PP/NB test

nevus pilosus

"hairy mole"; dermal sinus at the base of the spine, commonly associated with spina bifida

neonatal pain

-Neonatal responses to pain: do feel pain -Assessment of neonatal pain: consider health, type and duration of pain, environmental factors, state of alertness C- crying R- requiring increased oxygen I- increased vital signs E- expression S- sleeplessness -Nonpharmacologic: swaddling, snuggly wrapping with blanket, NNS, Oral sucrose, skin-to-skin, touch, massage, rocking, holding, environmental -Pharmacologic: local/topical anesthesia, non-opioid analgesic, morphine, fentanyl, epidural infusion, nerve blocks, intradermal or topical anesthetics

involution process

2 cm below umbilicus after delivery before placenta leaves, 24 hours uterus should be size of 20 week preg, should not be palpable after 2 weeks (hidden behind pelvic bone), 6 weeks should be non-preg state

late preterm

34 through 36 and 6/7 weeks

full term

39 through 40 and 6/7 weeks

post term

42 weeks and beyond

premature neuromuscular (Ballard)

90 degree square window (like an adults), positive scarf sign, heel to ear with leg fully extended, 45 degree ankle dorsiflexion (toes to nose) no moro

C, F

A BF'ing woman's c section birth occurred 2 days ago. investigation of the pain, tenderness and swelling in her left leg led to a medical dx of a DVT. care mgmt (ACUTE PHASE) for this woman involves: A: explaining that she needs to stop breastfeeding until anticoagulant therapy is completed B: Administering warfarin (Coumadin) orally C: Placing the woman on bedrest with her legs elevated D: filling the woman with an elastic stocking so she can exercise her legs E: telling her to avoid changing her position for the first 24 hours F: Administering heparin IV for 3-5 days

D

A PP woman in the fourth stage of labor received prostaglandin F2a (hemabate) 0.25 mg IM. The expected outcome of her care for the admin of this med is: A: relief from the pain of uterine cramping B: prevention of intrauterine infxn C: reduction in the blood's ability to clot D: Limitation of excessive blood loss that is occurring after birth

B, C, D (insert it at a 90 degree angle and use a 25 g,5/8 in needle)

A doc has ordered that a baby receive hep B max before d/c. in fullfilling this order, the nurse should: A: confirm that the mom is hep B positive before the injection is given B: obtain parental consent before giving it C: inform the parents that the next tax is given at 1 or 2 months D: admin the injection in the vastus lateralis muscle E: use a 1 in, 23 g needle F: insert the needle at a 45 degree angle

B (assess bleeding q30 min for the first 4 hours after!)

A newborn male has been scheduled for a circ. essential nursing care measures following this surgical procedure include: A: using the Ballard score to determine if the infant is in pain B: applying petroleum ointment to the site with every diaper change until the site is healed C: checking the penis for bleeding every 15 min for the first 4 hours D: teaching the parents to remove the yellowish exudate that forms over the glans using a diaper wipe

D (fundus should be 1cm above and centered)

A nurse is assessing a woman who gave birth 12 hours ago, which findings would require further assessment? A: bright-dark red uterine discharge B: midline episiotomy that is approximated with moderate edema, slight erythema and no ecchymoses C: protrusion of abdomen with slight separation of abd wall muscles D: fundus firm at 2 cm above umbilicus and to right of midline

C

A nurse is prepared to assess a postpartum woman's fundus. To facilitate the accuracy and comfort of the exam, the nurse should tell the woman to: A: elevate the HOB B: Place her hands under her head C: Flex her knees D: lie flat with her knees extended and her toes pointed

A (thermistor probe on upper quadrant of abd, temp bw 36-37!)

A radiant warmer will be used to help a newborn girl stabilize her temp. the nurse implementing her care measure should: A: undress and dry the infant before placing her under the warmer B: Set the control panel between 35-38 degrees C C: place the thermistor probe on her abdomen below her umbilical cord D: assess her rectal temp until her temperature stabilizes

C

A woman has determined the bottle feeding is the best method for her. instructions that the woman should receive regarding this feeding method include: A: check nipple before feeding to ensure that it allows passage of formula in a slow stream B: sterilize water by boiling; then cool and mix with formula powder or concentrate C: expect a 2 week old newborn to drink approx 90-150 ml of formula at each feeding D: microwave refridgerated formula for about 2 minutes before feeding newborn

