HR Pregnancy (rando set)
Severe and profound hypoglycemia
number 1 risk for newborns with diabetic mothers
Biophysical Profile
on-invasive "fetal physical exam" combines assessment of 5 components (scored 2 normal or 0 abnormal) in 30 minute time period 1. NST 2. Fetal breathing movements (one or more movements for 30 sec) Fetal movement (3 or more body, limb movements) Fetal tone (one or more episodes of flexion/extension, open/close hand Amniotic fluid volume index (AFI) Score 8-10/10 is reaussring, 6/10 equivocal. Deliver promptly if term, and if preterm, closely monitor and consider repeat in 24 hours. 0-4/10, emergent delivery
Non-Stres Test
reactivity based on gestational age, non invasive At least two fetal heart rate accelerations 15 beats above baseline heart rate sustained for 15 seconds with a 20 minute timeframe is a reactive result. Non-reassuring may indicate sleep cycle, hypoxia, CNS depression, acidosis, congenital anomalies
Contraction Stress Test
Evaluates FHR response to uterine contractions *invasive Negative (normal) CTS- no evidence of late or significant variable decelerations Results interpreted upon presence or absence of FHR decelerations or variations not associated with contradctions Positive CST (abnormal)- presence of late decelerations with 50% of contractions (even if frequency less than 3 in 10 minutes) Equivocal CST- unsatisfactory results (fewer than 3 UC in 10 minutes, intermittent lates, severe variables) Several contraindications such as third trimester bleeding, premature rupture of membranes, etc
L/S
Lecithen and sphingomyelin are components of surfactant. Ratio 2:1=developed at about 35 weeks
Maria's one hour oral Glucose Challenge Test (OGCT) results were 156. Based upon these results, the nurse would counsel Maria in what way? a. This level is high. Maria should return to the clinic for a 3 hour Oral Glucose Tolerance test. b. This level is normal. Maria should return to the clinic in 4 weeks for a regular antepartal assessment. c. This level is high. Maria should return tomorrow for another one hour Oral Glucose Challenge test. d. This level is dangerously high. Maria will need to be admitted to the hospital to hve her glucose level adjusted with insulin therapy.
a.
The results from the sterile speculum exam reveal "bleeding with a closed cervical os." The nurse would interpret this as: a. Threatened abortion b. Complete abortion c. Missed abortion d. Imminent abortion
a.
Lynn had a baseline Non-Stress Test (NST) which was non-reactive. What would the nurse anticpate as the next appropriate action to assess for fetal wellbeing? a. Amniocentesis b. Biophysical Profile c. Repeat the NST in 2 weeks d. Contraction Stress Test (CST)
b.
Maria's 3 hour Glucose Tolerance Test resulted in a diagnosis of gestational diabetes. Which of the following therapies does the nurse anticipate to be ordered for this patient? a. Oral hypoglycemic agents b. Diet control with exercise c. Regular insulin injections d. Genetic counseling
b.
Fetal Kick Counts
Assessment of fetal well being. Mother lies on side and places both hands over abdomen and records movements. Either 10 in up to 2 hours or 5 in 1 hour
Chorionic Villi Sampling
Done between 10-12 weeks *invasive procedure Purpose to obtained fetal tissue for chromosomes. Ultrasound guidance to locate chorionic villi and collect sample, either through thin catheter inserted vaginally into intrauterine cavity or a biopsy needle inserted abdominally or intravaginally
Ultrasound
Done early (6 weeks) and throughout pregnancy *noninvasive confirm fetal viability, gestational age, monitor growth, placenta location/maturity, amniotic fluid volume; assess uterine fibroids and cervical length. Use of high frequency sound waves to detect differences in tissue density and visualize outlines of structures
7. A primigravida 32 weeks gestation with severe headache is admitted to the hospital with preeclampsia. The physician orders intravenous Magnesium Sulfate therapy. Which of the following nursing assessments should be performed first? a. Assess deep tendon reflexes b. Assess baseline weight c. Obtain routine urinalysis d. Obtain nutritional intake
a.
A nurse works in a clinic with a high adolescent pregnancy population. The nurse provides teaching to the young women in order to prevent which of the following high risk complications of pregnancy? a. Preterm birth b. Gestational diabetes c. Macrosomic babies d. Polycythemia
a.
