NCLEX Maternity Practice Test Reminders

Who is at highest risk for DIC during pregnancy?

abruptio placentae, amniotic fluid embolism, dead fetus syndrome (in which the fetus has died but is retained in utero for at least 6 weeks), severe preeclampsia, septicemia, cardiopulmonary arrest, or hemorrhage.

What are the perameters for a Reactive "Normal" NST?

requires two or more fetal heart rate accelerations of at least 15 beats/min lasting at least 15 seconds from the beginning of the acceleration to the end, in association with fetal movement, during a 20-minute period.

What are the perameters for a Non-reactive "Abnormal" NST?

showing no accelerations or accelerations of less than 15 beats/min or lasting less than 15 seconds during a 40-minute observation.

DTR scale 1+ 2+ 3+ 4+

1+ Hypoactive 2+ Normal 3+ brisker than avg 4+ hyperresponsive/hyperactive

How much does the uterus involute each day postpartum?

1-2cm q 24 hrs

An electronic doppler U/s can detect fetal heart tones as early as

10weeks

Doppler U/s can pick up fetal heart sounds at __________ gestation and a fetoscope picks up heart sounds at ________ gestation

12wks 18-20wks

Multigravida can feel fetal mvmt as early as _______ primigravida feels fetal mvmt around ______

14-16wks 18wks +

Abd measurement reflects approximately the number of weeks gestation by _______ wks

18-30wks the height of the fundus in centimeters is approximately the same as the number of weeks of gestation, if the woman's bladder is empty at the time of measurement. If the fundal height exceeds the number of weeks of gestation, additional assessment is necessary to investigate the cause for the unexpectedly large uterine size. An unexpected increase in uterine size may indicate that the estimated date of delivery is incorrect and the pregnancy is more advanced than previously thought. If the estimated date of delivery is correct, more than one fetus may be present.

What is the protocol for glucose tolerance testing?

A maternal 1-hour blood glucose test may be prescribed as a screen for gestational diabetes. If it is increased (140 mg/dL or greater), a 3-hour glucose-tolerance test may be recommended to confirm the presence of gestational diabetes. Oral hypoglycemics and insulin would not be prescribed solely on the basis of an increased maternal 1-hour glucose level. Additionally, oral hypoglycemic agents are contraindicated during pregnancy. A result of less than 140 mg/dL indicates no need for further glucose testing and continued routine prenatal care.

What is the most optimal position to place the woman in precipitous labor?

A side-lying (lateral Sims) position enhances placental blood flow and reduces the effects of aortocaval compression. Added benefits of this position are slowing of rapid fetal descent and minimization of perineal tearing. The lateral Sims position also places less stress on the perineum. Because the upper leg is supported, the perineum can be better visualized as well.

Non-reactive NST =

Abnormal

coughing, wheezing, and short periods of apnea.

Hiatal hernia

Determining the position of the fetus is called

Leopold Maneuver *the nurse first asks the woman to empty her bladder, which will contribute to the woman's comfort during the examination. Next the nurse positions the client supine with a wedge placed under the hip to displace the uterus. Often the Leopold maneuvers are performed to aid the examiner in locating the fetal heart tones

True or False There is vaginal bleeding in complete uterine rupture

FALSE Its concealed *In a complete uterine rupture, the woman may complain of sudden sharp, shooting abdominal pain and may state that she felt like "something gave way." If she is in labor, her contractions will cease and the pain is relieved. In a complete uterine rupture, bleeding will be concealed, and therefore the client will exhibit signs of hypovolemic shock resulting from hemorrhage (hypotension, tachypnea, pallor, and cool, clammy skin). The fetus is the most common indicator of uterine rupture. Such changes in the fetal heart rate as late or variable decelerations, a decrease in baseline variability, or an increase or decrease in rate are commonly exhibited during a rupture. If the placenta separates, the fetal heart rate will be absent and fetal parts may be palpated through the abdomen

Post Amniotomy what order do you do the following? Determining the fetal heart rate Planning evaluation of the client for signs and symptoms of infection Taking the client's temperature, pulse, and blood pressure Noting the quantity, color, and odor of the amniotic fluid Replacing soiled underpads from beneath the client's buttocks

FHR Note amniotic fluid Maternal VS Change underpads Plan to eval for infx

Hiccups and spitting up after meals are clinical manifestations of

GERD

Sx's of false labor

Mild, irregular contractions and a lack of changes in the cervix

What is the ballottement test?

Near midpregnancy, a sudden tap on the cervix during a vaginal exam may cause the fetus to rise in the amniotic fluid and then rebound to its original position, a phenomenon known as ballottement. The examiner feels the rebound when the fetus falls back down.

Is age a risk factor for placental abruption?

No Maternal use of cocaine, which causes vasoconstriction of the endometrial arteries, is a leading cause. Other risk factors include hypertension, cigarette smoking, abdominal trauma, and a history of previous premature separation of the placenta

The following Apgar scores mean: 7-10 4-6 0-3

No difficulty transitioning to extra uterine life Mod difficulty transitioning to extrauterine life = recusitative efforts Severe distress = vigorious recusitation

True or False Breast engorgement treatment is the same as Mastitis treatment?

