Exam 3

Question 1

what is the best plan of care for an ectopic pregnancy?

Answer 1

methotrexate less than 8 weeks

salpingectomy to remove part of the tube

Question 2

what are the adverse effects of mag sulfate

Answer 2

respiratory depression
low BP
uterine bogginess in postpartum
absent DTR's
decreased urine output

Question 3

what are the expected outcomes of mag sulfate?

Answer 3

therapeutic range 4-7
decreased BP
relaxed smooth muscle

Question 4

explain the warning signs you may see with a pt with cerclage

Answer 4

discharge

Question 5

complications of incomplete abortions

Answer 5

sepsis (profuse bleeding, cramping, fever, chills)

Question 6

potential complications of placenta previa?

Answer 6

bleeding and hemorrhade

Question 7

contraindications with a placenta previa?

Answer 7

hypotension, tachycardia are signs for bleeding

Trendelenburg and oxygen

Question 8

important labs associated with pre-eclampsia and HELLP

Answer 8

elevated liver enzymes

low platelets

Question 9

most concerning symptoms of pre-eclampsia

Answer 9

swelling of face and hands

Question 10

CST

Answer 10

contraction stress test
stimulate contractions with oxytocin over 10 min to look at FHR
Positive = BAD
for late decelerations do UNCOIL
done for abnormal Biophysical profile

Question 11

plan of discharge for a 28 wk pregnant patient with pre-eclampsia

Answer 11

no ace inhibitors
monitor bp
measure I&O
kick counts
edema
diet control ( increase protein, low sodium)
NO fluid restriction
bedrest

Question 12

how do you know if mag sulfate is effective?

Answer 12

no seizures, monitor DTR’s (2+, 0 Clonus is normal), serum levels therapeutic 4-7, no pulmonary edema

Question 13

nursing interventions for patients with pre-eclampsia

Answer 13

anti-hypertensive meds
minimize environmental stimulation
seizure precautions

Question 14

inevitable abortions

Answer 14

dilated cervix without passage of tissue, first 20 weeks, no bleeding manage symptoms, if bleeding d&c

Question 15

incomplete abortions

Answer 15

open cervix with tissue in cervix, heavy and profuse bleeding, maybe D&C, suction or cytotec
risk of sepsis

Question 16

important interventions for preterm pregnancies with placenta previa

Answer 16

2 doses of betamethasone

no pelvic exams and complete pelvic rest

Question 17

signs and symptoms of molar pregnancy

Answer 17

dark red vaginal bleeding
increased fundal height
hyperemesis
preeclampsia prior to 20 weeks

Question 18

what’s included in a biophysical profile

Answer 18

US measurement of amniotic fluid, fetal movements, fetal tone, NST, and fetal breathing movements

Question 19

MSAFP

Answer 19

screens for opening of neural tube
occurs 15-20 weeks
low MSAFP = trisomy
Does not screen for turners or kleinfelters

Question 20

what symptoms are associated with concealed placental abruption?

Answer 20

increased fundal height
board like, rigid uterine atony
painful

Question 21

symptoms of mag toxicity

Answer 21

BLURR( low BP, decreased LOC, Decreased urine output, Low RR, Decreased DTR)
TURN OFF THE MAG

Question 22

diagnostic tests available for genetic testing in pregnancy

Answer 22

amniocentesis
chorionic vili sampling
if abnormal quad screening at 18 weeks, nuchal scan test ultrasound

Question 23

what labs test to see if woman is ovulating?

Answer 23

progesterone

Question 24

contraceptive efficacy best to least?

Answer 24

nexplanon
male sterilzation
mirena IUD (skyla, Kyla)
female sterilization
paraguard IUD
depro provera
estrogen pills, patches, and rings

Question 25

interventions of hypoglycemia in labor

Answer 25

if on insulin drip and hypoglycemic stop the insulin

Question 26

what's important about 1 hour glucose test

Answer 26

no fasting 130-140 elevated and requires 3 hours test SCREENING

Question 27

what's important about 3 hour glucose test

Answer 27

3 days unrestricted diet and exercise FASTING after midnight night before DIAGNOSTIC avoid caffeine and tobacco 12 hours prior

Question 28

type of birth control NOT recommended for breast feeding

Answer 28

anything with estrogen | xulane, nuvaring, orala, anovera, twirla, pills

Question 29

ways you can tell a woman is ovulating

Answer 29

regular predictable periods cramping dysmenorrhea spinbarcet mucous (egg white, cloudy, scant)

Question 30

ACHES (CHC)

Answer 30

``` abdominal pain chest pain/shortness of breath severe headache eye pain, visual disturbances severe leg pain ```

Question 31

PAINS (IUD)

Answer 31

``` period late, pregnant, abnormal bleeding abdominal pain with intercourse infection, abnormal discharge not feeling well, fever, chills, malaise string missing, short, long ```

Question 32

contraindications for CHC

Answer 32

migraine with aura clotting disorders smoking HTN

Question 33

pathophysiology of GDM

Answer 33

glucose crosses placenta not insulin | pregnancy with pre-existing DM the placenta is the problem

Question 34

emergency contaception

Answer 34

paraguard- up to 5 days after ella- 5 days after plan b- 3 days after

Question 35

hyperglycemia in 1st trimester can cause

Answer 35

congenital malformations especially CVD and CNS anomalies

Question 36

causes of poor quality sperm

Answer 36

``` age obesity hot testicles sti exposure to radiation/toxins anti-sperm antibodies ```

Question 37

low sperm count

Answer 37

``` hypospadias undescended testicles variceal decreased testosterone substances, tobacco, anabolic steroids ```

Question 38

maternal glucose

Answer 38

before meals 60-105 one hour after < 140 two hours after 120 2-6am- 60

Question 39

what is the main reason for treating opiate usage in pregnancy

Answer 39

to prevent intrauterine seizures during withdraw

Question 40

clomid

Answer 40

stimulates GnRH, binds to estrogen

Question 41

perginol

Answer 41

stimulates ovulation, has FSH/LH

Question 42

priority intervention with postpartum psychosis

Answer 42

never leave mom alone with baby medical emergency/ hospitalization supervise mom with baby

Question 43

complications for hyperemesis gravidarum- mom

Answer 43

esophageal rupture pneumomediastinum vitamin k and thiamine deficiencies

Question 44

complications of hyperemesis gravidarum- fetus

Answer 44

SGA prematurity low birth weight

Question 45

labs for hyperemesis gravidarum

Answer 45

``` ua cbc electrolytes LFT's bilirubin thyroid ```

Question 46

important education points for GDM postpartum

Answer 46

most likely to resolve after delivery of infant | likely to have in subsequent pregnancies