Unit 1 Case Studies: Normal Pregnancy, Diet and Nutrition, Vaginal Birth, Routine Postpartum Care, Discharge Teaching for Mom

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What is a primigravida?

A woman pregnant for the first time

What's a multigravida?

A woman who's been pregnant more than once

What's a multipara?

A woman who's given birth 2+ times

Recommended total weight gain during pregnancy for someone w BMI 18.5-24.9

25-35 lbs

After birth, foul-smelling lochia can indicate...?

Endometritis

Place the cardinal movements of labor in the order in which they occur. - internal rotation - flexion - extension - expulsion - engagement - restitution - descent

Engagement, descent, flexion, internal rotation, extension, restitution, expulsion The presenting part engages the pelvic outlet. It continues to descend. As the fetus descends, the chin is flexed towards the chest, positioning the smallest diameter of the fetal head to pass thru the bony pelvis. After the head passes thru the pelvis, the fetus internally rotates to align the shoulders w the largest diameter of the pelvis. When the fetal head is on the perineum, the fetus extends the head to emerge from the mother's body. After the head is out, the fetus will rotate again, known as restitution, to facilitate delivery of the shoulders. As the shoulders are delivered, expulsion of the remainder of the body occurs.

There are four stages of labor: dilation, birth, placental, and recovery. The first stage is the longest and is divided into the latent, active, and transitional phases. Identify whether each of the following are associated with the latent or active phase of labor. - Mother is talkative - Mother prefers to ambulate or sit - Mother is an active participant in care - The intensity of contractions is mild to moderate - Mother turns inward. Mother may prefer to lie down - Mother experiences feelings of less control - Mother prefers a quiet environment

Latent: talkative, prefers to ambulate or sit, active participant in care, mild to moderate intensity contractions Active: turning inward and preferring to lie down, feelings of less control, quiet environment Ambulation and position changes can both make the patient more comfortable while also facilitating the progression of labor. Contractions in the active phase are moderate to strong intensity.

What is a nulligravida?

a woman who has never been pregnant

Recommended total weight gain during pregnancy for BMI 30+

11-20 lbs

Recommended total weight gain during pregnancy for someone w BMI 25.0-29.9

15-25 lbs

What is a primipara?

A woman who's given birth once

Sayo, Caitlin and Jin's baby, was a big newborn, and the physician used forceps to assist Caitlin to push her out. As a result, Caitlin has a fourth degree perineal laceration. Caitlin is concerned that she has not had a bowel movement since giving birth. She is also concerned that having a bowel movement will hurt and that she might tear the stitches if she pushes too hard. To prevent constipation, which foods does Caitlin need to include in her diet? A. Fruits with the skin and whole grain foods B. Lean meats and canned vegetables C. Cheese and eggs D. Fats and simple carbohydrates

A. Fruits with the skin and whole grain foods These are high fiber foods, which promote GI motility. Canned veggies lose fiber during the preservation process. Lean meats and eggs are high in protein and an important part of a healthy diet, but not high in fiber and don't prevent constipation. Cheese may actually contribute to constipation since they're simple carbs. Fats too bc they're slow to digest.

After birth, red and warm areas on the breast can indicate...?

Mastitis - happens bc of obstructed breast milk that causes infxn

Kelly and her family are excited that the baby's girl, and everyone is involved in setting up the nursery. Kelly is now at 36 weeks gestation. Kelly's amniocentesis shows she is carrying a healthy baby girl. The result of the glucose tolerance test was normal. In other words, the pregnancy progresses to the third trimester without any problems. As Kelly approaches her due date, she needs to know the difference between true labor and false labor. Identify whether each of following are signs of true labor or false labor. - contractions are felt as discomfort in the suprapubic area or lower back and sometimes wrap around both - cervical change is progressive - the pattern of contractions is irregular - the pattern of contractions is regular - discomfort is localized to one area of the uterus - contractions do not result in cervical change - blood show is present - blood show is absent

True labor signs: contractions are felt as discomfort in the suprapubic area or lower back and sometimes wrap around both, cervical change is progressive, the pattern of contractions is regular, blood show is present False labor signs: the pattern of contractions is irregular, discomfort is localized to one area of the uterus, contractions do not result in cervical change, blood show is absent True labor is progressive. Contractions become more frequent, regular, and stronger in intensity, and result in actual cervical dilation. It starts in the back and wraps around the abdomen. Activity such as walking will increase the intensity and progress of labor. False labor or Braxton-Hicks contractions are the irregular, localized, and do not lead to cervical change. Because the cervix isn't changing, there's no bloody show.

Recommended total weight gain during pregnancy for someone w BMI < 18.5

28-40 lbs

Caitlin's recovery has been uneventful. However, as she prepares to go home, she needs to be aware of the complications that may develop during the postpartum period, as well as when she would need to call her provider. She would also like to know about the role her partner and family can play in her recovery and adaptation to motherhood. During the first weeks at home, the new parents' family and friends can engage in which of the following activities to assist them in the transition to motherhood? SATA A. Prepare meals for the family B. Take over infant care activities C. Perform household chores D. Tell the parents how to provide care for the infant E. Provide formula feeding to the breastfeeding baby so parents can sleep

A. Prepare meals for the family C. Perform household chores These sorts of things or doing laundry give the new parents time to rest and get to know their baby. An important part of the transition to parenthood involves spending time w and getting to know the baby, which is why they shouldn't take over the parenting responsibilities per se of the baby.

Caitlin's recovery has been uneventful. However, as she prepares to go home, she needs to be aware of the complications that may develop during the postpartum period, as well as when she would need to call her provider. She would also like to know about the role her partner and family can play in her recovery and adaptation to motherhood. Caitlin should call her provider when she experiences which of the following conditions? SATA A. Temperature of 101 F or higher with shaking and chills B. Soaking more than one pad per hour with red blood C. Burning on urination and voiding small quantities of urine D. Foul smelling lochia and uterine pain with cramps E. Excessive perspiration at night, with a temperature of 99 F F. Severe headache, vision changes, and upper abdominal pain

A. Temperature of 101 F or higher with shaking and chills B. Soaking more than one pad per hour with red blood C. Burning on urination and voiding small quantities of urine D. Foul smelling lochia and uterine pain with cramps F. Severe headache, vision changes, and upper abdominal pain Fever, burning during urination, foul smelling lochia, and uterine pain are possible signs of infxn. Soaking one pad per hr and the presence of red blood could possibly mean hemorrhage. Severe HA, vision changes, upper abd pain could indicate postpartum preeclampsia. All these conditions need to be reported to the provider promptly. Excessive perspiration w a normal temp is part of the normal diuresis process in the post birth period

Laura and Ellen have been married for 5 years. Last year, Ellen gave birth to a baby boy, Peter. Ellen and Laura used donor sperm. They have sperm from the same donor reserved for future pregnancies. Now it is Laura's turn to carry a pregnancy. Today Laura and Ellen are attending a preconception class at the community center. Laura considers herself healthy; she weighs 145 pounds and is 5'9" tall. She recently started eating a pescatarian diet and hopes to raise their son on that diet as well. What is included in a pescatarian diet? SATA A. shellfish B. fruits C. beef D. eggs E. legumes

A. shellfish B. fruits D. eggs E. legumes A pescatarian diet is a vegetarian diet w fish added to it, but not other meats.

Sayo, Caitlin and Jin's baby, was a big newborn, and the physician used forceps to assist Caitlin to push her out. As a result, Caitlin has a fourth degree perineal laceration. Caitlin is concerned that she has not had a bowel movement since giving birth. She is also concerned that having a bowel movement will hurt and that she might tear the stitches if she pushes too hard. What is the purpose of doing Kegel exercises after birth? A. To stimulate defecation B. To strengthen the pelvic floor muscles C. To restore pelvic joint stability D. To promote uterine involution

B. To strengthen the pelvic floor muscles This is purpose of doing Kegel exercises. Pelvic floor muscles support the uterus, bladder, and bowels. If the muscles are weak, these organs may lower or prolapse into a woman's vagina. Doing Kegel exercises is important after any pregnancy and are even more important after the birth of a large baby, an extended second stage of labor, or the use of forceps to assist w birth. Kegels don't stimulate defecation, promote involution or restore joint mobility.

B. every 30 minutes During the active phase, intermittent auscultation of FHR is done q30min in a low risk labor. During the latent phase of a low risk labor, FHR is assessed qhr, then q15min during transition.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. The nurse teaches Caitlin that the lochia will change in appearance as the lining of the uterus heals. Place the stages of lochia in order of appearance over the 6 week postpartum period. - serosa - rubra - alba

Rubra, serosa, alba As the placenta site heals, the lochia color changes from rubra (red), to serosa (brownish pink), to alba (white or yellowish white).

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. They're discussing lochia. Match each stage of lochia with the composition of the lochia at that stage: Stages: rubra, serosa, alba Composition: - leukocytes, epithelial cells, fat, mucus, and microorganisms - primarily blood - serous exudate, erythrocytes, leukocytes, and cervical mucus

Rubra: primarily blood Serosa: serous exudate, erythrocytes, leukocytes, cervical mucus Alba: leukocytes, epithelial cells, fat, mucus, microbes Lochia rubra is primarily blood coming from the fresh wound on the uterine wall where the placenta was attached. As healing begins, lochia serosa appears, which contains less blood and more serous exudate, erythrocytes, leukocytes, and cervical mucus. The final stage is lochia alba, which is made up of leukocytes, epithelial cells, fat, mucus, and microbes as the normal flora of the reproductive tract is reestablished.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. Jin asks if there are any activities Caitlin needs to avoid during the first 2 weeks at home. Match the activity to be avoided with the reason why. Activities: sexual intercourse, prolonged sitting, house cleaning, heavy lifting Reasons: - To allow healing of the perineum and to prevent infection of the uterus - To prevent DVT - To preserve enrgy for baby care - To decrease pressure on the pelvic organs and decrease the possibility of lower back strain due to diastasis recti

Sex should be avoided to allow healing of the perineum and to prevent infection of the uterus. Prolonged sitting should be avoided to prevent DVT. House cleaning should be avoided to preserve energy for baby care. Heavy lifting should be avoided to decrease pressure on the pelvic organs and to decrease the possibility of lower back strain due to the diastasis recti. During the first 2 wks postpartum, the body's blood volume, cardiac activity, and metabolism are returning to pre/non-pregnant state, and pelvic organs and perineum are healing after the process of giving birth. Activities that may be affected by or may disrupt these physiologic processes need to be avoided.

