NUR 353 Exam 2

Spontaneous abortion is characterized by a pregnancy terminated before 20 weeks of gestation or a fetal weight less than _____.

500 g.

An asian belief that describes extreme fatigue after mental effort and bodily weakness of persistent duration.

Neurasthenia

Relaxes smooth muscles including the uterus by blocking calcium entry. Another tocolytic agent that can suppress contractions.

Nifedipine

Do you have to fast for a 1-hour GTT?

No, but you do have to fast for a 3-hour GTT.

How do you assess the palmar reflex? What should the response be?

Place finger in palm of hand. Infant's fingers curl around examiner's fingers.

True or false: All women receive active management postpartum hemorrhage during the third stage of labor, which includes an oxytocin infusion and vigorous fundal massage for 15 seconds minimum.

True!

What is one major complication that can be seen with ectopic pregnancies?

Tubal rupture resulting in removal of the fallopian tube

Process in which the uterus goes back to it's original size

Uterine involution

What is the main risk with a TOLAC/VBAC?

Uterine rupture

More than five contractions in 10 minutes, averaged over a 30 minutes window. Adverse effect of Oxytocin/Pitocin

Uterine tachysystole

What part of the male genital system is severed with male sterilization?

Vas deferens

List 6 nursing interventions for a woman with a prolapsed umbilical cord.

(Call HCP) 1. Insert a sterile gloved hand into the vagina and hold the presenting part off the umbilical cord. 2. Assist mom into modified Sims, Trendelenburg, or knee-chest position. 3. Assist with a forceps- or vacuum-assisted birth if the cervix is fully dilated. 4. Administer O2 by nonrebreather mask. 5. Start IV fluids, or increase existing drip rate. 6. CONTINUOUS assessment!

Modified Sim's position

(With pillows under mom's hips) Helps treat umbilical cord prolapse

The sacred hour is the ___ hour after birth.

1st

Describe the contraceptive patch. How should you apply it? How often should the patch be replaced?

-The patch contains progesterone and estradiol, which is delivered at continuous levels through the skin into subcutaneous tissue. -To apply the patch, put it over dry skin overlying subcutaneous tissue of the bottom, abdomen, upper arm, or torso. Do not put it on the breast area. -It should be replaced once a week.

Dilation: 0 Effacement: 0-30% Station: -3 cm Cervical consistency: Firm Cervical position: Posterior What is the bishop score? (FOR EACH)

0

What is a severely depressed APGAR score? Moderately depressed? Excellent condition?

0-3. 4-6. 7-10.

Dilation: 1-2 Effacement: 40-50% Station: -2 cm Cervical consistency: Medium Cervical position: Midposition What is the bishop score? (FOR EACH)

1

Involution progresses rapidly the first few days postpartum. Describe the fundal descent.

1 to 2 cm every 24 hours

List some points to know when caring for a patient who is Native American. (13) Which family member is most respected? Do they avoid eye contact? Can you shake their hand? Do they resist pain or do they show it? Who attends the birth? What is given to mother's during delivery to reduce pain?

1. *Families are important, elders are cared for by their family and elders are respected.* 2. *They avoid eye contact when someone with authority speaks to them.* 3. Shaking hands are accepted 4. Rarely are family members left alone when sick 5. May communicate what they believe others want to hear (innermost respect) 6. Decision making is based on what is the beneficial to the group/family/friend 7. Illness is disharmony with the forces of life 8. They view that only the traditional healers and their sacred ceremonies can address the disharmony 9. Believe that no one can own personal possessions but belongs to all, tradition of giving gifts but impolite to say "thank you" if someone does something without being asked but ok if someone asks you to do something. 10. *Resist pain and and present in a stoic manner (viewed as courage)* 11. They don't want to cure sickness but instead to invoke positive blessings and avert misfortune 12. *Only women attend the birth while men are not allowed to see women give birth* 13. *Herbs are used to hasten delivery and reduce pain*

List some points to know when caring for a client who is of Eastern Indian descent. (11) Can you maintain eye contact with them? Can you hug and shake hands with them? Do they show pain or do they hide it? Which word or type of answer do they not like to express? What are their lucky colors? How do pregnant women eat during pregnancy? What happens with the mother and child postpartum with this culture?

1. *Hugs not acceptable with the opposite sex* 2. *Avoid shaking hands with them if you are the opposite sex* 3. Eye contact is okay 4. Extended families with view of trust of family members over others 5. *They will cry in pain and scream during pain and childbirth* 6. *They do not like to express the word 'no' or give negative answers* 7. Always greet the eldest first and bid goodbye to each person 8. White flowers are used at funerals 9. *Yellow, green and red are lucky colors* 10. *Pregnant women should not eat excess during pregnancy* 11. *Isolation of mother and child may be up to 40 days to avoid pollution and impurity linked to the delivery process*

List the 6 identifying factors for when you would need to activate hemorrhage protocol in a postpartum patient.

1. >500 mL vaginal blood loss or >1000 mL C-section 2. 15% Vital sign change 3. HR >110 4. BP <85/45 5. O2 Saturation <95% 6. Clinical symptoms (Nausea, pale skin, swelling and pain around vagina)

What are the three most classic symptoms of ectopic pregnancy?

1. Abdominal pain (lower-quadrant) 2. Delayed menses 3. Abnormal vaginal bleeding (spotting) that occurs approx. 6 to 8 weeks after the last normal menstrual period

List 4 disadvantages of fertility awareness methods.

1. Adherence needed for strict record keeping 2. Some women have irregular cycles, less effective 3. Decreased sexual activity 4. Time consuming training sessions

List 4 nursing interventions for superficial venous thrombosis.

1. Administer analgesics to relieve pain 2. Elevate affected leg and promote rest 3. Elastic compression stockings 4. Heat may be applied

List some beliefs and practices of the Amish faith. (3)

1. Alcoholic beverages and drugs are prohibited unless prescribed. 2. Abortion, artificial insemination, and stem cell use are prohibited. 3. Amish seldom purchase commercial health insurance.

If a baby is born covered with meconium, what are the priority nursing interventions? (3)

1. Assess the baby's respiratory efforts, heart rate, and muscle tone. 2. Suction only the baby's mouth and nose if the baby has strong respiratory efforts, good muscle tone, and a HR >100. 3. Suction the trachea using an endotracheal tube (inserted by a specialist) to remove any meconium present if the baby has depressed respirations, decreased muscle tone, and a HR <100.

What are therapeutic magnesium levels?

4-8 mg/dL

List some points to know when caring for a client who is of Asian descent. (5)

1. Avoid hugs on first meetings 2. Avoid eye contact 3. Able to shake hands, they'll bow with family members 4. Elders hold highest position, they usually are the decision makers 5. They will be silent and encouraged not to cry with pain and childbirth

List two mechanical dilators to ripen the cervix.

1. Balloon catheters (ex. Foley catheter) 2. Hydroscopic dilators (Substances that absorb fluid from surrounding tissues and then enlarge)

List 5 alternative methods for stimulating labor.

1. Blue cohosh 2. Castor oil 3. Black cohosh 4. Primrose oil 5. Acupuncture

List 4 interventions to reduce breast discomfort for nonbreastfeeding mothers.

1. Breast binder or well-fitted supportive bra 2. Ice packs 3. Fresh cabbage leaves 4. Mild analgesics

What are the 5 risk factors of postpartum complications?

1. Caesarean delivery 2. Prolonged rupture of membranes 3. Prolonged labor 4. Bladder catheterization 5. Hemorrhage

List some beliefs and practices of the Buddhist faith. (3)

1. Consumption of alcoholic beverages and illicit drugs is prohibited. 2. Moderation in diet and avoidance of extremes are practiced. 3. Central tenets are maintaining right views, intentions, speech, actions, livelihood, effort, mindfulness, and concentration.

List 5 common signs of early menopause.

1. Decrease estrogen production by the ovaries, erratic estrogen and progesterone levels 2. Low levels of testosterone 5. Thinner vaginal walls

What cardiovascular alteration is seen with women going through menopause? (2)

1. Decreased HDL (Good cholesterol) 2. Increased LDL (Bad cholesterol)

List two dermatological alterations that occur during menopause.

1. Decreased skin elasticity 2. Loss of hair on the head and pubic area

What are the three different shunts that close after childbirth in the newborn?

1. Ductus venosus 2. Ductus arteriosus 3. Foramen ovale

List 6 indications for caesarean birth.

1. Dysfunctional labor 2. Breech presentation 3. Abnormal FHR or patterns 4. Inadequate pelvic shape 5. Maternal or fetal demise 6. STIs such as HIV or herpes

List at least 3 manifestations of an acute pulmonary embolism.

1. Dyspnea and tachypnea 2. Tachycardia 3. Chest pain 4. Cough 5. Hemoptysis 6. Elevated temperature 7. Syncope

List some beliefs and practices of the Hinduism faith. (2)

1. Eating meat is not allowed. 2. Cremation is the most common form of body disposal, but fetuses or newborns are sometimes buried.

What are the three main focuses with newborns?

1. Establish and maintain respiratory function 2. Maintain body heat 3. Decrease risk of infection

Describe the care management of a newborn within the first two hours of birth. (3) (What medications do they get?)

1. Eye prophylaxis (Antibiotic ointment) 2. Vitamin K injection because the baby is unable to synthesize vitamin K on their own 3. Hepatitis B vaccine

List some beliefs and practices of the Islam/Muslim faith. (6)

1. Fasting during daytime house occurs during a month-long period called Ramadan. 2. Ritual cleansing with water before eating and before prayer is practiced. 3. Eating pork or taking medicines with pork derivatives is prohibited. 4. *Drinking alcoholic beverages is prohibited.* 5. *Can't do sperm donors unless it's the dad to the mom.* 6. *Following the death of a client who followed the Muslim faith, a Muslim of the same gender must ritualistically wash and wrap the body.*

What are three signs of endometritis?

1. Fever >100.4 2. Uterine tenderness 3. Foul-smelling, profuse lochia

The second stage (Taking hold/Dependent/Independent phase) of Reva Rubin's Model lasts 10 days to two weeks postpartum. What are the characteristics of it?

1. Focus is on new role and desire to take charge 2. Optimal time for teaching/learning 3. Mom is still recovering from birth

The third, and last, stage (Interdependent phase) of Reva Rubin's Model involves what characteristics?

1. Fully incorporating mothering role 2. Focus is moving forward with family unit 3. Reasserting of relationship with partner

List 4 causes of DIC.

1. Hemorrhage 2. Abruptio placentae 3. Amniotic fluid embolism 4. Severe preeclampsia

List 6 common symptoms of early menopause.

1. Hot flashes. 2. Night sweats 3. Decreased libido 4. Irregular periods 5. Mood swings 6. Vaginal dryness

Carbohydrates should make up ___ to ___ of the newborn's total caloric intake.

40 to 50%

List some points to know when caring for a patient who is of hispanic/Latino descent.

1. Hug acceptable among friends and acquaintances 2. Shaking hands and eye contact are acceptable 3. Family orientated with extended families in household and gatherings 4. Family decision making is often preferred over autonomous decision making 5. They will be very vocal including crying with pain and childbirth.

List 6 indications for labor induction.

1. Hypertensive complications of pregnancy. 2. Fetal death. 3. Diabetes mellitus 4. Postterm pregnancy 5. IUGR and fetal compromise 6. Premature rupture of membranes w/established fetal maturity

List the 3 nursing interventions associated with each cause of postpartum hemorrhage.

1. If the mother is experiencing uterine atony, the nurse should intervene with a fundal massage or administer a medication ordered for increased contractility of the uterus. 2. If the patient has coagulation problems, the nurse will start a transfusion of blood products that the patient is deficient in. 3. Trauma/lacerations are treated surgically Most important thing is repletion of blood volume to prevent hemorrhage.

List 6 nursing interventions after a mother is suspected to be having a postpartum hemorrhage.

1. Increase IV rate of lactated ringers and increase oxytocin rate. 2. Administer 0.2 mg IM of Methergine to increase blood pressure. 3. Continue fundal massages, empty bladder, and keep pt. warm. 4. Administer O2 to maintain saturation above 95% 5. Rule out retained products of conception, laceration, or hematoma. 6. Order type and crossmatch PRBCs if not already done.

What lab results would a nurse anticipate if a mother experiencing a postpartum hemorrhage is suspected of having a coagulopathy?

1. Increased prothrombin time 2. Increased partial thromboplastin time 3. Decreased platelets 4. Decreased fibrinogen level 5. Increased fibrin degradation products 6. Prolonged bleeding time

List some signs of postpartum depression.

1. Intense and pervasive sadness with labile mood swings 2. Intense fears 3. Intense anger 4. Intense anxiety All of these persist past the baby's first few weeks

What are three symptoms of postpartum hemorrhage?

