OB exam 3 study guide
OB exam 3 study guide NURB 331
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NURB 331: Lifespan EXAM 3 STUDY GUIDE 1. DIABETES (5 QUESTIONS) 2. CARDIAC (5 QUESTIONS) 3. LD COMPLICATIONS (15 QUESTIONS) 4. PP COMPLICATIONS (10 QUESTIONS) 5. NEWBORN COMPLICATIONS (15 QUESTIONS) Medical- surgical disorders (5 questions) 1. What are the four classes of cardiovascular disease? Class I- asymptomatic without limitation of physical activity Class II- symptomatic with slight limitation of activity Class III- symptomatic with marked limitation of activity Class IV- symptomatic with inability to carry any physical activity without discomfort 2. Why should a woman wait at least a year after a heart transplant to conceive a baby? Because the blood volume almost doubles during pregnancy and the heart has an increased workload. 3. What is the main goal of the antepartum period for cardiac disorder patients? Give them therapy focused on minimizing stress on the heart 4. Why do we test for fetal lung maturity in the antepartum period? We test because women who have cardiac disorders tend to deliver their babies early and we want to make sure the baby’s lungs are ready for the outside world. 5. Why do we use Lovenox or Heparin rather than Coumadin? These pregnancy categories are safe. They do not cross the placenta. PAGE 1 6. How are women who have cardiac disorders suggested to give birth? Vaginally in the side lying position 7. Why do we not use stirrups on women who have cardiac disorders? Prevents vena cava from increasing blood flow to the heart and instead will go to the head 8. Why do we want to have the patient avoid the Valsalva Maneuver? Bearing down can put more stress and workload on the heart causing more problems. 9. What are some subjective signs of cardiac decompensation the woman may feel? Increasing fatigue or dyspnea during usual activities Feeling like they are being smothered Cough this is frequent and may or may not contain blood Palpitations or feeling like her heart is racing 10. What is something we have to worry about with cardiac decompensation? We have to worry about blood going back up to the lungs and the rest of the body 11. What are some objective signs nurses may look for with cardiac decompensation? PAGE 2 Irregular, weak, rapid pulse (greater than or equal to 100 bpm) Heart murmurs Progressive generalized edema Crackles at the base of the lungs that do not go away with a cough Orthopnea, increasing dyspnea Rapid respiration of greater than 25 a minute Moist, frequent cough Cyanosis of lips and nails beds 12. A woman with a history of congestive heart disease is 36 weeks pregnant. Which of the following findings should the nurse report to the health care provider? A: presence of striae gravidarium B: Dyspnea on exertion C: 4-pound weight gain in 1 month D: Patellar reflexes +2 ( B) 13. A patient with class II heart disease is being seen for her first prenatal visit. Which of the following teaching points would the nurse stress for the patient? Select all that apply. A: avoid all OTC medications during pregnancy B: Regular exercise will help increase cardiac capacity during pregnancy PAGE 3 C: It is important to take prenatal vitamins and iron as prescribed D: Adequate nutrition to prevent anemia and avoid excessive weight gain (C and D) 14. Juanita Alvarez has a history of cardiac problems following an episode of rheumatic fever. She experiences dyspnea and palpitations when she bicycles around the neighborhood. Which classification of functional capacity best applies? A: Class I B: Class II C: Class III D: Class IV 15. Which of the following statements about the nutritional needs of pregnant women with a cardiac condition is accurate? A: They require major increases in iron and calories for decreased sodium B: They require increased protein and iron but decreased sodium (because of edema) C: They require optimal amounts of all essential vitamins but restricted caloric and iron intake. D: They require increased iron, protein, sodium, carbs, and fats b PAGE 4 16. What is endocarditis? Inflammation of the endocardium Endocrine and Metabolic Disorders (5 questions) 1. What is the most common endocrine disorder associated with pregnancy? Diabetes mellitus 2. What is pathogenesis? Group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both 3. What causes hyperglycemia? When the glucose accumulates in the blood stream 4. What are the different classifications of diabetes? Type 1: caused by pancreatic islet beta cell destruction (not enough insulin) Type 2: Insulin resistance and relative insulin deficiency (cells won’t accept the glucose) Gestational diabetes mellitus: Any degree of glucose intolerance with onset or recognition during pregnancy 5. What are the needs for insulin like in the first trimester? PAGE 5 Maternal glucose levels