In this antepartal situation, the nurse focuses on health promotion teaching with Sheila. (threatened abortion) Which of the following topics would be the most important to teach Sheila at this time? a. Fetal kick count (count 10 movements in up to 2 hours time) b. Pelvic tilt exercise at least 3 times/day c. Drink at least 4 cups of fluid/day d. Fetal kick count (at least 5 movements in 30 minutes)
a.
2. A woman who is 36 weeks gestation is admitted to the high risk antepartal unit for preeclampsia. Which of the following does the nurse prioritize for appropriate care with this patient? (Select all that apply) a. Monitor intake and output b. Promote activity as tolerated c. Teach about impending labor d. Assess deep tendon reflexes e. Encourage family members to visit for diversion
a. and d.
The following assessment findings were gathered by the nurse on a pregnant woman with preeclampsia. Which of the following is an indication that her condition is becoming worse? (Select all that apply) a. B/P 158/102 (two consecutive readings) b. Deep tendon reflexes 3+ c. Fetal heart rate 130 bpm d. Complains of right upper quadrant pain
a. and d.
A nurse is caring for a pregnant woman who has type I diabetes that is not well-controlled. The nurse understands that this patient is a risk for which of the following? (Select all that apply) a. Large for gestational age (LGA) newborn b. Hyperemesis gravidarium c. Generalized edema d. Urinary tract infection e. Hypertension
a. and e.
During further assessment, Angela has disclosed with the nurse that her partner has abused her. What is the most therapeutic response by the nurse? a. "Angela, I must report this case of abuse to the authorities immediately." b. "Angela, what you have just told me is very important, and I am very glad you have shared this with me. No one has the right to hurt you this way." c. "I will call the Women's abuse Shelter and see if they have an opening for you and your children immediately." d. "Why have you stayed with your boyfriend if he is abusing you like this? His behavior is very dangerous and he could injure your baby as well."
b.
Jasmine is a 15 year old seeking prenatal care. Which of the following would be the best approach to take when she tells the nurse she is undecided whether or not to maintain this unwanted pregnancy? a. "You should consider an abortion since you are so young." b. "This is a difficult decision. What have you thought about so far?" c. "Studies show that babies living with teen mothers often become teen parents as well." d. "Have you discussed this with your parents? They should be part of this decision."
b.
Sheila calls the clinic triage nurse crying, and states she is 17 weeks pregnant and bleeding. The triage nurse assesses Sheila's situation and determines she should go to the Emergency Department (ED). Sheila and her husband arrive at the ED. The nurse takes Sheila's history: G2 T0 P0 A1 L0. She had a previous miscarriage 1 year ago at 18 weeks gestation. Shelia noticed a small amount of bright red bleeding when she went to the bathroom early this morning. Two hours later, the bleeding had increased, saturating a full peri pad. Sheila and her husband are both very stressed and worried about losing this baby, like their first pregnancy. What is the best therapeutic response to Sheila and her husband by the nurse at this time? a. "Your baby will be fine. We'll start an IV to give you fluids, and get things under control in no time at all." b. "This is a very frightening time for you. We are going to do the best to care for both you and your baby." c. "This is a serious situation, especially with your history of losing a previous pregnancy. We may not be able to save this one either." d. "You are probably going to miscarry. But you should be relieved, because most miscarriages are the result of abnormalities in the fetus."
b.
Which of the following data clusters obtained from Julia's antenatal assessment would the nurse interpret as representing preeclampsia? a. BP change: 90/56 to 110/70. +1 glycosuria b. BP change: 110/70 to 146/96. +2 proteinuria, facial edema c. BP change: 120/80 to 130/86. +1 proteinuria, c/o backache d. BP change: 134/80 to 140/88. negative proteinuria, c/o shortness of breath
b.
10. Which of the following patients would have a definitive diagnosis of gestational diabetes? a. Primigravida with oral Glucose Challenge test (OGCT) result of 148 ml/dL b. Primigravida with fasting blood sugar of 110 ml/ dL c. Multigravida with two results greater than norm from the 3-hour Oral Glucose Tolerance test (OGTT) d. Multigravida pregnant with third baby; history of two previous macrosomic babies
c.