After birth, sx like dysuria and burning can indicate...?

UTI

How long does it take a woman's body to go back to its non-pregnant, homeostatic state after giving birth? (involution)

6 wks

Identify which of the following interventions are beneficial vs not beneficial in the plan of care for women anticipating a vaginal birth. - Continuous support during labor and birth - Delayed pushing in the second stage of labor - Universal screening for GBS at 35-37 weeks gestation - Delayed admission to the hospital until the active phase of labor - Discontinuation of epidural analgesia in late labor - Induction of labor prior to 41 weeks gestation in uncomplicated pregnancies - Administration of antibiotics for GBS prior to the onset of labor - Routine episiotomy to prevent perineal stretching

- Continuous support during labor and birth - beneficial - Delayed pushing in the second stage of labor - beneficial - Universal screening for GBS at 35-37 weeks gestation - beneficial - Delayed admission to the hospital until the active phase of labor - beneficial - Discontinuation of epidural analgesia in late labor - not beneficial - Induction of labor prior to 41 weeks gestation in uncomplicated pregnancies - not beneficial - Administration of antibiotics for GBS prior to the onset of labor - not beneficial - Routine episiotomy to prevent perineal stretching - not beneficial Delayed admission until the active phase of labor decreases exposure to unnecessary medical interventions. Continuous support from family or nursing staff, as well as delayed pushing in the second stage, have been shown to have positive outcomes. Universal screening for GBS w tx during labor has been shown to decrease incidence of neonatal sepsis. Non-beneficial interventions include discontinuation of epidural analgesia in late labor, obviously resulting in pain. The epidural may be decreased to facilitate the urge to push, but not dc'ed. Elective induction prior to 41 weeks in uncomplicated pregnancies is a/w higher rate of c sections and poor outcomes. Giving abx prior to onset of labor for a positive GBS patient isn't effective - they need to be getting it in 4 hr intervals before birth. Episiotomies are a/w increased discomfort and long term problems; therefore, natural stretching of the perineum should be supported and encouraged.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive During the examination, the nurse and the patient discuss the signs and symptoms that Kelly is experiencing. Categorize each as presumptive or probable signs of pregnancy. - Montgomery glands - Nausea - Breast tenderness - Positive home pregnancy test - Chadwick's sign - Fatigue

- presumptive - nausea, breast tenderness, fatigue - probable - positive home pregnancy test, Chadwick's sign, Montgomery glands Presumptive signs are sx experienced by the patient and aren't specific to pregnancy. They're subjective. Probable signs are objective signs that are visible to the patient and provider - + preg test, Chadwick's sign, presence of Montgomery glands. Probable signs may also be caused by conditions other than pregnancy though!

List the components of a postpartum exam/assessment

- uterine fundus for tone and position - lochia for color and amt - perineum for bruising, edema, and the integrity of sutures (if present) - amt of voiding - breasts for the condition of the nipples, initiation of milk production, and comfort during breastfeeding - legs for signs of DVT

Answer The nurse needs to figure out when the contractions started, how long they are and how far apart. Also how the mother is doing. You should also palpate and document contraction intensity (mild, mod, strong). If the patient thinks her water broke, the nurse should ask the patient when the rupture occurred, what color the fluid was, how much fluid she had, and if there was a foul odor. In addition, it's important to assess for vaginal bleeding before doing a vaginal examination. The patient's perception of fetal movement is an indirect measure of the fetus' tolerance of the onset of contractions. Knowing if the patient will be breastfeeding is important but is not a priority at this time, nor is asking ab the gender.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. During her examination of the patient, the nurse checks to see how far effaced Erika's cervix is. What happens during the process of effacement? A. The inner diameter of the cervix increases. B. The cervix releases the mucus plug. C. The presenting part enters the pelvic inlet. D. The cervix thins.

D. The cervix thins. The shortening and thinning of the cervix is called effacement. Effacement is measured in percentages from 0-100. When the cervix is completely thinned out, it's 100% effaced.

After birth, sx like red and warm areas on the leg can indicate....?

DVT - remember that pregnancy puts women's circulation into a more hypercoagulable state, making them more prone to clot formation in the lower extremities

The nurse places an ice pack on the perineum, and Khloe says, "It's cold, but it feels good." The nurse encourages Khloe to get some rest while the baby is sleeping and before her family comes to visit. The nurse positions the call bell in reach and tells Khloe to press the call button if she needs anything. Khloe gets comfortable in bed and falls asleep while watching her baby sleep. When Khloe wakes up she feels wet. At first, she thinks it is the melted ice pack, but then she sees a pool of blood in her bed. She calls the nurse because she does not remember bleeding this much with her other babies. The nurse immediately comes to Khloe's room. The nurse notes the following assessment findings: - Fundus firm, 2 finger breadths above the umbilicus and to the right of the midline - Lochia: rubra, moderate to heavy amount, no clots - Perineum: slightly edematous - Patient alert and oriented Place the actions in the correct order they should be implemented by the nurse. - take vital signs - assess the fundus - massage the fundus - call the provider

- assess the fundus (to see if it's midline) - massage the fundus (to express any clots that might be there and stimulate uterine contraction) - take vital signs - call the provider

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive As the nurse is completing the assessment of a newly pregnant Kelly, the patient shares that she wasn't planning another pregnancy at this time and isn't sure how she feels about it. What is the nurse's best response to the patient? A. "It is normal to feel ambivalent the first few months. Would you like to talk about it?" B. "I will make a referral to a counselor for you to express your feelings." C. "You should be happy that you have the opportunity to add to your family." D. "Some women struggle to become pregnant; you should be happy you are not one of those women."

A. "It is normal to feel ambivalent the first few months. Would you like to talk about it?" Even when a pregnancy is planned, the confirmation may come as a surprise and with feelings of ambivalence. Pregnancy is a life-changing event, and some uncertainty is expected. As a normal pregnancy progresses and the woman feels fetal movement, she begins to bond with the fetus, and feelings of ambivalence are replaced by feelings of excitement in anticipating the arrival of a new family member.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin, but first, the nurse asks Caitlin if she has any questions about her recovery or self-care at home. Caitlin asks the nurse, "How long will I have vaginal bleeding?" Which response by the nurse is most accurate? A. "Your lochia will decrease over the next 2 to 6 weeks." B. "Your lochia will stop by the end of the week." C. "Your lochia will continue until your hormones stabilize." D. "Your lochia will be present until your menstrual period returns."

A. "Your lochia will decrease over the next 2 to 6 weeks." Lochia is the dc coming from the site where the placenta was attached to the wall of the uterus. As the placenta site heals, the lochia decreases. Healing is complete btwn 2-6 wks after birth, so bleeding should stop by then.

The nurse helps Khloe back to bed. She rechecks her and finds the fundis is firm, midline and at the umbilicus, and the lochia is rubra and moderate in amount. The nurse offers to get Khloe another ice pack. The baby starts crying and Khloe picks her up and prepares to breastfeed. Before leaving the patient's room, the nurse reminds Khloe to order herself some lunch. She spends most of the afternoon with her baby. She's ambulating in her room, voiding, and feeling good. The nurse discontinues the IV. While the baby is sleeping, Khloe takes her baby to the nursery so Khloe can take a shower. After fixing her hair and getting dressed in her own pajamas, she retrieves her baby in anticipation of her children's visit to meet their new sibling. After the family leaves, the nurse arrives to perform another assessment. Khloe is afebrile, the fundus is firm, lochia is rubra, and perineum is less swollen. At 4 pm, her vitals are T 100.2, P 78, RR 16, BP 106/74. Khloe asks the nurse what she can do to decrease her risk of developing deep vein thrombosis. What advice would the nurse give Khloe? SATA A. Ambulate frequently B. Eat foods rich in vitamin K C. Do not cross your legs D. Massage your calves E. Keep well hydrated

A. Ambulate frequently C. Do not cross your legs E. Keep well hydrated All these actions promote venous return and decrease DVT risk. Dietary intake doesn't change DVT risk. Massaging the calves should be avoided bc it can dislodge a clot if you actually have one.

During the first prenatal visit, which laboratory test will be obtained for the patient who's 6 weeks pregnant? SATA A. CBC B. Rh factor C. Rubella titer D. Group B Streptococcus E. Maternal serum alpha feto-protein

A. CBC B. Rh factor C. Rubella titer

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. Erika is concerned about experiencing pain. During the first stage of labor, which criteria are used when deciding whether to administer medication for pain? SATA A. Cervical dilation B. Amniotic membrane is ruptured C. FHR > 140 bpm D. Patient's request for pain medication

A. Cervical dilation D. Patient's request for pain medication If you give pain meds before the active phase of labor, that could possibly slow or still the process. Therefore, a regular and well established pattern of uterine contractions and cervical dilation of 4 cm or more decreases the chance of slowing the progress of labor in an uncomplicated labor. However, the perception of pain is subjective, and some women may require meds prior to the active phase of labor.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. Jin asks the nurse if there is anything they should know about having sex again. What will the nurse tell them about resuming sex after giving birth? SATA A. Delay vaginal intercourse until the bleeding has stopped B. Vaginal lubrication may be lower because of decreased estrogen C. The mother might leak breast milk during sex D. You can show affection by kissing, cuddling, and hugging E. Avoid sex when the baby is in the house

A. Delay vaginal intercourse until the bleeding has stopped B. Vaginal lubrication may be lower because of decreased estrogen C. The mother might leak breast milk during sex D. You can show affection by kissing, cuddling, and hugging You can't have sex until vaginal bleeding has stopped and the perineum is completely healed. You might have to use lube bc natural vaginal lubrication is lower d/t decreased estrogen. Leaking breast milk during sex happens bc of the arousal.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive Kelly tells the nurse she has been experiencing nausea in the morning, immediately after getting out of bed. The nurse teaches the patient to take which action to decrease nausea? A. Eat plain crackers before getting out of bed B. Take an antiemetic every 12 hours C. Wake up every 4 hours and eat a source of complex carbohydrates D. Drink warm tea to relax before getting out of bed

A. Eat plain crackers before getting out of bed A common recommendation for self care is to eat plain crackers or dry toast before getting out of bed to prevent nausea. Because many antiemetics are teratogenic, they are generally not prescribed for morning sickness. Kelly doesn't need to wake up to eat complex carbs every 4 hrs - but while she's awake, small but frequent meals can be useful to take in nutrients and decrease n/v. Warm tea before getting outta bed isn't a recommended/researched way to decrease nausea in pregnancy, but not contraindicated (who knows, it might work for you).