are reduced and insulin response is enhanced The insulin need frequently decreases 6. Why happens to the insulin need during the second and third trimesters? As a result of placental maturation and production of human chorionic somatomammotropin hormone and other hormones. Insulin requirements may double or quadruple by the end of pregnancy 7. What are the maternal risks and complications with pregestational diabetes? Miscarriage Macrosomia (fat baby) Hydraminos (too much fluid) Ketoacidosis (accumulation of ketones in the blood leading to metabolic acidosis Hyperglycemia (too much blood sugar) 8. What are the target levels of glucose? Fasting between 65-95 mg/dl 1-hour post prandial should be less than 130 to 140 mg/dl 9. What is the care management of the first 24 hours after birth? Insulin requirements may decrease significantly So, they may require 1/3 to ½ usual insulin PAGE 6 Blood glucose should be monitored closely and insulin should be administered per sliding scale 10. A nurse who is caring for a pregnant diabetic should carefully monitor the patient for which of the following? A: UTI B: Multiple gestation C: Metabolic alkalosis D: Pathogenic hypotension UTI because there is sugar in pee and bacteria love sugar 11. An insulin dependent diabetic, 38 weeks’ gestation, is being seen in the LD suite in metabolic disequilibrium. The nurse knows that which of the following maternal blood levels is highest risk to unborn baby? A: Glucose 150mg B: pH 7.25 C: pCO2 34 mmHg D: Hemoglobin 11.0 gm B- this is acidosis 12. An insulin dependent diabetic woman will require higher doses of insulin as which of the pregnancy hormones increase in her body? A: estrogen PAGE 7 B: Progesterone C: Human Chorionic gonadotropin D: Human placental lactogen D because the placenta deals with hormones 13. A type 1 diabetic patient has developed hydraminos. The patient should be taught to report which of the following? A: uterine contractions B: reduced urinary output C: marked fatigue D: puerperal rash a 14. A gravid patient, 27 weeks’ gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this patient? A: Oral hypoglycemia agents B: Diet control with exercise C: Regular insulin injections D: insulin pump B because they do not get meds unless absolutely necessary PAGE 8 Labor and Delivery Complications (15 questions) 1. What is preterm labor? Onset of regular uterine contractions that cause cervical changes between 20-27 weeks 2. What is preterm birth? Occurs prior to end of 37 weeks’ gestation 3. What is the only factor that has defiantly shown to cause preterm labor? Infection 4. What are the less common causes of preterm birth? Bleeding and placental implantation Maternal and fetal stress Uterine over distention Allergic reaction Decrease in progesterone 5. What are signs someone may be going into preterm labor? Uterine contractions 10 min or less Discomfort Some may not even feel pain. They may just think they have back pain but they could really be going into labor Vaginal discharge 6. What is tocolytic therapy? PAGE 9 Suppression of uterine activity Their goal is to delay birth long enough to institute interventions that delay neonatal morbidity and mortality 7. What are the agents commonly used in tocolytic therapy to prevent preterm birth? Magnesium sulfate smooth muscle relaxant by competing with Ca in cells Procardia (nifedipine) Blocks calcium from entering smooth muscle cells Indomethacin (NSAID) Prostaglandin inhibition (because they will ripen cervix if given) 8. What do we NEVER given anymore for tocolytic therapy because of all the cardiac problems it causes? Terbutaline 9. When should you discontinue infusion of tocolytic therapy drugs and notify physician? If their HR is over 120-140 If they are having arrhythmias (abnormal heart rhythms) Chest pain Blood pressure less than 90/60 Fetal HR of greater than 180 PAGE 10 Pulmonary edema 10. What are signs and symptoms of pulmonary edema? Dyspnea Tightness in chest Orthopnea Crackles Decreased O2 sat Cough and frothy sputum 11. Why do we use glucocorticoid steroids to manage preterm LD? They promote fetal lung maturity We give these steroids not for mom, but so it goes to the baby They reduce the incidence of: Respiratory distress syndrome Necrotizing enter colitis Intraventricular hemorrhage Death 12. When do we use the glucocorticoid steroid Betamethasone (Celestone) to manage preterm LD? When the fetus is 24-24 weeks because that is when the lungs are prime to give a kick start 13. What is the problem with giving moms steroids? PAGE 11 Greater risk for infection 14. What is PROM? Premature rupture of membranes: (She isn’t contracting yet) Spontaneous rupture of amniotic sac and leakage of amniotic fluid beginning before onset of labor at any gestational age 15. What is PPROM? Preterm premature rupture of membranes: rupture of membranes before 37 weeks gestation 16. What does dystocia mean? Complications of labor 17. What is the dystocia dysfunctional labor? Abnormal uterine contractions that prevent normal progress of cervical dilation, effacement (primary powers), or descent (secondary powers), or combination of these. 