MATERNAL & NEONATAL Flashcards
(137 cards)
1
Q
An antenatal G2, T1, P0, L1 client is discussing her postpartum plans for birth control with her HCP. In analyzing the available choices, which has the greatest impact on her birth control options? A/ Satisfaction with prior methods B/ Preference of sexual partner C/ Breast or Bottle feeding plan D/ Desire for another child in 2 years
A
C/ Breast or bottle feeding is the greatest factor influencing postpartum birth control methods.
Most contraceptives should not be started until breast milk production is well established which can take up to 4-6 weeks.
Low-dose contraceptives may be the alternative choice
2
Q
Which of the following information would be important to include in the teaching plans for a client who wants more information on ovulation and fertility management?
A/ The ovum survives for 96 hours after ovulation, making conception possible during this time
B/ The basal body temperature falls at least 0.2 F after ovulation has occurred.
C/ Ovulation usually occurs on day 14, plus or minus 2 days, before the start of the next menstrual cycle.
D/ Most women can tell they have ovulated because of severe pain and thick-scant cervical mucous
A
C/ When ovulation occurs. Typically on the 14th day before the start of the next menstrual cycle, plus or minus 2 days.
The ovum typically only survives 12-24 hours after ovulation, during which time conception is possible.
The Basal Body temp rises at least 0.5 F and up to 1 F, NOT 0.2 F
Although some women may feel pelvic discomfort during ovulation, severe or unusual pain is rare.
3
Q
Which instructions about activities during menstruation would the nurse include when counseling and adolescent who has begun menstruating?
A/ Take a mild analgesic if needed for pain
B/ Avoid cold foods if pain persists
C/ Stop exercising while menstruating
D/ Avoid tampons until you’ve been menstruating for 1 year
A
A/ Take mild analgesics like Tylenol or Advil.
Foods rich in iron should be eaten, and exercise should not stop as it can strengthen abdominal tone.
Avoiding cold foods does not help with dysmenorrhea
Pads and Tampons are a person choice, and no evidence exists on waiting to use tampons.
4
Q
After teaching a reproductive class to adolescent females, the nurse concludes the teaching has been effective when a student states…
A/ “ Under ideal conditions, sperm can reach the ovum in 15 - 30 minutes resulting in pregnancy”
B/ I will not become pregnant if I abstain from sex during the last 14 days of my menstrual cycle”
C/ “Sperms from a healthy man usually remain viable in the female reproductive tract for 96 hours”
D/ “After the egg is fertilized by the sperm, the ovum contains 21 pairs of chromosomes”
A
A/ 15 - 30 minutes is all it takes to ruin your pre-adult life.
Sperm remains viable for only 24-72 hours in a female
After fertilization, there are 46 chromosomes
5
Q
A 20-year-old nulligravida expresses a desire to learn more about symptothermal method of family planning. Which information should be included in her teaching plan?
A/ This method has a 50% failure rate in the first year of its initiation
B/ Couples must abstain from sex for 5 days after menses
C/ Cervical mucous is carefully monitored for changes
D/ The male partner uses condoms for significant effectiveness
A
C/ Requires monitoring of cervical mucous changes and body temperature changes. This is because regular menstrual cycles often are 1-2 days late or early, this helps to determine the time which ovulation may occur.
Abstinence during ovulation is required, not 5 days post menses because this is an unlikely time for ovulation to occur.
The failure rate is more like 10-20%
6
Q
Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurses assess the client for which of the following? A/ Anemia B/ Hypertension C/ Dysmenorrhea D/ Acne Vulgaris
A
B/ Hypertension
Clients with HTN, thrombophlebitis, obesity or a hx of cerebral or cardiovascular incidents are poor candidates for oral contraceptives.
In addition, women who smoke, or are over 40 or have a hx of pulmonary disease should be advised not to take this form of contraceptive.
The other answers have no relation.
7
Q
After teaching a 20-year-old nulligravida about the adverse effects of oral contraceptives, the nurse realizes further education is needed when the client states which of the following as an adverse effect? A/ Weight Gain B/ Nausea C/ Headache D/ Ovarian Cancer
A
D/ There isn’t enough evidence to suggest any link between ovarian cancer and oral contraceptives.
The others are common side effects depending on the medication.
8
Q
Which information should be included for a 32-year-old female requesting information about using a diaphragm for family planning?
A/ Douching which an acidic solution after intercourse is recommended. LOL
B/ Diaphragms should not be used if the client develops acute cervicitis
C/ The diaphragm should be washed with a weak solution of bleach and water
D/ The diaphragm should be left in place for 2 hours after sex
A
B/ Acute cervicitis
This could be due to the rubber used in the diaphragm. Evidence also suggests diaphragms increase the risk of UTIs
Wash with mild soap and water
Leave in place for 6-24 hours after sex
YUCK.
9
Q
After being examined and fitted for a diaphragm, a 24-year-old client receives instructions on its use. Which statement indicates a need for more teaching?
A/ “I can continue to use the diaphragm for 2-3 years if I keep it in the case”
B/ “If I get pregnant, I will have to be refitted for another diaphragm after birth”
C/ “Before inserting the diaphragm, I should coat the rim with contraceptive jelly”
D/ “If I gain or lose 20 lb, I can still use the same diaphragm”
A
D/ Gaining or losing 20 lbs.
If the client gains or loses more than 15 lbs, their pelvic and vaginal contours to such a degree that the diaphragm will no longer protect against pregnancy.
It can be used for 2-3 years if protected well
10
Q
A 22-year-old patient states that she and her husband are trying to have a baby. When teaching the client about reducing the incidence of neural tube defects, the nurse should emphasize the need for increase the intake of which foods? SELECT ALL THAT APPLY.
A/ Leafy Green Veggies B/ Strawberries C/ Beans D/ Milk E/ Sunflower Seeds F/ Lentils
A
A/ Leafy Green Veggies B/ Strawberries C/ Beans E/ Sunflower Seeds F/ Lentils
Basically everything but Milk.
These all have folic acid, which women require 400-800mcg/day when prego.
11
Q
A couple is inquiring about vasectomy as a method of contraception. What should be included in their teaching plan?
A/ Another method of contraception should be used until sperm count is 0
B/ Vasectomy is easily reversed if children are desired in the future
C/ Vasectomy is contraindicated in males with a history of cardiac disease
D/ Vasectomy only requires a yearly follow up once the procedure is completed.
A
A/ Slap on some rubber until your soldiers die off.
The number of ejaculations differs from male to male, but it usually takes multiple episodes until sperm count is Zero, which can be determined by the lab.
All others are not true.
12
Q
A 39-year-old multigravida client asks the nurse for information about female sterilization with tubal ligation. Which client statement reflects effective teaching?
A/ “My fallopian tubes will be tied off through a small abdominal incision”
B/ “Reversal of a tubal ligation is easily done”
C/ “After the procedure, I must abstain from sex for at least 3 weeks”
D/ “Both of my ovaries will be removed during the procedure”
A
A/ A small incision will be made in which the tubes will be tied off.
Reversal is not easily done and the pregnancy success rate afterwards is roughly 30%
You can bump uglies 2-3 days afterwards.
13
Q
If a client is using the Basal temperature method for ovulation detection, what is the most important thing for them to know in order to ensure accuracy and success?
A
Take their temperature every morning at the same time when they get out of bed. Just before the day of ovulation, their temp will fall by around 0.5 F, and then rises during ovulation by 0.4-0.8 F
14
Q
A client is scheduled for IVF therapy for infertility. Which client statement suggests they understand the procedure?
A/ IVF requires supplemental estrogen to enhance the implantation process
B/ The pregnancy rate with IVF is higher than that of gamete intrafallopian transfer
C/ IVF involves bypassing the blocked or absent fallopian tubes
D/ Both ova and sperm are implanted in the open end of the fallopian tube
A
C/ Involves bypassing the blocked or absent fallopian tubes
Progesterone is given to enhance the implantation process, NOT estrogen
Gamete intrafallopian transfer has a higher success rate than IVF, however it cannot be used in women with blocked or absent fallopian tubes as it requires implantation in the fallopian tube.
15
Q
A 20-year-old primigravida client tells the nurse that is afraid of dying during childbirth as her mother had a friend who hemorrhaged 10 years ago. Which response would be MOST helpful to the client?
