SIM 1 practice questions

*Count the number of feedings in the last 24 hours. Have there been at least 8 feedings? *Assess the latch and mother's nipple soreness. Is baby latching properly? *How much weight has baby lost? *How many wet and dirty diapers has the baby had in the last 24 hours? *Does baby seem satisfied after feeding, even if it only lasts an hour? PreviousNext

A new mother is concerned her baby is "not getting enough" when breastfeeding. How can the nurse help assess whether the feedings are adequate?

*It is important to have the bath water warm but not hot *check the baby's temperature before and after the bath *Skin to skin can be performed after the bath to help baby stay warm

A nurse provides education while performing a newborn swaddle bath in the room with parents. What information would the nurse include?

((dont know)) guess: Want to keep them educated and aware of their progress. Educate them that as they progress to the next stage it can be more painful if they wish to have some pain medication. May be experiencing some nausea to treat.

Comfort measures/interventions for the First Stage, Active Phase of labor:

*Keep vaginal exams to a minimum *Use a sterile glove for perform vaginal exams

How can care providers assist with infection prevention after the bag of waters has broken?

*Assess patient demeanor/behavior/body language/pain score *Intrauterine pressure catheter (IUPC) *Palpation (mild like it feels to touch the tip of your nose, moderate like it feels to touch your chin, strong like it feels to touch your forehead)

How can contraction intensity be assessed?

infection

If a foul odor is present with the ROM, what concern would the nurse have?

*Explain that this is normal following the massive hormonal fluctuation at this time *Provide the woman with warmed blankets *Continue to assess the woman for eventual resolution; take the woman's temperature if no improvement or condition worsens

Immediately following delivery a woman is shivering and experiencing chills. How should the nurse respond?

variable - cord compression Early- head compression acceleration - ok late- placental insufficiency

Match the following FHT pattern with the cause: what goes with each letter VEAL (CHOP)

appearance or color pulse or heart rate grimace or reflex irritability attitude or muscle tone respiratory effort

Match the following in relation to APGAR scoring. what would APGAR stand for

Gynecoid

Pelvimetry is the estimation of pelvic shape and size. What is the most common?

nurse should provide fluid bolus before epidural placement, small test dose should be given to assess reaction, careful

Potential for significant hypotension following administration of epidural. What would be a preventative intervention?

color: clear vs green (meconium stained) vs bloody odor: odorless vs foul odor amount: slow leak vs intermittent trickle vs large gush time: what time did this occur?

ROM stands for Rupture of Membranes. This is when the bag of waters breaks (also known as "my water broke"). This can occur as a large gush or a slower trickle. The nurse should promptly perform a sterile vaginal exam to rule out a prolapsed cord. When ROM occurs, the nurse also assesses the following (COAT): Color Odor Amount Time what are you looking for with each letter

Fourth Stage of Labor

The last stage of labor (not acknowledged by some as a stage of labor) is known as the recovery period. Fundal massage and checks, as well as lochia assessment, occur every 15 minutes for the first hour, every 30 minutes for the second hour, then continue at routine intervals throughout the hospital stay. Fundus (the top of the uterus) should be firm, midline, and progressively lowering, measured in fingerbreadths in relation to the umbilicus. Abnormal findings include a boggy (not well-contracted) fundus, a fundus which is displaced to the right or left side of the umbilicus, or a fundus which is rising instead of lowering. What is this stage of labor called?

TOCO (tocotransducer)

The nurse is assessing fetal status/well-being and the contraction pattern using an external fetal monitor (EFM). Which part of the fetal monitor assesses uterine contractions?

doppler

The nurse is using an external fetal monitor (EFM) to assess fetal status/well-being, as well as the contraction pattern (frequency and duration). Which part of the fetal monitor assesses fetal heart tones (FHT)?

*Excessive maternal or fetal movement may result in inconsistent readings *Readjustments may be needed with position changes *Contraction frequency and duration can be assessed but not intensity

What are disadvantages of external fetal monitoring (EFM)?

*noninvasive *May be used whether membranes are intact or ruptured *May be used regardless of cervical dilation

What are the benefits of external fetal monitoring (EFM)

Fetal Scalp Electrode (FSE)

What device may be inserted into the fetal scalp in order to obtain an accurate, beat to beat electrocardiogram reading?

Breast, uterus, bladder, bowel, lochia, edema/emotions

What does the acronym BUBBLE stand for in relation to a postpartum assessment?

There is a loss of cushioning for the fetus

What happens as the amniotic fluid is lost?

frequency and duration (NOT intensity)

What information about contractions can be gained using an external fetal monitor (EFM)?

Cervical dilation (0-10cm) Effacement (0-100%) Cervical Position (posterior during pregnancy, anterior during labor) Cervical consistency (soft & pliable or firm) Fetal lie Fetal presentationFetal position Station

What information can be obtained from a vaginal exam?

Aspiration of meconium stool by the neonate

What is a concern if the amniotic fluid is meconium stained?