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive The midwife orders a pregnancy blood test. Which finding would confirm the findings of the home pregnancy test? A. Elevated human chorionic gonadotropin level B. Elevated estrogen level C. Elevated progesterone level D. Elevated estradiol levels

A. Elevated human chorionic gonadotropin level At the time of conception, the zygote begins producing hCG. This is the hormone detected in urine pregnancy tests. The levels rise rapidly until the trophoblastic cells implant in the wall of the uterus to develop a placenta, which then begins producing pregnancy-related hormones.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. Phil asks how Erika and the baby are doing. Which of the following should the nurse include in the response to Phil? SATA A. Erika is making progress, she is in the active phase of labor, and her contractions are regular. B. Erika is 6 cm and should be able to start pushing soon. C. The baby's heart rate looks good because there are moderate variability and occasional accelerations. D. Erika is in the transition phase of labor, which is why she is so uncomfortable at this time.

A. Erika is making progress, she is in the active phase of labor, and her contractions are regular. C. The baby's heart rate looks good because there are moderate variability and occasional accelerations. From the info given, you should know Erika's in the active phase of labor, which is when contractions become more regular and uncomfortable. The transition phase is when the cervix dilates 8-10 cm. Erika's cervix is at 6 cm so she still needs to open up some more before she can start pushing. FHR is WNL with good variability and accelerations, good signs of health.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive Based on the date of Kelly's LMP, it is estimated the pregnancy is approximately 6 weeks gestation. At this gestational age, which findings on a sonogram would confirm the pregnancy? SATA A. Fetal pole B. Cardiac activity C. Gestational sac D. Biparietal diameter E. Placental location

A. Fetal pole B. Cardiac activity C. Gestational sac During the first 8 weeks of gestation, the fetal pole and gestation sac are visible on the ultrasound and are positive confirmation of the pregnancy. Cardiac activity is visible starting at 6 weeks. The biparietal diameter and placental location aren't visible until second trimester.

Khloe has had an uneventful postpartum stay. On postpartum day 2, after completing the postpartum depression screening form given to her by the nurse, she gets out of bed and begins caring for herself and her baby, anticipating being discharged today. CBC results from earlier today: - WBC 16K - Hct 36 - Hgb 12.2 - Plts 250K Based on these lab results, what is the nurse's interpretation of Khloe's condition? A. Findings are within the expected range for 2 days post birth B. Elevated WBC count indicates an infection C. Low hematocrit and hemoglobin indicate iron deficiency anemia D. Platelet count is consistent with hypercoagulation

A. Findings are within the expected range for 2 days post birth Elevated WBC is normal during the first postpartum week. If there aren't any other signs of infxn, this is okay and expected. Hgb and Hct might be low bc of the hemodilution effect of increased plasma volume during pregnancy and blood loss at delivery. Plt count isn't indicative of hypercoagulation. Clotting studies such as fibrinogen level would be used to evaluate clotting status.

A. Fundus firm at the level of the umbilicus About 1 hr after birth, fundus is firm and at the level of the umbilicus. A tender fundus is a sign of possible infection and needs further assessment. A fundus above the level of the umbilicus is a signal of a full bladder or sub-involution and is often a/w increased bleeding. If uterine massage is needed to feel the fundus, that's not a normal finding and indicates uterine atony, which is also a/w increased bleeding.

A. G4 T3 P0 A0 L2 Gravidity is number of pregnancies, parity is number of times you've given birth/delivered a baby. Kelly has had 3 previous pregnancies PLUS THE CURRENT PREGNANCY - making her G4. She delivered 3 pregnancies at term (2 on the due date and one at 38 weeks). She has no preterm births or abortions. Although her 3 previous pregnancies resulted in live births, her daughter died at 2 months of age, meaning she only has 2 living children now. If a woman had a multifetal pregnancy (like twins), the pregnancy and the delivery count as one. However, the number of living children reflects the number of actual children she has.

Kelly and her family are excited that the baby's girl, and everyone is involved in setting up the nursery. Kelly is now at 36 weeks gestation. Kelly's amniocentesis shows she is carrying a healthy baby girl. The result of the glucose tolerance test was normal. In other words, the pregnancy progresses to the third trimester without any problems. At 39 weeks gestation, Kelly wakes up with a backache and irregular contractions. Her husband massages her back, and she falls asleep again. A couple of hours later the contractions are still irregular, and the midwife suggests she stays at home until the contractions are coming every 5 to 7 minutes. Although Kelly is uncomfortable, she plays games with her boys and even takes a walk outside. Suddenly she feels a popping sensation, and there's a pool of fluid at her feet. What should Kelly do at this time? A. Go to the labor and delivery unit B. Measure the amount of fluid C. Continue to wait for the contractions to become regular D. Attend her scheduled prenatal visit at the office later that day

A. Go to the labor and delivery unit When the membranes rupture, the patient needs to go to labor and delivery. Getting to a facility where labor can be monitored and the risk for infection evaluated is a priority. Waiting at home for the contractions to become regular is acceptable as long as the amniotic membrane is intact. Waiting for a scheduled office visit later in the day is not a safe action.

Which laboratory test is routinely obtained between 35 and 37 weeks' gestation? A. Group B Streptococcus B. PAP smear C. Maternal serum alpha feto-protein D. Hemoglobin concentration

A. Group B Streptococcus Vaginal and rectal swabs for GBS are obtained 4-5 wks before the EDD. If the swab is positive, the mother's gonna be given antibiotics DURING labor.

Six months later, Laura and Ellen are at the obstetrician's office. After her second insemination with the donor sperm, Laura's home pregnancy test is positive. Laura is 28 years old. With confirmation of this pregnancy she is a gravida 2, para 0. Her first pregnancy, at the age of 18, ended in a loss at 18 weeks' gestation. Laura is active, running three times a week and biking on weekends. Initial prenatal labs: - RBC 3.8 million/mm^3 - WBC 8K/mm^3 - Hct 33 g/dL - Hgb 11 g/dL - MVC 70 fl - MCH 23 fl - MCHC 32 fl - RDW 17% - Platelets 229L/mm^3 - U/A: color is clear and yellow; SG 1.020, pH 5.5; negative for protein, ketones, blood, and glucose' bacteria scant - BUN 9.0 mg/dL - Creatinine 0.52 mg/dL - Uric acid 3 mg/dL - ALT 28 IU/L - AST 32 IU/L - LDH 99 IU/L - Glucose 120 mg/dL - Sodium 140 mmol/L - Potassium 4.4 mmol/L - Chloride 99 mmol/L - HbA1c 4% Laura asks the nurse how iron deficiency anemia could impact a pregnancy. How would the nurse respond to Laura's question? SATA A. Iron deficiency anemia could make her feel more fatigued. B. Iron deficiency anemia could make her infant at risk for being large for gestational age. C. Iron deficiency anemia could make her more susceptible to infections. D. Iron deficiency anemia could make her infant at risk for having a low birthweight. E. Iron deficiency anemia could make her infant at risk for premature birth.

A. Iron deficiency anemia could make her feel more fatigued. C. Iron deficiency anemia could make her more susceptible to infections. D. Iron deficiency anemia could make her infant at risk for having a low birthweight. E. Iron deficiency anemia could make her infant at risk for premature birth. All of these are appropriate teaching points for iron deficiency anemia r/t pregnancy. Having a large for gestational age infant is a/w gestational diabetes and not iron deficiency anemia.

Kelly shares the news of the pregnancy with her husband, and he is excited. Kelly's initial doubt about this pregnancy has disappeared, and she is beginning to fantasize about the joy of having a newborn in the house. Kelly keeps her regular schedule of prenatal visits and continues to have a normal pregnancy. Kelly's nausea resolves at 12 weeks gestation, and she feels the fetus move at 16 weeks. Kelly has a maternal serum alpha feto-protein (MSAFP) screening done at 16 weeks gestation. The results are elevated. the nurse interprets these results as which of the following? A. Kelly's fetus has an increased risk for an open neural tube defect. B. Kelly's fetus will have an open neural tube defect. C. An elevated MSAFP screening is a sign of fetal well-being. D. Kelly will need to wait until she gives birth before her provider can further investigate this result.

