2024 NUR 2421 FINAL EXAM STUDY GUIDE WITH VERIFIED SOLUTIONS GRADED A | Exams Nursing | Docsity (2024)

Download 2024 NUR 2421 FINAL EXAM STUDY GUIDE WITH VERIFIED SOLUTIONS GRADED A and more Exams Nursing in PDF only on Docsity! 2024 NUR 2421 FINAL EXAM STUDY GUIDE WITH VERIFIED SOLUTIONS GRADED A Conception, fertilization, infertility, Sexually Transmitted Infections, Endometritis Conception • After ovulation, the ovum must be fertilized within 12-24 hours for fertilization to occur. • The sperm’s ability to fertilize the ovum lasts an average of 48-72 hours. Fertilization & Implantation 1. What is the route that the sperm must travel to reach the egg? vagin* > cervix > through uterus > fallopian tube 2. Where does fertilization usually take place? In fallopian tube 3. How long does it take for implantation? 1 week 4. Where does this usually occur? uterus 5. Where else could implantation occur? Fallopian tube; tubal pregnancy 6. What are methods to prevent this from occurring? Birth control Infertility Female AGE: Age greater than 35 years can affect fertility. DURATION OF INFERTILITY: More than 1 year of coitus without contraceptives. For females older than 35 years or who have a known risk factor, the recommendation is for 6 months. Male sem*n ANALYSIS: In 40% of couples who are infertile, inability to conceive is due to male infertility. This test is the first in an infertility workup because it is less expensive and less invasive than female infertility testing. It can need to be repeated. MEDICAL THERAPY ● Ovarian stimulation-medications are prescribed to stimulate the ovary to produce follicles: ◯ Clomiphene citrate ◯ Letrozole ● Other medications used to support ovulation: metformin ● Appropriate antimicrobial medications for preexisting infections Common STIs • Chlamydia: Bacterial • Gonorrhea: Bacterial • Syphilis: Bacterial • Trichom*oniasis: Protozoan parasite • Human Papilloma Virus (HPV): Viral • Candidiasis: Yeast Infection What is the most reported bacterial STI in the US? Chlamydia Sexually Transmitted Infections: STI • Bacterial Infections Chlamydia • Treat with broad spectrum antibiotic: Azithromycin or Amoxicillin Gonorrhea • Treat with broad spectrum antibiotic: Ceftriaxone or Azithromycin STIs • Chlamydia and Gonorrhea can be difficult to diagnose because they are often asymptomatic. If left untreated, can lead to pelvic inflammatory disease (PID), which can lead to infertility. • In pregnancy it can increase the risk of PROM, Chorioamnionitis, and newborn sepsis. • The CDC recommends screening all sexually active women younger then 25 years and/or at high risk be screened at their first prenatal visit and in the third trimester. Syphilis Syphilis is caused by the bacterium Treponema pallidum It has 3 stages: • Primary: painless Genital Chancre (3-90 days) • Secondary: Body Rash (4-10 weeks) • Tertiary: Internal Organs (3-15 years) • • Serology Tests: VDRL or Rapid Plasma Reagin (RPR) • Treatment: Penicillin G IM in a single dose. Trichom*oniasis Breaking Non compliance Advantages Cheap Protects against STI Accessible What are advantages and disadvantages of the female condom? Less popular Disadvantages Decreased sensation Advantages Over counter Cheap Prevent STI Woman in control Diaphragm Prevent pregnancy • Use with a small amount of spermicidal jelly • Replace: How often? Every 2 yrs • Refit: When? After having baby or gain/loss weight • Examine: For what? Suction with cervix A diaphragm may be inserted up to 6_hours prior to intercourse and must be left in at least 6_ hours after, but not to exceed a total time of 24_ hours? Disadvantages See OB/GYN to be fitted No STI protection Advantages Reusable Application of Spermicidal Jelly to the Rim of the Diaphragm Empty bladder before insertion The cervix should be felt through the diaphragm to verify placement The Contraceptive Sponge • The sponge is marketed as “Today Sponge” easy • Moisten with about 2 tsp. of water to activate the spermicide upon insertion. The maximal time to remain inserted is 30 hours, but at least 6 hours after intercourse. • No STI protection • One size fits all • What is an advantage of the sponge over diaphragm? One size fits all • What is a disadvantage of the sponge to the diaphragm? No STI protection Contraceptive Sponge: Concave Portion Faces the Cervix Forms of Contraception 1. How do you remove the contraceptive sponge? Pull string 2. What is the most effective form of non-permanent birth control? It’s 99% effective! IUD Intrauterine Devices (IUDs) • Copper IUD (ParaGard T380A) – Provides protection for 10 years – • Mirena Levonorgestrel Intrauterine System (LNG-IUS) – Provides protection for 5 years How can you tell if an IUD has become dislodged? The string becomes longer, always know the location of the string and how much it hangs out of the cervix Advantages of IUD Place and forget • High rate of effectiveness as you don’t need to do anything special once it has been placed • Continuous contraceptive protection • Relatively inexpensive over time Disadvantages of IUD MD office visit Cost In office placement Increased menstrual bleeding Increased risk of PID • Increased and intermenstrual bleeding • Increased risk of PID (contraindicated with a history of tubal pregnancies or endometritis) • Cost involved for practitioner to insert • Only recommended for monogamous relationships •What is all time most researched drug on the market? Birth control pill The Birth Control Pill (BCP) How does the BCP inhibit pregnancy? 1. Inhibits the release of the ovum 2. Creates an atrophic environment 3. Maintains a thick cervical mucus that slows sperm transport Combined Oral Contraceptive (COC) • Birth Control Pills are listed under many brand names • COC Contains both estrogen and progestin Combined oral contraception Rhogam (mechanism of action) and how it relates to the blood type Care of the Woman at Risk for Rh Alloimmunization • Rh blood group present on surface of erythrocytes • Applies to all Rh (-) women regardless of their A, B, or O blood type, if they are pregnant with a Rh (+) fetus. • If Rh (-) person exposed to Rh (+) blood: – Antibody-antigen response – sensitized – This usually occurs at delivery, so subsequent pregnancies can be impacted depending upon the next babies blood type. Pathophysiology of RhD Alloimmunization • Small amounts of fetal blood cross placenta • Rh (-) mother to her Rh (+) fetus • Maternal IgG antibodies produced • Hemolysis of fetal red blood cells result • This can also occur during procedures or trauma. A Kleihauer-Betke blood test, also called a “KB test”, looks for the presence of fetal cells in the maternal blood stream. What should be done if this test is positive? Rhogam Screening for Rh Incompatibility and Sensitization • First prenatal visit – Maternal blood type; Rh factor, antibody screen – Rhogam IM given prophylactically to all Rh-negative woman between 24-28 weeks gestation Clinical Therapy: Rhogam • Maternal Administration of Rh immune globulin 300 mcg IM – Must give within 72 hours after birth to a Rh (-) woman who gave birth to a Rh (+) newborn – After spontaneous or induced abortion – After ectopic pregnancy – After invasive procedures during pregnancy – After maternal trauma Naegele’s Rule Nägele’s Rule important to know • Most common method of determining EDB • First day of LMP, – 3 months, + 7 days, and (add 1 year if needed) = EDB Nägele’s Rule Examples A. Last Menstrual Period: Dec 18, 2013 = Sept 25, 2014 B. Last Menstrual Period: Jan 15, 2013 = Oct 22, 2013 Hydatidiform Mole • Hydatidiform Mole vesicles grow instead of fetus – Molar pregnancy – Loss of fetus – 1:1500 pregnancies • Invasive mole • Can lead to a Choriocarcinoma (invasive, malignant uterine tumor) Gestational Trophoblastic Disease: Signs and Diagnosis Signs: – vagin*l bleeding/Anemia (red spotting to bright red hemorrhage) – Passing of hydropic vesicles (grapelike clusters) – Uterine enlargement greater than expected for gestational age – Absence of fetal heart sounds – Markedly elevated human chorionic gonadotropin – Low levels of maternal serum alpha-fetoprotein – Hyperemesis Gravidarum – Preeclampsia – Diagnosis: Ultrasound (shows grapelike clusters instead of fetus) –What sign does the woman often notice first? Abdomen grows quicker than they expect Gestational Trophoblastic Disease: Treatment • Suction evacuation and curettage of uterus – Early evacuation decreases complications Can not get pregnant for at least 1 year Check for elevated HCG levels to indicate if cancer is present • Rh immune globulin if mother Rh negative • Careful follow-up – Baseline chest x-ray and repeat – To check for lung metastasis – includes serial hCG monitoring due to risk of patient attaining Choriocarcinoma Malignant Gestational Trophoblastic Disease Why is it critically important that a woman avoids getting pregnant for 1 year following this issue? They need to be able to see if cancer is present by