A/ Today’s modern medicine has resulted in a low maternal mortality rate
B/ Do no concern yourself with things that happened in the past
C/ The Canada, mothers rarely die from childbirth
D/ What is it that concerns you about pregnancy, labor, and birth?
A
D/ Gather additional data, asking her about what her concerns are will provide you an opportunity to educate her and help her through her concerns.
16
Q
What is an Ectopic pregnancy and why is it potentially life-threatening?
A
When implantation of fertilized ovum occurs in the fallopian tube or elsewhere in your abdomen. This can cause the rupture of the fallopian tube with hemorrhaging.
17
Q
Which of the following instructions should the nurse include for the health teaching of a 30-year-old multigravida who will be using an IUD for family planning?
A/ Amenorrhea is common with IUDs
B/ The client should use additional protection for contraception
C/ IUDs are more costly than other forms of contraceptives
D/ Severe cramping may occur when IUD is inserted.
A
D/ Severe cramping may occur
Common side effects include menstrual bleeding and subsequent anemia… NOT amenorrhea.
IUDs have an effective rate of 98%, so other protection is not required.
In the long run they are less expensive, as it is a one-time purchase rather than monthly contraceptives.
18
Q
When developing a teaching plan for an 18-year-old who asks about treatments for STIs, the nurse should explain that….
A/ Acyclovir is used to cure herpes genitalis
B/ Chlamydia is treated with penicillin
C/ Ceftriaxone is commonly used to treat Gonorrhoeae infections
D/ Metronidazole is used to treat condylomata acuminata (Genital warts)
A
C/ Ceftriaxone treats Gonorrhoeae
It is commonly combined with Doxycycline.
Acyclovir is used in herpes treatment but does not cure it.
Chlamydia is treated with doxycycline or azithromycin.
Metronidazole is used to treat vaginitis, NOT genital warts.
19
Q
A primigravid at 15 weeks gestation has had an amniocentesis and has received teaching concerns signs and symptoms to report. Which statement indicates further teaching is needed?
A/ “I need to call if I start to leak Amniotic fluid from my vagina”
B/ “If I start bleeding, I need to call back”
C/ “If my baby does not move, I need to call my HCP”
D/ “If I start running a fever, I should let the office know”
A
C/ A first-time prego will not feel her baby move at 15 weeks gestation. Typically does not occur until 18-20 weeks, and 16-18 weeks for a multipara.
All other symptoms need to be followed up.
20
Q
A 32-week gestation primigravida complains of heartburn. She needs further instruction when she states she must do what to avoid the heartburn? A/ Avoid highly seasoned foods B/ Avoid Lying down after a meal C/ Eat small frequent meals D/ Consume liquids only between meals
A
D/ Consuming liquids only between meals does not prevent heartburn; however, it is a great way to reduce nausea and vomiting during pregnancy
The other methods should be used to prevent heartburn.
21
Q
An Antenatal primigravida client is expecting twins. The nurse realizes she needs more prenatal education when the client states that carrying twins puts her at risk for which of the following complications? A/ Preterm Labor B/ Twin-to-twin Transfusion C/ Anemia D/ Group B Streptococcus
A
D/ Group B Streptococcus risk is associated with all pregnancies, so just because you’re having twins doesn’t make you special.
All others are associated with twins.
22
Q
After instructing a client about the radioimmunoassay preg test, the nurses determines the client understands the test when she states the test measures which of the following levels? A/ Prolactin B/ Follicle-Stimulating hormone C/ Luteinizing hormone D/ human chorionic gonadotropin (hCG)
A
D/ hCG - can be found in a little as 24-48 hours after implantation.
Prolactin is secreted by the pituitary gland to prepare breasts for lactation
Follicle-stimulating hormone is involved in follicle maturation during menstruation cycles.
Luteinizing hormone is responsible for stimulating ovulation
23
Q
Using Nägele's Rule for a client whose last period was May 10, the nurse determines that her due date is: A/ Jan 13 B/ Jan 17 C/ Feb 13 D/ Feb 17
A
D/ Feb 17
The nurse implements Nägele’s Rule by counting back three months from her last period and adding 7 days, making it February 17.
24
Q
The nurse determines that her primigravid client needs more teaching about the purpose of a placenta when the client states that which hormone is produced by the placenta? A/ Estrogen B/ Progesterone C/ human chorionic gonadotropin (hCG) D/ Testosterone
A
D/ Testosterone
hCG - stimulates the synthesis of estrogen and progesterone until the placenta can maintain this function later in pregnancy
Progesterone - Maintains the endometrium, inhibiting uterine contraction, development of breasts for lactation
Estrogen - Uterine and breast enlargement
25
The nurse is assessing a 24-week gestation primigravida and is unable to find the fetal heartbeat. The fetal heartbeat was heard during her previous visit 4 weeks prior. According to priority, the nurse should do the following tasks in which order?
1. Call the HCP
2. Explain that the fetal heartbeat cannot be found
3. Obtain different equipment and recheck
4. Ask the client if the baby is or has been moving
4. - Is/has Baby moving?
3. New equipment
2. Explain heartbeat cannot be found
1. Call HCP
26
A primiparous client at 10 weeks gestation asks why she needs to have ultrasounds because she states she feels fine. Which of the following nursing responses is appropriate/accurate for the client? SELECT ALL THAT APPLY
A/ Ultrasound helps us to view the gross anatomy of your fetus
B/ We need to determine gestational age
C/ The test will determine if the fetus is viable
D/ We must determine fetal position
E/ We must determine if there is sufficient supply for the fetus.
A/ Gross anatomy
B/ Gestational age
At this time, ultrasound cannot determine if the fetus is viable, nor is it important to see their fetal position in the first trimester.
Ultrasounds provide no information on nutrient supply.
27
When measuring the fundal height of a primigravid client at 20 weeks gestation, the nurse will locate the fundal height at which point?
A/ Halfway between the symphysis pubis and the umbilicus
B/ At or near the umbilicus
C/ Between their umbilicus and xiphoid process
D/ In their throat.
B/ 20 weeks, the fundal height should be around the umbilicus
12 weeks = symphysis pubis
36 weeks = xiphoid
Never should it be in her throat. Never.
28
A primigravida at 8 weeks gestation states that she wants an amniocentesis because Haemophilia A runs in her family. The nurse informs the client they cannot do the test until 15 weeks because...
A/ Fetal development must be complete before testing
B/ The volume of amniotic fluid needed for testing is not available until 15 weeks
C/ Cells indicating Haemophilia A are not present until week 15
D/ Amniocentesis prior to 15 weeks greatly increases the risk of infection
B/ Volume needed
At 15 weeks there are roughly 15mL available
Fetal development is ongoing...
Cells needed for Haemophilia A testing are present throughout pregnancy but aren't typically discoverable until 12 weeks...
Amniocentesis always carries the risk of infection.
29
When developing a teaching plan for a client who is 8 weeks prego, what foods should the nurse suggest to meet the client's need for increased folic acid? SELECT ALL THAT APPLY
```
A/ Spinach
B/ Bananas
C/ Seafood
D/ Yogurt
F/ Beans
```
A/ Spinach
F/ Beans
Both are rich in folic acid.
30
Which of the following choices are appropriate for teenagers but also for their fetus? Select all that apply
A/ Milkshake or yogurt with fresh fruit
B/ Chicken Nuggets and tater tots
C/ Cheese pizza with spinach and mushroom toppings
D/ Peanut Butter With crackers and juice
E/ Buttery light popcorn with diet soda
F/ Cheeseburger with a pickle and ketchup
A/ Milkshake/fruit
C/ Cheese Pizza
D/ Peanut Butter
31
```
The nurse is reviewing the file of a 24-week prego. Which of the following results should be reported?
A/ A+ Blood type
B/ 5mmol/L Blood Sugar
C/ VDRL Positive
D/ Rubella Titer Immune
```
C/ VDRL is a screening test for syphilis
The pregnant mother must be treated for syphilis before birth or she may transmit the disease to her baby.
32
The nurse is reviewing the immunization report for a pregnant client and remember which of the following immunizations are contraindicated during pregnancy? SELECT ALL THAT APPLY
```
A/ Tetanus
B/ Rubella
C/ Mumps
D/ Herpes Varicella-zoster
E/ Live Attenuated Flu Vaccine
F/ Hepatitis B
```
B/ Rubella
C/ Mumps
D/ Herpes Varicella-zoster
E/ Live Attenuated Flu Vaccine
All of these are living vaccines and cannot be given to a fetus.