A. Kelly's fetus has an increased risk for an open neural tube defect. An elevated MSAFP indicates an increased risk for a multiple gestation pregnancy or an open neural tube defect. Kelly had a first trimester ultrasound, so she doesn't have a multiple gestation pregnancy. It's important to emphasize to the patient that this is only a screening - it tells you chances and risks, not definitive yes/no dx, or guarantee. Based on the elevated MSAFP, the provider would recommend the patient undergo dx testing, which includes a more in depth US and possibly an amniocentesis.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. Prior to placing the fetal monitor on Erika's abdomen, the nurse performs which procedure to determine fetal position? A. Leopold's maneuvers B. Barlow's maneuver C. McBurney's sign D. Chadwick's sign

A. Leopold's maneuvers Leopold's maneuvers are a systematic way to determine fetus' position. The maneuvers consist of 4 distinct actions, each helping to determine the position of the fetus. Barlow's maneuver is used to identify congenital hip dysplasia. McBurney's sign is used to identify appendicitis, and Chadwick's sign is a result of increased blood flow to the cervix in early pregnancy.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. The nurse continually assesses Erika and the fetus. Which signs observed by the nurse are indicators of a potential complication during labor? SATA A. Maternal temperature > 100.4 F B. Contractions lasting 60 to 90 seconds C. Greenish-brown amniotic fluid D. A sustained fetal heart rate of 180 bpm E. Contractions less than 2 minutes apart

A. Maternal temperature > 100.4 F C. Greenish-brown amniotic fluid D. A sustained fetal heart rate of 180 bpm E. Contractions less than 2 minutes apart Fever could be a sign of infection. Sustained FHR above 160 bpm is another possible sign of infection. Contractions less than 2 min apart aren't allowing adequate time for the uterus to relax and for oxygen rich blood to circulate thru the placenta and fetus. This may cause fetal distress as well as inefficient uterine contractions. Amniotic fluid is pale yellow in color. Greenish brown color means there's meconium in the intrauterine environment. These are all warning signs of a potential complication. 60-90 sec contractions are normal for labor.

A. More than one pad per hour is saturated B. A constant trickle of lochia is visible E. Clots the size of a golf ball are present During the first 24-28 hrs postpartum, the lochia is a dark red color and has a non-offensive odor. Saturing more than one pad per hr or having a constant trickle of vaginal bleeding are signs of excessive bleeding (either d/t uterine atony or a laceration) and need to be investigated further. The passage of clots the size of a golf ball or larger may be a sign of retained placental fragments and also warrant further investigation to prevent complications.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. The nurse assesses the strength of Erika's uterine contractions. What is the correct technique to determine the strength of the contractions? A. Palpate the uterine fundus during a contraction, noting the degree of firmness. B. Place the toco (tocodynamometer) on the women's abdomen and record the number displayed in the fetal monitor. C. Observe the patient's facial expression and behavior during a contraction. D. Ask the patient to rate her pain on a scale of 1 to 10.

A. Palpate the uterine fundus during a contraction, noting the degree of firmness. The strength of a contraction is determined by palpation. The toco placed on the abd documents frequency and duration of contractions, but not strength. Facial expressions and bx are subjective and influenced by previous pain experiences and personal factors like culture.

A. Peanut butter D. Shellfish E. Apricots Peanut butter, shellfish, and apricots are sources of iron that Laura can add to her diet. Red meat is a source of iron, but we know from Laura's hx that she doesn't eat meat, so we wouldn't recommend that specifically for her d/t that dietary type.

A. Rho(D) immune globulin Kelly's prenatal labs indicate she's Rh negative. A dose of Rho(D) immune globulin is given btwn 26-28 wks to prevent the Rh negative mama from making antibodies during the pregnancy. Betamethasone is given if a premature birth is inevitable. Magnesium is given to stop premature labor or to tx preeclampsia. Rubella vaccine is never given during pregnancy.

Laura and Ellen have been married for 5 years. Last year, Ellen gave birth to a baby boy, Peter. Ellen and Laura used donor sperm. They have sperm from the same donor reserved for future pregnancies. Now it is Laura's turn to carry a pregnancy. Today Laura and Ellen are attending a preconception class at the community center. Laura considers herself healthy; she weighs 145 pounds and is 5'9" tall. She recently started eating a pescatarian diet and hopes to raise their son on that diet as well. In their preconception class, Laura and Ellen learn that according to the current recommendation all women who could become pregnant should take a daily vitamin. What should that vitamin contain? A. folic acid 400 mcg B. ferrous sulfate 600 mg C. vitamin A 400 mg D. calcium 600 mg

A. folic acid 400 mcg The recommendation is that women of childbearing age should take a daily supplement of folic acid 400 mcg. Additional iron and calcium are need needed until the second trimester of the pregnancy. A high level of vitamin A may be dangerous to the developing pregnancy, and therefore vitamin A supplementation is not recommended.

The next day, the nurse observes Khloe grimacing as the baby is breastfeeding. The nurse asks if the breastfeeding is causing her uterus to cramp. Khloe replies that she can feel some cramps, but it is the pain from the baby sucking on her nipples that is really uncomfortable. Because nipple pain can be caused by an improper latch while breastfeeding, the nurse observes the infant's latch. The nurse determines the baby is feeding appropriately and that Khloe's nipple pain is likely not due to an improper latch. Based on Khloe's complaints of nipple tenderness, which actions does the nurse recommend? SATA A. Rub some colostrum on the nipple B. Let the nipples air dry after each feeding C. Wash the nipple with soap and water D. Apply ice packs after each feeding E. Wear a supportive bra

A. Rub some colostrum on the nipple B. Let the nipples air dry after each feeding E. Wear a supportive bra Breastfeeding mothers need a supportive bra for comfort. Colostrum has healing properties and can decrease tenderness or irritation of the nipple. Air drying helps to decrease irritation and nipple cracks. The nipple should not be washed w soap bc soap causes tissue to become dry and more likely to crack. Applying ice packs after each feeding decreases milk production. However, ice is sometimes applied to the nipple only for 30-60 sec before the baby latches to decrease discomfort as the infant begins to suck.

Erika pushes for about 45 minutes and gives birth to a baby boy, who lets out a loud and lusty cry. The baby is immediately placed on Erika's abdomen. Erika and Phil are happy and admiring their newborn son. During the third stage of labor, what causes the placenta to separate from the wall of the uterus? A. Shrinking uterine size B. Pulling of the umbilical cord C. Manual removal with the provider's hand D. Spiral arteriole rupture and formation of a clot

A. Shrinking uterine size After the baby's born, the uterus continues to contract and begins to shrink or decrease in size. The placenta doesn't change size. Consequently, as the uterus shrinks, the placenta begins to ripple and spontaneously detaches from the uterine wall. Traction of the umbilical cord or attempt to manually detach the placenta may result in tearing of the tissue and retained placental tissue.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. After 9 hours of labor, Erika's cervix is 10 cm dilated. She is tired and asks for some time to rest before she starts pushing. How would the nurse respond to Erika's request? A. The nurse would grant this request, because providing the patient with a period of rest may lead to more effective pushing. B. The nurse would grant this request, because it ensures the woman will only have to push once or twice to deliver her baby. C. The nurse would not grant this request, because the patient must push as soon as her cervix dilates to 10 cm. D. The nurse would not grant this request, because not pushing will put the fetus at risk.

A. The nurse would grant this request, because providing the patient with a period of rest may lead to more effective pushing. Even though taking a break before pushing can make pushing more effective, that doesn't mean you'll only have to push once or twice. A woman doesn't have to push right when she hits 10 cm. In most cases, not pushing once the mother is completed dilated won't increase risk to the fetus.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. The nurse prepares for Erika's second stage of labor when which of the following signs are observed? SATA A. The patient is making grunting sounds. B. Strong contractions are occurring every 2 to 3 minutes. C. There is involuntary bearing down with each contraction. D. The perineum is bulging. E. The patient feels the urge to push.

A. The patient is making grunting sounds. C. There is involuntary bearing down with each contraction. D. The perineum is bulging. These are all signs of an imminent birth. Strong frequent contractions and feeling the urge to push are characteristics of the transition phase of labor.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. Caitlin tells the nurse that when her neighbor had a baby, she had spells of uncomfortable crying and feeling anxious and sad, but then should would say she had a great life. What is the nurse's best explanation of what the neighbor was exhibiting? A. These are symptoms of postpartum blues B. These are symptoms of postpartum depression C. These are symptoms of postpartum psychosis D. These are symptoms of manic depression

A. These are symptoms of postpartum blues These happens in the first week after birth and are r/t fluctuating hormone levels and the pressure of the overwhelming responsibilities the woman expereinces w the transition to motherhood. This is a self limiting condition. Family and friends can provide positive encouragement as well as assistance w household tasks so the new mama has time to care for herself and her baby.

Kelly shares the news of the pregnancy with her husband, and he is excited. Kelly's initial doubt about this pregnancy has disappeared, and she is beginning to fantasize about the joy of having a newborn in the house. Kelly keeps her regular schedule of prenatal visits and continues to have a normal pregnancy. Kelly's nausea resolves at 12 weeks gestation, and she feels the fetus move at 16 weeks. The patient is scheduled for a glucose challenge test at 24 weeks gestation. What is the purpose of the test? A. To identify insulin resistance B. To diagnose gestational diabetes C. To determine if there is adequate glucose for fetal growth D. To evaluate glucose metabolism

A. To identify insulin resistance A glucose challenge test involves drinking a concentrated glucose solution and then measuring a blood glucose level 1 hr later. It's a screening to identify insulin resistance. If the glucose challenge results are elevated, the patient would be scheduled for a 3 hr glucose tolerance test to diagnose whether or not she has gestational diabetes.

Kelly and her family are excited that the baby's girl, and everyone is involved in setting up the nursery. Kelly is now at 36 weeks gestation. Kelly's amniocentesis shows she is carrying a healthy baby girl. The result of the glucose tolerance test was normal. In other words, the pregnancy progresses to the third trimester without any problems. At 36 weeks gestation, Kelly lies down on the examination table. Suddenly she says she feels dizzy and nauseous. The nurse observes her face is pale, she is sweating, and her skin is clammy. What is the priority action by the nurse? A. Turn the patient on her left side. B. Take the patient's blood pressure and heart rate. C. Notify the provider immediately. D. Assess the fetal heart rate for signs of fetal distress.