checking elevation of HCG levels • If hCG plateaus or rises, or metastases detected – Chemotherapy -Methotrexate alone -Combination therapy Amniocentesis: Neural Tube Defect, Genetic Issues, Fetal Lung Maturity Amniocentesis The aspiration of amniotic fluid for analysis by insertion of a needle transabdominally into a client’s uterus and amniotic sac under direct ultrasound guidance locating the placenta and determining the position of the fetus. It may be performed after 14 weeks of gestation. Alpha- fetoprotein (AFP) can be measured from the amniotic fluid between 15 and 20 weeks (16 to 18 weeks of gestation is ideal) and can be used to assess for neural tube defects in the fetus or chromosomal disorders. Can be evaluated to follow up a high level of AFP in maternal blood. INDICATIONS POTENTIAL DIAGNOSES ● Previous birth with a chromosomal anomaly ● A parent who is a carrier of a chromosomal anomaly ● A family history of neural tube defects ● Prenatal diagnosis of a genetic disorder or congenital anomaly of the fetus ● AFP level for fetal abnormalities ● Lung maturity assessment • Auscultation of fetal heartbeat (via Doppler) • Visualization of the fetus by ultrasound by an advanced practitioner • Fetal movement determined by an advanced practitioner Nutrition & weight gain in pregnancy Pattern of Weight Gain • Normal weight: Average recommended weight gain 25-35 pounds – First trimester – 1.6–2.3 kg 3.5–5 pounds – Last two trimesters – 0.5 kg 1 pound per week • Underweight: Average recommended weight gain 28-40 pounds – Last two trimesters – 1.75 pounds per week • Overweight: Average recommended weight gain 15-25 pounds – Last two trimesters – 0.7 pounds per week Minerals • Calcium: 1,000 mg. daily – Mineralization of fetal bones and teeth – Energy and cell production What are good food sources? Leafy green veggies, soy milk, nuts, legumes • Zinc helps with: – Protein metabolism – Fetal growth – Lactation What are good food sources? Peanuts, spinach, beets • Iron – Oxygen-carrying capacity (Anemia= Hgb.<11 mg/dL, Hct. <33%) – Increased needs during pregnancy (Pica eating) – Milk and caffeine can interfere with the absorption of iron What are good food sources? Red meat, green veggies, fortified cereals, prenatal vitamins have 27mg of iron Vitamin C • Aids in the absorption of Iron • Nutritious diet should meet needs What are good food sources? Citrus juices, OJ, strawberries Gestational hypertension & Preeclampsia Clinical Manifestations and Diagnosis Most common cause of maternal & fetal death • Mild preeclampsia – After 20 weeks, BP 140 mm Hg systolic or 90 mm Hg diastolic – Proteinuria (3 g/24 hours) • Severe preeclampsia (life-threatening) – BP 160 mm Hg systolic or 100 mm Hg diastolic – Proteinuria (5 g/24 hours) – Elevated creatinine (>1.1 mg/dL) • Underlying Cause: Vasospasms causing poor tissue perfusion Hospital Care of Pre-eclampsia • Mild preeclampsia – Low activity, diet (well-balanced, high protein) – Frequent monitoring for fetal and maternal well-being • Severe preeclampsia – Immediate hospitalization for treatment – Possible early childbirth, foley catheter in Hospital Care of Preeclampsia (cont’d) • Rapid initiation of medication to lower BP • Therapeutic goal – diastolic BP between 90-100 mm Hg • Medications – Labetalol (Trandate) IV – Hydralazine (Apresoline) IV – Nifedipine (Procardia) PO – Magnesium Sulfate IV (4-7 mg/dl is therapeutic level) – prevent seizure, lowers BP short term; given for at least 24hrs -Antidote: Calcium Gluconate IV Eclampsia • Occurrence of seizure or coma • Treatment – Magnesium sulfate – Antihypertensive agents • Observe fetal reaction to seizure • Fetus should recover when mother stabilizes • Give supplemental oxygen following seizure Lab Diagnosis: HELLP Syndrome • Hemolysis • Elevated Liver enzymes • Low Platelet count Associated with severe preeclampsia • Symptoms – Nausea, vomiting, malaise, epigastric pain (liver), RUQ pain – Results in anemia, thrombocytopenia, jaundice – HELLP should be delivered regardless of gestational age! Magnesium Sulfate: Nursing care and side effects – Magnesium Sulfate IV (4-7 mg/dl is therapeutic level) – prevent seizure, lowers BP short term; given for at least 24hrs -Antidote: Calcium Gluconate IV Magnesium Sulfate • Magnesium Sulfate is used to prevent eclamptic seizures • It does NOT effectively lower BP •Deep Tendon Reflexes DTR (Know how to assess) 0 absent 1+ diminished 2+ expected 3+ brisk 4+ hyperactive- abnormal Clonus: CNS Irritability • Positive Sign: Dorsiflex the foot, release and note spasticity Nursing Considerations with Magnesium Sulfate • Schedule serial Magnesium Levels to prevent toxicity • Foley Catheter • Assess Respirations, DTR & Clonus hourly • Continuous FHR • Hyperglycemia • Shoulder Dystocia Quickening, lightening, fetal station Quickening: slight fluttering movements of the fetus felt by the client, usually between 16 to 20 weeks of gestation Lightening: Fetal head descends into true pelvis about14 days before labor; feeling that the fetus has “dropped”; easier breathing, but more pressure on bladder, resultingin urinary frequency; more pronounced in clients who are primigravida Relationship of Maternal Pelvis and Presenting Part – Floating Presenting part down toward pelvis but can still move away from inlet- head possibly too big for pelvis – Dipping Beginning of fetal descent just prior to engagement - Presenting part past inlet but can still move away by pressure through vagin*l exam- head drops down at times, happens a few days prior to labor – Engaged Presenting part at 0 station- during labor fetus is in pelvis, resistance when head is pushed – Station – Ischial spines are located at a “0” station = engaged- bony prominences nurse must palpate once baby is at “0” station – Presenting part from neg. to pos. (-4 high ,-3,-2,-1, 0 engaged,+1,+2,+3, +4 head is delivering) Fetal Station Non Stress Test (NST), Contraction Stress Test (CST), Biophysical Profile (BPP) Nonstress Test (NST) • Accelerations require an intact and mature CNS • Acceleration patterns are affected by gestational age (min. 28-32 weeks) • Accelerations must be 15 beats/minute above baseline, lasting 15 seconds, fetus HR is 110- 160 • Reactive – FETUS IS WELL OXYGENATED – Two or more accelerations (15X15) within 20 minutes; 15 beats above baseline lasting for 15 minutes • Nonreactive If after 20 min nothing has happened give mother water, get up to move around, fetal acoustic stimulator- gently vibrates around belly wakes up baby – Insufficient accelerations over 40 minutes- non reactive • Clinical management – Schedule next test as indicated if reactive, non-reactive= further testing, mom stays in office to be watched – One to two times weekly per maternal or fetal risks – NST NST Is this an example of a reactive or a non-reactive NST? 130 to 155 Reactive NST Is this an example of a reactive or a non-reactive NST? 130 baseline= Non Reactive Contraction Stress Test (CST) • Evaluates uteroplacental function, is the placenta doing its job • Identifies intrauterine hypoxia • Observes fetal heart rate (FHR) response to contractions • Indications: When an NST fails to produce reactive tracing and if no ultrasound available The following conditions are contraindicated: Preterm labor, PROM, repeat C/S, Placenta Previa, Abruptio Placenta, previous uterine rupture, incompetent cervical. Why? It can put them into labor • Procedure: start IV of oxytocin True Labor • Progressive dilation and effacement • Regular contractions – Increasing in frequency, duration, intensity – Intensity typically increases with ambulation • Pain usually starts in back, radiates to abdomen • Pain not relieved by ambulation or by resting • Contractions do not decrease with rest or with warm tub bath What is the classic sign that differentiates true from false labor? Cervical dilation False Labor • Lack of cervical effacement and dilatation • Irregular contractions do not increase in frequency, duration, and intensity • Contractions mainly in lower abdomen and groin • Pain may be relieved by: – Ambulation, changes of position, resting, or hot bath or shower • Education family as it can difficult to distinguish from true labor • Reassurance/Interventions to decrease anxiety, discomfort Phases and stages of labor First Stage of Labor: Latent or Early Phase • Beginning with cervical dilatation and effacement to 3 cm • No evident fetal descent • Contractions increase in frequency, duration, and intensity • Contractions usually mild, regular • Excited, talkative, smiling First Stage of Labor: Active Phase • Cervical dilatation from 4 to 7 cm • Progressive fetal descent • Contractions more frequent and intense • Maternal responses – Increased anxiety – May desire pain medication First Stage of Labor: Transitional Phase • Cervical dilatation from 8 to 10 cm • Progressive fetal descent • Contractions most frequent and intense Second Stage of Labor • Begins with complete