33
A 17-year-old gravida presents for her regularly scheduled 26-week prenatal visit. She appears disheveled, is wearing ill-fitted clothing and avoids eye contact. Which of the following items should the nurse discuss this visit? SELECT ALL THAT APPLY.
```
A/ Intimate partner violence
B/ Substance abuse
C. Depression
D/ Blood Glucose Testing
E/ hCG levels
```
A/ Intimate partner violence
B/ Substance abuse
C. Depression
D/ Blood Glucose Testing
All except E/ apply.
Health care workers should always assess for partner violence, especially during pregnancy.
Pregnant teens have increased rates of not finishing school, smoking, and substance abuse.
Based on appearance and lack of eye contact, it is possible the client is depressed.
It is routine the discuss blood glucose testing around 24-28 weeks gestation
34
A primigravid at 28 weeks gestation tells the nurse that she and her husband wish to travel to relatives 7 hours away. Which of the following responses is most appropriate for the nurse?
A/ "Try to avoid traveling anywhere in your 3rd trimester"
B/ "Limit the time you spend in the care to 4-5 hours per day"
C/ "Taking the trip is fine if you can stop every hour or two for a 10-minute walk"
D/ "Avoid wearing your seatbelt and drink alcohol to help yourself sleep for most of the trip"
C/ 10-minute breaks
After long periods of rest, the circulatory system becomes sluggish, so exercise will maintain proper blood flow.
35
Which of the following statements best identifies the rationale for why an adolescent primigravid should continue prenatal care throughout pregnancy?
A/ Pregnant adolescents are at a higher risk for pregnancy-induced hypertension
B/ Gestational diabetes can commonly develop in adolescent pregos
C/ Adolescents need additional instructions related to common discomforts
D/ The father is rarely involved in this age group.
A/ Pregnancy-induced hypertension
This is a common factor in adolescent mothers, and close prenatal screening may prevent this.
Other risks for young mothers include:
* Low birth weight
* Preterm Labour
* Iron deficiency anemia
* Cephalopelvic disproportion
36
In preparation for a prenatal class for newly pregnant women, the nurse should include which of thew following learning points?
A/ Your temperature decreases slightly in the first trimester
B/ Cardiac output increases by 25% to 50% during pregnancy
C/ The circulating fibrinogen level decreases as much as 50% during pregnancy
D/ The anterior pituitary gland secretes oxytocin late in pregnancy
B/ Cardiac output increases
So does their total blood volume
Temp increases in early pregnancy, not decreases.
Fibrinogen levels increase... not decrease
The Posterior pituitary gland releases oxytocin.. not the anterior
37
```
Which of the following factors affect fetal movement in utero? SELECT ALL THAT APPLY
A/ Fetal Sleep
B/ Barometric pressure changes
C/ Blood Glucose
D/ Time of day
E/ Smoking
```
A/ Fetal Sleep
C/ Blood Glucose
D/ Time of day
E/ Smoking
Barometric pressure has no effect on fetal movement.
38
A primigravid client at 36 weeks gestation tells the nurse that she has been experiencing insomnia for 2 weeks. Which suggestion would be most helpful?
A/ Practice relaxation techniques before bed
B/ Drink a cup of hot chocolate before bed
C/ Drink a small glass of wine before bed
D/ Exercise 30 minutes before bed
A/ Frankie Says Relax
Relaxation will help soothe discomfort and relax thought processes.
Caffeine will stimulate the client, so hot chocolate and coffee should be avoided.
Never is alcohol okay during pregnancy
Exercise will cause the client to become stimulated prior to sleep and make falling asleep more challenging.
39
What does the following mean?
```
G5
T4
P0
A1
L4
```
What does it mean about this woman specifically?
G = Gravity (number of total pregnancies)
T = Term Deliveries (38 weeks or more)
P = Preterm Births (Viability up to 37 weeks)
A = Abortions (Surgical and miscarriages)
L = Living children
So this woman has been pregnant 5 times (G5), Had 4 Term babies (T4), Had 0 preterm babies (P0), has had 1 abortion (A1), and has 4 living Children (L4).
40
What does the following mean about this woman?
```
G4
T1
P1
A2
L2
```
```
Pregnant 4 times (G4)
Went to term once (T1)
Went preterm once (P1)
Had 2 abortions (A2)
Has 2 living Children (L2)
```
41
```
What fetal feature develops around 3 months (roughly 9-12 weeks) in utero?
A/ External genitalia
B/ Myelination of nerves
C/ Brown fat stores
D/ Air ducts and alveoli
```
A/ External Sex organs. Although it is not easily discernable at this time
42
A primigravid client tells the nurse that twins run in her family. What should the nurse tell the client?
A/ Monozygotic twins results from fertilization of one ovum
B/ Monozygotic twins occur by chance regardless of race or heredity
C/ Dizygotic twins are usually the same gender
D/ Dizygotic twins occur more often in primigravidas than multigravidas.
B/ Don't get yer hopes up... it is totally random and genetics play no role in identical twins.
C/ is not always true.
D/ Primigravidas are less likely to have twins than multigravidas.
43
A primigravid client asks how much blood is lost during a normal vaginal birth. The nurse should tell the woman:
A/ Maximum blood loss is considered around 500mL
B/ Minimum blood loss is considered within normal limits around 1000mL
C/ Blood loss during childbirth is rarely estimated unless there is a hemorrhage
D/ It would be unusual to lose more than 100mL of blood
A/ In a normal uncomplicated birth, up to 500mL is expected.
Blood loss is almost always calculated because it is a good way to rule out a hemorrhage
44
A client is experiencing pain during the first stage of labour. What should the nurse instruct the client to do in order to manage her pain? SELECT ALL THAT APPLY
```
A/ Walk in the hospital room
B/ Use slow chest breathing
C/ Request pain medication on a regular basis
D/ Lightly massage the abdomen
E/ Sip Ice Water
```
A/ Walking
B/ Use slow breathing
D/ Massage abdomen
Pain medication could delay delivery
Sipping ice water will not help with pain, only hydration.
45
During a prenatal class, a primigravid states "How will I know I am in true labour?" The nurses best response to educate her on true contractions are...
A/ True labour contractions will decrease with ambulation
B/ True labour contractions may disappear with with ambulation, rest or sleep.
C/ The duration and frequency of true labour contractions remain the same
D/ True labour contractions are felt first in the back and then the abdomen.
D/ True labour is felt first in the back then the abdomen. The duration and frequency WILL increase, and ambulation and rest will not stop or decrease contractions.
False labour contractions stop with ambulation
46
A primigravid client tells the nurse that she has been experiencing some yellowish-gray frothy vaginal discharge and local itching. What is the best advice for the nurse to provide this client?
A/ Use and over-the-counter cream for yeast infections
B/ Schedule an appointment in the clinic for an examination
C/ Administer a vinegar douche under low pressure
D/ Prepare for preterm labour
B/ You got an infection.
Over-the-counter meds will not address this issue as it is unlikely a yeast infection due to it's presentation.
Douching is contraindicated during pregnancy
This is not a sign of preterm labour
47
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A multigravid client who has experienced hemolytic disease of the newborn in a previous pregnancy should be prepared for frequent antibody titer evaluations obtained from which source?
A/ Placental Blood
B/ Amniotic Fluid
C/ Fetal Blood
D/ Maternal Blood
```
D/ Maternal Blood
For the Rh negative mother who may be pregnant with an Rh positive fetus, and indirect Coombs test measures antibodies in the maternal blood.
Titers should be performed monthly in the 1st and 2nd trimesters. and bi-weekly in the 3rd.
48
```
Which diagnostic test would be the most appropriate for a 40-year-old primigravid in her second trimester?
A/ Beta Strep Screening
B/ Chorionic Villus Sampling
C/ Ultrasound Testing
D/ Quad Screen
```
D/ Quad Screen
Quad testing tests AFP, hCG, STriol, and Inhibin-A.
High levels of AFP indicated neural tube defects such as anencephaly or spina bifida. Abnormally low levels may indicate Trisomy 21
Beta strep is done in the 3rd trimester
Chorionic Villus sampling is done at 10 weeks to detect anomalies.
Ultrasounds are done in first and third trimesters.