No/Yes *First encourage bfeeding q 2-3hrs, have pt. massage breasts as bfeeding, apply ice-packs to reduce swelling, stand in warm shower before feeding to encourage let-down

A client admitted to the maternity unit 12 hours ago has been experiencing strong contractions every 3 minutes but has remained at station 0. The fetal heart rate on admission was 140 beats/min and regular. The fetal heart rate is slowing, and a persistent nonreassuring fetal heart rate pattern is present. The appropriate nursing action in this situation is: Preparing to induce labor Turning the client on her left side Preparing the client for a cesarean delivery Continuing to monitor the fetal heart rate pattern

Prepare for C/S Dystocia, failure of labor to progress, and a persistent nonreassuring fetal heart rate pattern are indications of the need for cesarean delivery

A nurse in the labor room is preparing to care for a client with hypertonic uterine dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. What is the priority nursing intervention in the care of this client? Providing pain relief Preparing the client for amniotomy Monitoring the oxytocin (Pitocin) infusion closely Encouraging the client to ambulate every 30 minutes

Providing pain relief: Management of hypertonic uterine dysfunction depends on the cause. Relief of pain is the primary intervention in promoting a normal labor pattern. The client with hypertonic uterine dysfunction would be encouraged to rest, not to ambulate every 30 minutes.

What is the progression of lochia?

Rubra 1-4 days postpartum Serosa (brown-pink) 4-10 days postpartum Alba (white) 11-14 days postpartum

purulent drainage or redness or edema at the base of the cord

Signs of umbilical infx

What is the anti-viral course of treatment for the pregnant woman with TB?

The preferred treatment for the pregnant woman is isoniazid plus rifampin for a total of 9 months. Ethambutol is added initially if drug resistance is suspected. Pyridoxine (vitamin B6) is often administered with isoniazid to prevent fetal neurotoxicity. The infant will be tested at birth and may be started on preventive isoniazid therapy. Skin testing of the infant should be repeated at 3 months, and isoniazid may be stopped if the result remains negative. If the result is positive, the infant should receive isoniazid for at least 6 months. If the mother's sputum is free of organisms, the infant does not need to be isolated from the mother while in the hospital.

How long is it normal for a postpartum woman to have a "fever" or temp. around 38?

Up to 24hrs *If its greater than 38 or persists beyond 24hrs could be a sign of an infection, regardless encourage fluid intake

When can a woman safely have sex postpartum?

Usually a woman may engage safely in sexual intercourse during the second to fourth week after childbirth as long as she experiences no discomfort during intercourse. *Episiotomy heals in about 3wks

What is the treatment for seborrheic dermatitis in the newborn?

apply oil to the affected part of the scalp *It sometimes results when parents do not wash over the anterior fontanel carefully for fear that they will hurt the infant. Treatment includes the application of oil (e.g., mineral oil) to the area to help soften the lesions followed by gentle removal of the scaly lesions with a comb before the head is shampooed. The nurse should teach the mother how to shampoo the scalp and explain that she will not damage the fontanel with normal gentle shampooing. The scalp should be rinsed well to remove all soap, which could cause irritation.

What is the clinical manifestation goal of oxy induction/augmentation of labor?

three good-quality contractions (of appropriate intensity and duration) in a 10-minute period. The uterus should return to resting tone between contractions, and there should be no evidence of fetal distress. If a nonreassuring fetal heart rate pattern is detected, the oxytocin infusion is stopped. A nonreassuring fetal heart rate pattern is associated with fetal hypoxia.

Goodell sign =

cervix becomes more vascular and slightly hypertrophic, edamatous *normal encouraging sign in first weeks of pregnancy

Variable decels =

cord compression

What are the clinical manifestations of congenital diaphragmatic hernia?

diminished or an absence of breath sounds on the affected side, bowel sounds heard over the chest, cardiac sounds heard on the right side of the chest, and respiratory distress, including dyspnea, cyanosis, nasal flaring, tachypnea, retractions, and a scaphoid abdomen, that develops soon after birth.

excessive oral secretions

esophageal atresia and tracheoesophageal fistula

Early dschg criteria for newborn

no evidence of significant jaundice in the 24 hours after birth. The infant should have urinated and passed at least one stool, completed at least two successful feedings, and have normal vital signs for at least 12 hours.

What is Mittelschmirz?

pelvic pain that occurs midway between menstrual periods or at the time of ovulation. The pain is due to growth of the dominant follicle within the ovary or to rupture of a follicle and subsequent spillage of follicular fluid and blood into the peritoneal space. The pain, which is fairly sharp, is felt on the right or left side of the pelvis. It generally lasts a few hours to 2 days, and slight (not profuse) vaginal bleeding may accompany the discomfort. The pain is not associated with intercourse

Placenta Previa vs. Placental Abruption

placenta previa is painless vaginal bleeding in the second or third trimester of pregnancy. vs Findings of abruptio placentae include dark-red vaginal bleeding and abdominal pain

Signs of congenital syphillis

poor feeding, slight hyperthermia, and "snuffles" (copious clear serosanguinous mucous discharge from the nose) — may be nonspecific at first. By the end of the first week, however, a copper-colored maculopapular dermal rash is characteristically observed on the palms and soles, in the diaper area, and around the mouth and anus.

EARLY decels =

psi on head of fetus during contraction

What is Nagale's Rule?

requires that the woman have a regular 28-day menstrual cycle. It is calculated by subtracting 3 months from the first day of the LMP, adding 7 days, and then adding 1 year to that date *First day of the LMP: September 19, 2013; subtract 3 months: June 19, 2013; add seven days: June 26, 2013; add 1 year: June 26, 2014

What is the treatment for uterine inversion?

tries to replace the uterus, by way of the vagina, in a normal position. If this is not possible, laparotomy with replacement is performed. A hysterectomy may be required. Two intravenous lines are established to allow rapid fluid and blood replacement. A tocolytic medication or general anesthesia usually is needed to relax the uterus enough to replace it. To help ensure that the inverted fundus is not trapped in the cervix, oxytocin is not given until the uterus has been repositioned. Fundal massage should be avoided if possible, but, if it is prescribed, it should be conducted very carefully. A Foley catheter may be inserted to keep the bladder empty so that the uterus can contract well, but this is not the immediate action.

LATE decels =

uteroplacental insufficiency