19. Which of the following will the nurse now carefully monitor Maria for during her prenatal care? (gestational diabetes) a. Multiple gestation b. Metabolic acidosis c. Urinary tract infection d. Iron deficiency anemia
c.
3. Which postpartum patient should receive RhoGAM? a. A postpartum woman who has a negative Indirect Coombs test and is A positive b. A postpartum woman who is B negative and has just delivered an infant who is B positive and has a positive direct Coombs test. c. A postpartum woman who is B negative and has just delivered an infant who is B positive and has a negative direct Coombs test. d. A postpartum woman who has just delivered an infant who is A negative.
c.
5. A primigravida is 9 weeks pregnant and admitted with a diagnosis of hyperemesis gravidarum. Which of the following orders by the primary health care provider is highest priority for the nurse to complete? a. Obtain complete blood count b. Check admission weight c. Start intravenous therapy with multivitamins d. Obtain urine for urinalysis
c.
8. A pregnant woman at 36 weeks gestation with 4+ proteinuria and 4+ reflexes is admitted to the hospital with severe preeclampsia. The nurse's goal of care is: a. Lower blood pressure b. Maintain fetal health c. Prevent grand mal seizure d. Monitor weight gain
c.
A new RN working is in the antepartal clinic. She has just completed the initial assessments of four patients. Which of the following women would the nurse refer the obstetrician to see first? a. A diabetic woman at 30 weeks with a record of morning blood sugars between 88-102. b. Pregnant woman at 29 weeks gestation with history of bleeding in first trimester. FHR 110-118 bpm. c. Pregnant woman at 35 weeks gestation with 5 lb weight gain in last week. BP 158/90. Complaints of headache for past week. d. Multigravida at 18 weeks gestation. Rh negative, previous Rh positive infant.
c.
A nurse is caring for a woman who is 32 weeks gestation and comes to the OB triage area. She reports vaginal bleeding and severe abdominal pain. The nurse interprets these symptoms as: a. Placenta previa b. Threatened abortion c. Placental abruption d. Imminent abortion
c.
A woman is pregnant at 16 weeks gestation with her second baby. Her blood type is A negative. She had a miscarriage at 10 weeks with her first pregnancy. What is the appropriate antepartum care? a. Administer RhoGAM to the mother after delivery if the baby is Rh negative. b. No intervention is necessary in this case. c. Administer RhoGAM at 28 weeks gestation. d. Administer RhoGAM if the Indirect Coombs is positive.
c.
At 37 3/7 weeks, Maria is scheduled for an amniocentesis due to increasing fetal growth. The results of the L/S ratio are 2.1:1. The nurse interprets these results to indicate: a. Neural Tube Defect (NTD) b. Down Syndrome c. Lung maturity d. Lung immaturity
c.
During Jasmine's antepartal care, which of the following vital signs should be monitored carefully? a. Heart rate b. Respiratory rate c. Blood pressure d. Temperature
c.
Lynn's blood type is O positive. The nurse might expect blood incompatibility problems if the fetus' blood is: a. Rh negative b. Type O negative c. Type A positive d. Rh positive
c.
Sheila calls the clinic triage nurse crying, and states she is 17 weeks pregnant and bleeding. The triage nurse assesses Sheila's situation and determines she should go to the Emergency Department (ED). Sheila and her husband arrive at the ED. The nurse takes Sheila's history: G2 T0 P0 A1 L0. She had a previous miscarriage 1 year ago at 18 weeks gestation. Shelia noticed a small amount of bright red bleeding when she went to the bathroom early this morning. Two hours later, the bleeding had increased, saturating a full peri pad. Sheila and her husband are both very stressed and worried about losing this baby, like their first pregnancy. Which of the following actions should the nurse do first in the care of this patient? a. Mother's vital signs b. Offer to call the hospital Chaplin for support c. Assess the FHR d. Prepare for an ultrasound
c.
The night nurse is performing Julia's assessment and interprets which of the following data as and early sign of Magnesium toxicity: a. Respirations 14 per minute b. Urine output 40cc per hour c. DTR weak, 1+ d. BP 162/78
c.