A. Turn the patient on her left side. When a pregnant woman lies on her back, the weight of the gravid uterus may compress the vena cava, causing a decrease in BP and feeling faint. Turning the patient to her side displaces the weight of the uterus and restroes blood flow, relieving the sx. Taking the patient's BP, notifying the provider, or assessing the FHR all delay changing the patient's position to relieve her sx.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive Kelly is scheduled for another prenatal appointment in 4 weeks. She is instructed to call the provider's office if which of the following signs and symptoms occur before the next visit? SATA A. Vaginal bleeding B. Abdominal cramping C. Dysuria D. Temperature > 100.4 F E. Change in fetal activity

A. Vaginal bleeding B. Abdominal cramping C. Dysuria D. Temperature > 100.4 F Vaginal bleeding and cramping are possible signs of pregnancy loss. Dysuria is a sign of UTI, which is a complication you need to get treated for. Fever may indicate infection. Fetal activity isn't felt until at least 16 weeks, so it's not something Kelly would feel or be told to look out for during the first trimester of pregnancy.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive Kelly experienced UTIs in her previous pregnancies. What teaching does the nurse provide to decrease the risk of developing a UTI during this pregnancy? SATA A. Wipe the perineal area front to back after voiding B. Wear cotton underpants C. Drink at least 8 glasses of water per day D. Take frequent bubble baths E. Hold urine to promote large volume voids

A. Wipe the perineal area front to back after voiding B. Wear cotton underpants C. Drink at least 8 glasses of water per day Cleaning from front to back prevents spread of fecal material near the urinary meatus. Cotton underpants absorb excess moisture. Adequate water intake keeps urine dilute and flushes the urinary tract. Bubble baths are avoided bc they alter the protective flora and may irritate the skin/mucosa. Pregnant women should void as soon as they feel the urge to keep the bladder empty. Holding urine in the bladder promotes bacterial growth and the development of infections.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. Caitlin asks the nurse if she needs to take the peri bottle home. Which is the best resonse by the nurse? A. Yes, you need to continue to clean the perineum until the bleeding stops. B. Yes, but you only need to use it to clean yourself after bowel movements. C. No, the peri bottle is only used while you are in the hospital. D. No, just take a tub bath every day to clean the perineum.

A. Yes, you need to continue to clean the perineum until the bleeding stops. The peri bottle is used to cleanse the perineum and promote healing w/o irritation. It should be used every time you use the toilet (urine or stool) for as long as the lochia is present. To prevent infxn, bathing in a tub isn't recommended until after the placental site is healed and the cervix is closed.

Sayo, Caitlin and Jin's baby, was a big newborn, and the physician used forceps to assist Caitlin to push her out. As a result, Caitlin has a fourth degree perineal laceration. Caitlin is concerned that she has not had a bowel movement since giving birth. She is also concerned that having a bowel movement will hurt and that she might tear the stitches if she pushes too hard. Because Caitlin has a fourth degree laceration, the nurse teaches her to avoid which of the following activities? SATA A. douching B. using tampons C. taking daily walks D. having sex E. eating high fiber foods

A. douching B. using tampons D. having sex All of these should be avoided to prevent possible disruptions to the suture line or putting pressure on the perineum for at least 6 wks.

A. orange juice B. strawberries E. tomatoes Orange juice, strawberries, and tomatoes are all high in vitamin C, which enhances the absorption of heme from dietary and supp iron. Dairy products like milk and yogurt shouldn't be taken at the same time as sources of heme bc they inhibit heme absorption.

Establishing and maintaining healthy eating habits before conceiving is important to both maternal and fetal well-being. Pregnant women should avoid which substances in their diet? SATA A. raw seafood B. foods with essential fats C. uncooked processed meats D. unpasteurized dairy E. alcohol

A. raw seafood C. uncooked processed meats D. unpasteurized dairy E. alcohol In general, raw, uncooked, undercooked, and unpasteurized foods should be avoided during pregnancy bc of the risk of foodborne illnesses, which can lead to complications such as miscarriage, congenital anomalies, or preterm labor. Alcohol is know to have long-lasting detrimental effects on the developing fetus and needs to be eliminated during pregnancy. Although fats may have a bad reputation, fats are macronutrients and are essential during pregnancy.

Laura and Ellen have been married for 5 years. Last year, Ellen gave birth to a baby boy, Peter. Ellen and Laura used donor sperm. They have sperm from the same donor reserved for future pregnancies. Now it is Laura's turn to carry a pregnancy. Today Laura and Ellen are attending a preconception class at the community center. Laura considers herself healthy; she weighs 145 pounds and is 5'9" tall. She recently started eating a pescatarian diet and hopes to raise their son on that diet as well. Laura enjoys eating fish, which is a good source of omega-3 fatty acids. Her instructor tells her that she should choose which of the following types of fish to eat while pregnant? SATA A. shrimp B. swordfish C. marlin D. salmon E. pollock

A. shrimp D. salmon E. pollock Shrimp, salmon, and pollock are good sources of omega 3's. On the other hand, large and fatty fish like swordfish or marlin may contain enough mercury to damage the fetus' nervous system, so they should be avoided during pregnancy. Consumers should also be aware of water quality if consuming locally caught fish.

Laura returns for her second prenatal visit. She is 13 weeks pregnant and has been experiencing significant morning sickness. When the nurse asks how she is feeling, Laura replies, "Better today, but I have spent the past month in the bathroom either vomiting or peeing, and the rest of the time sleeping so that I didn't think about vomiting or peeing." The nurse weighs Laura and finds she has lost 3 pounds since her first prenatal visit. Laura isn't surprised, because she hasn't eaten much over the past month. However, over the past couple of days her appetite has been returning, and she is looking forward to being able to eat for two now! Laura tells the nurse she will have no problem regaining those 3 pounds. Laura asks if there is a pattern of weight gain she should work toward for the remainder of this pregnancy. What is the expected pattern of weight gain for Laura in the second and third trimesters? A. 1 to 2 pounds per month B. 3 to 4 pounds per month C. 5 pounds per month D. 5 pounds in the second trimester and 15 pounds in the third trimester

B. 3 to 4 pounds per month A woman with a BMI in the normal weight range needs to gain 25 to 35 pounds during a pregnancy. That weight gain is distributed as 3 to 4 pounds in the first trimester and 3 to 4 pounds per month in the second and third trimesters.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. As Erika is returning to bed, her membranes rupture. What is the priority nursing assessment following spontaneous rupture of the membranes? A. Measure the amount of amniotic fluid. B. Auscultate the fetal heart rate. C. Clean the patient and apply a dry bed pad. D. Call the midwife to re-evaluate the patient.

B. Auscultate the fetal heart rate. You need to auscultate FHR to make sure the baby is okay. With rupture of membranes, the umbilical cord may prolapse, which interrupts the delivery of oxygen to the fetal and consequently results in fetal distress. After you check the baby's okay, documenting the amt and color of amniotic fluid, and cleaning up the patient are you next priorities.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. Caitlin gained 55 pounds during her pregnancy and is anxious to get back to her pre-pregnancy weight. What teaching does the nurse provide about post-birth weight loss? A. Start on a weight reduction diet immediately. B. Average weight loss is about 4.5 pounds per month. C. Many women never lose their baby weight. D. Most women are back to their pre-pregnancy weight in 6 weeks.

B. Average weight loss is about 4.5 pounds per month. This^^ means that it'll take some time to lose your baby weight, especially if you gained a lot of weight like Caitline did during pregnancy. Weight reduction diets during the immediate post birth period, especially if the woman is breastfeeding, aren't recommended and could be potentially harmful while the body is healing.

The nurse helps Khloe back to bed. She rechecks her and finds the fundis is firm, midline and at the umbilicus, and the lochia is rubra and moderate in amount. The nurse offers to get Khloe another ice pack. The baby starts crying and Khloe picks her up and prepares to breastfeed. Before leaving the patient's room, the nurse reminds Khloe to order herself some lunch. She spends most of the afternoon with her baby. She's ambulating in her room, voiding, and feeling good. The nurse discontinues the IV. While the baby is sleeping, Khloe takes her baby to the nursery so Khloe can take a shower. After fixing her hair and getting dressed in her own pajamas, she retrieves her baby in anticipation of her children's visit to meet their new sibling. After the family leaves, the nurse arrives to perform another assessment. Khloe is afebrile, the fundus is firm, lochia is rubra, and perineum is less swollen. At 4 pm, her vitals are T 100.2, P 78, RR 16, BP 106/74. The nurse assess Khloe's lower extremities. Which assessments will the nurse perform? SATA A. Perform Homans' sign B. Examine for warm, red, or painful areas C. Check pedal pulses D. Observe for pedal edema E. Compare appearance of contralateral leg

B. Examine for warm, red, or painful areas C. Check pedal pulses D. Observe for pedal edema E. Compare appearance of contralateral leg Postpartum patients are at risk for DVT. Leg exam should include pedal pulses to check circulation, look for pedal edema, comparing color and temp of the right and left leg. A difference btwn legs means possible DVT. Should also look at posterior calf for areas of redness, warmth, pain, which are other signs of DVT. You don't do Homans' sign bc it's unreliable and dorsiflexion of the foot may dislodge a clot if you actually have one.

Erika pushes for about 45 minutes and gives birth to a baby boy, who lets out a loud and lusty cry. The baby is immediately placed on Erika's abdomen. Erika and Phil are happy and admiring their newborn son. What is the criterion for a prolonged third stage of labor? A. Greater than 15 minutes B. Greater than 30 minutes C. Greater than 60 minutes D. Greater than 90 minutes

B. Greater than 30 minutes The third stage of labor is the shortest. The placenta detaches and is delivered shortly after the birth of the baby. If the placenta isn't delivered by 30 min after the baby, the third stage is considered prolonged.