49
A primigravid has completed her first prenatal visit and blood work. Her blood tests reveal that her Hep B surface antigen is positive. The nurse can advise the patient that the plan of care for her newborn will include the following: SELECT ALL THAT APPLY
A/ Hep B immune globulin at birth
B/ Series of 3 Hep B vaccinations per recommended schedule
C/ Hep B Screening when born
D/ Isolation of infant during hospitalization
E/ Universal precautions of mother and infant
F/ Contraindication for breastfeeding
A/ Hep B immune globulin at birth
B/ Series of 3 Hep B vaccinations per recommended schedule
E/ Universal precautions of mother and infant
Hep B immune globulin at birth provides the infant with passive immunity to Hep be and serves as prophylactic treatment.
The infant will be started on vaccinations
Routine precautions will still be provided. This is standard practice for all babies and mothers.
Hep B Mothers can breastfeed
50
A primigravid with asthma controlled through medication receives instruction on being pregnant. Which of the following statements reveals the new mother needs further teaching?
A/ I need to continue taking my medication as prescribed for asthma
B/ It is my goal to limit or prevent asthma attacks
C/ During an asthma attack, oxygen levels need to be high for both myself and my fetus
D/ Bronchodilators should be used only when necessary because the risk they present to my fetus
D/ Bronchodilator use
Bronchodilators can prevent asthma attacks and should be used throughout pregnancy and prophylactic treatment. They do not harm mother or fetus.
All other responses are true.
51
A woman at 22-weeks-gestation has right upper quadrant pain radiating to her back. She states the pain is a 9 out of 10 and says that it has occurred twice in the last week for around 4 hours each time. She does not associate the pain with food. Which nursing measure is the highest priority for this client?
A/ Educate the client on the changes occurring in the gallbladder as a result of pregnancy
B/ Refer the client to her HCP for evaluation and treatment of the pain
C/ Discuss nutritional strategies to decrease the possibility of heartburn
D/ Support the client's use of acetaminophen to relieve pain
B/ Refer to HCP
Referral makes the most sense due to the severity of the pain.
Due to the severity and increasing incidence of pain, it is most appropriate for the nurse to refer out. Along with the fact the nurse cannot diagnose the cause of the pain.
52
A client in the triage area states that she has not felt her baby move in the past week. She is 19 weeks pregnant. The fetal heart monitor shows no signs of heart tones. While evaluating this client, the nurse identifies her at being highest risk for developing which problem?
A/ Abruptio Placentae
B/ HELLP Syndrome
C/ Disseminated intravascular coagulation
D/ Threatened abortion
C/ DIC
The fetus has died and being retained in the uterus places mother at-risk for D.I.C.
This is because the clotting factors of the mother have been consumed when the non-viable fetus is retained. The longer the fetus is retained in utero, the greater the risk of D.I.C. and clotting
Disseminated intravascular coagulation (DIC), is a pathological process characterized by the widespread activation of the clotting cascade that results in the formation of blood clots in the small blood vessels throughout the body. This leads to compromised tissue blood flow and can ultimately lead to multiple organ damages.
She has no signs of Abruptio Placentae (Sharp pain, firm abdomen)
HELLP syndrome is a complication of preeclampsia that only happens after 20 weeks.
She shows no signs of an abortion (Vaginal bleeding, cramping, etc).
53
A 41-year-old client is expecting has a 3-year-old trisomy 21 child at home. The nurse is discussing amniocentesis and chorionic villus sampling as genetic screening methods for the expected baby. The nurse is confident that the teaching has been understood when the client makes which statement?
A/ Each test identifies a different part of the fetus' genetic makeup
B/ Chorionic Villus sampling can be performed earlier in pregnancy
C/ The test results take the same length of time to be completed.
D/ Amniocentesis is more dangerous procedure for the fetus
B/ CVS can be completed around 8-12 weeks, whereas Amniocentesis cannot be done before week 11.
Both test the genetic makeup as a whole rather than specific parts
CVS takes less time to complete
Both procedures at a risk to the fetus.
54
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A 10-week gestational client undergoes a dilatation and curettage (DC) after experiencing cramping and bright red vaginal spotting and the passage of material. The nurse should expect which expression from the client?
A/ Ambivalence
B/ Anxiety
C/ Fear
D/ Guilt
```
D/ Guilt
Associated with the loss of a fetus can be the feeling of guilt as to whether the couple or mother could have done something to prevent the miscarriage.
Anger, sadness, and disappointment are also common emotions after a loss.
55
```
After a dilatation and curettage, the nurse administers Hydroxyzine as prescribed. What is the expected outcome?
A/ Absence of nausea
B/ Minimalized pain
C/ Decreased uterine cramping
D/ Improved uterine contractility
```
A/ Nausea and tranquilization
It does not reduce fluid retention, reduce pain, decrease uterine cramping or promote uterine contractility.
Oxytocin may be used to increase contractility of uterus.
56
Rho (D) immune globulin (RhoGAM) is prescribed for a client before she is discharged after a spontaneous abortion. The nurse instructs the client that the drug is used to prevent which condition?
A/ Development of a future Rh-positive fetus
B/ An antibody response to Rh-negative blood
C/ A future pregnancy resulting in abortion
D/ Development of Rh-positive antibodies
D/ Development of Rh-positive antibodies
Rh sensitization can be prevented by Rho(D) immune globulin, which clears the maternal circulation of Rh-Positive cells before sensitization can occur.
57
```
A primigravid at 8 weeks gestation tells the nurse that she has started whoring herself out to a new sexual partner 2 weeks ago. Since then she has noticed flu-like symptoms, enlarged lymph nodes, and clusters of vesicles on her vagina. The nurse refers the client to a HCP because the nurse suspects which STI?
A/ Gonorrhea
B/ Chlamydia
C/ Syphilis
D/ Herpes Genitalis
```
D/ Herpes
Congratulations, you got Herps.
The symptoms match those typical of herpes.
Some women have no symptoms of Gonorrhea, while others experience itching and purulent discharge.
Chlamydia infections in women are usually asymptomatic, but could include a yellowish discharge and painful urination.
The first symptom of syphilis is a painless chancre (Ulcer on your yahoo)
58
When is surfactant amounts sufficient in the fetus to prevent alveolar collapse?
32 weeks gestation
59
What is Chorionic Gonadotropin? What hormone does it help release?
Hormone that is produced by the placenta after implantation. It is detected during pregnancy
Helps stimulate the release of progesterone by in-turn stimulating the corpus luteum
60
This is a hormone that helps to maintain a thick lining of the uterus by providing an area rich in vasculature in which the egg can develop further.
Progesterone
61
What is the function of the amniotic fluid?
1. Surrounds and cushions the fetus allowing for ease of fetal movement
2. Protects the fetus
3. Maintain fetal body temperature
62
What can genetic testing be done via Chroionic Villus Sampling (CVS)?
Week 10-12
63
What is the expected fetal heart rate at full term?
110-160 bpm
64
# Define the following terms:
Ductus Arteriosus
| Foramen Ovale
Ductus Arteriosus: Blood vessel that connects the pulmonary artery to the Aorta. Allowing blood from the right ventricle to bypass fetal lungs (which are non-functioning).
Foramen Ovale: Oxygen rich-blood is from the placenta (NOT the fetal lungs), so as this blood reaches the right atrium, it is more efficient for this blood to bypass the lungs and flow into the Left atrium to where it will reach the rest of the fetal body tissues.
65
A primigravida at 13 weeks gestation tests positive for syphilis. The nurses notes which complication may occur as a result of this infection during pregnancy?
A/ Premature rupture of membranes
B/ Increased RIsk of neonatal conjunctivitis
C/ Spontaneous abortions and physical deformities
D/ Exceptionally large fetus with spinal abnormalities
C/ Spontaneous abortions and physical deformities
mental subnormalities may also occur.
66
```
Under which circumstances would the nurse expect to give Zidovudine to the mother during perinatal period?
A/ HIV Infected mother
B/ Preterm labour due to viral infection
C/ Preeclampsia-induced preterm labour
D/ Gonorrhoea-infected mother
```
A/ HIV infected mother
Decreases the risk of HIV transmission to neonate
67
The nurse is providing teaching to pregnant client who is scheduled for an amniocentesis. What instruction should the nurse provide?