dilatation (10 cm) • Ends with birth of baby • Maternal responses – Urge to push Third Stage of Labor • Birth of infant to delivery of placenta • Placental separation – Signs (absence of cord pulse, lengthening of umbilical cord, sudden gush of blood, change in the shape of the uterus) – Delivery of Placenta -occurs with natural bearing down by mom or gentle pressure on the fundus of the contracting uterus – Retained (occurs if more than 30 minutes have elapsed) Why shouldn’t a practitioner pull on the cord? Cord can snap and cause mom to hemorrhage Fourth Stage of Labor • 1 to 4 hours after birth • Physiologic readjustment • Thirsty and hungry • Shaking- can last 10-15 min • Bladder is often hypotonic • Uterus should remain contracted CAUSES/COMPLICATIONS ● Compression of the fetal head resulting from uterine contraction ● Uterine contractions ● vagin*l exam ● Fundal pressure NURSING INTERVENTIONS: No intervention required. – Late Slowing of FHR after contraction has started with return of FHR to baseline well after contraction has ended CAUSES/COMPLICATIONS ● Uteroplacental insufficiency causing inadequate fetal oxygenation ● Maternal hypotension, placenta previa, abruptio placentae, uterine hyperstimulation with oxytocin ● Preeclampsia ● Late- or post-term pregnancy ● Maternal diabetes mellitus NURSING INTERVENTIONS ● Place client in side-lying position. ● Insert an IV catheter if not in place, and increase rate of IV fluid administration. ● Discontinue oxytocin if being infused. ● Administer oxygen by mask at 8 to 10 L/min via nonrebreather face mask. ● Elevate the client’s legs. ● Notify the provider. ● Prepare for an assisted vagin*l birth or cesarean birth –Variable Transitory, abrupt slowing of FHR 15/min or more below baseline for at least 15 seconds, variable in duration, intensity, and timing in relation to uterine contraction CAUSES/COMPLICATIONS ● Umbilical cord compression ● Short cord ● Prolapsed cord ● Nuchal cord (around fetal neck) NURSING INTERVENTIONS ● Reposition client from side to side or into knee-chest. ● Discontinue oxytocin if being infused. ● Administer oxygen by mask at 8 to 10 L/min via nonrebreather face mask. ● Perform or assist with a vagin*l examination. ● Assist with an amnioinfusion if prescribed. –Prolonged Fetal distress Fetal distress is present when ● The FHR is below 110/min or above 160/min. ● The FHR shows decreased or no variability. ● There is fetal hyperactivity or no fetal activity. Additional manifestations of fetal distress are late decelerations associated with absent or minimal variability, recurrent variables, and prolonged decelerations. Epidural pain relief in labor, spinal anesthesia, AROM: nursing considerations Regional Anesthesia • Temporary, reversible loss of sensation –Prevents initiation & transmission of nerve impulses • Types –Epidural: local anesthesia injected directly into epidural space- 60% of woman want, 85% get relief, 12% partial relief, 3% get no relief -Usually used from active phase of labor through birth/repair- takes 10-15 min to work last as long as you need it to last –Spinal: local anesthesia injected directly into CSF- takes affect in 60 sec and it wears off within about 1hr –Used for C-sections except emergencies that may require general anesthesia. Why do so many women in the US request an epidural? Long term pain relief without drowsiness, connected to IV pump Lumbar Epidural Block: Dark area demonstrates epidural space and nerves affected, and the gray tube represents a continuous plastic catheter. Force of injection pushing dura away from tip of needle. What are the advantages and disadvantages of an epidural? Advantage: Long term pain relief without drowsiness, connected to IV pump, lasts as long as you need it Disadvantage: can not get up to walk around, need foley catheter- 800mL of IV fluid given urine retention is risk- fluid given to prevent low BP, position pt on L side to reduce stress to fetus Technique for Block • Assessment of maternal and fetal status • Equipment: Epidural cart • Preload with 800-1,000 IV fluids over 15- 30 min prior- to improve BP • Positioning • Test dose Adverse Reactions/Nursing Care Mgmt. to Anesthetic Blocking Agents • Maternal hypotension –Administer a bolus of IV fluids to offset hypotension –Prevent mother from lying supine to release pressure of the vena cava –Initiate oxygen • Fetal bradycardia –Assess FHR & correct maternal hypotension • Inability to feel the urge to void: insert Foley Catheter Adverse Reactions/Nursing Care Mgmt. to Anesthetic Blocking Agents • Loss of the bearing down reflex –Coach client in pushing efforts. If ineffective, request anesthesiologist to re-evaluate pain management- can turn epidural off for 15min until urge returns, not ideal • Potential headache from leakage of the CSF at puncture site –Place client in supine position, bed rest in dark room- HA subsides when lying down, confirms spinal HA –Administer oral analgesics, caffeine, and fluids –Notify anesthesiologist to insert an autologous blood patch- take pt’s blood and pushes into spinal space to replace CSF • Loss of sensation and motor control in client’s legs –Assess for return of sensation prior to ambulation Epidural and Spinal Contraindications • Maternal refusal- if c-section need general anesthesia is an option • Allergy to a specific class of agents- like lidocaine • Maternal Coagulation problems such as platelets less than 100,000- bleeding precautions • If epidural or spinal anesthesia given –Check anesthesia level every 15 minutes and assess the ability of patient to move their toes • AROM: Artificial Rupture of Membranes –The primary practitioner may choose to complete an Amniotomy (AROM), if patient’s membranes are intact and fetus is engaged. What is the first nursing action after AROM? Check fetal HR –Then assess color, odor of amniotic fluid Care of the Woman During an Amniotomy • Artificial Rupture of Membranes (AROM) • Explain sterile vagin*l procedure to patient What should be established prior to AROM? Fetal head is engaged Abruptio Placentae • Maternal risks –Disseminated intravascular coagulation (DIC) – IV fluid, packed RBC, fibrinogen –Hemorrhage and Renal failure due to Shock • Fetal-neonatal risks –Most serious complications are from preterm labor, anemia, hypoxia What is the maternal treatment? C-section Episiotomy: nursing care, the pros and cons of various types of episiotomies Care of the Woman During an Episiotomy • Surgical incision of perineal body –Performed to prevent damage to soft tissues • Research indicates no maternal advantages • Risk factors that predispose women to episiotomy – Macrosomic fetus –OP position –Primigravida (Gravida 1 Para 0) –Use of forceps or vacuum extractor Episiotomy • Nursing advocacy needed –Promote selective not routine episiotomies • Episiotomy procedure –Sharp scissors with rounded points –Just before birth as crowning occurs –Usually performed with regional or local anesthesia Episiotomy Procedure • Midline (B)- could extend into the rectum if it’s a big baby – vagin*l orifice to fibers of rectal sphincter • Mediolateral (A) – Midline of posterior fourchette – 45-degree angle downward to right or left What are advantages of the Midline episiotomy? Going with the grain of the tissue it heals quicker, less painful, less bleeding What are advantages of the Mediolateral episiotomy? Not with the grain More painful, longer to heal Nursing Care Management Episiotomy or laceration Severity • First Degree: Perineal skin and soft tissue • Second Degree: Muscle involvement • Third Degree: To the anal sphincter • Fourth Degree: Through the anal sphincter Pain relief measures – Ice pack to perineum (20 min on/off for up to 24 hours) Monitor: every 15 min (1st hour after birth) –Swelling, redness, tenderness, and hematomas Difference between dizygotic twins and monozygotic twins • Monozygotic one egg versus Dizygotic twins two eggs DVT treatments • Early ambulation • Elevate legs while sitting and avoid crossing legs • Discontinue smoking • Apply SCD’s during and after a cesarean deliveries until the client is routinely ambulating • High risk women should wear anti-embolic stockings What is an example of a woman who is high risk for a DVT? h/o DVT, obesity Know common postpartum and newborn medications Clinical Therapy: Rhogam • Maternal Administration of Rh immune globulin 300 mcg IM – Must give within 72 hours after birth to a Rh (-) woman who gave birth to a Rh (+) newborn – After spontaneous or induced abortion – After ectopic pregnancy – After invasive procedures during pregnancy – After maternal trauma Rubella • Mild illness in children, adults, best is prevention • Live Attenuated Vaccine is not given in pregnancy, but encouraged postpartum (MMR) Newborn receive Erythromycin eye ointment within 1 hour of delivery to prevent blindness whose mother has what 2 common STI’s? Chlamydia and Gonorrhea *This medication may cause chemical conjunctivitis: redness or swelling A Vitamin K injection is administered IM into the vastus lateralis within 1 hour of birth to prevent hemorrhagic disorders Hepatitis B Immunization and Vitamin K Vitamin K (phytonadione) A Vitamin K injection is administered IM into the vastus lateralis within 1 hour of birth to prevent hemorrhagic disorders. Vitamin K is not produced in the GI until the baby is about a week old. Vitamin K is produced in the colon by bacteria that forms once formula or breast milk is introduced. • Hydramnios • Multiple babies • Grand Multips (>5 deliveries) • Soon after the delivery occurs • Obesity • Precipitous delivery • Use of magnesium sulfate What is an acceptable EBL for a vagin*l delivery? 