After 40 weeks of pregnancy and 12 hours of labor, Khloe and her husband Lance become the parents of a healthy 7 pound baby girl at 7:02 am. This is their fourth child. Khloe had a spontaneous vaginal birth with a perineal tear. Lance was great support to Khloe during labor. The baby cried immediately and had Apgar scores of 9 at 1 minute after birth and 9 at 5 minutes after birth. Khloe had no pain medication during labor and is only slight uncomfortable with cramps since giving birth. Her baby is on her belly and attempting to breastfeed. In the hour since her baby's birth, Khloe has been resting in bed, and her vital signs and postpartum checks are all within normal limits. The nurse brings Khloe a breakfast tray and informs her she will be transferred to a room on the Mother-Baby unit soon. You give report to one of the Mother Baby nurses, in which you discuss Khloe's case. She's a 28 year old who came in yesterday evening with contractions 4 to 5 minutes apart. G4 P4. Labor uneventful with no medications except IV pencillin because of her positive GBS swab at 36 weeks. Perineal tear was repaired. Placenta deliver spontaneously. Stable vitals since birth with the most recent set being T 99 F, RR 16, P 68, BP 110/74. Fundus is firm at the umbilicus, lochia is rubra and small in quantity. IV in right wrist infusing 20 units of oxytocin in a 1 liter bag of LR. Will bring her to Mother Baby soon as she's finished eating breakfast. Based on the transition of care report from the LND nurse, which question would the nurse from the Mother Baby unit ask? A. What type of diet is she on? B. Has she voided since giving birth? C. Is a family member with her? D. When is her next dose of penicillin?

B. Has she voided since giving birth? Voiding after giving birth is a physiologic need. It aids in the excretion of waste products and extra fluid from the pregnancy. More importantly, in the immediate postpartum period, an overly filled bladder may cause uterine atony and postpartum hemorrhage. Monitoring the time and quantity of the first void is part of the plan of care and the nurse's assessment. The type of diet will be indicated on the orders in the patient's health record. The penicillin was administered during labor bc of the positive GBS swab and isn't indicated in the post-birth period.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. The nurse also checks to see how far dilated Erika's cervix is. What happens during the process of dilation? A. The cervix thins. B. The inner diameter of the cervix increases. C. The presenting part enters the pelvic inlet. D. The cervix releases the mucus plug.

B. The inner diameter of the cervix increases. Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth. Cervical dilation is a result of uterine activity and the movement of the fetal presenting part into the lower uterine segment. Cervical dilation may occur naturally, or it may be induced by surgical or medical means. Cervical dilation is measured in cm (0-10).

The nurse places an ice pack on the perineum, and Khloe says, "It's cold, but it feels good." The nurse encourages Khloe to get some rest while the baby is sleeping and before her family comes to visit. The nurse positions the call bell in reach and tells Khloe to press the call button if she needs anything. Khloe gets comfortable in bed and falls asleep while watching her baby sleep. When Khloe wakes up she feels wet. At first, she thinks it is the melted ice pack, but then she sees a pool of blood in her bed. She calls the nurse because she does not remember bleeding this much with her other babies. The nurse immediately comes to Khloe's room. The nurse notes the following assessment findings: - Fundus firm, 2 finger breadths above the umbilicus and to the right of the midline - Lochia: rubra, moderate to heavy amount, no clots - Perineum: slightly edematous - Patient alert and oriented The nurse assists Khloe to the bathroom, where she voids 800 mL. After Khloe voids, the nurse teaches her how to care for her perineum to promote healing. Which actions will the nurse teach Khloe to perform after each void to prevent infection? SATA A. Use soap and water to wash the perineum after each bowel movement B. Use a peri-bottle to cleanse the perineum after urination C. Use warm tap water in the peri-bottle, squirting from front to back D. Use a soft wipe and gently pat the area dry, from front to back E. Use a mixture of betadine and sterile water in the peri-bottle

B. Use a peri-bottle to cleanse the perineum after urination C. Use warm tap water in the peri-bottle, squirting from front to back D. Use a soft wipe and gently pat the area dry, from front to back Keeping the perineum clean and preventing the introduction of fecal material into the vagina or urethra is key to infxn prevention. Gently patting the area dry from front to back and rinsing the area w water from a peri-bottle will keep the area clean. Avoid using soap or other cleansing agents such as betadine, bc they can irritate and dry the skin and mucosa.

Laura returns for her second prenatal visit. She is 13 weeks pregnant and has been experiencing significant morning sickness. When the nurse asks how she is feeling, Laura replies, "Better today, but I have spent the past month in the bathroom either vomiting or peeing, and the rest of the time sleeping so that I didn't think about vomiting or peeing." The nurse weighs Laura and finds she has lost 3 pounds since her first prenatal visit. Laura isn't surprised, because she hasn't eaten much over the past month. However, over the past couple of days her appetite has been returning, and she is looking forward to being able to eat for two now! Laura tells the nurse she will have no problem regaining those 3 pounds. The nurse seizes this teachable moment and points out that pregnant women can't really eat for two, but that during the second and third trimester of pregnancy, the woman needs additional calories per day beyond the woman's pre-pregnancy nutritional requirement. How many extra calories per day does the woman need? A. 100 B. 500 C. 300 D. 700 E. 1000

C. 300 During the second and third trimester of pregnancy, the woman needs an additional 300 calories per day to support fetal growth, growth of the placenta, increased amniotic fluid, breast tissue development, increased blood supply, maternal fat storage, and uterine growth.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. The nurse encourages Erika to void every 2 hours. When the patient asks "why," how would the nurse respond to the patient? A. Voiding every two hours ensures contractions remain regular. B. Holding your urine for long periods of time may contribute to a urinary tract infection. C. A full bladder can slow labor by inhibiting the descent of the fetal head into the pelvis. D. Holding urine for up to 2 hours allows time for cervical change.

C. A full bladder can slow labor by inhibiting the descent of the fetal head into the pelvis. UTI isn't a priority rn. Voiding q2h doesn't make contractions regular. Holding urine doesn't facilitate cervical changes during labor.

Khloe has had an uneventful postpartum stay. On postpartum day 2, after completing the postpartum depression screening form given to her by the nurse, she gets out of bed and begins caring for herself and her baby, anticipating being discharged today. CBC results from earlier today: - WBC 16K - Hct 36 - Hgb 12.2 - Plts 250K Lance and the baby have A positive blood. Khloe's blood type is A negative and antibody negative. Based on this information, which medication order does the nurse need to carry out before discharging Khloe and her baby? A. Administer Rho(D) immune globulin 300 mcg subcutaneous to Khloe B. Administer Rho(D) immune globulin 300 mcg IM to the baby C. Administer Rho(D) immune globulin 300 mcg IM to Khloe D. None, because both parents have type A blood.

C. Administer Rho(D) immune globulin 300 mcg IM to Khloe Rho(D) immune globulin is administered to Rh negative women who give birth to an Rh positive baby to prevent them from making Rh antibodies that could affect a future pregnancy. The normal dose is 300 mcg. It's administered by IM injection into a large muscle, not subcutaneously. Rho(D) Ig is never given to the baby or an individual Rh positive blood. Although both parents have type A blood, they have a different Rh factor. If an Rh negative woman is antibody positive, she has been sensitized to the Rh factor, and Rho(D) Ig wouldn't be given.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. Based on the fact that Erika had a positive GBS swab, what intervention will the nurse implement? A. Insert a Foley catheter to prevent an ascending urinary tract infection. B. Prepare the patient for a cesarean birth to protect the fetus. C. Administer intravenous penicillin now and every 4 hours until delivery. D. Begin intravenous antibiotics after the amniotic membranes have ruptured.

C. Administer intravenous penicillin now and every 4 hours until delivery. The recommended tx for a + GBS expecting mama is to start IV penicillin on adm, w the goal of having the abx infused a minimum of 4 hrs before delivery. The IV penicillin is then repeated every 4 hrs until the baby's out. A c section isn't required bc of + GBS. Inserting a foley might actually increase the incidence of UTI. The goal of abx admin is to achieve adequate blood levels prior to the delivery; therefore, waiting for rupture of the membranes decreases the potential to achieve the desired goal.

Erika pushes for about 45 minutes and gives birth to a baby boy, who lets out a loud and lusty cry. The baby is immediately placed on Erika's abdomen. Erika and Phil are happy and admiring their newborn son. Erika has entered the third stage of labor. During this stage, when is oxytocin administered? A. After delivery of the anterior shoulder B. After placental cord drainage occurs C. After delivery of the placenta D. After the mother initiates breastfeeding

C. After delivery of the placenta Oxytocin is given to enhance uterine contraction following the birth.

Kelly Greer, a 29 year old woman, comes to see the midwife after missing her period. She took a home pregnancy test, which was positive. She is the mother of 7 year old and 5 year old boys, both born on their due dates. Two years ago, she gave birth to a daughter at 38 weeks gestation who died of accidental suffocation during sleep at 2 months of age. Kelly has a regular 28 day menstrual cycle. Her last period was July 7-12. Prenatal labs: - WBC 8.4 - Hgb 13.8 - Hct 39.4 - Plts 329K - A1c 4.5 - U/A - protein, glucose, and ketones negative; no bacteria; color yellow - Blood type A negative - Antibody screen - negative - Rubella titer - positive Kelly is 8 weeks pregnant during her first prenatal visit. Her midwife follows a traditional schedule for prenatal visits. Using a traditional prenatal visit schedule, how many prenatal visits will Kelly have if the pregnancy remains low risk and continues to 40 weeks gestation? A. 3 visits B. Approximately 8 visits C. Approximately 14 visits D. Approximately 18 visits

C. Approximately 14 visits Routine prenatal care for a low risk pregnancy includes 1 visit every 4 weeks until 28 wks, 1 visit every 2 wks until 36 wks, then weekly visits until birth.