1. Low blood pressure 2. Tachycardia 3. Decreased urine production

List 3 advantages of fertility awareness methods.

1. Low to no cost 2. Absence of chemicals or hormones 3. Lack of alteration in menstrual flow pattern

List some beliefs and practices of the Catholic faith. (4)

1. Many fast and abstain from meat and meat products on Ash Wednesday and the Fridays of Lent. 2. Artificial contraception and direct abortion are prohibited. 3. Indirect abortion may be morally justified. 4. Sacrament of the Sick includes anointing of sick and oil, blessing by a priest, and communion.

List 4 obstetric emergencies.

1. Meconium stained amniotic fluid 2. Rupture of the uterus 3. Prolapsed umbilical cord 4. Shoulder dystocia

Describe the integumentary alterations that occur postpartum.

1. Melasma should disappear but may persist in 30% of women. 2. Hyperpigmentation of the areolae and line nigra may not disappear. 3. Stretch marks may fade but usually do not disappear. 4. Vascular abnormalities such as spider veins and palmar erythema generally subside, but some women may have permanent spider veins. 5. Hair growth slows, and some hair loss may occur. Fine hairs seen during pregnancy will disappear but the coarse or bristly hair that appears during pregnancy will remain.

What are two ways a baby can create heat?

1. Metabolism of brown fat 2. Voluntary muscle activity

What are 3 psychological/sleep alterations that occur with menopause?

1. Mood swings 2. Changes in sleep patterns 3. Decreased REM sleep

What are three abnormal assessment findings of the respiratory system of a newborn?

1. Nasal flaring 2. Grunting (sound babies make by using their accessory muscles to get more air in) 3. Retraction (When you can see the outline of the babies ribs, also indicated the baby is using their accessory muscles)

List the four categories of contraceptive methods.

1. Non-hormonal (Ex. barrier methods) 2. Hormonal (Ex. Depo Provera) 3. Intrauterine Devices (Ex. Paraguard) 4. Permanent sterilization (Ex. Vasectomy)

What is the normal range of voids per day of a newborn?

5-20

What is a normal glucose level within of the first 24 hours of childbirth in a newborn?

50 to 60 mg/dL

List 6 risk factors for developing VTE. (Venous thromboembolic disorders)

1. Operative vaginal birth 2. History of thromboembolic disorders 3. Obesity 4. Maternal age over 35 5. Multiparity 6. Smoking

What are the two main health risks for postmenopausal women?

1. Osteoporosis 2. Coronary Artery Disease

What are two common augmentation methods? Which four noninvasive interventions should be attempted before using the invasive methods?

1. Oxytocin infusion 2. Amniotomy 1. Empty bladder 2. Ambulation and position changes 3. Relaxation measures 4. Nourishment and hydration

What are 3 clinical manifestations of superficial venous thrombosis?

1. Pain and tenderness in the lower extremity 2. Warmth and redness 3. Enlarged, hardened vein over site of the thrombosis

List 5 interventions to treat hyperbilirubinemia.

1. Phototherapy 2. Sunlight 3. Fiberoptic blanket 4. Hydration 5. Feeding

Describe the cardiovascular changes that occur postpartum. List at least 4.

1. Plasma volume decreases due to diuresis and loss of blood during labor. 2. By third postpartum day, the plasma volume has been replenished as extravascular fluid returns to the intravascular space. 3. The mother may feel fatigued postpartum due to blood loss. 4. Stroke volume and cardiac output remain elevated for 12 weeks after birth and may not stabilize until 24 weeks after birth. 5. HR and BP return to normal levels within a few days postpartum. 6. Hematocrit and hemoglobin drop due to blood loss but stabilize by 8 weeks postpartum. 7. WBCs increase during the first 10-12 days after childbirth and can be between 20,000 to 25,000. 8. Coagulation factors increase to prevent PPH, but this causes an increased risk for thromboembolism. 9. Varicosities of the legs and around the anus (called hemorrhoids) are common during pregnancy, but regress after childbirth.

Describe the care management of a newborn after 2 hours after childbirth. (5)

1. Prevent infant abduction 2. Universal newborn screening (A blood test required by law) 3. Take weight and measurements such as head, chest, and body length. 4. Vital signs 5. Physical assessment

List 3 signs and symptoms of sub involution of the uterus.

1. Prolonged lochial discharge 2. Irregular or excessive bleeding 3. Hemorrhage

List 2 causes of sub involution of the uterus.

1. Retained placental fragments 2. Pelvic infection

List 3 physical methods used to stimulate labor.

1. Sexual intercourse 2. Nipple stimulation 3. Walking

What are 5 alternations of the genitourinary system during menopause?

1. Shrinking of labia 2. Decreased vaginal secretions 3. Increased vaginal pH 4. Vaginal dryness 5. Incontinence

What are at least 3 signs of cold stress in a newborn?

1. Skin cool to touch 2. Mottling 3. Central cyanosis 4. Decreased responsiveness 5. Jittery 6. Tachypnea

What is the nurse's role during a uterine rupture? (4)

1. Start IV fluids 2. Transfuse blood products 3. Administer O2 4. Assist with preparation for immediate surgery

List some beliefs and practices of the LDS faith. (4)

1. Strict dietary code called Word of Wisdom prohibits all alcoholic beverages, hot drinks, tobacco, and illegal or recreational drugs. 2. Fasting for 24 hour period occurs monthly on "Fast Sunday" 3. During hospitalization, an elder anoints the ill person with oil while a second elder seals the anointing with a prayer and blessing. 4. Abortion is prohibited except when a mother's life is in danger.

List some faiths and practices of the Judaism faith. (6)

1. Strictly observant Jews never eat pork, shellfish, or predatory fowl and never mix milk dishes and meat dishes in preparing foods. Fish with fins and scales are permissible. 2. Certain foods and drink are designated as kosher, which means "proper." All animals must be ritually slaughtered. 3. *On the eighth day after birth, boys are circumcised in a ritual called Brit Milah, and girls are given a dedication ceremony involving prayers and blessings.* 4. *Abortion is morally unacceptable except when the mother's life is in danger.* 5. *Organized support system for the sick includes a visit from the rabbi. The rabbi may pray with the sick person alone or in a minyan, a group of 10 adults over age 13.* 6. If an autopsy is performed, all body parts must be returned for burial.

How does hormonal contraception prevent pregnancy? (3)

1. Suppresses ovulation 2. Thickens cervical mucus to block semen 3. Alters the uterine decidua to prevent implantation

List nursing interventions for a patient experiencing shoulder dystocia.

1. Suprapubic pressure to the anterior shoulder in an attempt to push the shoulder under the symphysis pubis. 2. Instruct patient to perform McRoberts manuever. (Pulling legs back) 3. Gaskin maneuver (Hands and knees)

List a few quieting techniques new parents may use with their newborn.

1. Swaddling 2. Close skin contact 3. Pacifier 4. Rhythmic noises to stimulate utero sounds 5. Movement (Ex. infant swing) 6. Place newborn on their stomach across holder's lap and gently bounce legs 7. Eye contact and parallel

List 7 symptoms every pregnant should know is associated with preeclampsia.

1. Swelling of the eyes, face, or hands (NOT FEET). 2. Weight gain of more than 5 lbs in one week. 3. Headache that won't go away. 4. Vision disturbances. 5. Nausea and vomiting 6. Upper right belly pain 7. Difficulty breathing

The first stage (Taking in/Dependent phase) of Reva Rubin's Model occurs generally within the first 24 hours after delivery. What are the characteristics of it?

1. The focus is on self and meeting basic needs (Ex. I need food!) 2. Excited and talkative 3. Wants to review/relive the birth experience

What is the difference between the minipill and combined oral contraceptives?

1. The minipill only contains progestin whereas the combined oral contraceptive have estrogen and progestin too. 2. When taking the minipill, you CANNOT miss a pill. With combined, you shouldn't, but it's not as big of a deal. 3. With the minipill, you can take it while breastfeeding but with the combined pills you cannot.

Describe the four T's associated with postpartum hemorrhage.

1. Tone (Fundus or uterus is boggy and not contracting) 2. Trauma (Lacerations or episiotomy of the genital tract) 3. Tissue (Retained placenta or productions of conception) 4. Thrombin (Clotting problems)

What are 3 clinical manifestations of deep vein thrombosis?

1. Unilateral leg pain 2. Calf tenderness and swelling 3. Redness and warmth

List 5 clinical findings associated with ectopic pregnancy.

1. Unilateral stabbing pain and tenderness in the lower-abdominal quadrant 2. Scant, dark red, or brown vaginal spotting 3. Faintness and dizziness 4. Hypotension 5. Tachycardia, pallor

List 3 causes of postpartum hemorrhage.

1. Uterine atony (Uterus isn't contracting well enough) Caused by: -Polyhydramnios -Macrosomia -Multiple fetuses 2. Problem with clotting cascade (Coagulopathy) 3. Trauma or lacerations

List the signs and symptoms of preterm labor. (8)

1. Uterine contractions occurring more frequently than every 10 minutes persisting for 1 hour or more. (Contractions may be painful or painless). 2. Lower abdominal cramping similar to gas pains 3. Dull intermittent low back pain 4. Suprapubic pain or pressure 5. Bearing down feeling 6. Urinary frequency 7. Change in character or amount of usual discharge: thicker or thinner, blood, brown or colorless, increased amount, odor 8. Rupture of amniotic membranes

List some beliefs and practices of the Seventh-Day Adventism faith. What type of diet is encouraged? What type of meat can they not eat? Do they fast?

1. Vegetarian diet encouraged. 2. Nonvegetarian members refrain from eating foods derived from any animal having a cloven hoof that chews it cud (pigs and goats). Eating fish with fins and scales is acceptable, but you can't eat shellfish. 3. Consumption of alcoholic beverages is prohibited. 4. Fasting is practiced and involves abstaining from food or liquids by healthy members of the church.

What are the two primary causes of thromboembolic disorders?

1. Venous stasis 2. Hypercoagulation

List 3 comfort measures for a woman who has endometritis and wound infections.

1. Warm blankets or compresses 2. Perineal care 3. Sitz baths

When should new parents expect their newborns cord to fall off?

10 to 14 days after birth

If a pregnant woman's temperature is ____ or higher, notify the healthcare provider.

100.4 F (38 C)

How long does it take a baby to establish thermoregulation?

12 hours

At what bilirubin level would you discontinue phototherapy?

15 mg/dL

How long should a mother breastfeed each breast to ensure that her newborn receives adequate fat and protein?

15 to 20 minutes

What percentage of daily calories must come from fat in newborns?

15%

How long do newborns sleep every day?

16 to 19 hours a day

How long can it take to return to fertility after discontinuing the progestin shot?

18 months

What is a normal newborn length?

19-21 inches

Dilation: 3-4 Effacement: 60-70% Station: -1 or 0 cm Cervical consistency: Soft Cervical position: Anterior What is the bishop score? (FOR EACH)

2

To reduce engorgement, a mother should increase feedings to every __ hours.

2

How much larger should the head than the chest be?

2 to 3 cm larger

Due to decreased muscle tone in the intestines, lack of food, or dehydration during labor, how long may it take for a spontaneous bowel evacuation to occur postpartum?

2 to 3 days

At what postpartum period should the uterus NOT be palpable?

2 weeks

Postpartum depression persists longer than how long postpartum?

2 weeks and and it can even start up to a year postpartum.

How often should a woman get a new diaphragm or cervical cap, other than when it needs to be refitted due to weight fluctuations or pregnancy?

2 years

How long after discharge should a newborn be seen and examined at the doctor's office?

2-3 days

Fluid loss through perspiration and increased urinary output accounts for a weight loss of approximately ___kg during the puerperium.

2.25

By 24 hours after birth, the uterus is about the same size as it was at ____ weeks of gestation

20

How long after a male sterilization should a couple use an alternate form of birth control to allow all of the sperm to clear the vas deferent?

20 ejaculations, or one week to several months

With what weight fluctuation should you go to the doctor to have your diaphragm resized? In what other situations would you need to get it refitted?

20% weight fluctuation. After abdominal or pelvic surgery, and after pregnancy.

Acrocyanosis is normal within the first ___ hours of birth.

24

Meconium should pass within __ hours after birth.

24

How long after childbirth would a maternal fever be abnormal?

24 hours. Within the first 24 hours, a fever of up to 100.4 F or 38 C is normal due to dehydration, but after 24 hours there is worry about infection or sepsis.

Dilation: > or equal to 5 cm Effacement: > or equal to 80% Station: +1, +2 Cervical consistency: Soft Cervical position: Anterior What is the bishop score? (FOR EACH)

3

Postpartum psychosis begins in the first _____ months postpartum.

3

How long after childbirth will feedings stabilize the glucose levels of a newborn? What will the levels be?

3 days. 60-70 mg/dL

How many times per day should a breastfed newborn poop?