500 ml . c-section 1000mL What can PPH eventually lead to if left untreated? DIC Treatment for Postpartum Hemorrhage DETERMINE THE CAUSE • Express clots and massage • Administer uterine stimulants such as oxytocin, methylergonovine (Methergine IM) or misoprostol Who should not receive methylergonovine? Clients with HTN • IV fluid bolus • Elevate legs to increase venous return • Blood Replacement (Packed RBC’s, FFP) Uterine Atony • Uterine Atony is the inability of the uterine muscle to contract which can lead to postpartum hemorrhage. • This can result in Subinvolution of the uterus. • Risk Factors: -Prolonged labor or precipitous labor -Over distended uterine muscle What can cause this? Big baby, too many babies, hydramnios -Administration of anti-tocolytics (Terbutaline or MgSO4) -Trauma from delivery or a vagin*l operative birth Treatment for Uterine Atony • Massage the fundus, then oxytocin • Express clots only after the uterus is firmly contracted • Medications to stimulate uterine contractions How to determine an Apgar score Apgar Scoring of the Newborn An Apgar Score is based on a quick review of systems that is completed at 1 and 5 minutes after birth. 0 to 3 score indicates severe distress 4 to 6 score indicates moderate difficulty 7 to 10 score indicates minimal or no difficulty adjusting Apgar Score Chart Hyperbilirubinemia, newborn jaundice (pathologic vs. physiologic) and phototherapy Hyperbilirubinemia Hyperbilirubinemia is an increase of serum bilirubin levels resulting in jaundice which normally appears on the head and progresses down the abdomen and extremities. All babies should be screened prior to discharge. It is usually a heel stick done simultaneously with the Infant Metabolic Screening or completed by a transcutaneous bilirubin meter. Pathologic Jaundice Usually Symptomatic Within 24 hours Pathologic jaundice is the result of an underlying disease. It appears before 24 hours of age or is persistent after 2 weeks. Term newborn: Bilirubin levels increase at more than 0.5 mg/dL/hour, and peak at 13 mg/dL or higher. Pathologic jaundice is usually caused by blood group incompatibility, infection, or the result of RBC disorders. Complications from Pathologic Jaundice Acute bilirubin encephalopathy: This occurs when bilirubin is deposited in the brain. This happens once all of the binding sites for the bilirubin are used within the body, causing necrosis of neurons. Bilirubin levels higher than 25 mg/dL place the baby at risk this to occur. Kernicterus is an irreversible, chronic result of bilirubin toxicity. This baby suffers from severe cognitive impairments and spastic quadriplegia. Physiologic Jaundice: Occurs After 24 Hours This is considered benign resulting from normal newborn physiology of increased bilirubin production due to the shortened lifespan and breakdown of fetal RBC’s and an immature liver. 50% term, 80% preterm newborns experience some form of mild newborn jaundice often only requiring a bilirubin level check and observation. Phototherapy Nursing care • Check infants temperature every 2-4 hours • Eye protection, no lotion to the skin • Frequent feedings to promote excretion in the stool • Daily weights • Cover genitalia An Hour Specific Bilirubin Nomogram Measure blood pressure if cardiac anomaly suspected in all extremities Pulse 110 to 160 beats/min Respirations 30 to 60 respirations/min & irregular Pauses in respiration should not exceed 15 seconds! Blood pressure 70 to 50/45 to 30 mm Hg at birth Temperature normal range • 36.5°C to 37.5°C (97.7°F to 99.4°F) Common Newborn Labs Hemoglobin: 14 to 12 g/dL Hematocrit: 44% to 64% Platelets: 150,000-300,000 mm3 (same as adults) RBC count: 4.8x10 to 7.1x10 Glucose: 40-60 mg/dL WBC: 9,000-30,000/mm3 Bilirubin: 24 hours: 2 to 6 mg/dL 48 hours: 6 to 7 mg/dL 3-5 days: 4 to 6 mg/dL Newborn safety measures Car Seat Keep infants in rear-facing car seats in the back seat until age 2 or until the child reaches the maximum height and weight for the seat. Where should the “t piece” fall? armpits Where should the back of the straps fall on the car seat? Below shoulders Car seats should be placed at a 45 degree angle. Baby Bath Safety Newborns should receive a sponge bath with mild soap 2-3 times a week until the umbilical cord falls off (10-14 days) or circumcision is healed. Fold top of diaper down to keep the cord dry until the cord falls off. What are signs of an umbilical cord infection? Assess stump and base of cord for erythema, edema, and drainage with each diaper change Test the temperature of water with your elbow prior to a baby bath or your wrist when preparing formula to ensure it is not too hot. Newborn withdrawal: Nursing interventions Neonatal Substance Withdrawal Substance withdrawal in the newborn occurs when the mother uses drugs that have addictive properties during pregnancy. This includes illegal drugs, alcohol, tobacco, and prescription medications. Cocaine Use in Pregnancy: Impact on the Newborn Decreased birth weight Feeding difficulties Increased startle reflex Neonatal effects from breast milk Extreme irritability, vomiting and diarrhea Dilated pupils and apnea Avoid Eye Contact What are some newborn comfort measures? Pacifiers, vertical rocking, swaddle, skin to skin Heroin Use in Pregnancy: Impact on the Newborn Intrauterine growth restriction, IUFD Withdrawal symptoms after birth (within 72 hours up to 8 weeks) Narcan – given immediately in birthing room to patient exhibiting CNS depression Specific Drug Withdrawals Methadone: Increased risk of seizures, withdrawal can last many weeks, breastfeeding is not contraindicated as it helps minimize withdrawal, increased risk of SIDS, low light, swaddle snuggly Methadone crosses the placenta Result in Neonatal Abstinence Syndrome (NAS) Decreased startle reflex, sneezes frequently Low stimulation, bundle snuggly, very loose stools Treat with morphine & anti-seizure medication Neonatal Abstinence Scoring (NAS) System The newborn is scored on the following: CNS: High-pitched, shrill cry Metabolic, vasomotor and respiratory: nasal congestion with flaring, frequent yawning, tachypnea, and sweating Gastrointestinal: Poor feeding, projectile vomiting, diarrhea, and uncoordinated constant sucking Fetal Alcohol Syndrome (FAS) Alcohol is considered teratogenic, so the chronic intake of alcohol increases the risk of FAS. Newborns who have FAS show specific congenital physical defects and experience long-term complications. Physical Characteristics: small eyes, flat midface, thin upper lip, eyes with a wide spaced look, poor suck, possible cardiac anomalies. Psychological Complications: Developmental delays and neurologic anomalies FAS: Physical Characteristics Routine maternal and newborn immunizations including when Hepatitis B given to newborn See above Infant Metabolic Screening including PKU All US states mandate this screening be done after 24 hours of age. The specific metabolic tests vary from state to state: Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver will force the femoral head back into the acetabular rim with a noticeable “clunk.” Caput succedaneum vs. Cephalohematoma Cephalohematoma is a collection of blood between the surface of a cranial bone and the periosteal membrane. This is a Cephalohematoma over the right parietal bone. Increased risk of newborn jaundice. Takes longer to resolve, it appears in the first 1 to 2 days after birth and resolves in 2 to 8 weeks; Cause: trauma during birth such as pressure of the fetal head against the maternal pelvis in a prolonged difficult labor or forceps delivery. Caput Succedaneum is a collection of fluid (serum) under the scalp. Resolves quickly; Cause: pressure on the head during labor or VAD Physical differences between preterm and post-term newborns Gestational Age Assessment: New Ballard Scale Assessment of Physical Maturity Characteristics Resting posture – arms and legs curled up Skin: Lanugo – hair on baby, vernix – white coating Sole (plantar) creases – no creases premature Ear form & cartilage distribution – preme floppy Male genitals – preme not developed Female genitals – preme not developed Assess the skull Gestational Age Assessment: New Ballard Scale Assessment of Neuromuscular Maturity Characteristics Central nervous system matures at constant rate Cephalocaudal direction Characteristics evaluated Square window sign (wrist flexibility, more than 90 degree=premature) Arm recoil (no recoil=premature) Scarf sign (no resistance to baby’s arm across chest=premature) Heel-to-ear extension (reach heal to ear with no resistance=premature) ATI HW # 1 Questions 1. Gonorrhea is treated with Azithromycin and what other antibiotic? -Ceftriaxone 2. What might a change in the string length indicate with an IUD? - This indicates that the IUD has become dislodged. 