B

A woman was discovered to be be his positive as part of routine screening during pregnancy. she was immediately treated with HAART. Care management of her newly born child includes: A: encouraging breastfeeding B: teaching the mother about the importance of taking her infant for routine immunizations C: isolating the newborn in a special nursery D: initiating HAART as soon as the newborn is HIV positive

A

A woman who developed hep b during pregnancy gave birth via SVD to a healthy baby. her baby is receiving hep b immunoglobulin IM 2 hours after birth. When should he have his first does of the hep b vax? A: At the same time as immunoglobulin but in a different site B: one month after birth C: six months after birth D: one year after birth

10-90th percentile

AGA

pilonidal dimple

Abnormal opening between buttocks, can be direct opening to spinal canal

C, E, F (want squeeze bottle downward, anesthetic should be used sparingly)

Before d/c at 2 days PP, the nurse evaluates a woman's level of knowledge regarding the care of her 2nd degree peri lac. Which statements made by the woman indicate the need for further instruction before d/c? A: I will wash my stitches at least once a day with a mild soap and warm water B: I will change my pad every time I go to the bathroom, at least 4x a day C: I will position my squeeze bottle upward so that the warm water can remove lochia from my vagina D: I will use my squeeze bottle filled w warm water after I pee to clean my stitches E: I will wear a pair of clean disposable gloves when I wash my stitches and change my pad like the nurses did F: I will apply anesthetic cream to my stitches at least 6x per day

afterpains

Cramping pain after childbirth caused by alternating relaxation and contraction of uterine muscles; can be days, weeks, worsen with each pregnancy bc ut. Has to work harder to go back to normal, happens avg. 3-7 days

psuedomenstruation

Discharge from genitalia in female newborns. Blood-tinged mucus in response to maternal hormones

B (gain weight 10-14 days, 6-8 wet diapers daily, breastfeeding 8-10x day)

During a home visit, the mom of a 1-week-old tells the nurse she is very concerned about whether her baby is getting enough breast milk. the nurse should tell the mom that at 1 week a well nourished newborn should exhibit: A: weight gain sufficient to reach his birth weight B: a minimum of 3 bowel movements a day of soft, yellow, seedy stools C: approx 10-12 wet diapers/day D: BF at a frequency of Q4 hours, or about 6 times per ay

greater than 90th

LGA

serosa

Pinkish/brown, serosanguineous. lasts 3-4 days, then turns red

B, C, E, F

Preterm infants are at risk for cold stress. what s/sx should alert the nurse that the preterm infant that are caring for may be hypothermic? A: Acrocyanosis B: Hypoglycemia C: irritability D: periodic breathing pattern E: bradycardia F: Abdominal distention

less than 10th

SGA

Universal newborn screening

Test the baby for over 50 disorders Not reliable until the newborn has ingested adequate amounts of protein from breast milk of formula; usually 24 hrs after initial feeding; heel prick with blood draw in all four circles

C, E (calcium should be at least 7.8)

The nurse evaluates the lab results of a newborn who is 4 hours old, which results require notification of the pediatrician? A: hemoglobin 20 B: HCT 54 C: glucose 34 D: WBC 24,000 E: calcium of 7

A

The nurse responsible for the care of a PP woman recognizes that the first sign of puerperal infxn most like is: A: temp elevation to 38 degrees C or higher after the first 24 hours following birth B: increased WBC count C: Foul smelling profuse lochia D: bradycardia

eye prophy

To prevent ophthalmia neonatorum or neonatal conjunctivitis (prevention for GBS and STDs)

False

True or false: Vit K and Hep B can go in the same vastus lateralis muscle.

B, D, E

When assessing PP women during the first 24 hours after birth, the nurse must be alert for signs that could indicate the development of a postpartum physiological complication. which signs should concern a nurse? A: temp 38 degrees C B: fundus midline and boggy C: lochia, three quarters of a pad saturated in three hours D: positive homans in rt leg E: anorexia F: voids approx 150-200 mL or urine in each of the first three voiding after birth

b

When caring for a preterm infant at 30 weeks gestation, the primary nursing dx is: A: risk for infection r/t decreased immune response B: Ineffective breathing pattern r/t surfactant deficiency and weak respiratory muscle effort C: ineffective thermoregulation r/t immature thermoregulation center D: Imbalanced nutrition: less than body requirements related to ineffective suck and swallow

B

a BF'ing mom asks the nurse about a reliable and safe method of birth control she should use during the PP period. The best recommendation during the first 6 weeks after birth is: A: combo oral contraceptive that she used before she was pregnant B: barrier method using a combination of a condom and spermicide foam C: The diaphragm she used before getting pregnant D: complete breastfeeding- baby only receives breast milk for nourishment