3 or more

How long is implantable progestin contraception good for?

3 years

The hCG hormone can be detected in the maternal system for how long after birth?

3-4 weeks

What is a normal RR of a newborn? What will the breaths be like? Will there be pauses?

30-60. Shallow and irregular. Yes, there can be pauses between breaths of 10-15 seconds.

What is a normal newborn chest circumference?

31-36 cm

What is a normal newborn head circumference?

33-38 cm

A sufficient amount of surfactant is available at what gestational age?

36 weeks

What is a normal newborn axillary temperature?

37.5 C

Newborns should not go longer than __ hours without being fed.

4 hours

The first void of a newborn should be within ___ _ ___ hours of birth.

4 to 6

The uterus, which at full term weighs approximately 11 times its prepregnancy weight, involutes to approximately ___g by 1 week after birth and to ___g by 2 weeks after birth. At 6 weeks postpartum, it weighs __to __g.

500. 350. 60 to 80.

What is the average age of menopause?

51 years old

All women should urinate within __ hours of delivery or catheter removal.

6

How long should a contraceptive sponge be left in place after intercourse? How long does it provide protection for?

6 hours. 24 hours.

How long before intercourse can you place the diaphragm? How long after intercourse must you keep it in? How long can you keep a diaphragm in for?

6 hours. 6 hours. 24 hours.

How long before intercourse can you place the cervical cap? How long after intercourse should you leave it in place? What is the maximum amount of time you should leave your cervical cap in?

6 hours. 6 hours. 48 hours.

When should solids be introduced to a babies diet?

6 months

How long does it take for the abdominal wall to return almost to its pre pregnancy state?

6 weeks

In a postpartum female, approximately how long does it take for the uterus to go back to it's original shape prepartum?

6 weeks

What is normal newborn blood pressure?

60-80/40-50

Up to how long after unprotected sex should a client take an emergency oral contraceptive? What typically is administered one hour before taking the pill to counteract the high doses of estrogen and progestin?

72 hours. An antiemetic.

A Bishop score of ___ or less indicates something for cervical ripening is needed.

8

How long can breast milk be stored at room temperature? Refrigerated? Frozen?

8 hours. 8 days. 6 months.

Newborns nurse on average how often every 24 hours?

8-12

What is normal temperature range for a newborn?

97.7 F to 99.5 F (36.5 to 37.5)

Implant, male or female sterilization, and IUD. Most effective, highly effective, or less effective?

Most effective

Male and female condom, sponge, withdrawal, fertility awareness, and spermicide. Most effective, highly effective, or less effective?

Less effective

The breasts of a bottle-feeding woman are engorged. The nurse should tell her to: a. wear a snug, supportive bra. b. allow warm water to soothe the breasts during a shower. c. express milk from breasts occasionally to relieve discomfort. d. place absorbent pads with plastic liners into her bra to absorb leakage.

A (A snug, supportive bra limits milk production and reduces discomfort by supporting the tender breasts and limiting their movement. Cold packs reduce tenderness, whereas warmth would increase circulation, thereby increasing discomfort. Expressing milk results in continued milk production. Plastic liners keep the nipples and areola moist, leading to excoriation and cracking.)

A pregnant woman's amniotic membranes rupture. Prolapsed cord is suspected. Which intervention is the nurse's top priority? a. Place the woman in the knee-chest position. b. Cover the cord in a sterile towel saturated with warm normal saline. c. Prepare the woman for a cesarean birth. d. Start oxygen by face mask.

A (A. The woman is assisted into a position (e.g., modified Sims position, Trendelenburg position, or the knee-chest position) in which gravity keeps the pressure of the presenting part off the cord. B. If the cord is protruding from the vagina, it may be covered with a sterile towel soaked in saline. Although this is an appropriate intervention, relieving pressure on the cord is the nursing priority. C. If the cervix is fully dilated, the nurse should prepare for immediate vaginal delivery. Cesarean birth is indicated only if cervical dilation is not complete. D. The nurse should administer O2 by facial mask at 8 to 10 L/min until delivery is complete. This intervention should be initiated after pressure is relieved on the cord. Not only should the woman be placed in knee-chest position, the nurse may also use her gloved hand or two fingers to lift the presenting part off the cord.)

Baby-friendly hospitals mandate that infants be put to breast within what time frame after birth? a. 1 hour b. 30 minutes c. 2 hours d. 4 hours

A (Baby-friendly hospitals mandate that the infant be put to breast within the first hour after birth (BFHI, 2010). The ideal time to initiate breastfeeding is within the first 1 to 2 hours after delivery. In many countries this is the norm; however, the Baby-Friendly Hospital Initiative (BFHI) mandates 1 hour. Ideally an infant should go no longer than 2 hours after delivery before being put to breast. This is much too long to wait to initiate breastfeeding, whether the hospital is baby-friendly or not.)

As part of the postpartum assessment, the nurse examines the breasts of a primiparous breastfeeding woman who is 1-day postpartum. Expected findings include: a. little if any change b. leakage of milk at let-down c. swollen, warm, and tender on palpation d. a few blisters and a bruise on each areola e. small amount of clear, yellow fluid expressed

A (Breasts are essentially unchanged for the first 24 hours after birth. Colostrum is present and may leak from the nipples. Leakage of milk occurs after the milk comes in 72 to 96 hours after birth. Engorgement occurs at day 3 or 4 postpartum. A few blisters and a bruise indicate problems with the breastfeeding techniques being used. E. Colostrum, or early milk, a clear, yellow fluid, may be expressed from the breasts during the first 24 hours.)

Which postpartum conditions are considered medical emergencies that require immediate treatment? a. Inversion of the uterus and hypovolemic shock b. Hypotonic uterus and coagulopathies c. Subinvolution of the uterus and idiopathic thrombocytopenic purpura d. Uterine atony and disseminated intravascular coagulation (DIC)

A (Inversion of the uterus and hypovolemic shock are considered medical emergencies. A hypotonic uterus can be managed with massage and oxytocin. Coagulopathies should be identified before delivery and treated accordingly. Although subinvolution of the uterus and ITP are serious conditions, they do not always require immediate treatment. ITP can be safely managed with corticosteroids or IV immunoglobulin. DIC and uterine atony are very serious obstetric complications; however, uterine inversion is a medical emergency requiring immediate intervention.)

A school nurse is providing teaching to an adolescent about levonorgestrel contraception. Which of the following information should the nurse include in the teaching? a. "You should take the medication within 72 hours following unprotected sexual intercourse." b. "You should avoid taking this medication if you are on an oral contraceptive." c. "If you don't start your period within 5 days of taking this medication, you will need a pregnancy test." d. "One dose of this medication will prevent you from becoming pregnant for 14 days after taking it."

A (Levonorgestrel is an emergency contraceptive which inhibits ovulation to prevent conception. The nurse should instruct the adolescent to take this medication as soon as possible within 72 hr after unprotected sexual intercourse.)

What skeletal alteration is seen with women going through menopause?

Decreased bone density

Nursing care management for mothers and fathers suffering grief from the loss of their baby includes: (Select all that apply.) a. using therapeutic communication and caring techniques. b. listening as parents tell their story of loss and grief. c. avoiding asking any questions about the loss of parents. d. giving advice from personal experiences. e. insisting parents name the baby in order to be remembered.

A B (The nurse should utilize therapeutic communication and caring techniques. The nurse should listen patiently while people tell their story of loss and grief. It may be necessary to ask questions that help people talk about their grief. The nurse should resist the temptation to give advice or use clichés in offering support. A caution about naming is important. Naming is an individual decision that should never be imposed on parents. Beliefs and individual needs vary greatly, sometimes based upon cultures and religious preferences as well.)

The labor and delivery nurse is admitting a woman complaining of being in labor. The nurse completes the admission database and notes that which factors may prohibit the woman from having a vaginal birth? (Select all that apply.) a. Unstable coronary artery disease b. Previous cesarean birth c. Placenta previa d. Initial blood pressure of 132/87 e. History of three spontaneous abortions

A B C (Indications for cesarean birth include: Maternal · Specific cardiac disease (e.g., Marfan syndrome, unstable coronary artery disease) · Specific respiratory disease (e.g., Guillain-Barré syndrome) · Conditions associated with increased intracranial pressure · Mechanical obstruction of the lower uterine segment (tumors, fibroids) · Mechanical vulvar obstruction (e.g., extensive condylomata) · History of previous cesarean birth Fetal · Abnormal fetal heart rate (FHR) or pattern · Malpresentation (e.g., breech or transverse lie) · Active maternal herpes lesions · Maternal human immunodeficiency virus (HIV) with a viral load of more than 1000 copies/mL · Congenital anomalies Maternal-Fetal · Dysfunctional labor (e.g., cephalopelvic disproportion, "failure to progress" in labor) · Placental abruption · Placenta previa · Elective cesarean birth (cesarean on maternal request) The blood pressure can be elevated because of pain and is not necessarily a contraindication to vaginal birth until further assessment is completed. Having a history of three spontaneous abortions is not a contraindication to vaginal birth.)

A nurse is caring for a client who reports indications of preterm labor. Which of the following findings are risk factors of this conditions? (Select all that apply). a. UTI b. Multifetal pregnancy c. Oligohydramnios d. Diabetes mellitus e. Uterine abnormalities

A B D E

For the first 2 hours after birth, the amount of uterine discharge should be about that of WHAT?

A heavy menstrual period

Describe APGAR.

A: Activity (Muscle tone) P: Pulse G: Grimace (Reflex irritability) A: Appearance (Skin color) R: Respiration

What length is considered a short cervix?

Less than 25 mm in length

Postpartum, a mother's blood sugar _____ due to a decrease in placental hormones.

Decreases

Red or purple splotches of the skin in the newborn due to cold stress

Mottling

How do you assess the plantar reflex? What should the response be?

Place finger at base of toes. Toes curl downward.

A condition in which the head is born but the anterior shoulder cannot pass under the pubic arch.

Shoulder dystocia

What is the length of the postpartum period?

After delivery of infant and placenta until 6-12 weeks after delivery, when the mom has returned to her pre-pregnant state.

Describe the breast changes that occur postpartum for breastfeeding mothers.

After the milk comes in after the colostrum is gone, the breasts can feel warm, firm, and somewhat tender. There may be leakage of milk from the breasts. The breasts can feel nodular and lumps due to the milk glands and milk ducts filled with milk. Some mothers may experience engorgement but this is temporary that typically lasts only 24 to 48 hours.

When does fundal massage begin?

After the placenta is born. NOT before it is born!

Uncomfortable cramping postpartum. More common in pregnant mothers who have had multiple gestations.

Afterpains

The flow of lochia increases with what two activities?

Ambulation and breastfeeding

Which pulse of the newborn do you take to assess for heart rate? How long?

Apical for a full minute

A pause of greater than 20 seconds between breaths in a newborn is called what?

Apnea

Usually occurs in response to a specific stressor and is characterized by dissociation or trance-like states, crying, uncontrollable spasms, trembling, or shouting. Hispanic/Latino culture.

Ataque de nervios

The stimulation of uterine contractions after labor has started spontaneously but progress is unsatisfactory (Trying to move it along).

Augmentation of labor

Why is magnesium sulfate is given to women with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To prevent and treat convulsions c. To decrease blood pressure readings d. To prevent a boggy uterus and lessen lochial flow

B

A woman gave birth to a 7-lb, 3-oz boy 2 hours ago. The nurse determines that the woman's bladder is distended because her fundus is now 3 cm above the umbilicus and to the right of the midline. In the immediate postpartum period, the most serious consequence likely to occur from bladder distention is: a. urinary tract infection. b. excessive uterine bleeding. c. a ruptured bladder. d. bladder wall atony.

B (A urinary tract infection may result from overdistention of the bladder, but it is not the most serious consequence. Excessive bleeding can occur immediately after birth if the bladder becomes distended, because it pushes the uterus up and to the side and prevents it from contracting firmly. A ruptured bladder may result from a severely overdistended bladder. However, vaginal bleeding most likely would occur before the bladder reaches this level of overdistention. Bladder distention may result from bladder wall atony. The most serious concern associated with bladder distention is excessive uterine bleeding.)

The priority nursing intervention for a woman who suffered a perineal laceration is to: a. apply a cold compress. b. establish hemostasis. c. administer analgesia. d. administer a stool softener.

B (Bleeding should be stopped first. After bleeding has been controlled, the care of the woman with lacerations of the perineum includes analgesia administration, hot or cold applications, and stool softeners. Stool softeners may be used to assist the woman in reestablishing bowel habits without straining and putting stress on the suture lines.)