C. April 14 Use Nagele's rule. The first day of the LMP was July 7. To calculate the EDD based on Nagele's rule, subtract 3 months then add 7 days to the LMP. July 7 - 3 months = April 7 + 7 days = April 14

A vaginal birth is the preferred method to bring a new baby into the world. However, there are some contraindications to a vaginal delivery. Which condition is an absolute contraindication to a vaginal delivery? A. History of herpes simplex infection B. Previous cesarean birth C. Complete placenta previa D. History of stillbirth

C. Complete placenta previa A complete placenta previa is an absolute contraindication because the recurrent contraction and descent of the fetus would result in antenatal hemorrhage. In addition, the fetus would have to pass through the placenta, resulting in loss of its oxygen and nutrient supply. A woman with a previous cesarean birth may be able to have a vaginal birth in subsequent pregnancies depending on the type of reason for the first c section and the type of incision that was made on the uterus at that time. Hx of herpes simplex infxn isn't a contraindication, but if the woman has an active infection at the time of birth, a vaginal birth is contraindicated.

The nurse places an ice pack on the perineum, and Khloe says, "It's cold, but it feels good." The nurse encourages Khloe to get some rest while the baby is sleeping and before her family comes to visit. The nurse positions the call bell in reach and tells Khloe to press the call button if she needs anything. Khloe gets comfortable in bed and falls asleep while watching her baby sleep. When Khloe wakes up she feels wet. At first, she thinks it is the melted ice pack, but then she sees a pool of blood in her bed. She calls the nurse because she does not remember bleeding this much with her other babies. The nurse immediately comes to Khloe's room. The nurse notes the following assessment findings: - Fundus firm, 2 finger breadths above the umbilicus and to the right of the midline - Lochia: rubra, moderate to heavy amount, no clots - Perineum: slightly edematous - Patient alert and oriented Based on the nurse's assessment, what is the nurse's next action? A. Call the provider STAT B. Add 20 units of oxytocin to the IV C. Encourage the patient to void D. Massage the uterine fundus

C. Encourage the patient to void The fundus is above the umbilicus and deviated to the right. This is a sign of a full bladder. Therefore, encouraging the patient to void and then rechecking the position of the fundus is the next action. Because the fundus is firm, uterine massage and more oxytocin aren't indicated.

Laura and Ellen have been married for 5 years. Last year, Ellen gave birth to a baby boy, Peter. Ellen and Laura used donor sperm. They have sperm from the same donor reserved for future pregnancies. Now it is Laura's turn to carry a pregnancy. Today Laura and Ellen are attending a preconception class at the community center. Laura considers herself healthy; she weighs 145 pounds and is 5'9" tall. She recently started eating a pescatarian diet and hopes to raise their son on that diet as well. Based on the available information about Laura, how would her pre-pregnancy weight be classified? A. Underweight B. Overweight C. Normal weight D. Obese

C. Normal weight Laura's BMI is 21.4, which is in normal range. 5'9" is 69 in. 1 in = 2.54 cm. 69 x 2.54 = 175.26 cm 175.26 / 100 = 1.7526 m 1 kg = 2.2 lbs. 145 lbs / 2.2 = 65.90 kg BMI = kg/m^2 65.90/(1.75)^2 = 65.90/3.0625 = 21.5

Six months later, Laura and Ellen are at the obstetrician's office. After her second insemination with the donor sperm, Laura's home pregnancy test is positive. Laura is 28 years old. With confirmation of this pregnancy she is a gravida 2, para 0. Her first pregnancy, at the age of 18, ended in a loss at 18 weeks' gestation. Laura is active, running three times a week and biking on weekends. Initial prenatal labs: - RBC 3.8 million/mm^3 - WBC 8K/mm^3 - Hct 33 g/dL - Hgb 11 g/dL - MVC 70 fl - MCH 23 fl - MCHC 32 fl - RDW 17% - Platelets 229L/mm^3 - U/A: color is clear and yellow; SG 1.020, pH 5.5; negative for protein, ketones, blood, and glucose' bacteria scant - BUN 9.0 mg/dL - Creatinine 0.52 mg/dL - Uric acid 3 mg/dL - ALT 28 IU/L - AST 32 IU/L - LDH 99 IU/L - Glucose 120 mg/dL - Sodium 140 mmol/L - Potassium 4.4 mmol/L - Chloride 99 mmol/L - HbA1c 4% The nurse would anticipate which additional lab tests to be ordered for Laura? SATA A. Total protein B. Creatinine clearance C. Serum iron D. TIBC E. Ferritin

C. Serum iron D. TIBC E. Ferritin A serum iron less than 35, a TIBC > 430, and ferrtin < 100 are used to confirm a fx of iron deficiency anemia. A total protein level and creatinine clearance provide information about renal function and aren't useful follow up values to Laura's prenatal labs.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. The nurse also determines the frequency of Erika's uterine contractions. How is the frequency of contractions determined? A. The time from the end of one contraction until the beginning of the next contraction. B. The time from the beginning of one contraction until the end of that contraction. C. The time from the beginning of one contraction until the beginning of the next contraction. D. The average number of contraction in a 60 minute period of time.

C. The time from the beginning of one contraction until the beginning of the next contraction. This is how we determine contraction frequency, which tells us ab contraction regularity and progression during the labor stage of birth.

Caitlin and Jin are taking their newborn daughter, their first child, home. The nurse enters Caitlin's hospital room to prepare for discharge. She has a number of teaching materials and discharge instructions to share with Caitlin. They're discussing lochia. The nurse teaches Caitlin that she needs to contact her midwife if which change occurs in her lochia? A. The amount is decreasing each day. B. The lochia looks brownish-pink on the fifth day. C. There is a return to red bleeding. D. There is a slightly increased amount during breastfeeding.

C. There is a return to red bleeding. Lochia is a sign of healing. As part of the healing process, it's expected that lochia will be rubra until about the fifth day, when it turns to serosa. If go back to red blood after signs of healing have happened, there might be a new or reinjured area on the uterine wall. This sort of thing is frequently caused by the detachment of a retained placental fragment. If the bleeding is heavy, the patient should contact her provider. It is normal for the amt to decrease every day, and bc breastfeeding does cause uterine contractions, it's expected that'll cause an associated increase in lochia dc for the first couple weeks. Color should not change w breastfeeding tho.

Sayo, Caitlin and Jin's baby, was a big newborn, and the physician used forceps to assist Caitlin to push her out. As a result, Caitlin has a fourth degree perineal laceration. Caitlin is concerned that she has not had a bowel movement since giving birth. She is also concerned that having a bowel movement will hurt and that she might tear the stitches if she pushes too hard. Caitlin has not had a bowel movement since giving birth three days ago. Which teaching will the nurse provide to the patient to prevent constipation? SATA A. insert a suppository every day B. avoid dairy products C. drink 6 to 9 glasses of water per day D. eat high fiber foods E. take short walks

C. drink 6 to 9 glasses of water per day D. eat high fiber foods E. take short walks Hydration, activity, and fiber all help prevent constipation. A suppository might relieve sx but doesn't relieve the constipation itself, not to mention that it might be contraindicated if the patient has a 4th degree peri laceration or episiotomy. Dairy doesn't impact bowel function unless the person has lactose intolerance, which would lead to diarrhea.

Laura returns for her second prenatal visit. She is 13 weeks pregnant and has been experiencing significant morning sickness. When the nurse asks how she is feeling, Laura replies, "Better today, but I have spent the past month in the bathroom either vomiting or peeing, and the rest of the time sleeping so that I didn't think about vomiting or peeing." The nurse weighs Laura and finds she has lost 3 pounds since her first prenatal visit. Laura isn't surprised, because she hasn't eaten much over the past month. However, over the past couple of days her appetite has been returning, and she is looking forward to being able to eat for two now! Laura tells the nurse she will have no problem regaining those 3 pounds. The nurse completes a nutrition assessment and determines that Laura is experiencing pica. Which findings from the data collected during the assessment support the finding of pica? A. eating chocolate B. eating pickles C. eating starch D. eating spicy foods E. eating ice

C. eating starch E. eating ice Pica is eating nonfood items which have no nutritional value, such as starch, ice, dirt, or clay. Chocolate, pickles, or spicy foods can be the subject of cravings, which are a strong desire for a particular food item.

Six months later, Laura and Ellen are at the obstetrician's office. After her second insemination with the donor sperm, Laura's home pregnancy test is positive. Laura is 28 years old. With confirmation of this pregnancy she is a gravida 2, para 0. Her first pregnancy, at the age of 18, ended in a loss at 18 weeks' gestation. Laura is active, running three times a week and biking on weekends. Initial prenatal labs: - RBC 3.8 million/mm^3 - WBC 8K/mm^3 - Hct 33 g/dL - Hgb 11 g/dL - MVC 70 fl - MCH 23 fl - MCHC 32 fl - RDW 17% - Platelets 229L/mm^3 - U/A: color is clear and yellow; SG 1.020, pH 5.5; negative for protein, ketones, blood, and glucose' bacteria scant - BUN 9.0 mg/dL - Creatinine 0.52 mg/dL - Uric acid 3 mg/dL - ALT 28 IU/L - AST 32 IU/L - LDH 99 IU/L - Glucose 120 mg/dL - Sodium 140 mmol/L - Potassium 4.4 mmol/L - Chloride 99 mmol/L - HbA1c 4% Based on the patient lab results, the nurse identifies that Laura may have, or is at risk for developing, which condition during this pregnancy? A. gestational diabetes B. preeclampsia C. iron deficiency anemia D. urinary infection

C. iron deficiency anemia The labs show low H and H, which could possibly mean anemia. MCV is also low and RDW is high, both reinforcing anemia. All other values are WNL, meaning there aren't any signs of gestational diabetes or infection. Preeclampsia is diagnosed after the 20th week of pregnancy.