A/ Strict bedrest is required after procedure
B/ Hospitalization is necessary for 24 hours after procedure
C/ An informed consent needs to be signed before procedure
D/ A fever is expected after the procedure because of trauma to the abdomen
C/ Amniocentesis is an invasive procedure, informed consent must be obtained.
Rest may be needed after procedure, but light activity can resume after cramping dissipates.
Puncture site must be kept clean and client should report any signs of infections or decreased fetal movement, uterine contractions or cramping.
68
```
A nonstress test is performed on a client who is pregnant, and the results indicate non-reactive findings. the HCP orders a contraction stress test, and the results are negative. How should the nurse document these findings?
A/ Normal test result
B/ Abnormal test result
C/ A high-risk for fetal demise
D/ The need for a cesarean delivery
```
A/ Normal
Negative results indicate no late decelerations occurred in the FHR. This is a normal finding.
69
A rubella titer result of a 1-day postpartum client is less that 1:8, and rubella vaccine is prescribed before discharge. The nurse provides what information about the rubella vaccine. SELECT ALL THAT APPLY
A/ Breast feeding must be stopped for 3 months
B/ Pregnancy must be avoided for 1-3 months
C/ The vaccine is administered subcutaneously
D/ Exposure to immunocompromised individuals needs to be avoided
E/ A hypersensitivity reaction may occur if you have an allergy to eggs
F/ The area of the injection site needs to be covered with sterile gauze for 1 week
B/ No Pregnancies
C/ Subcutaneously
D/ Immunocompromised
E/ Hypersensivity reaction
Live-vaccine will not affect breast milk, so breast feeding dose not need to be stopped.
The live vaccine posses a threat to a fetus, so pregnancy should not occur for 1-3 months after vaccination.
Immunocompromised people could become infected if in contact with vaccinated client.
Vaccine is made in duck eggs, and allergies to eggs could cause a reaction.
No need for sterile gauze.
70
What is Chorioamnionitis?
Bacterial infection of the amniotic cavity that can lead to rupture of the membranes, vaginitis, pospartum endometritis, and neonatal sepsis.
71
What common side effects may a neonate experience from a mother with diabetes mellitus?
1. Large size
2. Possible Hypoglycemia
3. Hyperbilirubinemia (Jaundice)
4. Respiratory Distress
5. Hypocalcemia
6. Congenital Abnormalities
72
Which of the following clients are at a greater risk for developing gestational diabetes? SELECT ALL THAT APPLY
A/ 37-year-old multigravida
B/ 19-year-old primigravida who weighs 67kg
C/ 27-year-old who weighs 118kg
D/ 31-year-old primigravida with history of breast cancer
E/ 22-year-old primigravida with family history of diabetes mellitus who weighs 74kg
A/
C/
E/
Predisposing factors include: maternal age greater than 35 (A), Obesity (C), Multiple Gestations (A), And a family history of diabetes mellitus (E)
73
What is Disseminated Intravascular Coagulation (DIC), and what complications during pregnancy can cause DIC?
Rapid and extensive formation of clots that causes the depletion of platelets and clotting factors, thus leading to severe bleeding and potential vascular occlusion of organs from thrombemboli
```
Risk factors include:
Abruptio Placentae
Amniotic fluid embolisms
Gestational Hypertension
Intrauterine Fetal death
Liver Disease
Sepsis
```
74
What is an amniotic Fluid Embolism?
When Amniotic fluid and debris in amniotic sac enters maternal blood stream.
75
What is Endometritis and what would be done to treat it?
Infection of the lining of the uterus in postpartum period.
Treatment includes:
Administration of antibiotics
Administration of Oxytocin to increase uterine tone
Positioning in Fowler's position to facilitate drainage of Lochia
76
A primigravida at 31 weeks comes to the clinic complaining of weight loss for 2 weeks, and she states she hasn't felt her fetus move for since her last visit 3 weeks ago. What is the mother at risk of developing?
A/ Amniotic Fluid Embolism
B/ Sepsis due to Intrauterine Death
C/ Disseminated Intravascular Coagulation
D/ Hemorrhagic stroke
C/ DIC
Fetal death has occurred and as a result, clotting factors and platelets have been used since the fetus likely died weeks ago This places mother at significant risk for DIC, especially is fetal death occurred 3-4 weeks ago.
77
What are the expected treatment options for a multigravida who has developed Disseminated Intravascular Coagulation due to fetal death in utero at 34 weeks gestation? SELECT ALL THAT APPLY
```
A/ Oxygen Therapy
B/ Administration of Tocolytics
C/ Administration of Dexamethasone
D/ Delivery of fetus
E/ Heparin Administration therapy
```
A/
D/
E/
Oxygen therapy will be used.
Tocolytics are used to stop uterine contractions and are not indicated
Dexmethasone is used to increase lung surfactant in fetuses and is not indicated.
Delivery of the fetus is needed to prevent further development and consumption of coagulation factors
Heparin may be used to dissolve clots due to DIC.
78
Why should oxytocin therapy be avoided for the delivery involving a mother infected with HIV?
Oxytocin increases the risk of vaginal tearing of the need for episiotomy which could place the fetus at risk of transmission though maternal blood contact.
79
What is a hydatidiform Mole?
The formation cells that creates a grape-like cluster of edematous cysts instead of the formation of a fetus. Typically non-malignant but can become malignant.
80
Which of the following women at are the greatest risk for developing Gestational Hypertension? SELECT ALL THAT APPLY
A/ 18-year-old Primigravida, weighing 68kg
B/ 41-year-old Multigravida, with a history of asthma
C/ 32-year-old multigravida, weighing 71 kg
D/ 22-year-old multigravida with a history of hydronephrosis
E/ 27-year-old primigravida with chronic renal disease
F/ 34-year-old multigravida with a history of Rh incompatibility
A/
B/
E/
F/
```
Risk factors include:
Primigravida
Women younger than 19 and older than 40
Chronic renal disease or hypertension
Diabetes mellitus
Rh Incompatibility
History of family gestational hypertension
```
81
What are possible complications associated with Gestational Hypertension?
DIC - disseminated intravascular coagulation
Abruptio Placentae
Thrombocytopenia (Low Platelets)
Placental Insufficiency
Intrauterine growth restriction or fetal death
HELLP Syndrome
82
What is HELLP Syndrome?
A laboratory finding diagnosis for severe preeclampsia characterized by:
Hemolysis (Lysis of RBCs)
Elevated Liver enzymes
Low Platelet levels
83
```
A 34-year-old primigravida is diagnosed with severe preeclampsia, the nurse know the patient will have to administer which of the following medications, and why?
A/ Oxytocin
B/ Fentanyl
C/ Calcium Gluconate
D/ Magnesium Sulfate
```
D/ Magnesium Sulfate
Prevents seizures due to hypertension.
84
What is eclampsia? What are the symptoms and how do we treat it?
Generalized seizures due to high blood pressure during pregnancy
Call for help
Ensure open airway, turn client to side and administer O2 at 8-10L/min via face mask
Administer Medications to control seizures
Suction mouth after seizure
Prepare client for possibly delivery if warranted
85
```
A primigravida comes to the clinic complaining of flu-like symptoms and a rash. She states she hasn't been in contact with anyone who is knowingly sick, and has been staying at home watching TV with her 2 cats and her mother-in-law since last week. Which possible infection should the nurse predict?
A/ Rubella
B/ Toxoplasmosis
C/ Cytomegalovirus
D/ Herpes Zoster
```
B/ Toxoplasmosis
Typically transmitted through handling of feline feces or digesting uncooked beef.
The nurse should inquire whether the client changes the litter or if the litter is close to where she has been resting. Or if she ingested partially or uncooked beef recently.
Toxoplasmosis can cause Spontaneous abortions in the first trimester.
86
```
A multigravida delivers a neonate who suffers from Jaundice, blindness and seizures. Which is most likely the root cause of their symptoms?
A/ Herpes Simplex Virus
B/ Group B Streptococcus
C/ Rubella
D/ Cytomegalovirus
```
D/ Cytomegalovirus
Mother can be asymptomatic; most neonates can be asymptomatic at birth too.
Can also cause:
Low birth weight
Enlarged Liver and spleen
Hearing loss
87
A multigravida at 32 weeks has contracted Tuberculosis and is started on Antibiotic therapy. What should she be given to prevent fetal-neurotoxicity due to Isoniazid therapy?
