OB Exam 2

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Baby starts at (-) station and gradually descends to

(+) station

Abstinence failure rate

0%

Normal INR

0.8-1.2

Fourth stage of labor

1-4 hours after delivery

Normal PT

11-12.5 sec

What is the normal fetal HR

110-160 bpm

Active stage of labor contractions last

45-60 seconds

Blood loss for vaginal birth

500 mL

How many wet diapers should newborn have per day

6-8

In transition, contractions last from

60-90 seconds

Bowels should be

Abdomen soft/nondistended. Normal bowel sounds x4 quadrants, passing flatus, no difficulty with BMs

Emotional State

Adequate mother/newborn attachment

When do fontanels close

Anterior at 18 months Posterior at 8-12 weeks

Apgar stands for

Appearance, Pulse, Grimace, Activity, and Respiration

Pain

Assess pain every 4 hours; admin pain meds when needed

Excessive bleeding is described as

Bleeding that soaks more than one pad per hour

Describe BUBBLEHE-P

Breasts, Uterus, Bladder, Bowels, Lochia, Episiotomy/incision, Homan's, Emotional, Pain

Mini-pill

Can be used during lactation

A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first?

Change the client's position

A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not." Which of the following should the nurse recognize as a sign of true labor?

Changes in the cervix

Homan's

Check for redness, warmth, to r/o blood clot

Variable deceleration =

Cord compression

Episiotomy/abdominal incision should be

Edges well approximated No drainage, warmth, redness or edema

Flexion

Fetal chin flexes downward onto chest

Internal Rotation

Fetal head rotates to fit diameter of pelvic cavity

Uterus should be

Firm fundus, midline, at or below level of umbilicus

Contractions like rollercoaster

First phase: Go up Second phase: Peak or acme Third phase: Let up (go down)

A nurse is caring for a client who is postpartum and received methylergonovine. Which of the following findings indicates that the medication was effective?

Fundus firm to palpation

If GBS positive

Give 2 doses of Penicillin before deliver

S/S of placental delivery

Globular shaped uterus rise of fundus in abdomen sudden gush or trickle of blood Further protrusion of umb. cord from vagina

Engagement

Greatest diameter of head passes through the pelvic inlet

Methergine is contraindicated in patients with

HTN

Early declerations =

Head compression

Apgar includes

Heart rate Resp effort Muscle tone Reflex irritability Color

What is intensity

How strong is contraction

GBS can cause

Infant respiratory distress

A nurse in a hospital is caring for a client who is at 38 weeks of gestation and has a large amount of painless, bright red vaginal bleeding. The client is placed on a fetal monitor indicating a regular fetal heart rate of 138/min and no uterine contractions. The client's vital signs are: blood pressure 98/52 mm Hg, heart rate 118/min, respiratory rate 24/min, and temperature 36.4° C (97.6° F). Which of the following is the priority nursing action?

Initiate IV access

what is precipitous labor

Labor that last three hours or less from the onset of contractions to the time of delivery

Stage one of labor has 3 parts

Latent, active, transition

Risk factors of precipitous labor

Lungs do not compress enough to remove fluid from lungs

Unrelieved vaginal bleeding that is not resolved by fundal massage will require?

Methergine

Descent

Movement of fetus through the birth canal

Diaphragm

Must be fitted by HCP

Accelerations =

OK

A nurse is caring for a client who is in active labor and notes late decelerations in the FHR. Which of the following actions should the nurse take first?

Obtain a 30 min electronic fetal monitoring (EFM) strip prior to induction

Extension

Occiput, brow and face emerge from vagina

Latent stage of labor is the

Onset of labor until 3 cm dilation

What is the most crucial postpartum assessment?

Palpating the uterus

Late decelerations =

Placental insufficiency (perfusion/decreased O2/blood supply)

A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take?

Position with one hip elevated

A nurse is preparing to administer methylergonovine IM to a client who experienced a vaginal delivery. The nurse should explain to the client that the purpose of this medication is to prevent which of the following conditions?

Postpartum hemorrhage

Interventions for late decelerations

Reposition, side lying O2 non-rebreather DC Oxy/Run IV wide open Call HCP is not resolved Prepare for vaginal delivery is c-section

Key when giving oxytocin

See how baby and mom are doing

If pregnancy and need rubella vachcination, when is this given?

