CNM Varney's Review Book Part D Flashcards Preview

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Flashcards in CNM Varney's Review Book Part D Deck (70)
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31

head restitutes to ROA, where will it be after external rotation?

ROT

32

If on abdominal exam you feel the fetal back on the maternal left side and on vag exam you feel sagittal suture in right oblique diameter, what is osition of fetus?

LOA

33

What physiologic change is abnormal in second stage?

persistent, constant vomiting

34

what are some NORMAL physiologic maternal changes in second stage?

increase in BP of 20 mm Hg during ctxn
tachycardia at time of delivery
maternal temp elevation of 2 degrees F

35

Generally accepted frequency of BP checks in second stage is how often?

q 15 min

36

When is the lithotomy position contraindicated?

severe varicosities
(of course, in general it's not what we want to do, but there are exceptions..shoulder dystocia, etc)

37

what is the usual concentration of lidocaine used for a pudendal block?

1%

38

what is the best gauge to use for local infiltration of the perineal body?

22 gauge

39

VBAC most likely contraindicated for which one of the following:
previous c/s for CPD
2 PLTCS for failure to progress
previous c/s with vertical incision of lower uterine segment
previous emergency c/s at 26 wks before onset of labor

book says D, but I say C
I guess because it's in the lower uterine segment, it remains a slim option. I don't understand why an emergent section before labor in a second trimester would mean risking out of VBAC, unless it implies a high vertical incision.

40

How does management of a woman laboring for VBAC (good candidate) differ from women without previous c/s?

Manage the same as any woman in labor

41

In someone with a classical uterine incision, what is the best option for the next delivery?

scheduled RLTCS without labor

42

For which of the following women would a dx of preterm labor be accurate?
18 wks, contractions, ROM
24 wks, ctxn q 6 min
20 wks, ctxn q 8 min, ROM
34 wks, ctxn q 10, 1 cm dilation

20 wks, ctxn q 8, ROM

43

Antenatal corticosteroid therapy has been shown to be most effective at improving neonatal oucome when administered at what GA to women at risk for preterm birth?

24-34 wks

44

What are some sequelae of PTB?

RDS
intraventricular hemorrhage
LBW

45

reserach has demonstrated that what is associated with prevention of PTL among women with multiple gestation or a hx of PTL/PTB?

daily contact with a nurse

46

Waht percentage of women with PROM will go into spontaneous labor within 24 hours?

80-85%

47

What s/s are associated with intrauterine infection?

fetal tachycardia
BPP 6 or less
white blood cell count with a shift to the left

48

In a client with PROM at 32 weeks with no curren tsigns of infection, what is the most appropriate mgmt plan?

watchful waiting and allowing pregnancy to continue for as long as possible because the risks of prematurity outweight reisks of sepsis (or thats what the 2002 book said)

49

s/s: 38 wk GA, temp 102, leaking some liqid that "smells really bad". uterus tender, HR 100 bpm, FHR 180. What is your dx?

chorioamnionitis

50

What is the most appropriate first step to take if you suspect chorio in antepartum?

admit to hospital for induced vaginal birth or c/s within 24 hours

51

Calculate Montevideo units for a woman who iin the last twenty minutes has had four contractions, each 5 minutes apart, lasting 45 seconds, and with a baseline of 10 mm Hg, amplitude of 55 mm Hg.
90,110,135, 165

90

52

Why should oxyocin only be administered with a physiologic electrolyte solution such as LR and not with an aqueous fluid such as dextrose in water?

to avoid water intoxication

53

dduring which decel pattern is the FHR most likely to dip befow 100 bpm?

variable decels

54

Can late decels occur within normal HR range and be as shalow as 10 bpm?

yes

55

in the absence of administration of any medications, a sinusoidal pattern of the FHR is associated with what?

severe fetal hypoxia

56

what is teh definition of hypoxia?

decreased oxygen in the tissue

57

what is the definition of asphyxia?

decreased oxygen in the tissue and metabolic acidosis

58

deep transverse arrest is associated with what?

android pelvis

59

upon vag exam of woman in second stage labor with hypotonic uterine dysfunction, you determine that the saggital suture is in the transverse diameter of the mother's pelvis and that there is considerable molding and formation of caput succadeneum. What is most likely dx?

deep transverse arrest

60

What might you do to remedy deep transverse arrest?

change maternal position
pitocin
instument or cesarean delivery if condition is not overcome