Vitamin B6
88
Differentiate the 4 stages of labour.
Stage 1:
Contractions begin and worsen cervical dilation is anywhere from 1-10 cm but doesn't include active pushing. The focus is on monitoring status and ensuring comfort measure as labour progresses.
Stage 2: Active pushing and expulsion of the fetus occur. Cervical dilation is complete and delivery begins.
Stage 3:
Expulsion of the placenta anywhere from 5-30 minutes after fetus. Assessment of mother is crucial at this period to ensure placenta is fully delivered and post-partum hemorrhaging does not occur.
Stage 4:
Physical Recovery period for mother and babe. 1-4 hours after delivery of the placenta, with focus on maternal assessments routinely. Previous health status should return to pre-pregnancy normal (BP, pulse, Blood sugars)
89
Differentiate between the following phases of stage 1 of delivery:
Latent
Active
Transient
Latent Phase:
Cervical dilation is 1-4 cm
Uterine contractions are far apart (15-30 minutes)
Active Phase:
Cervical Dilation is 4-7cm
Uterine contractions are roughly 3-5 minutes apart and longer in duration.
Transient Phase:
Cervical dilation is 8-10 cm
Uterine contractions are every 2-3 minutes and are increasing in strength and duration
90
The nurse in the labour and delivery room is caring for a client in the active stage of the first phase of labour. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action?
A/ Administer O2 via face mask
B/ Place mother in supine position
C/ Increase the rate of Oxytocin IV
D/ Document the findings and continue to monitor the fetus
A/ Oxygen therapy
Late decelerations are due to uteroplacental insufficiency and occur due to decreased blood flow rich in oxygen to the fetus.
8-10 L via face mask is needed to provide an adequate supply.
The client could also be placed on her side to relieve pressure on her vena cava caused by the extended uterus.
Oxytocin would be discontinued when late decelerations are noted as it causes further hypoxemia due to the increases stimulation of the uterus during contractions. However, Oxygen would be the first route of therapy.
91
```
The nurse is assessing a client scheduled for a cesarean delivery. Which of the following findings would indicate the need to contact their HCP prior to surgery?
A/ Hemoglobin of 110mmol/L
B/ Fetal heart rate of 180 bpm
C/ Maternal Pulse of 85 bpm
D/ WBC count of 12000 cells/mm
```
B/ Fetal HR
A normal FHR is 110-160 bpm. This heart rate indicates stress on the fetus and would warrant immediate notification to the HCP.
By full term, normal maternal Hgb is between 110mmol/L and higher due to increased plasma volume.
Maternal pulse is normal
WBC count in second and third trimesters will elevate with a normal range of 11000 cells/mm - 15000 cells/mm. During immediate pospartum, these values go increase by as much as 25000-30000 cells/mm
92
```
The nurse is reviewing the record of a client in the labour room and notes that the HCP documented tat the fetal presenting part is at -1 station. This finding indicates that the fetal presenting part is located at which area?
A/ 1 inch below the coccyx
B/ 1 cm below the iliac crest
C/ 1 cm above the ischial spine
D/ 1 inch below the symphysis pubis
```
C/ 1 cm below the ischial spine
The measurements are always in centimeters, never inches. Use this as a way of narrowing down the correct answers.
The iliac crest is the top of the pelvic bone and the ischial spine is slightly below to symphysis pubis and are bilateral protruberances on the inside of the lower pelvis.
93
A client is rushed into the birthing centre in active labour. Her membranes are still intact and the HCP prepares to perform an amniotomy. What will the nurse relay to the client as the most likely outcome of the amniotomy?
A/ Decreased pressure on her cervix
B/ Decreased number of contractions
C/ Increased efficiency of contractions
D/ The need for increased maternal blood pressure monitoring
C/ increased efficiency of contractions
Amniotomies can be used to induce labour. It allows the fetal head to contact the cervix more directly and may increase the efficiency of contractions.
94
```
The nurse is monitoring a client in labour. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction?
A/ Variability
B/ Accelerations
C/ Early Decelerations
D/ Variable Decelerations
```
D/ Variable Decelerations
Variable Decelerations occur if the umbilical cord becomes compressed, reducing blood flow between the placenta and fetus. Variability refers to the fluctuations of the fetal heart rate baseline.
Accelerations are a reassuring sign and usually occur with fetal movement.
Early decelerations result from pressure on the fetal head during contractions.
95
A client is being rushing into the Operating room for a cesarean section. What position should the nurse place the client on the operating table?
A/ Supine position with a wedge under the right hip
B/ Trendelenburg's position
C/ Prone position with the legs separated and elevated
D/ Semi-fowler's position with a pillow under the knees
A/ Supine with wedge under right hip
Vena cava and descending aorta compression by the pregnant uterus impedes blood return from the lower trunk and extremities. This leads to decreasing cardiac return, cardiac output and blood flow to the uterus and subsequently the fetus.
Trendelenburg's Position would place pressure on the client's lungs and diaphragm due to the uterus, therefore decreasing her oxygenation and respiratory capacity.
The other two positions should be obvious as illogical for abdominal surgery.
96
A client is active labour is having contractions every 3 minutes that last for 45 seconds. The nurse notes that the fetal heart rate between contractions is 104 bpm. What nursing intervention is most appropriate?
A/ Notify the HCP
B/ Continue to monitor the fetal heart rate
C/ Encourage the client to continue pushing with each contraction
D/ Instruct the client's coach to encourage deep breathing techniques
A/ Notify the HCP
A normal Fetal HR is 110-160 bpm between contractions. Fetal bradycardia between contractions could indicate the need for immediate medical management and the HCP or midwife must be notified.
97
During an assessment of the fetal heart rate patterns on a client in labour, the nurse notices the presence of episodic accelerations. Which action by the nurse is most appropriate?
A/ Notify the HCP of the findings
B/ Reposition the mother and check the monitor for further changes
C/ Take the mother's vital signs and tell her that bed rest is needed to conserve oxygen
D/ Document the findings and tell the mother that the pattern on the monitor indicates fetal well-being
D/ Fetal well-being
Accelerations often indicate fetal movement which then causes increases in fetal HR. This is a sign of fetal well-being and proper oxygenation of the fetus.
98
The nurse is assessing a client undergoing induction of labour at 41 weeks. The client's contractions are moderate and occurring every 2-3 minutes with a duration of 60 seconds each while on Oxytocin IV. An internal fetal heart monitor is in place with a baseline of roughly 124 bpm. What is the priority nursing action?
A/ Notify the HCP
B/ Discontinue the infusion of Oxytocin
C/ Place O2 face mask on the client at 8-10L/min
D/ Contact the client's primary support person(s) is not currently present.
B/ Discontinue Oxytocin Drip
Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta.
After stopping the oxytocin, the nurse should reposition the mother, apply oxygen to the client, increase IV solution (not oxytocin), and notify the HCP as delivery will begin soon.
Contacting family is not a priority at this time. If they ain't there, they miss out.
99
```
A multigravida at 32 weeks gestations comes to the clinic complaining of copious fluid leakage from her perineal area. After the assessment, it is revealed that the client's membranes have ruptured, the fetal heart monitor shows a baseline of 157 bpm. What is the first priority for the nurse?
A/ Administer antibiotics and tocolytics
B/ Monitor fetal and maternal status
C/ Administer vaginal examination
D/ Notify the HCP
```
B/ Monitor mother and fetus
Only administer antibiotics if signs of infections are present (abnormalities in amniotic fluid, fetal tachycardia, maternal fever, etc).
Tocolytics are used to prevent contractions and are unlikely to be prescribed at 32 weeks unless determined by the HCP as appropriate.
Vaginal examinations after membrane ruptures can increase the risk of infection and should be avoided if possible.
The HCP should be notified but if not the first priority. The maternal and fetal status should be obtained first
100
The nurse is training a novice nurse on how to resolve their client's prolapsed umbilical cord. The novice nurses requires further education when they suggest which of the following methods to correct a prolapsed umbilical cord?
A/ Place client in Tendeleburg's position
B/ Administer O2 at 4-5L/min
C/ Prepare to start IV fluids or increase the current rate of infusion
D/ Prepare for immediate birth
E/ Monitor fetal heart rate and assess fetus for hypoxia
B/ Administer Oxygen at 4-5L/min
Oxygen would be applied via face mask at 8-10L/min to provide adequate oxygenation
All other suggestions would be appropriate.