3. Naegele’s Rule: Determine the EDC based on the LMP of November 10? Month, day, and year - August 17, 2021 4. The human ovum can be fertilized up to 24 hours after ovulation. 5. What is the maximum time that a motile sperm has the ability to fertilize the ovum? - 48 to 72 hours 6. How often should a diaphragm be replaced for a woman who has not experienced surgery or had any significant weight changes? - 2 years 7. Does a diaphragm need to be replaced after every delivery? - Yes 8. A diaphragm can be inserted up to how many 6 hours prior to intercourse and must stay in place at least how many hours after intercourse? - 6 hours 9. How often should the transdermal patch be reapplied? - Once a week, on the same day of the week for 3 weeks 10. Clients taking Medroxyprogesterone should maintain an adequate amount of what mineral? - Calcium and Vitamin D 11. Medroxyprogesterone is given IM every 11 to _12 weeks. 12. The injection site of Medroxyprogesterone should not be _massage as this can accelerate the medication absorption that will shorten the duration of effectiveness. 13. Is a transcervical sterilization effective immediately? Yes/no 14. Is a bilateral tubal ligation effective immediately? Yes/no 15. Is a vasectomy effective immediately? Yes/noNo 16. Medications such as some antibiotics and antifungal agents that can make oral contraceptives lose their effectiveness. State one other medication for which this is also true. – Anticonvulsants 17. Name the most commonly reported STI in American women that is difficult to diagnose because it is often asymptomatic. If left untreated, it can lead to PID which can cause infertility. - Chlamydia 18. What 2 trimesters should pregnant women be screened for Syphilis and HIV? - 1st prenatal visit and 3rd Trimester 19. What is the most common viral STI? - HPV 20. What STI is caused by the protozoan parasite whose symptoms include a yellow- green frothy vagin*l discharge with a foul odor? It can lead to PID. - Preterm - Abortion - Living Children 18. A pregnant woman should drink _8_ to _10_ glasses of fluid should a day. 19. Leg cramps often originate from an imbalance of the ratio of what two minerals? - _Calcium_ & _Phosphorus 20. Are fetal heart sounds, visualization of the fetus by ultrasound, fetal movement palpated by an experienced examiner presumptive, probable, or positive signs of pregnancy? - Positive Signs of Pregnancy 21. Are nosebleeds (epistasis) and bleeding gums a normal condition during pregnancy? - Yes 22. According to ATI, there are 2 good resting positions for a pregnant woman to avoid supine hypotension. One is the semi-sitting position with knees flexed, and the other one is ? - Left-side lying 23. What is a good food for a pregnant woman to eat before getting out of bed in the morning who is experiencing nausea and vomiting? - Crackers 24. The recommended weight gain for a low risk woman during pregnancy is _25 to _35 pounds. 25. Leafy vegetables, dried peas and beans, seeds, and orange juice are all high in this vitamin. - Folic Acid 26. How many mcg. of a folic acid supplement should a pregnant woman take every day? - 600 mg 27. Foods that are high in protein such as fish, poultry, red meat, eggs, nuts, and dairy products as well as Aspartame should be avoided in order to prevent what metabolic syndrome? - Maternal PKU 28. What is the maximum daily recommended amount of mg. of caffeine that is acceptable during pregnancy per ACOG sand March of Dimes according to ATI? - 200 mg 29. Name the test that combines a Nonstress test and a fetal ultrasound to assess fetal well- being. - Biophysical Profile 30. Gestational hypertension plus _proteinuria confirms the diagnosis of preeclampsia. 31. Is Hegar’s sign, Chadwick’s sign, Goodell’s sign, Ballottement, Braxton Hicks contractions, and a positive pregnancy test examples of presumptive, probable, or positive signs of pregnancy? - Probable 32. What is the most widely used technique for antepartum evaluation of fetal well- being performed during the third trimester? - Nonstress Test 33. Caffeine as well as what other food item can interfere with the absorption of iron supplements? - Milk 34. What is the recommended length of time a pregnant woman should exercise daily? - 30 mins 35. Name the disorder when women crave nonfood substances such as dirt or red clay. - PICA 36. The (WIC) Program assists financially limited pregnant clients and their children up to _5_ years of age. 37. Headache, weakness, hunger and blurred vision are classic signs of what complication related to gestational diabetes? - Hypoglycemia 38. Should a pregnant woman have a full or empty bladder for an abdominal ultrasound? - Full Bladder 39. How frequently should a Nonstress Test be done for high risk women starting at 28- 32 weeks gestation? - Twice per week 40. What is the name of the reassuring/normal result for a Contraction Stress Test (CST)? - Negative CST ATI Maternal Newborn Questions at the end of Chapters 1-9 Chapter 1 A nurse in a health clinic is reviewing contraceptive use with a group of clients. Which of the following client statements demonstrates understanding? - A water-soluble lubricant should be used with condoms. A nurse is instructing a client who is taking an oral contraceptive about manifestations to report to the provider. Which of the following manifestations should the nurse include? - Shortness of breath A nurse at an OB clinic is teaching a client about using an IUD for contraception. Which of the following statements by the client indicates an understanding of the teaching? - “ I will check to make sure that the string of the IUD is still present after my periods.” A nurse is teaching a client about potential adverse effects of implantable progestins. Which of the following adverse effects should the nurse include? - Irregular vaginl bleeding - Wt. gain - nausea A nurse in a clinic is teaching a client about a new prescription for medroxyprogesterone. Which of the following information should the nurse include in the teaching? - Wt. fluctuations can occur - Increase intake of calcium - Irregular vagin*l spotting can occur Chapter 2 A nurse in a clinic caring for a group of female clients who are being evaluated for infertility. Which of the following clients should the nurse anticipate the provider will refer to a genetic counselor? - A client whose partner has von Willebrand disease (genetic disorder) A nurse is caring for a couple who is being evaluated for infertility. Which of the following statements by the nurse indicates understanding of the infertility assessment process? - “The male is easiest to assess, and the provider will usually begin there”. A nurse in an infertility clinic is providing care to clients who have been unable to conceive for 18 mths. Which of the following data should the nurse assess? - Occupation - Menstrual hx - Childhood infectious disease Chapter 3 A nurse is caring for a client who is pregnant and states that their LMP was April 1st. What is the client’s EDD? - January 8th A nurse in a prenatal clinic is caring for a client who is in the 1st trimester of pregnancy. Which of the following findings should the nurse expect? - Goodell’s sign - Ballottement - Chadwick’s A nurse in a prenatal clinic is caring for a client who is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. What of the following responses should the nurse make? - This is due to the weight of the uterus on the vena cava. A nurse in a clinic receives a phone cell from a client who would like to be tested in the clinic to confirm a pregnancy. Which of the following information should the nurse provide to the client? - “You should collect urine from the 1st morning void”. A nurse at an antepartum clinic is caring for a client who is 4 months gestation. The client reports continued nausea, vomiting, and scant prune colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse expect? - Hydatidiform mole - A nurse is caring for a client who is experiencing a ruptured ectopic pregnancy. Which of the following findings are expected? - Severe shoulder pain Chapter 8 Nurse is admitting a client who is in labor and has HIV. Which of the following interventions should the nurse identify as contraindicated for this client? - Vacuum extractor - forceps - internal fetal monitoring - A nurse in an antepartum clinic is assessing a client who has a TORCH infection. Which