PKU (phenylketonuria)

a condition that makes it impossible for babies to metabolize certain proteins; can managed with diet

B

a newborn male has been designated LGA, his mother was dx with GDM late in her pregnancy. The nurse should be alert for signs of hypoglycemia. Which assessment finding is consistent with hypoglycemia? A: high pitched cry B: jitteriness C: hyperthermia D: laryngospasm

D, E, F

a newborn male is est. to be 40 weeks gestation follwing assessment with New Ballard scale. New Ballard scale findings consistent with this newborn's full-term status are: A: apical pulse rate of 120 beat/min, regular, strong B: popliteal angle of 160 degree C: weight of 3200 g, placing him in 50th percentile D: Thinning of langue with some bald areas E: Testes descended in scrotum F: elbow does not pass midline when arm pulled across chest

B (see that antibodies are not formed yet)

a nurse is preparing to admin rhoGAM to a postpartum woman. Before implementing the care measure the nurse should: A: ensure the med is given within 12 hours of birth B: verify that the indirect and direct Coombs test results are negative C: Make sure that the newborn is RH negative D: Cancel the admin of RhoGAM if it was given during pregnancy

exchange transfusion

a technique of removing the patient's blood and infusing donor blood until a large fraction of the patient's blood has been replaced; used when bilirubin rises quickly despite use of phototherapy

B

a woman 24 hours after giving birth complains to the nurse that her sleep was interrupted the night before because of sweating and had to have her gown and linens changed. nurse's first action is to: A: assess the woman for s/sx of infxn B: explain to the woman that the sweating represents the body's attempt to eliminate the fluid that was accumulated during pregnancy C: notify the physician D: Document the finding as postpartum diuresis

B, E, F

a woman in labor admits that she used heroin during her pregnancy. after the birth of her baby boy, the nurse should be alert for which signs that indicate NAS: A: sleepiness B: Poor feeding C: Bradypnea D: below normal body temp E: diarrhea F: frequent yawning

A

a woman is trying to calm her fussy baby in prep for feeding. she exhibits a need for further teaching if she: A: removes all clothing from the infant except for the diaper B: dims the lights in the room and turns off the tv C: gently rocks the baby and talks to her in a low voice D: allows the baby to suck on her finger

NEC (necrotizing enterocolitis)

acute gastrointestinal disorder in the hypoxic neonate; leads to intestinal ischemia, bacterial colonization and enteral feedings typically potentiate this disorder

2500-4000

average newborn weight in grams

LGA (large for gestational age)

babies weighing greater than 4000 g; ____ despite gestation when the weight is greater than 90th percentile; can be preterm or posterm or infants of diabetic mothers

Patent urachus

base of umbilical cord draining fluid

ELBW (extremely low birth weight)

birth weight less than 1000g

Cephelhematoma

bleeding into the periosteum during birth; bruise that does not cross the suture line

post mature

born after completion of 42 weeks gestation and showing the effects of progressive placental insufficiency

permature

born before completion of 37 weeks gestation

Unconjugated bilirubin

breakdown product of heme, lipid soluble

BPD (bronchopulmonary dysplasia)

chronic pulmonary disease occurring in infants whose lungs require supplemental oxygen; ventilators cause the respiratory system to become too stiff

Choanal atresia

closure of nasal cavity due to congenital septum between nasal cavity and pharynx

Rectal atresia

complete obstruction of rectum with inability to pass stool, requires immediate surgery

post mature infants

complications include meconium aspiration syndrome and persistent pulmonary htn of the newborn

corrected age

difficult to predict accurately so they add gestational with postnatal and milestones are corrected until age 2.5

caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days

D

during the acute distress phase of the grief response parents are most likely to experience; A: fear and anxiety about future pregnancies B: difficulty with cognitive processing C: search for meaning D: shock and numbness

4 hours

gestational age needs to be established within ____ _____ of birth using the Ballard scale. The baby's second assessment can be performed within 24 hours.

physiologic jaundice

has a 3-5 day peak, resolves on its own

SGA with IUGR

have a high risk for perinatal asphyxia, hypo OR hyperglycemia, polycythemia or heat loss

LPI (late preterm infant)

have a higher risk of respiratory distress syndrome, thermoregulation problems, nutritional issues, hypoglycemia, hyperbilirubinemia, and infection

postpartal diuresis

increased production of urine that occurs in the pospartum period to rid the body of extracellular fluid retained during pregnancy; encourage the patient to void and increase activity and remind them that swelling will increase but still continue activity

umbilical cord

initially white/gelatinous with 2 arteries and one vein, but will be dry, shriveled and blackened by the 2nd-3rd day and falls of in 7-10 days; should not bleed or have foul smelling drainage