A nurse is assessing a full-term newborn 15 min after birth. Which of the following findings requires intervention by the nurse? a. HR 168 b. RR 18 c. Tremors d. Fine crackles

B (During the first phase of a newborn's transition to extrauterine life, which is up to 30 min after birth, a heart rate between 160 to 180/min is an expected clinical manifestation. The respiratory rate is low and can range between 20 to 100/min normally. *Tremors, fine crackles, and nasal flaring are expected clinical manifestations within 30 minutes after birth*.)

A primiparous woman is in the taking-in stage of psychosocial recovery and adjustment following birth. Recognizing the needs of women during this stage, the nurse should: a. foster an active role in the baby's care. b. provide time for the mother to reflect on the events of and her behavior during childbirth. c. recognize the woman's limited attention span by giving her written materials to read when she gets home rather than doing a teaching session now. d. promote maternal independence by encouraging her to meet her own hygiene and comfort needs.

B (Once the mother's needs are met, she would be more able to take an active role, not only in her own care but also the care of her newborn. Women express a need to review their childbirth experience and evaluate their performance. Short teaching sessions, using written materials to reinforce the content presented, are a more effective approach. The focus of the taking-in stage is nurturing the new mother by meeting her dependency needs for rest, comfort, hygiene, and nutrition.)

In follow-up appointments or visits with parents and their new baby, it may be useful if the nurse can identify parental behaviors that can either facilitate or inhibit attachment. What is a facilitating behavior? a. The parents have difficulty naming the infant. b. The parents hover around the infant, directing attention to and pointing at the infant. c. The parents make no effort to interpret the actions or needs of the infant. d. The parents do not move from fingertip touch to palmar contact and holding.

B (Reluctance to name the baby is an inhibiting behavior. Hovering over the infant, as well as obviously paying attention to the baby, is a facilitating behavior. Failure to interpret the actions and needs of the infant is an inhibiting behavior. Lack of fingertip, palmar touch, and holding represents an inhibiting behavior.)

What statement by a newly delivered woman indicates that she knows what to expect about her menstrual activity after childbirth? a. "My first menstrual cycle will be lighter than normal and then will get heavier every month thereafter." b. "My first menstrual cycle will be heavier than normal and will return to my prepregnant volume within three or four cycles." c. "I will not have a menstrual cycle for 6 months after childbirth." d. "My first menstrual cycle will be heavier than normal and then will be light for several months after."

B (She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles. This is an accurate statement and indicates her understanding of her expected menstrual activity. Most women experience a heavier than normal flow during the first menstrual cycle, which occurs by 3 months after childbirth. She can expect her first menstrual cycle to be heavier than normal, and the volume of her subsequent cycles to return to prepregnant levels within three or four cycles.)

Which description of postpartum restoration or healing times is accurate? a. The cervix shortens, becomes firm, and returns to form within a month postpartum. b. Rugae reappear within 3 to 4 weeks. c. Most episiotomies heal within a week. d. Hemorrhoids usually decrease in size within 2 weeks of childbirth.

B (The cervix regains its form within days; the cervical os may take longer. Rugae are never again as prominent as in a nulliparous woman. Localized dryness may occur until ovarian function resumes. Most episiotomies take 2 to 3 weeks to heal. Hemorrhoids can take 6 weeks to decrease in size.)

When providing nutritional education for a Mexican-American patient with newly diagnosed hypertension, the nurse notes that the patient is nodding "yes" to everything that is being said. With a better understanding of cultural interdependence, a nurse should immediately a. write everything down for the patient to refer to later. b. prompt the patient further to elicit additional questions or concerns. c. call the recognized elder for this patient. d. call the patient's oldest male relative for help with decision making.

B (The patient is nodding "yes" because it is a polite way of indicating that the power distance is too close for the patient. Acknowledging power distance is the way in which a less powerful member of an organization or institution (such as a family) accepts and indicates that power is being distributed unequally. Cultures that endorse a low power distance expect and accept power relations that are more consultative or democratic. People relate to one another more as equals, regardless of formal positions in the culture. Subordinates are more comfortable with and demand the right to contribute to and critique the decision making of those in power. In cultures that endorse a high power distance, less powerful persons accept power relations that are more autocratic and paternalistic. Subordinates acknowledge the power of others simply based on where they are situated in certain formal, hierarchical positions. When a nurse provides nutritional education for a patient who is from a culture that values a greater power distance, as does the Mexican-American culture, it might appear that the patient is willing to accept all that the nurse suggests; further prompting would elicit additional questions or concerns. A patient from a collectivist culture will usually consult family members about the best course of action. It is not acceptable for a nurse to take it upon herself or himself to call a recognized elder or oldest male relative for help with decision making. Although writing everything down may be acceptable in some cultures, with an Asian patient it may be best to prompt the patient further to elicit additional questions or concerns.)

The nurse examines a woman 1 hour after birth. The woman's fundus is boggy, midline, and 1 cm below the umbilicus. Her lochial flow is profuse, with two plum-sized clots. The nurse's initial action would be to: a. place her on a bedpan to empty her bladder. b. massage her fundus. c. call the physician. d. administer Methergine, 0.2 mg IM, which has been ordered prn.

B (There is no indication of a distended bladder; thus having the woman urinate will not alleviate the problem. A boggy or soft fundus indicates that uterine atony is present. This is confirmed by the profuse lochia and passage of clots. The first action would be to massage the fundus until firm. The physician can be called after massaging the fundus, especially if the fundus does not become or remain firm with massage. Methergine can be administered after massaging the fundus, especially if the fundus does not become or remain firm with massage.)

A nurse is providing care for a client who is diagnosed with marginal abroptio placentae. The nurse is aware that which of the following findings are risk factors for developing the condition? (Select all that apply.) a. Fetal position b. Blunt abdominal trauma c. Cocaine use d. Maternal age e. Cigarette smoking

B C E

When helping a woman cope with postpartum blues, the nurse should offer what appropriate suggestions? (Select all that apply.) a. The father should take over care of the baby, because postpartum blues are exclusively a female problem. b. Get plenty of rest. c. Plan to get out of the house occasionally. d. Asking for help will not foster independence. e. Use La Leche League or community mental health centers.

B C E (Remember that the "blues" are normal and that both the mother and the father or partner may experience them. · Get plenty of rest; nap when the baby does if possible. Go to bed early, and let friends and family know when to visit and how they can help. (Remember, you are not "Supermom.") · Use relaxation techniques learned in childbirth classes (or ask the nurse to teach you and your partner some techniques). · Do something for yourself. Take advantage of the time your partner or family members care for the baby—soak in the tub (a 20-minute soak can be the equivalent of a 2-hour nap), or go for a walk. · Plan a day out of the house—go to the mall with the baby, being sure to take a stroller or carriage, or go out to eat with friends without the baby. Many communities have churches or other agencies that provide child care programs such as Mothers' Morning Out. · Talk to your partner about the way you feel—for example, about feeling tied down, how the birth met your expectations, and things that will help you (do not be afraid to ask for specifics). · If you are breastfeeding, give yourself and your baby time to learn. · Seek out and use community resources such as La Leche League or community mental health centers. One nationally recognized resource is: Postpartum Support International 927 North Kellogg Ave. Santa Barbara, CA 93111 (805) 967-7636 www.postpartum.net)

A nurse is reviewing the medical record of a client who is menopausal. Which of the following findings should the nurse expect? (Select all that apply.) a. Increased vaginal secretions b. Decreased bone density c. Increased HDL level d. Decreased skin elasticity e. Increased pubic hair growth f. Decreased FSH level

B D

Describe the BUBBLE-LE mnemonic device associated with postpartum assessment.

B: Breasts U: Uterus B: Bowel B: Bladder L: Lochia E: Episiotomy/lacterations L: Legs (Thrombosis) E: Emotions

A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes. Which statement if made by the client indicates a need for further education? A. "I need to stay on the diabetic diet." B. "I will perform glucose monitoring at home." C. "I need to avoid exercise because of the negative effects of insulin production." D. "I need to be aware of any infections and report signs of infection immediately to my health care provider."

C

This postpartum psychologic disorder is characterized by mood swings, feelings of sadness and/or anxiety, crying, difficulty sleeping, and loss of appetite. The symptoms resolve within a few days, and treatment is not needed.

Baby blues

What depressive state following childbirth is the most common and does not impair functioning of the woman?

Baby blues

Afterpains generally resolve in what time period?

Between 3-7 days

A pre-labor scoring system to assist in predicting whether induction of labor will be required.

Bishop's Score

What is one frequently reported adverse affect of hormonal oral contraceptives?

Breakthrough vaginal bleeding

A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea and vomiting and scant, prune-colored discharge. She has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect? a. Hyperemesis gravidarum b. Threatened abortion c. Hydatidiform mole d. Preterm labor

C

Which measure would be least effective in preventing postpartum hemorrhage? a. Administer Methergine, 0.2 mg every 6 hours for four doses, as ordered b. Encourage the woman to void every 2 hours c. Massage the fundus every hour for the first 24 hours following birth d. Teach the woman the importance of rest and nutrition to enhance healing

C (Administration of Methergine can help prevent postpartum hemorrhage. Voiding frequently can help the uterus contract, thus preventing postpartum hemorrhage. The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Rest and nutrition are helpful for enhancing healing and preventing hemorrhage.)

A patient who has recently moved to this country states he is frustrated about the pressure to give up his original identity and develop a new cultural identity. The nurse should use which term to best describe this type of cultural change? a. Biculturalism b. Acculturation c. Assimilation d. Ethnicity identification

C (Assimilation is a process by which a person gives up their original identity and develops a new cultural identity by becoming absorbed into the more dominant cultural group. Acculturation is the process of acquiring new attitudes, roles, customs, or behaviors as a result of contact with another culture. Ethnicity refers to a common ancestry that leads to shared values and beliefs. It is transmitted over generations by one's family and community. Ethnicity is a powerful determinant of one's identity or ethnic identity. In the case of biculturalism, the individual has a duel pattern of identification and chooses which aspects of the new culture he/she wishes to adopt and which aspects of their original culture he/she wishes to retain.)

The nurse is triaging a Latin-Caribbean patient who is behaving hysterically in the emergency room. The patient is crying, has uncontrollable spasms, and is trembling and shouting. It is important to identify the manifestation of illness in order to effectively treat a patient. The nurse identifies this as a culture-bound syndrome called a. Shenjing shaijo. b. Loco de la cabeza. c. Ataque de nervios. d. Neurasthenia.

C (Ataque de nervios is a Latin-Caribbean culture-bound syndrome that usually occurs in response to a specific stressor and is characterized by dissociation or trance-like states, crying, uncontrollable spasms, trembling, or shouting. Shenjing shaijo refers to "weakness of nerves" in Chinese culture; it is caused by a decrease in vital energy that reduces the function of the internal organ systems and lowers resistance to disease. Loco de la cabeza is a Spanish phrase meaning "crazy in the mind," a condition that is not necessarily manifested by physical symptoms. Neurasthenia is used in Asian cultures to describe extreme fatigue after mental effort and bodily weakness of persistent duration.)

With regard to the condition and reconditioning of the urinary system after childbirth, nurses should be aware that: a. kidney function returns to normal a few days after birth. b. diastasis recti abdominis is a common condition that alters the voiding reflex. c. fluid loss through perspiration and increased urinary output account for a weight loss of more than 2 kg during the puerperium. d. with adequate emptying of the bladder, bladder tone usually is restored 2 to 3 weeks after childbirth.

C (Kidney function usually returns to normal in about a month. Diastasis recti abdominis is the separation of muscles in the abdominal wall; it has no effect on the voiding reflex. Excess fluid loss through other means occurs as well. Bladder tone usually is restored 5 to 7 days after childbirth.)

Following the birth of her baby, a woman expresses concern about the weight she gained during pregnancy and how quickly she can lose it now that the baby is born. The nurse, in describing the expected pattern of weight loss, should begin by telling this woman that: a. return to prepregnant weight is usually achieved by the end of the postpartum period. b. fluid loss from diuresis, diaphoresis, and bleeding accounts for about a 3-lb weight loss. c. the expected weight loss immediately after birth averages about 11 to 13 lbs. d. lactation will inhibit weight loss since caloric intake must increase to support milk production.

C (Prepregnant weight is usually achieved by 2 to 3 months after birth, not within the 6-week postpartum period. Weight loss from diuresis, diaphoresis, and bleeding is about 9 lbs. The expected weight loss immediately following delivery is 11 to 13 lbs, followed by a gradual decrease and a return to prepregnancy weight in 2 to 3 months. Weight loss continues during breastfeeding since fat stores developed during pregnancy and extra calories consumed are used as part of the lactation process.)

A nurse is assessing a newborn who is 12 hr old. Which of the following clinical manifestations requires intervention by the nurse? a. Acrocyanosis of the extremities b. Murmur at the left sternal border c. Substernal chest retractions while sleeping d. Positive Babinski reflex

C (Substernal chest retractions can indicate respiratory distress syndrome in the newborn. This clinical manifestation requires further assessment and intervention by the nurse.)