of the following finding should the nurse expect? -Joint pain -Malaise -rash -tender lymph nodes What is the suspected medication the dr will prescribe for Gonorrhea? -Ceftriaxone What infection can be treated during labor or immediately following birth? -Gonorrhea -Chlamydia -HIV -Group B streptococcus beta-hemolytic A nurse manager is going over ways to prevent TORCH infection during pregnancy with a group of new nurses. Which statement by a nurse indicates understanding of the teaching? -A client should avoid consuming undercooked meats during pregnancy Chapter 9 A nurses caring for a client that is 14weeks of gestation and has hyperemesis gravidarum. The nurse should identify which of the following are risk factors for the client? -Diabetes -Multifetal pregnancy -Gestational trophoblastic disease A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing laboratory results. Which of the following findings is a manifestation of this condition? -Urine ketones present Nurse is administering Magnesium sulfate IV for seizures prophylaxis to a client who has severe preeclampsia. Which of the following indicates mag sulfate toxicity? - RR less than 12/min - Decrease level of consciousness - urinary output less the 25ml/hr - A nurse is caring for a client who is receiving IV mag sulfate. Which should the nurse expect to admin if mag sulfate tox is suspected? -Calcium gluconate A nurse is reviewing a new prescription for ferrous sulfate with a client who is 12weeks gestation. Which of the following statements by the client indicates understanding of teaching? -I plan to drink more OJ while taking this pill POWER-POINT QUESTIONS 1. What is the route that the sperm must travel to reach the egg? - _vagin*_>_cervix_>_uterus_>_fallopian tubes_(R or L) 2.Where does fertilization usually take place? - fallopian tubes 3.How long does it take for implantation? - 1 week 4.Where does this usually occur? - uterus 5. Where else could implantation occur? - fallopian tube (tubal pregnancy) 6.What are methods to prevent this from occurring? - abstinence/ birth control 7.What are the advantages and disadvantages for using the condom? - Advantages: cheap, protect against STI, easily accessible - Disadvantage: Breaks and Noncompliance What are advantages and disadvantages of the female condom? - Advantage: OTC, cheap, prevent STI, Female in control - Disadvantage: Noncompliance Diaphragm.. replace how often? - Every 2 years Refit: WHen? - periodically after delivering a baby and 20 % body wt loss/gain Examine: for what? - Look for holes, clean with mild soap and water It may be inserted up to _6_ hrs prior to intercourse and must be left in at least _6_ hrs after. BUT not exceeding a total time of _24 hrs? 1.How do you remove the contraceptive sponge? Pull the string 2.What is the most effective form of non-permanent birth control? It’s 99% effective! - - - - IUD _ What 2 types of medications can make oral contraceptives lose their efficacy? _Antibiotics_& _Anticonvulsants 1. What route is medroxyprogesterone given? - IM injection 2. What should the practitioner avoid doing that can shorten the duration of effectiveness? - Massage the site 3. Women must maintain adequate amount of the mineral _Ca and Vitamin _D as it can decrease bone mineral density. 1. What is the leading form of contraception in the US for women under 35 years? - Pill 2. What is the leading form of contraception in the US for women over 35 years? - Sterilization Vasectomy VS Tubal Ligation What is safer? –Vasectomy Which is effective immediately? –Tubal ligation Are they both reversible? - Yes What is the most reported bacterial STI in the US? - Chlamydia What are ways to decrease getting a yeast infection? - Avoid tight clothes - avoid Douching - Limit damp clothing - Wear Cotton underwear - Increase active culture of yogurt McDonald”s Sign: What information may abnormal measurements suggest? - Abnormal measurement suggest the following: GDM, incorrect due date calculation, multiple babies, or stillbirth/ fetus has stop growing 1. What is the term for the bluish color of the newborn’s hands and feet? • acrocyanosis 2. What is the term for “easily broken”? • friable 3. What is the white-ish protective substance that coats the fetal skin? • vernix 4. What is the term for the newborn’s initial odorless, black stool? • meconium 5. What is the application of pressure to the sacrum during contractions? • counter pressure 6. What is the term capability of living outside the uterus occuring after 20 weeks gestation? • viability 7. What is the name for a hemorrhagic spot caused by bleeding under the skin? • ecchymosis 8. What is the term for a lack of muscle tone? • atony 9. What is the term for the skin and muscle covered area between the vagin* and the anus? • perineum 10. What is the term for the downy hair on the fetus after 20 weeks gestation? • lanugo 11. What is the name of the procedure by using 4 different abdominal palpations to determine fetal position? • Leopold Maneuvers 12. What is the term for too much amniotic fluid? • hydramnios 13. What is the articulation of 2 pubic bones located on the lower anterior [art of the abdomen? • symphysis pubis 14. Which response correctly reflects the EFM tracing? • normal tracing with accelerations 15. Ideally, pain medication for labor should not be given within how many hours from delivery? • 4 hours 16. Determine Apgar Score: HR 110, weak cry, well flexed extremities, vigorous cry upon suctioning, acrocyanosis? • 8 17. Which is not a benefit of skin-to-skin contact following delivery? • prevents the development of newborn rash 18. How soon must Phytonadione (Vitamin K) be given after delivery? • 1 hour 19. Where should hands be placed to assess the fundus? • 1 hand above fundus and 1 hand above the symphysis pubis 20. What is the best laboratory indicator for blood loss? • hematocrit 21. What should be the initial nursing action upon excessive vagin*l loss? • continuous fundal massage 22. What is the most accurate method to record excessive blood loss? • weigh the perineal pads and underpads 23. What is the nurse’s main responsibility regarding informed consent? • verify patient received enough information 24. Which factor increases a patient’s risk of PPH? • history of chorioamnionitis 25. Which patient should not receive Carboprost? • history of asthma 26. A patient’s blood type is B-. What type of blood can she receive? • B- and O- ATI Questions Chapter 6 1. A nurse is reviewing findings of a client’s biophysical profile (BPP). The nurse should expect which of the following variables to be included in this test? (Select all that apply.) - Fetal breathing movement - Fetal tone - Amniotic fluid volume 2. A nurse is caring for a client who is in preterm labor and is scheduled to undergo an amniocentesis. The nurse should evaluate which of the following tests to assess fetal lung maturity? • Lecithin/sphingomyelin (L/S) ratio 3. A nurse is caring for a client who is pregnant and undergoing a nonstress test. The client asks why the nurse is using an acoustic vibration device. Which of the following responses should the nurse make? • “It awakens a sleeping fetus.” 4. A nurse is teaching a client who is pregnant about the amniocentesis procedure. Which of the following statements should the nurse include in the teaching? • You should empty your bladder prior to the procedure.” 5. . A nurse is caring for a client who is pregnant and is to undergo a contraction stress test (CST). Which of the following findings are indications for this procedure? (Select all that apply.) • Decreased fetal movement • Intrauterine growth restriction (IUGR) • Postmaturity D. Placenta previa Chapter 11 1. A client calls a provider’s office and reports having contractions for 2 hr that increased with activity and did not decrease with rest and hydration. The client denies leaking of vagin*l fluid but did notice blood when wiping after voiding. Which of the following manifestations is the client experiencing? • True Contractions 2. A nurse is caring for a client having contractions every 8 min that are 30 to 40 seconds in duration. The client’s cervix is 2 cm dilated, 50% effaced, and the fetus is at a -2 station with a FHR around 140/min. Which of the following stages and phases of labor is this client experiencing? • First stage, latent phase 3. A nurse is caring for a client who is 40 weeks of gestation and reports having a large gush of fluid from the vagin* while walking from the bathroom. Which of the following actions should the nurse take first? • Check the FHR 4. A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagin* for 2 days. Which of the following conditions is the client at risk for developing? • Infection 5. A nurse is completing an admission assessment for a client who is 39 weeks of gestation and reports fluid leaking from the vagin* for 2 days. Which of the following conditions is the client at risk for developing? • Transition