Premature characteristics (Ballard)

lack flexion, lots of lanugo, smooth feet without creases, lack cartilage in ears, no areola/breast tissue, female genitals have a prominent labia minora/majora and clitoris, male testes have few rugae

rubra

lasts for the first 3 days, dark red/maroon/brown all together

Chemical conjunctivitis

may occur as a result of eye prophy with erythomycin eye ointment on newborns

B (the MAJOR side effect of methergine is HTN!!!)

methergine is ordered for a woman who gave birth vaginally 1 hour ago; it is to be admin IM to treat profuse lochial flow with clots. Her fundus is boggy and does NOT respond well to massage. She is still being treated for preeclampsia with IV mag sulfate at 1g/hour. her BP 5 min ago was 155/98. In fulfilling this order, the nurse should: A: Measure the woman's BP again 5 min after giving the med B: Question the order, based on the woman's hypertensive status C: admin the methergine bc it is the best choice to counteract the possible uterine relaxation effects of the mag sulfate infusion the woman is receiving D: tell the woman that the medication will lead to uterine cramping

36.5-37.3 (97.7-99.3)

newborn temperature

2-4 weeks

no pacifier for ______ _____ if breastfeeding!

b, c, f

nurse is caring for a male newborn whose mother had GDM. his estimated gestational age is 41 weeks and he is macrosomic. what should the nurse be alert for during assessment? A: fracture of the femur B: hypocalcemia C: blood glucose of 38 D: signs of congenital heart defect E: pale complexion F: round cherubic face

pathological jaundice

occurs in the first 24 hours of life, requires phototherapy to resolve

lochia

postbirth uterine discharge/bleeding (can last 4-8 weeks, typically less after c section

TTN (transient tachypnea of the newborn)

respiratory distress in a term infant related to to delayed absorbtion of fluid in lungs from delivery; occurs more often in c section babies bc extra fluid not pushed out of lungs during squeeze out of birth canal

ROP (retinopathy of prematurity)

retinal detachment and blindness due to too much O2

phimosis

stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis

Bulb syringe teaching

stop suctioning when the newborn's cry sounds clear, use mouth (cheeks, never the throat or they will throw up) to nose

A

the expected outcome for care when an oxytocin is administered to a postpartum woman is that the woman will: A: demonstrate expected lochial characteristics B: Achieve relief of pain associated with uterine cramping C: Remain free of infection D: void spontaneously within 4 hours of birth

meconium

the greenish material that collects in the intestine of a fetus and forms the first stools of a newborn; helps rid the body of bilirubin

D

the nurse should teach BF'ing mothers about breast care measures to preserve the integrity of the nipples and areola. what should the nurse include in her instructions? A: cleanse nipple/areola 2x day with mild soap and water B: apply vit E cream to nipples/areola 4x daily and before a feeding C: insert plastic lined pads into the bra to absorb leakage and protect clothing D: apply modified lanolin to both dry and sore nipples

Conjugated bilirubin

water soluble; never normal in urine

B

when assessing a baby after birth, the nurse notes limited movement of the left arm with crepitus at the shoulder and absence of the moro reflex on the left side, the nurse suspects: A: brachial plexus injury B: Fracture of clavicle C: Phrenic nerve injury D: intracranial hemorrhage on the right side of the brain

D (reduces pressure on perineum repairs and pain!, x2 a day for 20 min is appropriate)

when teaching a postpartum woman with an episiotomy about using a situ bath, the nurse should emphasize: A: using sterile equipment B: filling the situ bath basin with hot water (at least 42 degrees Celsius) C: taking a sitz bath once daily for at least 10 min D: Squeezing her buttocks together before sitting down and then relaxing them

D (new mom, bottle feeding a small baby)

which woman at 24 hours following birth is least likely to experience afterpains? A: primipara who is breastfeeding her twins, who were born at 38 weeks of gestation B: Multipara who is breastfeeding her 10 pound full term baby girl C: Multipara who is bottle feeding her 8 pound baby boy D: Primipara who is bottle feeding her 7 pound baby girl

alba

yellow to white for 10-13 days

Infant hypoglycemia

•Usually defined as blood glucose levels less than 45 mg/dl (normal is 45-60 ish); all infants whose moms have diabetes or who are SGA, LGA or preterm get heel sticks before feeds