18. What is the MOST common dystocia? Dysfunctional uterine contractions (this prolongs labor) Too strong or too weak contractions 19. What is the most common type of uterine dysfunction? Hypotonic uterine dysfunction 20. What is the dystocia hypertonic contractions? Marked by increase in resting tone of more than 15 mmHg PAGE 12 Usually occur in latent phase (dilation of 4 cm) Contractions are uncoordinated Uterus may not relax between contractions VERY PAINFUL 21. What are the maternal risks in precipitate labor or birth? Premature separation of placenta Lacerations of birth canal from forceful delivery 22. What is pelvic dystocia? Problems with the passage Abnormal fetal presentation and positions occurs as fetus tries to accommodate for the passage Least common cause of dystocia 23. What is the first most common fetal malposition? Persistent OP (sunny side up babies) The mom may feel sever pain from sacral pressure 24. What is the second most commonly occurring complication? Face and brown trying to come through Breech is most common 25. What are some characteristics of breech malpresentation? Risk of prolapsed cord if membranes rupture early Presence of meconium is expected due to being under stress PAGE 13 Head trauma of baby 26. What is entrapment? When the baby has a larger head and it gets trapped by the cervix 27. What are the fetal causes of dystocia? Twin births Multiple births 28. What are examples of obstetric emergencies? Meconium in amniotic fluid Shoulder dystocia Prolapsed umbilical cord 29. Do we suction babies on the way out the perineium? No 30. What are signs of shoulder dystocia? Slowing of progression of labor Formation of caput that increases in size Turtle head 31. What is McRobert’s maneuver? Changing position to help baby get out Put their knees to their ears so baby can get through 32. What is a prolapsed umbilical cord? PAGE 14 Umbilical cord trapped between presenting part and maternal pelvis This causes compression and then there isn’t blood supply to the baby 33. What are the risk factors for a prolapsed cord? Fetal presenting part is high station (anything -) Fetus that poorly fits pelvic inlet because of small size or abnormal presentation (breech, transverse, etc.) Excessive volume of amniotic fluid Placenta Previa CPD preventing firm Multiple gestation PROM 34. What do you ALWAYS check immediately after ROM (rupture of membranes)? FHR 35. What are signs of a prolapsed cord? Fetal bradycardia with variable decelerations during uterine contractions Women reports feeling cord after membranes rupture Cord is seen or felt protruding from vagina 36. What is the management of prolapsed cord? PAGE 15 Stick gloved hand and push presenting part up to get it off prolapsed cord and then keep hand on it and ride to OR 37. What is Trendelenburg? Head down 38. What is sims position? On stomach with hips elevated with pillows Labor and Delivery Complications Part II 1. How do forceps assist birth of fetus? Provide traction Providing means to rotate fetus head to occiput- anterior position 2. When are forceps used with baby problems? When the baby wont come down When the baby wont rotate Abnormal presentation Face or brow coming first Baby in fetal distress but too far along to do c section Preterm babies 3. When are forceps used for maternal problems? Inability to push because mom is exhausted Chronic disease (cardiac disease or hypertension) 4. What is vaccum extraction used for? PAGE 16 Assist birth of baby by using suction 5. What is the most common indication for the use of a vacuum extraction? Prolonged second stage of labor 6. Why is a vacuum extraction preferred over forceps? It is easier on the baby and doesn’t cause as many problems afterwards for baby and less trauma to mom 7. What should you tell parents if they ask about the baby’s cephalohematoma? Tell them it will disappear within 2-3 days 8. What is DIC? a condition that prevents your body from controlling blood clotting and bleeding. Initially, blood clots form in many areas of your body. Your body responds by overproducing an agent to break down the blood clots. This leads to excessive bleeding, which can be life-threatening. 