phase POWERPOINT Questions- Chapter 16 What is this ultrasound so important to many women? Gender reveal What is a common method used to assess fetal movement? fetal kick count What location should a nurse apply an EFM for a woman whose fetus is in the ROA position? right side What is the classic sign that differentiates true from false labor? cervix contracting Why shouldn’t a practitioner pull on the cord? cord can break and bleed Chapter 20 Is the RN applying the tocodynamometer or the ultrasound transducer? What type of deceleration is depicted? variable Chapter 23 What are 2 major fetal-neonatal risks? Newborn infection & Complications of premature baby What is the advantage? cheap What is the primary use for Terbutaline (Brethine)? Asthma What is the obstetrical off-label use for Terbutaline? slow contractions What is a common side effect of the medication that should be explained to the patient? palpitations Why should it be used with caution for diabetics? can increase blood sugar Terbutaline can cause a drop in the level of what mineral? decrease potassium What are the 2 most common symptoms of MgSO4 toxicity? no DTR & RR <12 What are the most common causes of abruptio placentae? domestic violence, trauma, high blood pressure What is the maternal treatment? delivery or c-section Why consider early IV access & a second IV line? good vein access & Blood transfusion Why should there be no vagin*l examinations? can cause bleeding How many ml. of amniotic fluid defines hydramnios? >1500ml. AFI less than 5 at term How is this determined? Ultrasound What is the most common complication for the fetus with oligohydramnios? fetal distress dur to lack of O2= late decelerations What is a common deceleration caused by oligohydramnios? variable caused by cord compression ATI QUESTIONS: Ch 10 ATI 1. A nurse is caring for a client who reports manifestations of preterm labor. Which of the following findings are risk factors of this condition? (Select all that apply). A. Urinary tract infection B. Multifetal pregnancy C. Oligohydramnios D. Diabetes mellitus E. Uterine abnormalities 2. A nurse is providing care for a client who is in preterm labor at 32 weeks of gestation. Which of the following medications should the nurse anticipate the provider will prescribe to hasten fetal lung maturity? A. Calcium gluconate B. Indomethacin C. Nifedipine D. Betamethasone 3. A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? A. Blood-tinged sputum B. Dizziness C. Pallor D. Somnolence 4. A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? (Select all that apply.) A. Fetal distress B. Preterm labor C. vagin*l bleeding D. Cervical dilation greater than 6 cm 2. A nurse is teaching a client about the benefits of internal fetal heart monitoring. Which of the following statements should the nurse include? (Select all that apply.) A. “It is considered a noninvasive procedure.” B. “It can detect abnormal fetal heart tones early.” C. “It can determine the amount of amniotic fluid you have.” D. “It allows for accurate readings with maternal movement.” E. “It can measure uterine contraction intensity.” 3. A nurse is reviewing the electronic monitor tracing of a client who is in active labor. A fetus receives more oxygen when which of the following appears on the tracing? A. Peak of the uterine contraction B. Moderate variability C. FHR acceleration D. Relaxation between uterine contractions 4. A nurse is caring for a client who is in labor and observes late decelerations on the electronic fetal monitor. Which of the following is the first action the nurse should take? A. Assist the client into the left-lateral position. B. Apply a fetal scalp electrode. C. Insert an IV catheter. D. Perform a vagin*l exam. 5. A nurse is performing Leopold maneuvers on a client who is in labor. Which of the following techniques should the nurse use to identify the fetal lie? A. Apply palms of both hands to sides of uterus. B. Palpate the fundus of the uterus. C. Grasp lower uterine segment between thumb and fingers. D. Stand facing client’s feet with fingertips outlining cephalic prominence. CH 14 ATI 1. A nurse is caring for a client and partner during the second stage of labor. The client’s partner asks the nurse to explain how to know when crowning occurs. Which of the following responses should the nurse make? A. “The placenta will protrude from the vagin*.” B. “Your partner will report a decrease in the intensity of contractions.” C. “The vagin*l area will bulge as the baby’s head appears.” D. “Your partner will report less rectal pressure.” 2. A nurse is caring for a client who is in the transition phase of labor and reports that they need to have a bowel movement with the peak of contractions. Which of the following actions should the nurse make? A. Assist the client to the bathroom. B. Prepare for an impending delivery. C. Prepare to remove a fecal impaction. D. Encourage the client to take deep, cleansing breaths. 3. A nurse is caring for a client in the third stage of labor. Which of the following findings indicate placental separation? (Select all that apply.) A. Lengthening of the umbilical cord B. Swift gush of clear amniotic fluid C. Softening of the lower uterine segment D. Appearance of dark blood from the vagin* E. Fundus firm upon palpation 4. A nurse is planning care for a newly admitted client who reports, “I am in labor and I have been having vagin*l bleeding for 2 weeks.” Which of the following should the nurse include in the plan of care? A. Inspect the introitus for a prolapsed cord. B. Perform a test to identify the ferning pattern. C. Monitor station of the presenting part. D. Defer vagin*l examinations. 5. A nurse is caring for a client who is in the first stage of labor and is encouraging the client to void every 2 hr. Which of the following statements should the nurse make? A. “A full bladder increases the risk for fetal trauma.” B. “A full bladder increases the risk D. Supine with a rolled towel under one hip 3. A nurse is caring for a client who is in labor. With the use of Leopold maneuvers, it is noted that the fetus is in a breech presentation. For which of the following possible complications should the nurse observe? A. Precipitous labor B. Premature rupture of membranes C. Postmaturity syndrome D. Prolapsed umbilical cord 4. A nurse is caring for a client who is at 42 weeks of gestation and in active labor. Which of the following findings is the fetus at risk for developing? A. Intrauterine growth restriction B. Hyperglycemia C. Meconium aspiration D. Polyhydramnios 5. A nurse is caring for a client in active labor. When last examined 2 hr ago, the client’s cervix was 3 cm dilated, 100% effaced, membranes intact, and the fetus was at a -2 station. The client suddenly states, “My water broke.” The monitor reveals a FHR of 80 to 85/min, and the nurse performs a vagin*l examination, noticing clear fluid and a pulsing loop of umbilical cord in the client’s vagin*. Which of the following actions should the nurse perform first? A. Place the client in the Trendelenburg position. B. Apply pressure to the presenting part with the fingers. C. Administer oxygen at 10 L/min via a face mask. D. Initiate IV fluids C/h 17 ATI 1. A nurse is performing a fundal assessment for a client who is 2 days postpartum and observes the perineal pad for lochia. The pad is saturated approximately 12 cm with lochia that is bright red and contains small clots. Which of the following findings should the nurse document? A. Moderate lochia rubra B. Excessive lochia serosa C. Light lochia rubra D. Scant lochia serosa 2. During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On assessment, a nurse finds the uterus to be firm, midline, and at the level of the umbilicus. Which of the following findings should the nurse interpret this data as being? A. Evidence of a possible vagin*l hematoma B. An indication of a cervical or perineal laceration C. A normal postural discharge of lochia D. Abnormally excessive lochia rubra flow 3. A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given the varicella vaccine. Which of the following statements by the client indicates understanding of the teaching? A. “I will need to use contraception for 3 months before considering pregnancy.” B. “I need a second vaccination at my postpartum visit.” C. “I was given the vaccine because my baby is O-positive.” D. “I will be tested in 3 months to see if I have developed immunity.” 