With regard to afterbirth pains, nurses should be aware that these pains are: a. caused by mild, continual contractions for the duration of the postpartum period. b. more common in first-time mothers. c. more noticeable in births in which the uterus was overdistended. d. alleviated somewhat when the mother breastfeeds.

C (The cramping that causes afterbirth pains arises from periodic, vigorous contractions and relaxations that persist through the first part of the postpartum period. Afterbirth pains are more common in multiparous women because first-time mothers have better uterine tone. A large baby or multiple babies overdistend the uterus. Breastfeeding intensifies afterbirth pain because it stimulates contractions.)

A nurse is teaching a client who has pre gestational type 1 diabetes mellitus about management during pregnancy. Which of the following statements by the client indicates an understanding of the teaching? a. "I should have a goal of maintaining my fasting blood glucose between 100 and 120." b. "I should engage in moderate exercise for 30 minutes if my blood glucose is 250 or greater." c. "I will continue taking my insulin if I experience nausea and vomiting." d. "I will ensure that my bedtime snack is high in refined sugar."

C (The nurse should teach the client to continue to take her insulin as prescribed during illness to prevent hypoglycemic and hyperglycemic episodes.)

When making a visit to the home of a postpartum woman 1 week after birth, the nurse should recognize that the woman would characteristically: a. express a strong need to review events and her behavior during the process of labor and birth. b. exhibit a reduced attention span, limiting readiness to learn. c. vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn. d. have reestablished her role as a spouse/partner.

C (This is characteristic of the taking-in stage, which lasts for the first few days after birth. This is characteristic of the taking-in stage, which lasts for the first few days after birth. One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage. This stage lasts for as long as 4 to 5 weeks after birth. This reflects the letting-go stage, which indicates that psychosocial recovery is complete.)

A nurse is reviewing formula preparation with parents who plan to bottle-feed their newborn. Which of the following information should the nurse include in the teaching? (Select all that apply.) a. Use a disinfectant wipe to clean the lid of the formula can. b. Store prepared formula in the refrigerator for up to 72 hours. c. Place used bottles in the dishwasher. d. Check the nipple for appropriate flow of formula. e. Use tap water to dilute concentrated formula.

C D E (Chemicals should not be used on the formula cans. You can store formula that is prepared for up to 48 hours.)

A postpartum woman preparing for discharge asks the nurse about resuming sexual activity. Which information is appropriate to include in the patient teaching? (Select all that apply.) a. Do not perform Kegel exercises to decrease pelvic floor muscle healing time. b. If breastfeeding, sexual interest may be delayed. c. Fatigue may affect interest in sexual activity. d. Sexual activity can usually be safely resumed by 5 to 6 weeks after birth. e. Water-soluble lubrication may increase comfort. f. The female-on-top position may be more comfortable than other positions.

C D E F (Kegel exercises are usually recommended and can strengthen the pubococcygeal muscle. Breastfeeding mothers often are interested in returning to sexual activity before nonbreastfeeding mothers. The amount of psychologic energy expended by the mother in child care activities may lead to fatigue and decreased interest in sexual activity. Most women can safely resume sexual activity by 5 to 6 weeks after birth. A water-soluble gel or jelly is recommended for lubrication. A position in which the mother has control of the depth of insertion of the penis, such as the female-on-top position may be more comfortable than other positions.)

While taking the progestin shot, what vitamins and minerals should you maintain an adequate intake of?

Calcium and Vitamin D

Vacuum or forceps delivery can only be done if the baby is ____.

Crowning

A yellowish white discharge that is seen 10 days after childbirth up to 4-8 weeks postpartum.

Lochia alba

Which type of birth doubles the risk for venous thromboembolic disorders?

Cesarean birth

Infection of the amniotic membranes, there is an increased risk of this infection because of PROM.

Chorioamnioitis

What is the number one cause of miscarriages?

Chromosomal abnormalities

Withdrawal of penis from vagina prior to ejaculation

Coitus interruptus (withdrawal)

Transfer from heat to a cooler surface by direct skin contact. Baby may be placed on a cold scale, this would be bad. You want baby to be on a blanket. A cold stethoscope as well.

Conduction

The flow of air. Babies can lose heat by being under an air conditioning vent, a fan in the room. Any draft or breeze can make the baby lose heat. Nurse needs to be aware of drafts in the room.

Convection

A nurse is caring for a client who has a diagnosis of ruptured ectopic pregnancy. Which of the following findings is seen with this condition? a. No alteration in menses b. Transvaginal ultrasound indicating a fetus in the uterus c. Serum progesterone greater than the expected reference range d. Report of severe shoulder pain

D

A nurse is reviewing discharge teaching with a client who has premature rupture of membranes at 26 weeks gestation. Which of the following instruction should the nurse include in the teaching? a. Use a condom with sexual intercourse. b. Avoid bubble bath solution when taking a tub bath. c. Wipe from the back to front when performing perineal hygiene. d. Keep a daily record of fetal kick counts.

D

Two hours after giving birth a primiparous woman becomes anxious and complains of intense perineal pain with a strong urge to have a bowel movement. Her fundus is firm at the umbilicus and midline. Her lochia is moderate rubra with no clots. The nurse suspects: a. bladder distention b. uterine atony c. constipation d. hematoma formation

D (Bladder distention results in an elevation of the fundus above the umbilicus and deviation to the right or left of midline. Uterine atony results in a boggy fundus. Constipation is unlikely at this time. Increasing perineal pressure along with a firm fundus and moderate lochial flow are characteristic of hematoma formation.)

A nurse is planning care for a client who is 2 hr postpartum. Which of the following interventions should the nurse plan to implement during the taking-hold phase of postpartum behavioral adjustment? a. Discuss contraceptive options with the client and her partner b. Repeat information to ensure client understanding c. Listen to the client and her partner as they reflect upon the birth experience d. Demonstrate the client how to perform a newborn bath

D (Demonstrating to the client how to perform a newborn bath occurs during the taking-hold phase. The new mother moves from being passively dependent to taking a stronger interest in her new role as a mother. She is now focusing on the care of her newborn and acquiring parenting skills. The nurse should provide positive reinforcement during this phase to give the new mother confidence and promote maternal adjustment.)

Postbirth uterine/vaginal discharge, called lochia: a. is similar to a light menstrual period for the first 6 to 12 hours. b. is usually greater after cesarean births. c. will usually decrease with ambulation and breastfeeding. d. should smell like normal menstrual flow unless an infection is present.

D (Lochia flow should approximate a heavy menstrual period for the first 2 hours and then steadily decrease. Less lochia usually is seen after cesarean births. Lochia usually increases with ambulation and breastfeeding. An offensive odor usually indicates an infection.)

A nurse is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the nurse use to help minimize the pain of the procedure for the newborn? a. Apply a cool pack for 10 min to the heel prior to the puncture. b. Request a prescription for IM analgesic. c. Use a manual lance blade to pierce the skin. d. Place the newborn skin to skin on the mother's chest.

D (Placing the newborn skin to skin on the mother's chest is an effective technique to significantly decrease the newborns pain level and anxiety. The nurse should implement this technique before, during, and after the procedure.)

This discharge resembles period blood and is seen in the first few days postpartum.

Lochia rubra

A nurse is caring for a newborn immediately following birth. Which of the following nursing interventions is the highest priority? a. Initiating breastfeeding b. Performing the initial bath c. Giving a vitamin K injection d. Covering the newborns head with a cap

D (The greatest risk to the newborn is cold stress. Therefore the highest priority intervention is to prevent heat loss. Covering the newborn's head with a cap prevents cold stress due to excessive evaporative heat loss.)

On examining a woman who gave birth 5 hours ago, the nurse finds that the woman has completely saturated a perineal pad within 15 minutes. The nurse's first action is to: a. begin an IV infusion of Ringer's lactate solution. b. assess the woman's vital signs. c. call the woman's primary health care provider. d. massage the woman's fundus.

D (The nurse may begin an IV infusion to restore circulatory volume, but this would not be the first action. Blood pressure is not a reliable indicator of impending shock from an impending hemorrhage; assessing vital signs should not be the nurse's first action. The physician should be notified after the nurse completes assessment of the woman. The nurse should assess the uterus for atony. Uterine tone must be established to prevent excessive blood loss.)

Postpartum women experience an increased risk for urinary tract infection. A prevention measure the nurse could teach the postpartum woman would be to: a. acidify the urine by drinking three glasses of orange juice each day. b. maintain a fluid intake of 1 to 2 L/day. c. empty her bladder every 4 hours throughout the day. d. perform perineal care on a regular basis.

D (Urine is acidified with cranberry juice. The woman should drink at least 3 L of fluid each day. The woman should empty her bladder every 2 hours to prevent stasis of urine. Keeping the perineum clean will help prevent a urinary tract infection.)

Which findings would be a source of concern if noted during the assessment of a woman who is 12 hours' postpartum? (Select all that apply.) a. Postural hypotension b. Temperature of 100.4° F c. Bradycardia—pulse rate of 55 beats/min d. Pain in left calf with dorsiflexion of left foot e. Lochia rubra with foul odor

D E (Postural hypotension is an expected finding related to circulatory changes after birth A temperature of 100.4° F in the first 24 hours most likely indicates dehydration, which is easily corrected by increasing oral fluid intake. A heart rate of 55 beats/min is an expected finding in the initial postpartum period. These findings indicate a positive Homans' sign and are suggestive of thrombophlebitis and should be investigated. Lochia with odor may indicate infection.)

What is the main difference between SVT medical management and DVT medical management?

DVT is initially treated with anticoagulant therapy. The similarities are that it is treated with bedrest with the affected leg elevated and analgesia.

What alteration in renal function is seen postpartum?

Diminishing steroid levels after childbirth reduces renal function, but it returns to normal within 1 month after birth. Diuresis also occurs, caused by decreased estrogen levels, to decrease excess fluid.

This discharge is lighter and more watery and is seen after 3 to 4 days postpartum. It lasts until about 22 to 27 days postpartum.

Lochia serosa

Clotting and anti-clotting mechanisms occur at the same time, as a result of other complications (PPH).

Disseminated Intravascular Coagulation (DIC)

Abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Associated with retained products of conception and abruptio placentae.

Disseminated intravascular coagluopathy

Excessive maternal bleeding can occur if the bladder is _____.

Distended (Full!)

What should a woman do prior to insertion of her diaphragm? How should she wash her diaphragm?

Empty her bladder. Wash it with mild soap and warm water after each use.

Diana voids 500 mL of urine. Her fundus is boggy but became firm with massage and is now at the level of the umbilicus. Her lochial flow is slightly decreased. Diana has an IV of LR (Lactated ringers) with 20 units of oxytocin infusing at 125 mL an hour. What else can the nurse do to help Diana's uterus contract?

Encourage breastfeeding because it releases natural oxytocin to increase uterine contractions to prevent postpartum hemorrhage.

Assessment of _____ and _____ _____ is essential to monitor the progress of normal involution and to identify potential problems.

Lochia. Fundal height.

What is the most common postpartum infection?

Endometritis

Combined oral contraceptives contain which two hormones?

Estrogen and progestin

What are two important etiologic factors that contribute to postpartum depression?

Estrogen fluctuations and the change from the high levels of estrogen and progesterone at the end of pregnancy to much lower levels of both hormones that are present after birth.

The rapid decrease in _____ and _____ levels after expulsion of the placenta is responsible for triggering many of the anatomic and physiologic changes in the puerperium.

Estrogen. Progesterone.

How often should a nurse perform fundal massages for the first hour after delivery? For the next four hours?

Every 5-15 minutes for the first hour then every 30 minutes for the next four hours.

What occurs postpartum to a woman who is beginning to lose her excess tissue fluid accumulated during pregnancy?

Excessive diaphoresis, especially at night, for the first 2 or 3 days after childbirth.

Which hormone is increased during menopause? Which hormone is decreased?

FSH. Estrogen.

True or false: In phototherapy, the light should be at least 10 cm from the infant.

False, it should be at least 15-20 cm from the infant.

True or false: A perineal pad saturated in 45 minutes or less or pooling of blood under the buttocks is an indication of excessive blood loss requiring immediate assessment, intervention, and notification of the primary health care provider.

False. 15 minutes or less!

True or false: Breast fed poop smells worse than formula fed poop.

False. Breast fed smells better than formula fed poop.

True or False: A nurse should instruct a new mother to feed her baby every time it cries.

False. Overfeeding can lead to stomach aches and diarrhea.

True or false: Within one or two cycles, the amount of menstrual flow returns to the woman's prepregnancy volume.

False. Three or four.

This contraceptive method involves tracking the menstrual cycle to identify the infertile and fertile phases of menstruation to prevent or increase the chances of pregnancy.