9. When do we do a c section? If mom doesn’t respond to Pitocin They aren’t dilating anymore Uterus isn’t working anymore Abnormal presentations Fetal Distress Cord compression PAGE 17 Falling pH Loss of fetal heart tone Late deceleration Diabetes Cancer Chronic hypertension 10. What is an important preparation measure for a c section? Administering antacids 30 minutes before surgery to prevent aspiration 11. After a c section, when you palpate the fundus, what do you need to remember? To support incision 12. Why can a woman not labor if they have had a classic incision? Because it could put pressure on the incision, bust open, and cause a uterine rupture 13. What does induction mean? Stimulation of contractions before onset of spontaneous labor, with or without ROM. (Not in labor yet) 14. What is augmentation? PAGE 18 Stimulation of contractions when spontaneous contractions are not causing progressive dilation or descent. (Already in labor) 15. What are some contraindications for induction of labor? Fetal malpresentation Women of high parity Women who have had a classical uterine incision 16. When should Cervidil be removed? 12 hours after insertion, after onset of active labor, or if uterine hyper stimulation occurs 17. What is the amount label of Pitocin? Milli units per minutes 18. Why do we never push Pitocin? Because the uterus may rupture. If this happens she may go into shock from all the blood loss 19. What are conditions that should always be reported? Uterine hyperstimulation (not enough rest in between contractions) no reassuring FHR pattern Suspected uterine rupture 20. What are the emergency measures you take if something goes wrong? Discontinue Pitocin PAGE 19 Turn mother on her side 21. What are some signs of hyper stimulation? Contractions lasting more than 90 sec. and occurring more frequently than every 2 minutes Uterine resting tone greater than 20 mm Hg Nonreassuring FHR 22. What is an indication that baby isn’t doing well? Minimal variability Late decelerations Decrease in fetal heart rate 23. What are the main interventions for hyperstimulation? Side-lying position Turn of oxytocin 24. What is amniotomy? Artifical rupture of the amniotic membranes (AROM) 25. What is the most common operative procedure in OB? Amniotomy 26. What are the disadvantages of amniotomy? Birth must occur because of the increase risk of infection Danger of PROLAPSED cord (want baby in engagement) Compression and molding of fetal head because no longer have a cushion PAGE 20 27. What do you need to make sure to do before rupturing membrane? Assess FHR just prior to and immediately after procedure (change in environment can effect this) 28. What is the biggest risk during the rupture of membranes? Prolapsed cord 29. What is the nursing care for AROM? Bedrest is maintained unless presenting part is firmly against cervix (moving can cause prolapsed cord) (if baby isn’t ballottement then the mom can move around) 30. What are the different kinds of episiotomy? Midline Medio lateral 31. What is a midline episiotomy? Involve an incision straight down from vagina Main problem is it can tear into the rectum 32. What is Medio lateral episiotomy? Involve incision at 4 o’clock or 7 o’clock position and go against natural longitudinal pattern of musculature of perineum 33. What are the measures to avoid episiotomy? Allow woman to push when woman feels right PAGE 21 Tell woman to avoid pushing during crowing Push with feet flat on bed Modify birth position Do not hyperextend legs in stirrups Lower legs at birth to reduce tension on perineum Post-Partum Complications (10 Questions) 1. What do you do first in a PPH? Massage the fundus 2. What are the two main PP complications? Hemorrhage and UTI 3. What is a normal amount of PP bleeding? 500 ml which = a unit of whole blood 4. How much blood can a woman lose before becoming symptomatic? 1000-15000 (2-3 units of whole blood) 5. What is the leading cause of morbidity and mortality of maternal? PPH 6. What are risk factors for PPH? Uterine atony Lacerations Hematomas PAGE 22 Retained placenta 7. What are the signs and symptoms of PPH? Persistent bleeding in presence of firm fundus indicates soft tissue damage Increased pulse and decrease bp 8. What are the late signs of PPH? Decrease bp Increasing pulse Decreasing urinary output 9. What is uterine atony? Absence of prompt and sustained uterine contraction which can result in significant blood loss 10. What accounts for 80-90% of early PPH? Uterine atony 11. What are the contributing factors of PPH? Anesthesia Drugs that cause uterus to relax (Mag sulfate) Prolonged 3 stage Rapid or prolonged labor Asian or Hispanic heritage Pervious history of atony 12. What are the nursing interventions for PPH? PAGE 23 Evaluate contractility of uterus Massage fundus amd express any clots in the uterus DON’T STOP MASSAGING FUNDUS (IF YOU STOP MORE BLEEDING WILL OCCUR) 13. What is the first line of PPH? Administer oxytocin 14. What is the amount of continuous infusion of Pitocin? 10-40 u in 1000 ml 15. If Pitocin doesn’t work for PPH the what would you give next? Methergine 16. Who can you NOT give methergien to? Those with hypertension 17. What is the route and dose of methergine? IM q 10 min X 2 to produce sustained uterine contractions 18. What is given if methergine does not work? Hemabate 19. How many IM of hemabate does it usually take for hemorrhage to be controlled? 