101
A primigravida at 30 weeks comes to the clinic stating that she has been experiencing pain that started bleeding 4 hours ago without any pain or cramping. She describes the blood as bright red. Upon examination, the nurse notes that her uterus feels soft to the touch and larger in size than expected gestational age. Based on these findings, the nurse expects which complication?
A/ Placenta Previa
B/ Abruptio Placentae
C/ Amniotic Fluid Embolism
D/ Fetal Distress due to Hypertensive episode
A/ Placenta Previa.
The cardinal sign of placenta previa is the sudden onset of BRIGHT red bleeding with no pain or tenderness. The fundal height may be bigger than expected, and the uterus will feel soft.
102
What symptoms would a nurse expect to find an a client experiencing Abruptio Placentae?
SELECT ALL THAT APPLY
```
A/ Dark Red bleeding from vagina
B/ Boggy and tender Uterus
C/ Severe Abdominal Pain
D/ Fetal distress
E/ Maternal Pallor
F/ Maternal hypotension
```
A/ Dark Red bleeding from vagina
C/ Severe Abdominal Pain
D/ Fetal distress
The uterus will not be boggy or soft, but more rigid and tender.
Maternal Pallor and Hypotension are not necessarily the case with Abruptio.
Other signs include:
Maternal Shock if bleeding is excessive
103
What is Vena Cava syndrome? What assessment findings might you expect to find and what interventions can be provided to the client?
When the venous return to the heart is impaired by the weight of the uterus on the vena cava. This is the partial occlusion of the vena cava and aorta that results in decreased cardiac return and output and blood pressure... ultimately affecting fetal supply.
```
Assessment finding:
Pallor, faintness, dizziness
Tachycardia
Hypotension
Sweating, cool damp skin
Fetal distress
```
Intervention:
Reposition mother onto one of her sides to shift her weight off the venous return.
104
A primigravida at 38 weeks gestation, comes to the Emergency room via EMS complaining of severe chest pain, dyspnea, cyanosis, and tachypnea that began 45 minutes ago. Her BP is 89/58 and is experiencing chills. The fetal monitor shows a baseline of 97 bpm and diminished fetal activity. The nurse suspects which of the following?
A/ Pulmonary embolism due to bedrest
B/ Amniotic Fluid Embolism
C/ Intrauterine Fetal Demise induced Disseminated intravascular coagulation
D/ Endocarditis
B/ Amniotic fluid embolism
AFE is a condition in which amniotic fluid enters maternal circulation, specifically her pulmonary arterioles causing pulmonary edema. Eventually leading to certain complications such as respiratory failure, disseminated intravascular coagulation, cardiovascular collapse, seizures, coma, and maternal death.
Signs of an Amniotic Fluid embolism include:
Abrupt onset of respiratory distress and chest pain
Cyanosis
Fetal bradycardia (if delivery has not occurred)
105
What assessment findings may you expect on a client experiencing fetal distress?
SELECT ALL THAT APPLY
```
A/ Fetal HR of 121 bpm
B/ Meconium-stained amniotic fluid
C/ Fetal hypoactivity
D/ Late decelerations
E/ Vaginal bleeding
```
B/ Meconium-stained amniotic fluid
D/ Late decelerations
Fetal HR with either be bradycardic (less than 110 bpm) or tachycardic (more than 160 bpm)
The fetus will be hyperactive, not hypoactive.
Vaginal bleeding is not associated with fetal distress necessarily
Other symptoms may include:
Progressive decrease in baseline variability
Late deceleration in fetal monitoring
106
What is the most serious complication of Intrauterine Fetal Demise?
Disseminated Intravascular Coagulation disorder
This is caused by fetal consumption of platelets and coagulation factors in maternal circulation. Signs of DIC may include bleeding from puncture sites.
107
```
What amount of vaginal bleeding after delivery warrants inspection and investigation into post-delivery hemorrhaging?
A/ 200mL
B/ 500mL
C/ 750mL
D/ 1000mL
```
B/ 500mL indicates the potential of a hemorrhage
108
A woman returns to the hospital 2 days after vaginal delivery with zero complications. She is complaining of vaginal bleeding and abdominal tenderness. Upon assessment, the nurse discovers the client is likely suffering from involution and expects which of the following treatment options.
SELECT ALL THAT APPLY
A/ Administration of Oxytocin IV
B/ Leg elevation
C/ Administration of O2 via face mask at 8-10L/min
D/ Monitoring of Hematocrit and Hemoglobin Levels
E/ Catheterization to reduce urinary retention
F/ Administration of Methylergonovine Maleate
B/ Leg elevation
D/ Monitoring of Hematocrit and Hemoglobin Levels
F/ Administration of Methylergonovine Maleate
Subinvolution is the incomplete or failure of the uterus to return to it's normal size and condition.
Leg elevation with improve venous return associated with subinvolution
Hematocrit and hemoglobin levels should be monitored
Methylergonovine Maleate will provide sustained contraction of the uterus and help it return to normal size
Catheterization is not required, HOWEVER, frequent voiding will aid the process. Oxytocin is not required, neither is O2 therapy.
109
The nurse is monitoring a client in the immediate postpartum for signs of a hemorrhage. Which of the following may be an early sign of excessive blood loss?
A/ A temperature of 38.8 Celsius
B/ Increased pulse rate from 88 to 103 bpm
C/ A blood pressure change from 130/88 to 110/71 mmHg
D/ Increase in respiratory rate from 18 to 22 breaths/min
B/ Increased Pulse rate
Tachycardia is an early sign of blood loss as the heart pumps faster to compensate for reduced blood volume.
Slight increase in temp is normal.
Decreased blood pressure would appear with blood loss but in the later stages as more blood is lost.
Respiratory rate is an insignificant finding
110
```
The nurse is assessing a client who recently had a cesarean section. She is looking for signs and symptoms of superficial venous thrombosis. Which sign 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
```
C/ Enlarged, hardened veins
Thrombosis of superficial veins is accompanied by swelling, redness, tenderness, and warmth of the extremity. The vein may even be palpable. Client may also experience pain when they walk.
111
A client in the postpartum unit complains of sharp chest pain and dyspnea. The nurse notes the client is tachycardic at 129 bpm, and her respiratory rate is 31 breaths/min. The nurse suspects a pulmonary embolism and initiates which intervention first?
A/ Initiate IV line
B/ Assess her BP
C/ Prepare to administer Morphine Sulfate
D/ Administer O2, 8-10L/min via face mask.
D/ Administer Oxygen
If pulmonary embolism is suspected, oxygen should be administered to decrease hypoxia. The client is also kept on bed rest with the head of the bed elevated to relieve dyspnea.
Morphine may be prescribed but it is not an initial action. IV line would also be prescribed but is not an initial action either.
Vital should always be monitored, but oxygenation is most important for this client.
112
The RN is preparing to care for 4 different clients. WHich of the following clients is at greatest risk for postpartum hemorrhage?
A/ A primigravida who delivered 4 hours ago
B/ A multigravida who delivered 6 hours ago
C/ A primigravida who delivered 6 hours ago and had epidural anesthesia
D/ A multigravida who delivered a large baby after oxytocin induction
D/ Huge Baby, little hole.
The cause of postpartum hemorrhaging is due to uterine atony; laceration of the vagina; hematoma development in the cervix, perineum, or labia; and retained placental fragments. Predisposing factors include a previous history of postpartum hemorrhage, placenta previa, abruptio placentae, overdistention of the uterus from polyhydramnios, multiple gestations, large neonates, infections, multiparity, dystocia or labour that is prolonged, etc....
This client has the most risk factors.
113
```
The nurse is monitoring a client in the postpartum unit who received epidural anesthesia for delivery for the presence of a vulvar hematoma. What assessment finding would best indicate the presence of a hematoma?
A/ Changes in vital signs
B/ Signs of heavy bruising
C/ Complaints of intense pain
D/ Complaints of a tearing sensation
```
A/ Changes in vitals
Because she was anesthetized, she cannot feel pain, pressure, or a tearing sensation. Changes in vital signs would indicate hypovolemia.
Heavy bruising may be seen, but changes in vitals would indicate a hematoma caused by blood collection in perineal tissues.
114
Briefly, explain the Moro Reflex.