Fertility awareness methods

Injury confined to the vaginal mucosa

First degree laceration

Injury to the external and internal sphincter and rectal mucosa/anal epithelium

Fourth degree

A maneuver in which the mom goes on her hands and knees to help resolve shoulder dystocia.

Gaskin maneuver

Meconium-stained amniotic fluid is which color?

Green

What symptom postpartum can be indicative of postpartum-onset preeclampsia, stress, and leakage of the cerebrospinal fluid into the extradural space during placement of the needle for administration of epidural or spinal anesthesia?

Headaches

Injectable, pill, patch, ring, and diaphragm. Most effective, highly effective, or less effective?

Highly effective

How do you assess the moro reflex? What should the response be?

Hold the newborn in a semi-sitting position, then allow the newborn's head and trunk to fall backward. Place infant supine on flat surface and perform sharp hand clap. There should be symmetric abduction and extension of arms. The fingers should fan out and form a C with thumb and forefinger. A cry may accompany.

Which positive test may be indicative of venous thromboembolism?

Homan's sign

Describe vasomotor manifestations of menopause.

Hot flashes and irregular menses

What does APGAR tell us?

How well the baby transitioned from inside the uterus to outside the uterus.

What is one common maternal effect of betamethasone?

Hyperglycemia

What alteration in deep tendon reflexes is manifested in preeclampsia?

Hyperreflexia

What are two safe antihypertensives to use in pregnancy?

Labetolol and hydralazine

If a newborn is exhibiting signs of cold stress, what is one condition you should assess for to rule out?

Hypoglycemia

Persistent significant bleeding: Perineal pad is soaked within 15 minutes; initially may not be accompanied by a change in vital signs or maternal color or behavior. • Woman states that she feels weak, light-headed, "funny," or "nauseated" or that she "sees stars." What is possibly occurring?

Hypovolemic shock

What is a possible complication of using a diaphragm cup?

Increased risk of TSS, and if you have a history of TSS or frequent UTIs you should not get the diaphragm.

Relaxes uterine smooth muscle by inhibiting prostaglandins. Stops preterm labor.

Indomethacin

What supplement should a newborn get after 6 months of being born to prevent anemia?

Iron

What is the most common adverse effect reported by women with the progestin implant?

Irregular and unpredictable menstruation

What is a distinguishing feature of PPD?

Irritability (Ex. "He never helps me." or, "She cries all the time, and I feel like hitting her.")

How is cervical mucus altered during ovulation?

It becomes thin and flexible under the influence of estrogen and progesterone to allow for sperm viability and motility. Couples will monitor cervical mucus to determine if she is in her fertile stage.

How is temperature altered at the time of ovulation?

It can drop slightly

Describe menopausal hormone therapy.

It is used to suppress vasomotor manifestations of menopause, such as hot flashes. It also prevents atrophy of vaginal tissue and reduces risk of fractures. It contains estrogen and progestin. It increases the risk of cardiovascular disorders and breast cancer.

Describe the contraceptive sponge. What does it contain?

It's a small, round, polyurethane sponge that contains spermicide. It is designed to fit over the cervix, and is one size fits all.

What is the advantage of a classic vertical incision over a transverse incision?

It's much quicker, so if there is an emergency and you need to get the baby out as quick as possible the classic incision is much more effective.

What is the difference between lochial and nonlochial bleeding?

Lochial bleeding usually trickles from the vaginal opening and the flow increases when the uterus contracts. Nonlochial bleeding spurts from the vagina, which may indicate tears in the cervix or vagina. Nonlochial bleeding tends to be excessive and bright red, whereas lochial is a trickle and can be darker in color when is has been pooled in the vagina.

What term may hispanics/latinos use when describing a patient who is 'crazy in the mind' and is not necessarily manifested by physical symptoms?

Loco de la cabeza

What signs of a possible adverse effect should a woman taking combined hormonal oral contraceptive look for?

Looks for signs of chest pain, shortness of breath, leg pain from a possible clot, headache, eye problems from a stroke, and hypertension.

What is the normal consistency of breast fed poop?

Loose and seedy texture

Weight of less than 2500 g at birth.

Low birth weight

Medication of choice to prevent seizures in the client who has eclampsia and severe preeclampsia.

Magnesium sulface

CNS depressant; relaxes smooth muscles including uterus.

Magnesium sulfate

What is the first thing a nurse needs to do after a baby is born?

Maintain airway and airway assessment

Breast infection. Occurs from an unresolved or pulled milk duct. Always needed to be treated with antibiotics. You can continue to breastfeed with it.

Mastitis

A maneuver in which the mom lays on her back and spreads her legs and pulls her knees to her chest to open up the pelvis. Can help resolve shoulder dystocia.

McRoberts maneuver

The cessation of menses. It will appear on an infrequent cycles for a period of time that does not exceed 2 years. It is considered complete when no menses have occurred for 12 months.

Menopause

This medication inhibits cell division and embryo enlargement, dissolving the pregnancy.

Methotrexate

Within 12 hours of delivery, where do we want the uterus to be at?

Midline with the umbilicus AND at the umbilicus. If it's above or displaced, it is abnormal.

A postpartum patient lied in bed for several hours then stood up and a gush of blood came out of her. Is this a PPH?

No, it is the lochia that pools when she was laying down and should not be confused with hemorrhage.

Know several nursing theorists followed up and added to the Rubin model.

Ok chill

How do you assess the Babinski reflex? What should the response be?

On sole of foot, beginning at heel, stroke upward along lateral aspect of sole; then move finger across ball of foot. All toes hyperextend, with dorsiflexion of big toe—recorded as a positive sign.

What is the wide range of a normal stool pattern for an infant?

Once every 2-3 days or as many as 10 daily

What blood pressure alteration is seen postpartum?

Orthostatic hypotension can occur within the first 48 hours of childbirth so precautions should be taken by instructing the mother to stand up slowly and have someone help her get around.

What bladder alteration postpartum due to a decreased urge to void and postpartal diuresis can cause excessive bleeding from the uterus?

Overdistended bladder because it pushed the uterus up and to the side and prevents it from contracting firmly.

Which medication aids in the contraction of the uterus to prevent maternal hemorrhage?

Oxytocin (Pitocin)

Placenta is in right place but because of different factors such as preeclampsia or drug abuse, a collection of blood forms near the placenta. Premature separation of the placenta. Vaginal bleeding and complaining of severe abdominal pain. Uterine tenderness and sometimes a board like uterus.

Placenta abruption

This complication of pregnancy is characterized by bright red painless bleeding. It begins at the beginning of pregnancy but occurs when the placenta forms near the cervix.

Placenta previa

A postpartum blood loss of more than 500 mL after VAGINAL delivery, or more than 1000 mL of blood loss following a C-section.

Postpartum hemorrhage

The presence of a fever of 38° C (100.4° F) or more on 2 successive days of the first 10 postpartum days (not counting the first 24 hours after birth)

Postpartum infection

The increase of what hormone during breastfeeding contributes to lack of ovulation?

Prolactin

This ripens the cervix, making it softer and causing it to begin to dilate and efface; it stimulates uterine contractions. Off label use, not FDA approved.

Prostaglandin E1 (Misoprostol (Cytotec))

This ripens the cervix, making it softer and causing it to begin ti dilate and efface; it stimulates uterine contractions. It is the only FDA-approved medication for cervical ripening or labor induction.

Prostaglandin E2 (Dinoprostone)

Which thromboembolic disorder is more common in the postpartum period?

Pulmonary embolism

Transfer from the neonate to a cooler object that are not in contact with the baby. An example would be the windows of the room, the baby could lose heat because the windows are cold.

Radiation

Abstinence during fertile periods of the menstrual cycle

Rhythm method

List two common risk factors for ectopic pregnancy

STIs and IUDs

Injury of vaginal mucosa and perineal muscles, but not the anal sphincter

Second degree laceration

Which position should be maintained postpartum to localize infection and prevent spreading?

Semi-Fowlers

Consists of BP that is 160/110 mmHg or greater, proteinuria greater than 3+, oliguria, elevated serum creatinine greater than 1.1 mg/dL, cerebral or visual disturbances (headache and blurred vision), hyperreflexia with possible ankle clonus, extensive peripheral edema, hepatic dysfunction, epigastric and right upper-quadrant pain, and thrombocytopenia.

Severe preeclampsia

An asian belief that refers to "weakness of nerves" caused by a decrease in vital energy that reduces the function of the internal organ systems and lowers resistance to disease.

Shenjing shaijo

How do you assess the startle reflex? What should the response be?

Shine a bright light into a newborn's eyes. They should squint.

In relation to thermoregulation, a baby cannot regulate heat very well due to the limited ability to ____ or _____.

Shiver, sweat

Vaginal bleeding, uterine cramping, and partial or complete expulsion of products of conception

Spontaneous abortion

The failure of the uterus to return to a non pregnant state.

Subinvolution

The production of ____ decreases with cold stress and respiratory distress can occur as a result.

Surfactant

Knee-chest position

Takes pressure off of umbilical cord Helps treat umbilical cord prolapse

How do you assess the glabellar reflex? What should the response be?

Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open. The newborn should blink for the first four or five taps.

Relaxes smooth muscles, inhibiting uterine activity, and causing bronchodilation

Terbutaline

Should not be used in women with a history of cardiac disease, pregestational or gestational diabetes, severe gestational hypertension, preeclampsia or eclampsia, migraine headaches, or hyperthyroidism, or with significant hemorrhage.

Terbutaline

This medication inhibits uterine contractions

Terbutaline

True or false: Women who are over 35 and smoke should not take combined oral contraceptives.

True

Describe the breast changes that occur postpartum for nonbreastfeeding mothers.

The breasts will also feel nodular due to milk in the ducts. There may be tissue tenderness and engorgement. The breasts may be swollen, firm, tender, and warm to the touch. Discomfort is temporary and usually subsides within 24 to 36 hours. Lactation will cease within a few days to a week if no milk expression or nipple stimulation occurs.

Describe the cervical cap and what it needs to be used with.

The cervical cap is a silicone rubber cap that fits snugly around the base of the cervix. It comes in three sizes and you should use it with spermicide.

Which side of the diaphragm should the spermicidal gel or cream be applied to?

The cervical side

Describe the diaphragm and what it needs to be used with.

The diaphragm is a dome-shaped cup with a flexible rim made of silicone that fits snugly over the cervix. It must be used with spermicidal cream or gel.

How does a mother know if her newborn is latched on correctly?

Their nose, cheeks, and chin will be touching her breast.

Describe the respiratory change that occurs postpartum.

There is a decrease in intraabdominal pressure, so the diaphragm has more room. Chest wall compliance increases, but rib cage elasticity can take months to return to a pre pregnancy state.

What alteration in her feet may a mother notice postpartum?

There may be a permanent increase in her shoe size

Why is a newborn at risk for infection for the first 6 weeks of life?

They don't start developing their antibodies until 2-3 months of age

Injury to the perineum involving the anal sphincter

Third degree

What is the most common cause of PPH, account for 70% of all cases?

Tone

How do you assess the sucking and rooting reflex? What should the response be?

Touch infant's lip, cheek, or corner of mouth with nipple or finger. Infant turns head toward stimulus and opens mouth.

How do you assess the extrusion reflex? What should the response be?

Touch or depress tip of tongue. Newborn forces tongue outward.

The observance of a woman and her fetus for a reasonable period (e.g., 4 to 6 hours) of spontaneous active labor to assess the safety of vaginal birth for the mother and infant. It may be initiated if the mother's pelvis is of questionable size or shape or if the fetus is in an abnormal presentation or position. By far the most common reason for this is if the woman wishes to have a vaginal birth after a previous cesarean birth. A planned attempt to labor by a woman who has previously undergone a cesarean delivery and desires a subsequent vaginal delivery

Trial of Labor

True or False: After discharge, telephone follow-up, hot lines, support groups, lactation counselors, home visits by nurses, and teaching materials (videos, written materials) are all interventions that can be implemented to decrease the risk for postpartum infections.

True

True or False: The first menstrual flow after childbirth is usually heavier than normal.

True

True or false. Dehydration stimulates uterine contractions.

True

True or false: All admissions are screened for hemorrhage risk.

True

True or false: Delayed cord clamping (≥2 minutes after birth) has been reported to be beneficial in improving hematocrit and iron status and decreasing anemia; such benefits can last up to 6 months.

True

True or false: In a newborn, diaphragmatic and abdominal breathing is normal.

True

True or false: Physiologic jaundice is normal because it occurs greater than 24 hours old.

True

True or false: Pre-existing mood and anxiety disorders are particularly likely to recur or worsen during the few weeks following childbirth.

True

Mothers who are breastfeeding and are vegetarians who exclude meat, fish, and dairy products should provide what supplementation to their newborns?

