into the lungs -leads to pulmonary HTN which interferes with the closed of the ductus arterious -indomethacin is used to cause closer of the patent ductus arteriousus

transient tachypnea:

respiratory rate doesnt slow d/t delayed absorption of alveolar fluid in the lungs -any tachypnea within 1 hr after birth (a rate above 30-60) s/s: -not in distress other than effort of breathing -nasal flaring -mild retractions dx: chest x-ray will show hyperexpansion treatment--> oxygen

missed miscarriage:

spontaneous miscarriage in the 2nd trimester where the fetus dies in utero and nothing is expelled -a DNC would be done to remove everything -there is an increased risk for infection if the mom doesn't pass the baby and cells on her own -if this happens really late into labor would could induce mom and she would deliver a still born

rooting reflex

stroke cheek and baby will turn toward the side you're stroking

prolapsed umbilical cord:

the umbilical cord delivers before the baby and is how the fetus gets oxygenation -when cord is prolapsed the fetus oxygenation is compromised *medical emergency* interventions: -knees to chest -oxygen -place in exagerrated tendelenburg position -elevate presenting part with hand to relive pressure -monitor FHR for signs of hypoxia (increased variability and bradycardia) -have emergent c-section

vas previa:

the umbilical vessel is inserted near the cervical os and leads to it being delivered prior to the fetus -may need to have a c-section if mom cant get the baby out immediately

swallowing reflex

they have a lesses gag reflex than we do, helps then maintain a clear airway

true or false: respiratory vaccinations are safe for pregnant mothers

true

true or false: rupture of membranes more than 24 hrs before brith is a risk for puerperal infection

true

inversion of the uterus:

uterus turns inside out with either birth if the fetus or delivery of the placenta -a large amount of blood suddenly gushes out -fundus is no longer palpable -pt shows s/s of blood loss, hypotension, dizziness, paleness, or diaphoresis -oxytocin should be discontinued --> it makes the uterus more tense and difficult to replace *never attempt to replace an inversion or to remove the placenta* --> because handling of the uterus or removing placenta could increase the bleeding