2 IM injections 20. When should we NEVER give hemabate? In someone with asthma PAGE 24 21. What drugs should NEVER BE ADMINISTERED IV PUSH? Pitocin, Methergine, Ergotrate, and Hemabate 22. Why should we never do an IV push with Pitocin, Methergine, Ergotrate, and Hemabate? It will cause uterine rupture 23. What is the amount of Cytotec you should give for prevention of PPH? 200-400 mcg PO 24. What is the amount of Cytotec you should give to treat PPH? 600-1000 mcg 25. When should you suspect lacerations of the genital tract? When vaginal bleeding persists in the presence of a firmly contracted uterus 26. What is the most common cause of delayed hemorrhage? Retained placental fragments 27. What are hematomas? Result from injury to blood vessel from birth trauma or from inadequate repair of an incision or laceration (areas of tissue that fill up with blood) 28. How long do hematomas take to heal? Several days PAGE 25 29. What is the common measure to treat hematomas? Ice pack to perineum for 1 st hour after birth and intermittently for 8-12 hours 30. What are the causes of uterine inversion? Fundal implantation or abnormal adherence of placenta Excess traction on umbilical cord or vigorous manual removal of placenta Mag sulfate causes uterus to contract 31. What is DIC? (disseminated intravascular coagulation) pathologic form of clotting that is diffuse and consumes large amounts of clotting factors including platelets, fibrinogen, prothrombin and factors V and VII 32. What is puerperal sepsis? Any infection of genital canal within 28 days after abortion or birth 33. What are the most common infecting agents? Streptococcal and anaerobic organism 34. What are the signs and symptoms of mild infection? Vaginal discharge that may be scant or profuse, bloody, and foul smelling 35. What are the signs and symptoms of severe infection? PAGE 26 Abdominal tenderness and severe pain, saw tooth temp spikes (101-104), tachycardia, and chills 36. What is a sing of B-hemolytic strep infection? Scant/odorless lochia 37. What are the classic perineal s/s of infection? Redness Warmth Edema Purulent drainage Local pain may be severe Use REEDA 38. What are the treatments of perineal wound infections? I and D of wound Sutures removed and wound left open so it can heal from the inside out Antibiotics given Repairement 39. What are the predisposing factors of c section infection? Obesity, PROM, diabetes, metritis, prolonged labor, steroids (suppress immune systems) 40. What is mastitis? PAGE 27 An infection of breast connective tissue, primarily occurring in women who are lactating (can be in either breast feeders or bottle feeders) 41. What causes mastitis? A result from trauma to tissue such as: Fissures Overdistention Manipulation Milk stasis 42. What is the most common source of infection of mastitis? The baby’s nasopharynx 43. What are some characteristics of mastitis? Onset is sudden after 10 days Fever greater than 101 Flulike symptoms Severe pain 44. Should a woman continue breast feeding if she has mastitis/ YES! Its going to hurt like fire but it will help it pass fast if you breast feed a lot 45. What is thrombosis? PAGE 28 Formation of blood clots or clots inside of blood vessels and is caused by inflammation or partial obstruction of blood vessels 46. When is thrombosis most common? Third trimester 47. What is pulmonary embolism? Deep venous thrombosis occurring when part of blood clot dislodges and is carried to pulmonary artery where it occludes vessel and obstructs blood flow to lungs 48. What is deep vein thrombosis or pulmonary embolism usually treated with? IV heparin (continued for 5-6 days) 49. What are post-partum blues? Feelings of depression that occur in most women during the first week or 2 after birth 50. What are the main causes of postpartum blues? Psychological adjustments and hormone changes 51. When does PP depression usually occur? Anytime in the first year 52. When is PP depression at greatest risk? At 4 weeks PP 53. What is PP depression described as? PAGE 29 Intense and pervasive sadness with severe labile mood swings 54. Who are at risk for PP depression Primiparas If they have poor self esteem Unstable interpersonal relationships Ambivalence toward pregnancy (longer than first trimester) Lack of effective social support History of depression 55. What is PP psychosis? Syndrome characterized by depression, delusions, and thoughts of harming either self or baby 56. What are symptoms of psychosis? Agitation Hyperactivity Insomnia Mood lability Confusion Hallucinations Newborn Complications (15 questions) 1. What is a type of infection newborns up to the age of one get, but