Vitamin B12

Which supplement is recommended in the first few days of life daily?

Vitamin D

How do you assess the fencing reflex? What should the response be?

With infant in supine neutral position, turn the head quickly to one side. The infant should raise or flex their opposite arm and flex their opposite leg.

How should a female wash her cervical cap?

With mild soap and warm water after each use

You are listening to the heartbeat of a newborn and hear a murmur. Is this normal? Should you report it?

Yes because the shunts are still working on closing so it's more common to hear murmurs with newborn children, but you should still report it.

Refers to the perfect balance that needs to be maintained. In medicine imbalance results in disease. Examples are hot & cold, stillness & movement, light & dark. Asian people believe in this.

Yin and Yang

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment is considered successful if: a. blood pressure is reduced to prepregnant baseline. b. seizures do not occur. c. deep tendon reflexes become hypotonic. d. diuresis reduces fluid retention.

B (A temporary decrease in blood pressure can occur; however, this is not the purpose of administering this medication. Magnesium sulfate is a central nervous system (CNS) depressant given primarily to prevent seizures. Hypotonia is a sign of an excessive serum level of magnesium. It is critical that calcium gluconate be on hand to counteract the depressant effects of magnesium toxicity. Diuresis is not an expected outcome of magnesium sulfate administration.)

Signs of a threatened abortion (miscarriage) are noted in a woman at 8 weeks of gestation. What is an appropriate management approach for this type of abortion? a. Prepare the woman for a dilation and curettage (D&C). b. Place the woman on bed rest for at least 1 week and reevaluate. c. Prepare the woman for an ultrasound and blood work. d. Comfort the woman by telling her that if she loses this baby, she may attempt to get pregnant again in 1 month.

C (D&C is not considered until signs of the progress to an inevitable abortion are noted or the contents are expelled and incomplete. Bed rest is recommended for 48 hours initially. Repetitive transvaginal ultrasounds and measurement of human chorionic gonadotropin (hCG) and progesterone levels may be performed to determine if the fetus is alive and within the uterus. If the pregnancy is lost, the woman should be guided through the grieving process. Telling the client that she can get pregnant again soon is not a therapeutic response because it discounts the importance of this pregnancy.)

List three interventions for a patient who is experiencing gestational hypertension.

1. Antihypertensive medications 2. Diet 3. Exercise

List at least 3 risk factors associated with placenta abrupto.

1. Maternal hypertension 2. Blunt trauma 3. Cocaine use 4. Cigarette use 5. Premature rupture of membranes 6. Multifetal pregnancy

What are three classic clinical manifestations of preeclampsia?

1. Proteinuria 2. Epigastric pain 3. Headaches

How many values in the 3-hour GTT must be elevated for there to be a diagnosis of gestational diabetes mellitus?

2 out of the 3

A woman with severe preeclampsia has been receiving magnesium sulfate by IV infusion for 8 hours. The nurse assesses the woman and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the physician, anticipating an order for: a. hydralazine. b. magnesium sulfate bolus c. diazepam. d. calcium gluconate.

A (Hydralazine is an antihypertensive commonly used to treat hypertension in severe preeclampsia. An additional bolus of magnesium sulfate may be ordered for increasing signs of central nervous system irritability related to severe preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms of magnesium toxicity.)

A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa? A. Disseminated intravascular coagulation B. Chronic hypertension C. Infection D. Hemorrhage

D (Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.)

If a woman is diagnosed with GDM, what is the first pt. education provided to help treat this?

Diet and exercise. If glucose levels are persistently high, insulin or oral hypoglycemia therapy is begun.

Severe preeclamptic manifestations with the onset of seizure activity or coma.

Eclampsia

Abrupt unilateral lower-quadrant abdominal pain with or without vaginal bleeding

Ectopic pregnancy

This occurs when a fertilized ovum is implanted outside the uterus. 95% of these occur in the fallopian tube. Characterized by unilateral lower-quadrant abdominal pain with or without vaginal bleeding.

Ectopic pregnancy (tubal pregnancy)

Gestational hypertension (>140/90) with the addition of proteinuria of greater than or equal to 1+. Report of transient headaches might occur along with episodes or irritability. Edema can be present.

Mild preeclampsia.

What level is a positive 1-hour GTT?

Over 140 mg/dL

List 7 risk factors related to gestational hypertensive disorders.

1. Abnormal maternal age (<19 or >40) 2. Prima gravida 3. Obesity 4. Having multiple fetuses 5. Chronic hypertension 6. Family history of preeclampsia 7. Having DM

List 5 manifestations of magnesium sulfate toxicity.

1. Absence of patellar deep tendon reflexes. 2. Urine output less than 30 mL/hr 3. RR less than 12/min 4. Decreased LOC 5. Cardiac dysrhythmias

3 points for client education for a female taking methotrexate.

1. Avoid alcohol 2. Avoid vitamins containing folic acid to prevent a toxic response to medication 3. Advise the client to protect herself from sun exposure due to photosensitivity

What are three diagnostic procedures that would be conducted on a patient with GDM to assess fetal well-being?

1. BPP 2. Amniocentesis 3. NST

List at least 3 expected findings associated with a miscarriage. (There are 6)

1. Backache and abdominal tenderness 2. Rupture of membranes 3. Dilation of the cervix 4. Fever 5. Hypotension 6. Tachycardia

List at least 5 risk factors associated with miscarriages. (There are 9)

1. Chromosomal abnormalities 2. Maternal illness 3. Advanced maternal age 4. Premature cervical dilation (Cervical insufficiency) 5. Chronic maternal infections 6. Maternal malnutrition 7. Trauma or injury 8. Anomalies in the fetus or placenta 9. Substance use

Client education for a pregnant woman experiencing cervical insufficiency. (3)

1. Client will be on activity restriction or bed rest. 2. Hydrate more, because dehydration stimulates uterine contractions. 3. Avoid intercourse, tampons, and douching. Anything that can be inserted into the vagina.

List two risk factors for cervical insufficiency.

1. History of cervical trauma (Cervical tears, excessive dilations, surgical procedures.) 2. Congenital structural defects

List at least 3 expected findings seen in a molar pregnancy.

1. Hyperemesis gravidarum 2. Rapid uterine growth 3. Dark brown bleeding 4. Anemia from blood loss 5. Clinical findings of preeclampsia that occur prior to 24 weeks of gestation.

List four expected findings for cervical insufficiency.

1. Increase in pelvic pressure or urge to push. 2. Pink stained vaginal discharge or bleeding 3. Water may break 4. Miscarriage (Uterus contracts with the expulsion of the fetus)

List 6 client education points for managing gestational hypertensive disorders postpartum.

1. Maintain bed rest and encourage side-lying position. 2. Promote diversional activities, such as watching TV, visits from family or friends, and gentle exercise 3. Avoid foods that are high in sodium 4. Avoid alcohol, tobacco, and caffeine intake 5. Drink 6-8 glasses of water a day 6. Maintain a dark environment to prevent seizures

Four causes of early pregnancy bleeding (<20 weeks).

1. Miscarriage 2. Ectopic pregnancy 3. Incompetent cervix 4. Hydatidiform mole

List three things you cannot do before a 3-hour GTT.

1. No eating 12 hours before test. 2. Do not drink caffeine. 3. Do not smoke 12 hr prior to testing.

Client education for a patient that has just had a miscarriage.

1. Notify provider of heavy, bright red vaginal bleeding, elevated temperature, or foul smelling vaginal discharge 2. A small amount of discharge is normal for 1-2 weeks 3. Take prescribed antibiotics 4. Refrain from tub baths, sexual intercourse, or placing anything into the vagina for 2 weeks 5. Avoid becoming pregnant for 2 months

List 5 points for client education following a spontaneous abortion.

1. Notify provider of heavy, bright red vaginal bleeding, elevated temperature, or foul-smelling vaginal discharge (Infection) 2. A small amount of discharge is normal for 1 to 2 weeks. 3. Take prescribed antibiotics (Bc of increased risk of infection) 4. Refrain from tub baths, sexual intercourse, or placing anything in the vagina for 2 weeks. 5. Avoid becoming pregnant for 2 months.

Two causes of bleeding later in pregnancy.

1. Placenta previa 2. Placental abruption

List at least 3 risk factors associated with placenta previa.

1. Previous placenta previa 2. Uterine scarring 3. Maternal age >35 4. Multifetal gestation 5. Smoking

What are two risk factors for a molar pregnancy?

1. Prior molar pregnancy 2. Clients in early teens or older than age 40

List four laboratory tests conducted on a pregnant woman who is suspected to have GDM.

1. Routine urinalysis to test for glycosuria 2. 1 hour GTT 3. 3 hour oral GTT 4. Urinalysis to test for presence of ketones in urine

What 3 diagnostic procedures are conducted to test for gestational hypertensive disorders?

1. Urine testing for proteinuria and creatinine clearance. 2. NST, CST, and BPP to assess fetal status 3. Doppler blood flow analysis to assess fetal well-being

Gestational hypertension begins after the ____ week of pregnancy.

20th

What levels should pregnant women keep their blood sugar between? What should they keep their postprandial BG levels less than?

65 to 95 mg/dL. 130 mg/dL.

The pituitary hormone that stimulates the secretion of milk from the mammary glands is: A. Prolactin B. Oxytocin C. Estrogen D. Progesterone

A

A nurse is providing care for a client who is at 32 weeks gestation and who has a placentae previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? a. Betamethasone b. Indomethacin c. Nifedipine d. Methylergonovine

A (Betamethasone is given to promote lung maturity if delivery is anticipated.)

Clients with gestational diabetes are usually managed by which of the following therapies? A. Diet B. NPH insulin (long-acting) C. Oral hypoglycemic drugs D. Oral hypoglycemic drugs and insulin

A (Clients with gestational diabetes are usually managed by diet alone to control their glucose intolerance. Oral hypoglycemic agents are contraindicated in pregnancy. NPH isn't usually needed for blood glucose control for GDM.)

A maternity nurse is caring for a client with abruptio placenta and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation? A. Swelling of the calf in one leg B. Prolonged clotting times C. Decreased platelet count D. Petechiae, oozing from injection sites, and hematuria

A (DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis.)

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time she is at the greatest risk for: a. hemorrhage. b. infection. c. urinary retention. d. thrombophlebitis.

A (Hemorrhage is the most immediate risk because the lower uterine segment has limited ability to contract to reduce blood loss. Infection is a risk because of the location of the placental attachment site; however, it is not a priority concern at this time. Placenta previa poses no greater risk for urinary retention than with a normally implanted placenta. There is no greater risk for thrombophlebitis than with a normally implanted placenta.)

In the 12th week of gestation, a client completely expels the products of conception. Because the client is Rh negative, the nurse must: A. Administer RhoGAM within 72 hours B. Make certain she receives RhoGAM on her first clinic visit C. Not give RhoGAM, since it is not used with the birth of a stillborn D. Make certain the client does not receive RhoGAM, since the gestation only lasted 12 weeks.

A (RhoGAM is given within 72 hours postpartum if the client has not been sensitized already.)

A pregnant client in the last trimester has been admitted to the hospital with a diagnosis of severe preeclampsia. A nurse monitors for complications associated with the diagnosis and assesses the client for: a. Any bleeding, such as in the gums, petechiae, and purpura. b. Enlargement of the breasts c. Periods of fetal movement followed by quiet periods d. Complaints of feeling hot when the room is cool

A (Severe Preeclampsia can trigger disseminated intravascular coagulation because of the widespread damage to vascular integrity. Bleeding is an early sign of DIC and should be reported to the M.D.)

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? a. "I will maintain strict bedrest throughout the remainder of pregnancy." b. "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." c. "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." d. "I will watch for the evidence of the passage of tissue."

A (Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.)

A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply.) a. RR less than 12/min b. Urinary output less than 30 mL/hr c. Hyperreflexic deep-tendon reflexes d. Decrease LOC e. Flushing and sweating

A B D

The nurse is caring for a woman who is at 24 weeks of gestation with suspected severe preeclampsia. Which signs and symptoms would the nurse expect to observe? (Select all that apply.) a. Decreased urinary output and irritability b. Transient headache and +1 proteinuria c. Ankle clonus and epigastric pain d. Platelet count of less than 100,000/mm3 and visual problems e. Seizure activity and hypotension

A C D (Decreased urinary output and irritability are signs of severe eclampsia. Ankle clonus and epigastric pain are signs of severe eclampsia. Platelet count of less than 100,000/mm3 and visual problems are signs of severe preeclampsia. A transient headache and +1 proteinuria are signs of preeclampsia and should be monitored. Seizure activity and hyperreflexia are signs of eclampsia.)