To assess for rupture of membranes

What is a nitrazine strip/test used for?

*contraction become longer and stronger *the cervix must dilate from 0-10 cm

What must occur during labor so the baby can be born?

vaseline

What should be applied to the penis with each diaper change while a circumcision is healing?

b

What would be considered a reassuring FHT? a- Minimal variability with a 30 bpm decrease in baseline FHT lasting 25 seconds after the start of a contraction b- Moderate variability with a 20 bpm acceleration lasting 20 seconds with fetal movement

When was the first day of your last period?

Which question would be asked in order to determine the estimated date of confinement (EDC) (due date)?

The risk for infection increases without the protective barrier of the membrane

Why is it important to note the time when ROM occurs?

((dont know)) guess: This might be performed to speed up the delivery/ labor process. It will help the cervix dilate.

Why might AROM be performed?

*The pregnancy is post-dates (past the due date/42 weeks gestation or more) *The fetus is experiencing physiologic stress

Why might meconium stained fluid occur?

*relieves pain while allowing mother to be awake and present/engaged in the delivery and immediate postpartum experience *may help the mother relax and allow labor to. progress more smoothly

advantages of epidural

((dont know)) guess: During this phase, you would want to assess the patient's physiological readiness. Want to provide them with support and encouragement. have them aware of what the process will most likely look like.

comfort measures/interventions for the First Stage, Latent Phase of labor:

((dont know)) guess: Pain management may be more of a priority here as they are experiencing more contractions, but follow how the patient wishes to manage their pain. Encouragement, and preparing for the next phase coming.

comfort measures/interventions for the First Stage, Transitional Phase of labor:

*if given too soon before active labor is established, it may slow labor progression *may provide intermittent or ineffective pain relief *increase needing risk of vacuum or forceps assisted delivery

disadvantages of epidural

Every two to three days with spot cleaning in between

how often should aa new born be bathed

(our examples on SIM practice test) G2P1

scenario question: Based on the prenatal information provided, what is Mary's gravida and para?

(our examples on SIM practice test) 23-26 pounds

scenario question: What has been Mary's total weight gain throughout this pregnancy?

true

true or false A +3 station occurs when the presenting part is below the maternal ischial spines.

false

true or false A -3 station occurs when the presenting part is below the maternal ischial spines.

true

true or false A negative station means the presenting part is above the maternal ischial spines.

true

true or false A nurse explains to a new mother that breastfeeding should occur on demand from the baby, with a goal of 8-12 times in a 24 hour period. There may be periods of frequent (cluster) feedings and then the baby may sleep for a longer spell. The nurse states she will need to perform a latch assessment during at least one feeding to ensure there are no issues with the baby's latch and suck. The nurse encourages the mother that the lack of sleep during this time is tough but frequent feedings do play an important role in successful breastfeeding. Establishing a strong milk supply requires a foundation of early, frequent feedings (or pumping if baby is unable to feed).

true

true or false A positive station means the presenting part is below the maternal ischial spines.

true

true or false A woman is 12 hours post delivery. The nurse documents the fundus as firm, midline, and located at the umbilicus. Lochia is mild and rubra. The nurse charts these findings as within normal limits.

true

true or false The umbilical cord will transition from moist to dry. It will fall off within 1-2 weeks. The cord site should be kept clean and dry. Care provider should be notified if the area becomes red, tender or begins to have drainage.

true

true or false Zero station means the presenting part is level with the maternal ischial spines.

diagonal conjugate, spines, sacrum and arch (give estimate of maternal pelvic adequacy for birth)

what are particular points of interest when doing a physical exam

complications during pregnancy, labor or delivery

what are points of particular interest when covering a patients past OB history

artificial rupture of membranes.

what does AROM stand for

estimated date of confinement, delivery, or birth

what does EDC/EDD/EDB stand for

number of pregnancies a women has had (including current one)

what does Gravida mean

Last menstural period

what does LMP stand for

number of births past the age of viability (20 weeks gestation)

what does Para mean

term, preterm, abortion (elective or spontaneous), living children

what does TPAL stand for

diabetes, hypertension, genetic disorders, accidents, injuries or surgeries affecting reproductive function (individual history included)

what past medical family history conditions should be noted

second stage

what stage/ phase of labor: an average length in multiparous women 15-30 min nulliparous 1-2 hours cervical dilation 10 cm (complete) to birth

first stage, active phase

what stage/ phase of labor: an average length in multiparous women 2.4 hours, nulliparous 4.6 hours, cervical dilation 4-7 cm, contraction frequency every

first stage, latent phase

what stage/ phase of labor: an average length in multiparous women 5.3 hours, nulliparous 8.6 hours, cervical dilation 0-3 cm. contraction frequency every.

first stage, transition phase

what stage/ phase of labor: an average length in multiparous women 5.3 hours, nulliparous 8.6 hours, cervical dilation 8-10 cm. contraction frequency

third stage

what stage/ phase of labor: placenta is expelled and lacerations are repaired