older children typically are not harmed by it? PAGE 30 Sepsis neonatorum 2. When should you obtain a culture? Before antibiotic therapy has begun 3. How will you know, based on WBC labs, that a baby may have sepsis? Their WBC count will be LOW as well as their immature WBCs 4. What are some signs of sepsis in a newborn? Behavioral changes Low temperature always means a sick baby Rash Tachypnea High heart rate Low blood pressure 5. What is toxoplasmosis acquired by? Ingestion of tissue cyst stage from undercooked meat or other animal products Ingestion or inhalation of the oocyst stage excreted in feline feces or contaminated soil Trans placental or blood-product transmission 6. What are the most common anomalies with rubella? Congenital cataracts Patent ducts arteriosus PAGE 31 Sensorineural deafness Meningocephalitis 7. How long are babies with rubella contagious? 12 months! 8. What are some characteristics of the cytomegalovirus infection (CMV)? They tend to be asymptomatic Typical rash Enlarged liver They try not to do treatment unless it is severe because of the enlarged liver 9. What is the number one cause of newborn blindness worldwide? Chlamydia trachomatis 10. What can chlamydia trachomatis also cause besides blindness? Pneumonia 11. What is the most common cause of neonatal sepsis and meningitis? Group B streptococcus 12. What are the risks of tobacco use during pregnancy? Lower birth weight Higher incidence of perinatal death PAGE 32 Carbon dioxide and nicotine decreases availability of 02 to maternal and fetal tissues 13. What is considered one of the primary teratogens in the Midwest? Alcohol 14. What is fetal alcohol syndrome? Includes a series of malformations frequently found in infants exposed to alcohol in utero 15. What are the common abnormalities of babies’ who had mothers taking amphetamines? Small head circumference Cleft palate Heart deformities 16. What drug prevents moms from being able to breast feed because the drug goes into the milk? Amphetamines 17. What is neonatal abstinence syndrome? Group of symptoms associated with drug withdrawal in the neonate Urine or meconium labs will be drawn to find out what drug the mother may have been on 18. What are the S/s in the GI of NAS? Poor feeding Vomiting Regurgitation Diarrhea PAGE 33 Excessive sucking (because they are uncomfortable) 19. What are the s/s in the CNS of NAS? Irritability Tremors Shrill cry Incessant crying Little sleep Convulsions Hyperactivity 20. What are the s/s of NAS in metabolic, vasomotor, and respiratory? Nasal congestion Tachypnea Sweaty Frequent yawning Increase rr greater than 60 Fever 21. What are signs of infant distress? Gaze aversion Yawning Sneezing Hiccoughs Arching Splaying of fingers 22. What are drugs that can be given to babies for withdrawal symptoms? Morphine and phenobarbital 23. What is hemolytic disease? When maternal antibodies are present naturally or form in response to antigen from fetal blood crossing placenta and entering into mother’s circulation 24. What is the most common metabolic error? PKU 25. What is PKU? The breakdown of proteins and they end up in skin or brain 26. What may an infant with PKU look like? PAGE 34 Typically, normal Blue eyes and blonde hair Fair skin 27. What is neutral thermal environment (NTE)? Environmental temperature at which oxygen consumption is minimal but adequate to maintain body temperature 28. What things do we monitor with blood work? ABG levels, pH, blood glucose levels, electrolytes, and status of blood cultures 29. Up to how many weeks’ gestation do infants not produce enough surfactant to survive extra uterine life? 34 weeks 30. What are the benefits of artificial surfactant? Improves respiratory compliance until infant can generate enough surfactant on his or her own 31. What is gavage feeding? Breast milk or formula is given tot infant through NG tube or OG tube (check residuals every four hours) 32. What is kangaroo care? Skin to skin holding which helps premature infants to directly interact with their parents 33. What are the complications of prematurity? Respiratory distress syndrome (RDS) Necrotizing enter colitis (NEC) Complications of oxygen therapy Retinopathy of prematurity (ROP) 34. What is respiratory distress syndrome caused by? Lack of surfactant 35. What are the s/s of respiratory distress syndrome? Tachypnea, grunting, nasal flaring, retractions, acidosis, hypotension, and shock 36. What is necrotizing enter colitis (NEC)? An acute inflammatory disease of the GI mucosa, commonly complicated by perforation and is often fatal 37. What is the cause of NEC? Unknown 38. Who is at risk for NEC? PAGE 35 Asphyxia, RDS, umbilical artery catheter, exchange transfusion, early enteral feedings, polycythemia, anemia, patent ductus arteriosus, congenital heart disease, and shock 39. What is the management of