Shortly after giving birth

Expulsion

Shoulders and body quickly follow to delivery

External Rotation

Shoulders enter pelvis, turning head to one side

Soon after delivery, the mother may appear primarily concerned with herself. This is known as the?

Taking in phase

A nurse is assessing a client who is in active labor and notes that the presenting part is at 0 station. Which of the following is the correct interpretation of this clinical finding?

The lowermost portion of the fetus is at the level of the ischial spines

Second stage of labor is

The period after cervix is dilated to 10 cm until baby is delivered

What do uterotonics do

Tone the uterus

There are several causes of postpartum hemorrhage, list them:

Uncontracted uterus Injury to the birth canal Large infant/twins Excessive amniotic fluid Prolonged/precipitous labor

What is Bishop Score

Used to determine cervical readiness

A nurse is caring for a client who is in the first stage of labor, undergoing external fetal monitoring, and receiving IV fluid. The nurse observes variable decelerations in the fetal heart rate on the monitor strip. Which of the following is a correct interpretation of this finding?

Variable decelerations are due to umbilical cord compression

A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include?

Your contractions will become stronger and more frequent

Ischial spine marks what station

Zero

Condom is considered what method

barrier

Most important nursing action is to

check the FHR

Why give vitamin K

clotting

Third stage of labor is

delivery of placenta

The immediate postpartum period of fourth stage of labor lasts from the delivery of the placenta to the

first 4 hours after labor

What are the signs that the placenta is about to be delivered?

globular shaped abdomen lengthening of the cord

Variable declerations position

knee to chest

Scant lochia

less than 1 inch

light lochia

less than 4 inches

Labor induction

no contractions

REEDA

redness, edema, ecchymosis, drainage, approximation

heavy lochia

saturated pad w/i one hour

The APGAR scoring system is useful in determining:

status of overall condition.

Involution

uterus reducing to pre pregnancy size

labor augmentation

when spontaneous labor stops

When to give vitamin K

within one hour of birth

Is Oxytocin piggybacked?

yes

What is frequency

Time between the beginning of one contraction and the beginning of the next contraction

What is duration

Time of beginning of contraction to end of same contraction

4 T's of PPH

Tone Tissue Trauma Thrombin disorder

A nurse is caring for a client who is in labor and has an external fetal monitor. The nurse observes late decelerations on the monitor strip and interprets them as indicating which of the following?

Uteroplacental insufficiency

What is dystocia

difficult labor or failure to progress

moderate lochia

less than 6 inches

Breasts should be

normal, soft, no cracking or bleeding nipples, erect nipples for breast feeding

where to give vitamin K

vastus lateralis

A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse locates the fetal heart tones above the client's umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions?

Frank breech

Bladder should be

Nondistended and nonpalpable; voiding clear/yellow

What are some risks/concerns for the mother in the postpartum period

Postpartum hemorrhage Infection Preeclampsia/eclampsia

5 P's of labor

Powers (contractions) Passageway (birth canal) Passenger (fetus) Psychological response Position

Lochia

Rubra (dark red) up to 4 days Serosa (pinkish/brown) 4-10 days Alba (whitish/yellow) 10-28 days

A nurse is admitting a client who is at 38 weeks of gestation and is in the first stage of labor. Which of the following assessment findings should the nurse report to the provider first?

Continuous contraction lasting 2 minutes

Blood loss for C-section

1000 mL

Give Rhogam at

28 weeks gestation and 72 hours after birth

Active stage of labor continues from

3 cm until 7 cm dilation

Active stage of labor, how long between contractions

3-5 minutes

In transition, time between contractions is

30 seconds to 2 minutes

In latent stage of labor contractions last

30-45 seconds

A postpartum patient should void ______________ ml/voiding

300-400 mL

When to check mother for GBS status

36-37 weeks gestation

In latent stage of labor how many minutes between contractions

5-30 minutes

A nurse is caring for a newborn and calculating the Apgar score. At 1 min after delivery, the following findings are noted: heart rate of 110/min; slow, weak cry; some flexion of extremities; grimace in response to suctioning of the nares; body pink in color with blue extremities. Calculate the newborn's Apgar score. Answer the number only.

6

Transition phase of labor continues from

7 cm - 10 cm

Normal temperature:

97.9-99F axillary


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