Which of the following antenatal tests would the nurse anticipate the physician would order as most appropriate for this patient's plan of care? (preeclampsia) a. Biophysical profile b. Ultrasound c. Non-Stress Test (NST) d. Contraction Stress Test (CST)
c.
Which of the following symptoms would indicate that Julia is developing HELLP syndrome? a. Stable creatinine level 1.2 (0.6-1.6g/24hours) b. Platelet level 150,000 (140,000-340,000) c. Elevated AST & ALT liver enzymes d. Hgb level 11.2 g/dL
c.
multigravida type II diabetic is 30 weeks gestation. Which of the following does the nurse anticipate as a potential complication for this patient? a. Potential fetal genetic abnormalities b. Rh isoimmunization c. Macrosomic baby d. Placenta previa
c.
11. A multigravida with gestational diabetes is 36 and 4/7 weeks with increased fetal growth. The results of her amniocentesis are Lecithin/Sphingomyelin (L/S ratio) 1:2. The nurse interprets these results to indicate: a. Lung maturity b. Down's syndrome c. Low risk for respiratory distress syndrome d. Lung immaturity
d.
4. The nurse is caring for a pregnant woman who is 39 weeks and arrives at the high risk triage clinic with complaints of vaginal bleeding and intense abdominal pain. What assessment should the nurse perform first? a. Perform mother's vital signs b. Measure the fundal height c. Assess blood glucose level d. Auscultate the fetal heart rate
d.
6. A mulitgravida's 32-week assessment was BP 110/60, P-92, R-20 weight 145 lbs. and urine negative for protein. Which of the following findings at the 34-week appointment would the nurse highlight for the certified nurse midwife? a. BP 110/70; P-88, R-20 b. Weight 147 lbs; BP 130/74 c. Urine protein trace; BP 134/70 d. Weight 155 lbs; urine protein +2; BP 142/88
d.
9. A gravida 6 para 5 is 24 weeks gestation and admitted to the hospital for placenta previa. Which of the following is an appropriate long-term goal for this woman? a. The patient will state an understanding of the need for bedrest. b. The patient will have a reactive non-stress test on day 2 of hospitalization. c. The patient will call her children shortly after admission. d. The patient will be symptom-free until the end of 37 weeks' gestation.
d.
A nurse is performing an assessment on four 22 week pregnant women. Which of the following women would the nurse suspect may be carrying twins, and reports this to the obstetrician? a. The woman states "she feels huge." b. The woman has a total weight gain of 13 pounds. c. The woman with an alpha-fetoprotein level that is high. d. The woman who has a fundal height measurement of 26 cm.
d.
Because of a teenager's body requirements and special nutritional needs, the nurse will evaluate Jasmine's dietary intake for: a. Protein and magnesium b. Carbohydrates and zinc c. Pyroxidine and thiamine d. Calcium and iron
d.
Lynn is an 18 year old primigravida who came to the clinic with her girlfriend. She reports that she is pregnant, but not sure how far along since she has had several sexual encounters. Lynn starts to cry and says, "I'm so messed up - such a weak person." She admits to excessive alcohol consumption and use of marijuana during the past 6 months. "But now that I'm pregnant, I want to stop these behaviors." Which response by the nurse would be most therapeutic with Lynn? a. "I am concerned about you and your baby. What can I do to help you?" b. "I don't believe that you are weak at all. You just need to say no to drugs." c. "I have heard that before. You need to get serious now or your baby will suffer." d. "That is a very positive plan. Could you tell me more about feeling like a weak person?"
d.
The nurse provides anticipatory guidance to Angela by explaining that living in an environment with constant stress is not healthy to her and the baby. The nurse explains that stress can affect the baby by: a. Increasing the risk of congenital anomalies b. Excess stress on fetal heart function leading to cardiac anomalies c. Increasing the risk of chromosomal anomalies d. Depriving the baby of blood and oxygen that can cause decreased growth and low birth weight
d.
Amniocentesis
done beginning at 12 weeks *invasive purpose to analyze amniotic fluid for chromosomal abnormalities, fetal lung maturity, infection, and presence of bilirubin in Rh sensitized pregnancies. Needle is inserted into abdomen, into amniotic sac, obtaining sample of fluid