NEC? Discontinue feedings to rest GI tract OGT inserted TPN is started Antibiotics HANDWASHING since it is contagious If the bowel gets perforated, then surgical intervention 40. What decreases the incidence of NEC? Nonnutritive sucking 41. What can result from cold stress? Oxygen consumption and energy are diverted from maintaining normal brain and cardiac function and growth to thermogenesis for survival The BMR increases Metabolic acidosis develops Respiratory acidosis develops Hypoglycemia develops 42. What is the only organ not enlarged in macrosomia? Brain because insulin can’t cross the blood brain barrier 43. What is the primary growth hormone for intrauterine development? Insulin 44. What is surfactant? Phospholipid that is necessary to keep the fetal lung alveoli from collapsing; amount is usually sufficient after 32 weeks’ gestation NCLEX questions 1. The nurse is providing instructions to a pregnant woman with HIV infection regarding care to the newborn after delivery. The client asks the nurse about the feeding options that are PAGE 36 available. The best response by the nurse to the client would be? A: you will need to bottle feed your newborn B: You will need to feed your newborn with an NG tube C: You will be able to breast feed for 6 months then will need to switch to bottle feeding D: you will be able to breast feed for nine months and then will need to switch to bottle feeding Answer: A 2. The nurse is monitoring a client who is in the active stage of labor. The client has been experiencing contractions that are short, irregular, and weak. The nurse documents that the client is experiencing which type of labor dystocia? A: hypotonic B: precipitous C: hypertonic D: preterm labor Answer: A 3. The nurse has developed a plan of care for a client experiencing dystocia and includes several nursing actions in the plan of care. What is the priority nursing action? A: providing comfort measures B: Monitoring the FHR C: Changing the client’s position frequently D: Keeping the significant other informed about the progress of the labor Answer: B PAGE 37 4. The nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the presence of the umbilical cord protruding from the vagina. What is the first nursing action with this finding? A: gently push the cord into the vagina B: place the client in Trendelenburg’s position C: Find the closest telephone and page the health care provider stat D: Call the delivery room to notify the staff that the client will be transported immediately Answer: B 5. The nurse is monitoring a client in the immediate post-partum period for signs of hemorrhage. Which sign, if noted, would be an early sign of excessive bleeding? A: a temp of 100.4 B: an increase in the pulse rate from 88 to 102 beast in a minute C: A blood pressure change from 130/88 to 124/80 D: An increase in the respiratory rate from 18 to 22 Answer: B PAGE 38 6. The nurse is preparing a list of self-care instructions for a PP client who was diagnosed with mastitis. Which instructions should be included on the list? Select all that apply. A: wear a supportive bra B: rest during the acute phase C: maintain a fluid intake of at least 3000 ml D: continue to breast feed if the breasts are not too sore E: take the prescribed antibiotics until the soreness subsides F: avoid decompression of the breasts by breastfeeding or breast pump Answers: A, B, C, D 7. The nurse is providing instructions about measures to prevent PP mastitis to a client who is breast feeding her newborn. Which client response would indicate a need for further client teaching? A: I should breast feed every 2-3 hours B: I should change the breast pads frequently C: I should wash my hands well before breastfeeding D: I should wash my nipples daily with soap and water Answer: D PAGE 39 8. The PP nurse is assessing a client who delivered a health infant through a c section for s/s of superficial venous thrombosis. Which signs would the nurse note if superficial venous thrombosis were present? A: paleness of the calf area B: coolness of the calf area C: enlarged hardened veins D: palpable dorsalis pedis pulses Answer: C 9. A client in a PP unit complains of a sudden sharp pain in her chest and dyspnea. The nurse notes that the client is tachycardia and the respiratory rate is elevated. The nurse suspects a pulmonary embolism. Which should the be the initial nursing action? A: initiate an intravenous line B: assess the client’s BP C: prepare to administer morphine sulfate D: Administer oxygen 8-10 L a minute by face mask Answer: D PAGE 40 10. The nurse is assessing a client in the fourth stage of labor and notes that the fundus is firm, but that bleeding is excessive. Which should be the initial nursing action? A: record the findings B: massage the fundus C: notify the health care provider D: place the client in Trendelenburg’s