4. A nurse is assessing a postpartum client for fundal height, location, and consistency. The fundus is noted to be displaced laterally to the right, and there is uterine atony. The nurse should identify which of the following conditions as the cause of the uterine atony? A. Poor involution B. Urinary retention C. Hemorrhage D. Infection 5. A nurse is providing education to a client who is 2 hr postpartum and has perineal laceration. Which of the following information should the nurse include? (Select all that apply.) A. Use a perineal squeeze bottle to cleanse the perineum. B. Sit on the perineum while resting in bed. C. Apply a topical anesthetic cream or spray to the perineum. D. Wipe the perineum thoroughly with a back-and-forth motion. E. Apply cold or ice packs to the perineum CH 18 ATI 1. A nurse concludes that the parent of a newborn is not showing positive indications of parent-infant bonding. The parent appears very anxious and nervous when asked to bring the newborn to the other parent. Which of the following actions should the nurse use to promote parent-infant bonding? A. Hand the parent the newborn, and suggest that they change the diaper. B. Ask the parent why they are so anxious and nervous. C. Tell the parent that they will grow accustomed to the newborn. D. Provide education about infant care when the parent is present. 2. A client in the early postpartum period is very excited and talkative. They repeatedly tell the nurse every detail of the labor and birth. Because the client will not stop talking, the nurse is having difficulty completing the postpartum assessments. Which of the following action should the nurse take? A. Come back later when the client is more cooperative. B. Give the client time to express feelings. C. Tell the client they need to be quiet so the assessment can be completed. D. Redirect the client’s focus so that they will become quiet. 3. A nurse is caring for a client who is 1 day postpartum. The nurse is assessing for maternal adaptation and parent-infant bonding. Which of the following behaviors by the client indicates a need for the nurse to intervene? (Select all that apply.) A. Demonstrates apathy when the newborn cries 1. A nurse is caring for a client who is postpartum. The nurse should identify which of the following findings as an early indicator of hypovolemia caused by hemorrhage? A. Increasing pulse and decreasing blood pressure B. Dizziness and increasing respiratory rate C. Cool, clammy skin, and pale mucous membranes D. Altered mental status and level of consciousness 2. A nurse educator on the postpartum unit is reviewing risk factors for postpartum hemorrhage with a group of nurses. Which of the following factors should the nurse include in the teaching? (Select all that apply.) A. Precipitous delivery B. Obesity C. Inversion of the uterus D. Oligohydramnios E. Retained placental fragments 3. A nurse on the postpartum unit is assessing a client who is being admitted with a suspected deep-vein thrombosis (DVT). Which of the following clinical findings should the nurse expect? (Select all that apply.) A. Calf tenderness to palpation B. Mottling of the affected extremity C. Elevated temperature D. Area of warmth E. Report of nausea 4. A nurse is planning care for a client who is postpartum and has thrombophlebitis. Which of the following nursing interventions should the nurse include in the plan of care? A. Apply cold compresses to the affected extremity. B. Massage the affected extremity. C. Allow the client to ambulate. D. Measure leg circumferences. 5. A nurse is caring for a client who has disseminated intravascular coagulation (DIC). Which of the following antepartum complications should the nurse understand is a risk factor for this condition? A. Preeclampsia B. Thrombophlebitis C. Placenta previa D. Hyperemesis gravidarum CH 22 ATI 1. A nurse is assessing a postpartum client who is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown. Which of the following conditions are associated with these manifestations? A. Postpartum fatigue B. Postpartum psychosis C. Letting-go phase D. Postpartum blues 2. A nurse is caring for a postpartum client who delivered their third infant 2 days ago. Which of the following manifestations could indicate postpartum depression? (Select all that apply.) A. Fatigue B. Insomnia C. Euphoria D. Flat affect E. Delusions 3. A nurse is assessing a client who has postpartum depression. The nurse should expect which of the following manifestations? (Select all that apply.) A. Paranoia that their infant will be harmed B. Concerns about lack of income to pay bills C. Anxiety about assuming a new role as a parent D. Rapid decline in estrogen and progesterone E. Feeling of inadequacy with the new role as a parent 4. A nurse is caring for a client who has postpartum psychosis. Which of the following actions is the nurse’s priority? A. Reinforce the need to take antipsychotics as prescribed. B. Ask the client if they have thoughts of harming themselves or their infant. C. Monitor the infant for indications of failure to thrive. D. Review the client’s medical record for regarding why this medication is given? A. “It assists with blood clotting.” B. “It promotes maturation of the bowel.” C. “It is a preventative vaccine.” D. “It provides immunity.” 5. A nurse is taking a newborn to a parent following a circumcision. Which of the following actions should the nurse take for security purposes? A. Ask the parent to state their full name. B. Look at the name on the newborn’s bassinet. C. Match the parent’s identification band with the newborn’s band. D. Compare name on the bassinet and room number. CH 25 ATI 1. A nurse is giving instructions to a parent about how to breastfeed their newborn. Which of the following actions by the parent indicates understanding of the teaching? A. The parent places a few drops of water on their nipple before feeding. B. The parent gently removes their nipple from the infant’s mouth to break the suction. C. When they are ready to breastfeed, the parent gently strokes the newborn’s neck with a finger. D. When latched on, the infant’s nose, cheek, and chin are touching the breast. 2. A nurse is teaching a group of new parents about proper techniques for bottle feeding. Which of the following instructions should the nurse provide? A. Burp the newborn at the end of the feeding. B. Hold the newborn close in a supine position. C. Keep the nipple full of formula throughout the feeding. D. Refrigerate any unused formula. 3. A nurse is caring for a newborn. Which of the following actions by the newborn indicates readiness to feed? A. Spits up clear mucus B. Attempts to place their hand in their mouth C. Turns the head toward sounds D. Lies quietly with their eyes open 4. A nurse is reviewing formula preparation with parents who plan to bottle-feed their newborn. Which of the following information should the nurse include in the teaching? (Select all that apply.) A. Use a disinfectant wipe to clean the lid of the formula can. B. Store prepared formula in the refrigerator for up to 72 hr. C. Place used bottles in the dishwasher. D. Check the nipple for appropriate flow of formula. E. Use tap water to dilute concentrated formula. 5. A nurse is reviewing breastfeeding positions with the parent of a newborn. Which of the following positions should the nurse discuss? A. Over-the-shoulder B. Supine C. Chin-supported D. Cradle CH 26 ATI 1. A nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following instructions should the nurse include in the teaching? A. Cover the cord with a small gauze square. B. Trickle clean water over the cord with each diaper change. C. Apply hydrogen peroxide to the cord twice a day. D. Keep the diaper folded below the cord. 2. A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following conditions are contraindications? (Select all that apply.) A. Hypospadias B. Hydrocele C. Family history of hemophilia D. Hyperbilirubinemia E. Epispadias 3. A nurse is providing discharge teaching to the parents of a newborn regarding circumcision care. Which of the following statements made by a parent indicates an understanding of the teaching? A. “The circumcision will heal within a couple of days.” B. “I should remove the yellow mucus that will form.” C. “I will clean the penis with each diaper change.” D. “I will give him a tub bath within a couple of days.” 4. A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following actions should the nurse implement? A. Apply Gelfoam powder to the site. B. Place the newborn in the prone position. C. Apply petroleum gauze to the site. D. Avoid changing the diaper until the first voiding. 5. A nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position? A. Front seat, rear-facing B. Front seat, forward-facing C. Back seat, rear-facing D. Back seat, forward-facing CH 27 ATI 1. A nurse is caring for a client who is at 42 weeks gestation and in labor. The client asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make? A. “Your baby will have excess body fat.” B. “Your baby will have flat areola without breast buds.” C. “Your baby’s heels will easily move to his ears.” D. “Your baby’s skin will have a leathery appearance.” 2. A nurse is caring for an infant who has a high bilirubin level and is receiving phototherapy. Which of the following is the priority finding in the newborn? A. Conjunctivitis B. Bronze skin discoloration C. Sunken fontanels