Khloe has had an uneventful postpartum stay. On postpartum day 2, after completing the postpartum depression screening form given to her by the nurse, she gets out of bed and begins caring for herself and her baby, anticipating being discharged today. CBC results from earlier today: - WBC 16K - Hct 36 - Hgb 12.2 - Plts 250K Khloe gave birth 2 days ago. The nurse assesses the position of the fundus. What is the expected position of the fundus? A. midline and at the level of the umbilicus B. deep in the pelvis and not palpable C. midline and 2 fingerbreadths below the umbilicus D. 5 fingerbreadths below the umbilicus and dextro-rotated

C. midline and 2 fingerbreadths below the umbilicus The involution of the uterus results in the fundus descending toward the pelvic cavity at a rate of 1 fingerbreadth per day. By approximately 14 days post birth, the fundus is in the pelvic cavity and is no longer palpable

C. on her back with the bed flat To accurately assess the position of the patient's fundus, the patient needs to be on her back with the bed flat. If the head of the bed is elevated or the bed is in a semi-Fowler's position, it'll make an accurate assessment of the fundal height impossible. Laying on the left side w knees drawn to the chest is the best position for inspecting the patient's perineum.

After 40 weeks of pregnancy and 12 hours of labor, Khloe and her husband Lance become the parents of a healthy 7 pound baby girl at 7:02 am. This is their fourth child. Khloe had a spontaneous vaginal birth with a perineal tear. Lance was great support to Khloe during labor. The baby cried immediately and had Apgar scores of 9 at 1 minute after birth and 9 at 5 minutes after birth. Khloe had no pain medication during labor and is only slight uncomfortable with cramps since giving birth. Her baby is on her belly and attempting to breastfeed. In the hour since her baby's birth, Khloe has been resting in bed, and her vital signs and postpartum checks are all within normal limits. The nurse brings Khloe a breakfast tray and informs her she will be transferred to a room on the Mother-Baby unit soon. You give report to one of the Mother Baby nurses, in which you discuss Khloe's case. She's a 28 year old who came in yesterday evening with contractions 4 to 5 minutes apart. G4 P4. Labor uneventful with no medications except IV pencillin because of her positive GBS swab at 36 weeks. Perineal tear was repaired. Placenta deliver spontaneously. Stable vitals since birth with the most recent set being T 99 F, RR 16, P 68, BP 110/74. Fundus is firm at the umbilicus, lochia is rubra and small in quantity. IV in right wrist infusing 20 units of oxytocin in a 1 liter bag of LR. Will bring her to Mother Baby soon as she's finished eating breakfast. Khloe and her baby are brought to the Mother Baby unit at 9:30 am. Lance is with them and helps Khloe move from the wheelchair to the bed. The nurse enters the room and prepares to take Khloe's vital signs. Khloe says, "The other nurse just took my vital signs in labor and delivery. How often are you going to take my vital signs?" What is the nurse's best response? A. "For the first 12 hours, we will assess your vital signs every 4 hours." B. "For the first 12 hours, we will assess your vital signs every 2 hours." C. "For the first 24 hours, we will assess your vital signs every 8 hours." D. "For the first 24 hours, we will assess your vital signs every 4 hours."

D. "For the first 24 hours, we will assess your vital signs every 4 hours." Following birth, mama's VS are monitored q15min for the first hr, q30min for the second hr, then when she's stable and transferred to Mother Baby VS are q4h for the rest of the first 24 hrs. Finally q8h until discharge if the patient's stable.

D. "I will get you an ice pack for your perineal area." The ice pack is gonna decrease swelling and bruising from the trauma of the birth and repaired perineal laceration. As the swelling is minimized, pain decreases. During the first 12-24 hrs after birth, ice is the most effective non-pharm intervention.

Khloe has had an uneventful postpartum stay. On postpartum day 2, after completing the postpartum depression screening form given to her by the nurse, she gets out of bed and begins caring for herself and her baby, anticipating being discharged today. CBC results from earlier today: - WBC 16K - Hct 36 - Hgb 12.2 - Plts 250K Because Khloe does not have immunity to rubella, the midwife has ordered a rubella vaccination on discharge. What teaching does the nurse provide when administering a rubella vaccination to Khloe? A. Ask the pediatrician to immunize your baby B. Stay away from children under 16 for 2 weeks C. Prevent others from having contact with your body fluids D. Avoid pregnancy for 28 days after the vaccination

D. Avoid pregnancy for 28 days after the vaccination Rubella, or German measles, is a viral infxn that can cause birth defects if acquired during pregnancy. If a woman is rubella nonimmune, it's recommended that she be given the rubella vax. However, it's a live attenuated virus vaccine and shouldn't be given/taken during pregnancy.

Erika's labor progresses. The contractions are coming every 3 to 5 minutes and are moderate in intensity. She is using breathing and relaxation techniques to cope with the contractions. Phil is providing effleurage and massage of her neck and back between contractions. The fetal heart rate has a baseline of 130, with moderate variability and occasional accelerations. The midwife performs a vaginal examination, and the cervix is 100% effaced, 6 cm dilated, the station is 0, and the membranes are intact. After some more time, Erika is completely dilated. The nurse teaches the patient to take a deep breath with each contraction and hold it for a count of 10, exhale, and repeat 3 to 4 times with each contraction. The nurse has taught the patient which pushing method? A. Accelerated pushing B. Open glottis pushing C. Delayed pushing D. Closed glottis pushing

D. Closed glottis pushing Breathing, holding, and pushing is closed glottis pushing, AKA Valsalva pushing or purple pushing. It's effective. It increases intrathoracic pressure and blood flow to the placenta and fetus. It is tiring to the mother tho.

The nurse helps Khloe back to bed. She rechecks her and finds the fundis is firm, midline and at the umbilicus, and the lochia is rubra and moderate in amount. The nurse offers to get Khloe another ice pack. The baby starts crying and Khloe picks her up and prepares to breastfeed. Before leaving the patient's room, the nurse reminds Khloe to order herself some lunch. She spends most of the afternoon with her baby. She's ambulating in her room, voiding, and feeling good. The nurse discontinues the IV. While the baby is sleeping, Khloe takes her baby to the nursery so Khloe can take a shower. After fixing her hair and getting dressed in her own pajamas, she retrieves her baby in anticipation of her children's visit to meet their new sibling. After the family leaves, the nurse arrives to perform another assessment. Khloe is afebrile, the fundus is firm, lochia is rubra, and perineum is less swollen. At 4 pm, her vitals are T 100.2, P 78, RR 16, BP 106/74. What is a priority nursing action based on these assessment findings? A. Restart the patient's antibiotics B. Prepare the patient for a fever workup C. Contact the provider about the elevated temperature D. Encourage the patient to drink fluids

D. Encourage the patient to drink fluids During the first 24 hrs after birth, a common reason for a minor elevation in temp is dehydration. If temp is below 100.4 and there aren't any other signs of infection like tender uterus or foul-smelling lochia, encouraging the patient to increase fluid intake is the priority. The nurse should recheck the temp in 4 hours.

Erika and Phil are anticipating the birth of their first baby. Erika is 28 years old and has had an uncomplicated pregnancy. Together they attended childbirth and breastfeeding classes. Five days ago, during her scheduled prenatal visit at 39 weeks gestation, Erika's cervix was 605 effaced and 1 cm dilated. Erika wakes up this morning with some suprapubic cramping. Over the next couple of hours, she starts having contractions. She calls her midwife when the contractions become 5 to 7 minutes apart. The midwife tells Erika and Phil to go to Labor and Delivery. The prenatal record indicates Erika had a positive GBS swab at 37 weeks gestation. The nurse is notified that Erika is being sent to LND for evaluation. When she arrives, the patient is walking without assistance but stops and leans on her partner during a contraction. She is happy, excited, and talkative. She is thrilled to finally be in labor, but she expresses a little apprehension. The nurses' initial assessment is that the patient is in which part of the labor experience? A. Prodromal phase of stage 1 B. Active phase of stage 1 C. Transitional phase of stage 1 D. Latent phase of stage 1

D. Latent phase of stage 1 This phase is marked by excitement for the upcoming birth. Labor is comfortable and the discomfort is bearable w support of a partner. These assessment findings should be confirmed w a sterile vaginal exam.

Laura and Ellen have been married for 5 years. Last year, Ellen gave birth to a baby boy, Peter. Ellen and Laura used donor sperm. They have sperm from the same donor reserved for future pregnancies. Now it is Laura's turn to carry a pregnancy. Today Laura and Ellen are attending a preconception class at the community center. Laura considers herself healthy; she weighs 145 pounds and is 5'9" tall. She recently started eating a pescatarian diet and hopes to raise their son on that diet as well. Laura and Ellen also learn that women can make dietary changes and enhance nutritional practices during the preconception period to decrease the risk of which pregnancy outcome? A. Trisomy 21 B. Placenta previa C. Morning sickness D. Neural tube defects

D. Neural tube defects Supplementation of the diet with folate/folic acid has shown to decrease the incidence of neural tube defects in the developing embryo. Trisomy 21 is r/t genetics and not impacted by diet. A placenta previa, which occurs when the placenta covers the cervical os, is not r/t diet either. Although first trimester dietary practices like eating crackers before getting out of bed can help alleviate the discomfort of morning sickness, dietary changes during the preconception period do not modify the risk of developing nor the incidence of morning sickness during early pregnancy.

Sayo, Caitlin and Jin's baby, was a big newborn, and the physician used forceps to assist Caitlin to push her out. As a result, Caitlin has a fourth degree perineal laceration. Caitlin is concerned that she has not had a bowel movement since giving birth. She is also concerned that having a bowel movement will hurt and that she might tear the stitches if she pushes too hard. At the time of hospital discharge, a patient with a fourth degree laceration may be prescribed which medication for use at home? A. Enema B. Glycerin suppositories C. Loperamide D. Stool softener

D. Stool softener A stool softener makes it easier to poop by softening the stools. It decreases the need for forceful pushing and straining. Enemas and suppositories aren't recommended in patients w 4th degree laceration d/t possible disruption of the suture line. Loperamide, an antidiarrheal, isn't appropriate for this patient's problem.

Unit 1 Case Studies: Normal Pregnancy, Diet and Nutrition, Vaginal Birth, Routine Postpartum Care, Discharge Teaching for Mom

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