position Answer: C 11. The nurse is preparing to care for four assigned clients. Which client is at higher risk for hemorrhage? A: a primaparious client who delivered 4 hours ago B: a multipara client who delivered 6 hours ago C: a primapara client who delivered 6 hours ago and had an epidural D: a multipara client who delivered a large baby after oxytocin induction Answer: D 12. A PP client is diagnosed with cystitis \. The nurse should plan for which priority nursing action in the care of the client? A: providing sitz bath PAGE 41 B: encourage fluid intake C: placing ice on the perineum D: monitoring hemoglobin and hematocrit Answer: B 13. The nurse is monitoring a PP client who received an epidural for delivery for the presence of the vulvar hematoma. Which assessment finding would best indicate the presence of a hematoma? A: changes in vitals B: signs of heavy bruising C: complains of intense pain D: complaints of tearing sensation Answer: A 14. The nurse is developing a plan of care for a PP client with a small vulvar hematoma \. The nurse should include which specific action during the 12 hours after delivery? A: assess vital every 4 hours B: prepare an ice pack for the application tot eh area C: measure the fundal height every 4 hours D: inform the health care provider of assessment findings PAGE 42 Answer: C 15. On assessment of a PP client. The nurse notes that the uterus feels soft and boggy. The nurse should take which initial action? A: elevate the client’s legs B: document the findings C: massage the fundus until firm D: Push on the uterus to assist in expressing clots Answer: C 16. The nurse in a newborn nursey is monitoring a preterm newborn for respiratory distress syndrome. Which assessment findings would alert the nurse to the possibility of the syndrome? A: tachypnea and retractions B: acrocyanossi and grunting C: hypotension and bradycardia D: presence of barrel chest and acrocyanosis Answer: A 17. The nurse is assessing a newborn who was born to a mother who is addicted to drugs. Which of the following PAGE 43 assessment findings would the nurse expect to note during the assessment of this newborn? A: Lethargy B: sleepiness C: constant crying D: cuddles when being held Answer: C 18. The nurse notes hypotonia, irritability, and a poor sucking reflex in a full term newborn on FAS (fetal alcohol syndrome) and is aware of which additional sign would be consistent with this syndrome? A: length of 19 inches B: abnormal palmar creases C: birth weight of 6 pounds 14 oz. D: head circumference appropriate for gestation age Answer: B 19. The nurse is preparing the plan of care for a newborn with fetal alcohol syndrome. The nurse should include which priority intervention in the plan of care? A: allow newborn to establish own sleep rets pattern PAGE 44 B: maintain the newborn in brightly lighted areas of the nursery C: encourage frequent handling of the newborn by staff and parents D: monitor the newborns response to feedings and weight gain patterns Answer: D 20. The nurse is administering erythromycin ointment to the eyes of a newborn and the mother asks the nurse why this is performed. Which explanation is best for the nurse to provide about neonatal eye prophylaxis? A: protects newborns eyes from possible infections acquired while hospitalized B: prevents cataracts in the newborn C: minimizes the spread of microorganism to the newborn from invasive procedures during labor D: prevents an infection called ophthalmic neonatrum from occurring after delivery in a newborn born to a woman with an untreated gonococcal infection Answer: D 21. The nurse is planning care for a newborn of a mother with diabetes. What is the priority nursing consideration for the newborn? A: developmental delays because of excessive size B: maintaining safety because of low glucose levels PAGE 45 C: choking because of impaired suck and swallow reflexes D: elevated body temperatures because of the excess fat and glycogen Answer: B 22. Methylegonvine is prescribed for a woman to treat PPH. Before administration, what is the primary nursing assessment? A: uterine tone B: blood pressure C: amount of lochia D: deep tendon reflexes Answer: B 23. RhoGam is prescribed for a client after a delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect the next baby from which condition? A: having rh positive blood B: Developing a rubella infection C: developing physiological jaundice D: Being affected by rh incompatibility PAGE 46 Answer: D 24. Methergonovine is prescribed for a client with PPH. Before administering the medication, the nurse contacts the HCP who prescribed the medication if which condition is documented in the client’s medical history? A: hypotension B: hypothyroidism C: diabetes D: peripheral vascular disease Answer: D PAGE 47 PAGE 48
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