A nurse is the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states she missed one menstrual cycle and cannot be pregnancy because she has an intrauterine device. The nurse should suspect which of the following? a. Missed abortion b. Ectopic pregnancy c. Severe preeclampsia d. Hydatidiform mole

B

A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits: a. a sleepy, sedated affect. b. a respiratory rate of 10 breaths/min. c. deep tendon reflexes of 2+. d. absent ankle clonus.

B (Because magnesium sulfate is a central nervous system (CNS) depressant, the client will most likely become sedated when the infusion is initiated. A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory depression (bradypnea) from magnesium toxicity. Deep tendon reflexes of 2+ are a normal finding. Absent ankle clonus is a normal finding.)

The most prevalent clinical manifestation of abruptio placentae (as opposed to placenta previa) is: a. bleeding. b. intense abdominal pain. c. uterine activity. d. cramping.

B (Bleeding may be present in varying degrees for both placental conditions. Pain is absent with placenta previa and may be agonizing with abruptio placentae. Uterine activity may be present with both placental conditions. Cramping is a form of uterine activity that may be present in both placental conditions.)

A nurse in a labor room is assisting with the vaginal delivery of a newborn infant. The nurse would monitor the client closely for the risk of uterine rupture if which of the following occurred? A. Hypotonic contractions B. Forceps delivery C. Schultz delivery D. Weak bearing down efforts

B (Excessive fundal pressure, forceps delivery, violent bearing down efforts, tumultuous labor, and shoulder dystocia can place a woman at risk for traumatic uterine rupture. Hypotonic contractions and weak bearing down efforts do not alone add to the risk of rupture because they do not add to the stress on the uterine wall.)

An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placenta is present. Based on these findings, the nurse would prepare the client for: A. Complete bed rest for the remainder of the pregnancy B. Delivery of the fetus C. Strict monitoring of intake and output D. The need for weekly monitoring of coagulation studies until the time of delivery

B (The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.)

Presence of cervical funneling

Beaking

This medication promotes fetal lung maturation

Betamethasone

A nurse is caring for a client at 30 weeks gestation who has just been diagnosed with gestational diabetes. The client has a lot of questions about the risks to her baby with GDM. What is the best explanation by the nurse for why her fetus is at risk for macrosomia and hypoglycemia at delivery? a. To prevent macrosomia, you should only gain 11-20 lbs. total during this pregnancy. b. When your blood sugar levels are too high, the insulin that you make can cross the placenta and affect your baby's metabolism. c. Extra sugar (glucose) can cross the placenta to your baby. This may cause your baby to gain extra weight and to have sudden low blood glucose after birth. d. Your baby may be born with diabetes.

C

A nurse is completing the admission assessment of a client who is at 38 weeks gestation and has severe preeclampsia. Which one of the following findings is consistent with the diagnosis of severe preeclampsia? a. Polyuria b. Absence of clonus c. Epigastric pain d. Tachycardia

C

The nurse is preparing to discharge a 30-year-old woman who has experienced a miscarriage at 10 weeks of gestation. Which statement by the woman would indicate a correct understanding of the discharge instructions? a. "I will not experience mood swings since I was only at 10 weeks of gestation." b. "I will avoid sexual intercourse for 6 weeks and pregnancy for 6 months." c. "I should eat foods that are high in iron and protein to help my body heal." d. "I should expect the bleeding to be heavy and bright red for at least 1 week."

C (After a miscarriage a woman may experience mood swings and depression from the reduction of hormones and the grieving process. Sexual intercourse should be avoided for 2 weeks or until the bleeding has stopped and should avoid pregnancy for 2 months. A woman who has experienced a miscarriage should be advised to eat foods that are high in iron and protein to help replenish her body after the loss. The woman should not experience bright red, heavy, profuse bleeding; this should be reported to the health care provider.)

A woman with preeclampsia is receiving magnesium sulfate. The nurse assigned to care for the client determines that the magnesium therapy is effective if: A. Ankle clonus in noted B. The blood pressure decreases C. Seizures do not occur D. Scotomas are present

C (For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient. Ankle clonus indicated hyperreflexia and may precede the onset of eclampsia. Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure.)

A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present? A. Absence of abdominal pain B. A soft abdomen C. Uterine tenderness/pain D. Painless, bright red vaginal bleeding

C (In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompanies placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and boardlike on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by failure of the uterus to relax in attempt to constrict blood vessels and control bleeding.)

A primigravida is receiving magnesium sulfate for the treatment of pregnancy induced hypertension (PIH). The nurse who is caring for the client is performing assessments every 30 minutes. Which assessment finding would be of most concern to the nurse? A. Urinary output of 20 ml since the previous assessment B. Deep tendon reflexes of 2+ C. Respiratory rate of 10 BPM D. Fetal heart rate of 120 BPM

C (Magnesium sulfate depresses the respiratory rate. If the respiratory rate is less than 12 breaths per minute, the physician or other health care provider needs to be notified, and continuation of the medication needs to be reassessed. A urinary output of 20 ml in a 30 minute period is adequate; less than 30 ml in one hour needs to be reported. Deep tendon reflexes of 2+ are normal. The fetal heart rate is WNL for a resting fetus.)

A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician's orders and would question which order? A. Prepare the client for an ultrasound B. Obtain equipment for external electronic fetal heart monitoring C. Obtain equipment for a manual pelvic examination D. Prepare to draw a Hgb and Hct blood sample

C (Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.)

When making a visit to the home of a postpartum woman one week after birth, the nurse should recognize that the woman would characteristically: A. Express a strong need to review events and her behavior during the process of labor and birth B. Exhibit a reduced attention span, limiting readiness to learn C. Vacillate between the desire to have her own nurturing needs met and the need to take charge of her own care and that of her newborn D. Have reestablished her role as a spouse/partner

C (One week after birth the woman should exhibit behaviors characteristic of the taking-hold stage as described in response 3. This stage lasts for as long as 4 to 5 weeks after birth. Responses 1 and 2 are characteristic of the taking-in stage, which lasts for the first few days after birth. Response 4 reflects the letting-go stage, which indicates that psychosocial recovery is complete.)

Which measure would be least effective in preventing postpartum hemorrhage? A. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered B. Encourage the woman to void every 2 hours C. Massage the fundus every hour for the first 24 hours following birth D. Teach the woman the importance of rest and nutrition to enhance healing

C (The fundus should be massaged only when boggy or soft. Massaging a firm fundus could cause it to relax. Responses 1, 2, and 4 are all effective measures to enhance and maintain contraction of the uterus and to facilitate healing.)

A nurse is caring for a pregnant client with Preeclampsia. The nurse prepares a plan of care for the client and documents in the plan that if the client progresses from Preeclampsia to eclampsia, the nurse's first action is to: A. Administer magnesium sulfate intravenously B. Assess the blood pressure and fetal heart rate C. Clean and maintain an open airway D. Administer oxygen by face mask

C (The immediate care during a seizure (eclampsia) is to ensure a patent airway. The other options are actions that follow or will be implemented after the seizure has ceased.)

A nurse is caring for a pregnant client with severe preeclampsia who is receiving IV magnesium sulfate. Select all nursing interventions that apply in the care for the client. A. Monitor maternal vital signs every 2 hours B. Notify the physician if respirations are less than 18 per minute. C. Monitor renal function and cardiac function closely D. Keep calcium gluconate on hand in case of a magnesium sulfate overdose E. Monitor deep tendon reflexes hourly F. Monitor I and O's hourly G. Notify the physician if urinary output is less than 30 ml per hour.

C D E F G (When caring for a client receiving magnesium sulfate therapy, the nurse would monitor maternal vital signs, especially respirations, every 30-60 minutes and notify the physician if respirations are less than 12, because this would indicate respiratory depression. Calcium gluconate is kept on hand in case of magnesium sulfate overdose, because calcium gluconate is the antidote for magnesium sulfate toxicity. Deep tendon reflexes are assessed hourly. Cardiac and renal function is monitored closely. The urine output should be maintained at 30 ml per hour because the medication is eliminated through the kidneys.)

What is the antidote for magnesium sulfate?

Calcium gluconate

This occurs when expulsion of the products of conception occurs. Premature cervical dilations. A cause of bleeding during pregnancy.

Cervical insufficiency

Magnesium sulfate toxicity can cause what serious adverse effect?

Coma

A nurse in a prenatal clinic is reviewing results from recent one-hour oral glucose tolerance tests. Which one of the 4 pregnant clients needs to be scheduled for a follow-up, diagnostic three-hour glucose tolerance test? a. One hour GTT result: 115 mg/dl b. One hour GTT result: 95 mg/dl c. One hour GTT result: 125 mg/dl d. One hour GTT result: 160 mg/dl

D

A nurse is assessing a patient with preeclampsia who delivered 12 hours ago. Which of the following assessments would indicate that the condition has not yet resolved? a. blood pressure reading at prenatal baseline b. adequate urinary output and no proteinuria c. presence of 1-2+ deep tendon reflexes d. patient complaints of blurred vision and headache

D

A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse suspects the onset of: a. eclamptic seizure. b. rupture of the uterus. c. placenta previa. d. placental abruption.

D (Eclamptic seizures are evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture presents as hypotonic uterine activity, signs of hypovolemia, and in many cases the absence of pain. Placenta previa presents with bright red, painless vaginal bleeding. Uterine tenderness in the presence of increasing tone may be the earliest finding of premature separation of the placenta (abruptio placentae or placental abruption). Women with hypertension are at increased risk for an abruption.)

Four hours after a difficult labor and birth, a primiparous woman refuses to feed her baby, stating that she is too tired and just wants to sleep. The nurse should: A. Tell the woman she can rest after she feeds her baby B. Recognize this as a behavior of the taking-hold stage C. Record the behavior as ineffective maternal-newborn attachment D. Take the baby back to the nursery, reassuring the woman that her rest is a priority at this time

D (Response 1 does not take into consideration the need for the new mother to be nurtured and have her needs met during the taking-in stage. The behavior described is typical of this stage and not a reflection of ineffective attachment unless the behavior persists. Mothers need to reestablish their own well-being in order to effectively care for their baby.)

Which of the following symptoms occurs with a hydatidiform mole? A. Heavy, bright red bleeding every 21 days B. Fetal cardiac motion after 6 weeks gestation C. Benign tumors found in the smooth muscle of the uterus D. "Snowstorm" pattern on ultrasound with no fetus or gestational sac

D (The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.)

What type of stomach pain is experienced in preeclampsia?

Epigastric pain with right upper quadrant pain

An impaired tolerance to glucose with the first onset or recognition during pregnancy.

Gestational diabetes mellitus (GDM)

Hypertensive disorder of pregnancy whereby the woman has an elevated blood pressure at 140/90 mmHg or greater recorded on two different occasions at least 4 hours apart. Proteinuria is absent.

Gestational hypertension

Describe HELLP.

H: Hemolysis resulting in anemia and jaundice. EL: Elevated liver enzymes, such as ALT, AST, including epigastric pain and nausea and vomiting. LP: Low platelets (Less than 100,000/mm3), resulting in thrombocytopenia. Results in reduced clotting factors, causing manifestations such as bleeding gums.

A problem with the fertilization of the ovum. Two sperm try to fertilize themselves which forms a ball of cells, there is no viable fetus. A woman does miss her period, her fundal height will be very large, she will have some sort of vaginal bleeding, these molar pregnancy cells grow very fast. Methotrexate is used to stop them from growing.

Hydatidiform mole (molar pregnancy)

Pathophysiology of preeclampsia.

In a normal pregnancy, spiral arteries widen to improve perfusion to the placenta. In a preeclamptic pregnancy, the spiral arteries do widen, but not nearly as much which decreases blood flow to the placenta. Your brain perceives hypo perfusion, and your brain thinks that you are bleeding out. Your brain is going to release vasoconstrictor hormones and try to redirect that blood to vital organs, such as the heart, brain, lungs, etc. Your brain doesn't think of the baby as a vital organ. This vasoconstriction leads to an increase in blood pressure. Over time, this increase in BP causes wear and tear in your blood vessels, leading to little holes in the vessels. Your brain stimulates a lipoprotein to be released to try to repair the vessels, but they are not able to. The lipoprotein leaks out from the vessels and into the intravascular space. The proteins attract water which causes edema. Liver necrosis can occur long term due to the initiation of the clotting cascade by the brain, causing hypoxia, then ischemia, then necrosis.

A cervix that opens without contractions which can cause a preterm labor or birth. The cervix is too short. We don't want it to open early because that keeps the baby inside the uterus. Vaginal bleeding can occur. We can stitch the cervix closed until she is past the risk of going into preterm labor.

Incompetent cervix/cervical insufficiency

First and most important nursing care associated with an ectopic pregnancy.

Replace fluids, and maintain electrolyte balance

Patient education for a client with placenta previa.

You cannot have intercourse, insert tampons, or put anything in the vagina. No vaginal exams may be conducted by the provider or nurse. You will have a C-section.