When holding the neonate in the semi-sitting position, the examiner allows the head and body to fall backward slightly. The neonate will then assume a sharp extension and abduction of their arms (Reaching outwards) with the thumbs and forefingers in a "C" position.
Persistent response lasting longer than 6 months may indicate neurological anomalies.
115
Explain the Babinski Reflex.
Beginning at the heel, use a finger or tool to stroke gently upward along their foot and then along the ball of the foot.
Toes will hyperextend while the big toe will dorsiflex (Curl outward or up).
Absence of the reflex indicates need for neurological assessment
116
What are the common signs of Respiratory Distress in Neonates?
Nasal Flaring
Increasingly severe retractions of neck muscles
Grunting
Cyanosis
Bradycardia and periods of apnea longer than 15 seconds
117
What is Meconium Aspiration Syndrome? What is the intervention?
Unknown cause... Release of meconium into amniotic fluid due to stressfull fetal event causing aspiration of meconium. Can also occur during first breath. Respiratory distress at birth may be present. Nails, skin, and umbilical cord may be stained yellowish-green
Intervention:
Suction MUST be done immediately after the head is delivered and before the first breath is taken.
118
What is intraventricular Hemorrhaging in neonates? What are some signs and symptoms?
Bleeding from the ventricles in the brain due to prematurity, respiratory distress, trauma, asphyxia.
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Assessment:
Diminshed or absent Moro Reflex (dropping)
Lethargy
Apnea
Poor feeding
High-pitched Shrill crying
Seizure Activity
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119
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A 6 day-old neonate born at 31 weeks gestation is rushed into the NICU. The nurse notes increased abdominal girth, absent bowel sounds, vomiting, bile-stained emesis, and occult blood in the stool. Based on these findings, what might the nurse suspect?
A/ Hyperbilirubinemia
B/ Necrotizing Enterocolitis
C/ Hirschsprung's disease
D/ Retinopathy of Prematurity
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B/ Necrotizing Enterocolitis
Acute inflammatory disease of the GI tract that typically occurs 4-10 days after birth is most often seen in preterm babies.
120
Explain Hyperbilirubinemia in neonates. Provide assessment findings and interventions.
Hyperbilirubinemia (Jaundice) occurs in neonates with immature Livers that have difficulty in replacing old red blood cells. As a result, a hig concentration of bilirubin circulates in the blood causing yellowing of the skin and sclera.
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Assessment may show:
Enlarged Liver
Elevated Serum Bilirubin
Yellowing of skin and Sclera
Lethargy
Poor Sucking reflex
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Interventions:
Keep baby well hydrated to maintain blood volume
Facilitate early, frequent feeding to hasten the passage of meconium and encourage excretion of bilirubin
Phototherapy (Lamp or UV Blanket)
121
What does the Acronym TORCH represent in neonates? Define each term
T- Toxoplasmosis - Harmful parasite that is transmitted to fetus and results in severe physical and developmental abnormalities. Common in feline feces and raw beef
O - Other organisms and Infections - Can include gonorrhea, syphilis, variacella, Hep B, HIV, HPV, etc
R - Rubella - Systemic Viral infection that causes congenital Rubella syndrome if infected in first trimester. Can result in Congenital Heart disease, Growth retardation, Pneumonia, Deafness, etc.
C - Cytomegalovirus - Viral infection that persists in the body indefinitely; has periods of reactivation without symptoms. Can infect fetus or newborn during delivery or after birth through breast milk. May cause: Microcephaly, Blindness, Deafness, Mental and Motor retardation
H - Herpes Simplex - Sexually transmitted with periods of reactivation. Newborn commonly infected during delivery by contact with perineal lesions. Cause neurological impairment or death.
122
A primigravida at 35 weeks gestation visits the clinic for the first time and admits she's an active heroin addict. Knowing this, the nurse can expect the neonate to present which which of the following traits. SELECT ALL THAT APPLY
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A/ Lethargy
B/ Negative Babinski Reflex
C/ High-pitched Cry
D/ Hyperactivity
E/ Low nasal bridge
F/ Respiratory Distress
G/ Seizures
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C/ High-pitched Cry
D/ Hyperactivity
F/ Respiratory Distress
G/ Seizures
Other symptoms include:
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Irritability
Tremors
Vomiting
Sneezing
Fever
Diarrhea
Excessive sweating
Poor feeding
Extreme sucking of fists
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123
A multigravida who suffers from alcohol dependence recently gave birth to a baby girl at full term. Upon assessment, the nurse notices the following traits of Fetal Alcohol syndrome.
SELECT ALL THAT APPLY
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A/ Short nose with low bridge
B/ Hyperactivity
C/ Diarrhea
D/ Hypoplastic Philtrum
E/ Thin Upper lip
F/ Sneezing
G/ Tremors
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A/ Short nose with low bridge
D/ Hypoplastic Philtrum
E/ Thin Upper lip
G/ Tremors
Hyperactivity is seen with addicted neonates, so too is sneezing.
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Other characteristics include
Flat mid-face
Abnormal Palmar creases
Respiratory distress
Congenital heart defects
Irritability and hypersensitivity to stimuli
Poor feeding
Seizures
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124
What are important interventions and warning signs to watch for in neonates born with Fetal Alcohol Syndrome?
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Monitor for respiratory distress
Monitor For hypoglycemia
Assess suck and swallow reflex
Suction as needed and place neonate on side to facilitate proper clearance of fluids
Decrease environmental stimuli
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125
A primigravida at 10 weeks gestation is concerned to have her baby knowing she is HIV positive. Which of the following statements involving HIV and pregnancy is incorrect?
A/ Neonates cannot Room with mothers after delivery in order to prevent transmission
B/ Antiviral medications might be given for the first 6 months of life
C/ HIV positive mothers cannot breast feed their neonates
D/ Neonates with HIV are prone to impaired growth and development
E/ Neonates with HIV can receive all routine vaccines except MMR and Varicella
A/ Neonates CAN room with their mother regardless of infection status
Antiviral medications may even be given beyond 6 months of life.
HIV positive mothers cannot breast feed their infants as this is a means of transmission
HIV neonates are prone to growth impairment, and hepatomegaly, splenomegaly, and lymphadenopathy
Vaccines are safe as long as they are not living (MMR, Varicella).
Also,
Circumcisions are not done until neonate HIV status is known.
Neonate skin must be thoroughly cleaned prior to any invasive procedures.
126
The mother of a newborn calls the clinic and reports that when cleaning the umbilical cord, she noted that the cord was moist and there was discharge. What is the best response form the nurse?
A/ Bring the infant to the clinic
B/ This is a normal occurrence
C/ Increase the number of times that the cord is cleaned per day
D/ Monitor the cord for another 24-48 hours and call the clinic if the discharge continues
A/ Bring em in
Symptoms of umbilical infection include moistness, oozing, discharge and a reddened base around the cord. If symptoms of infection occur, they need to see their HCP. Antibiotics may be needed.
127
Which assessment finding of a preterm neonate would suggest the possibility of respiratory distress syndrome?
A/ Tachypnea and retractions
B/ Acrocyanosis and grunting
C/ Hypotension and Bradycardia
D/ Presence of Barrel chest and acrocyanosis
A/ A neonate with Respiratory distress may present with cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.
Acrocyanosis (a blue colouration of the hands and feet) is associated with premature peripheral circulation and is common in the first few hours of life.
The other options are stupid.
128
The nurse is preparing a plan of care for a newborn with fetal alcohol syndrome. The nurse should include which priority intervention in the plan of care?
A/ Allow the newborn the establish it's own sleep-rest pattern
B/ Maintain the newborn in a brightly lighted area of the nursery
C/ Encourage frequent handling of newborn by staff and parents
D/ Monitor newborn response to feedings and weight gain
D/ Monitor
Primary nursing goal for fetal alcohol syndrome is to establish nutritional balance. These neonates may be hyperirritable, exhibit vomiting, diarrhea, or uncoordinated sucking and swallowing ability.
A quiet environment with minimal stimuli and handling would help establish appropriate sleep-rest cycles.
129
The nurse is preparing to care for a neonate undergoing phototherapy. Which interventions should be included in the plan of care? SELECT ALL THAT APPLY
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A/ Avoid stimulation
B/ Decrease fluid intake
C/ Expose all of the newborn's skin
D/ Monitor Skin temperature closely
E/ Reposition neonate q2h
F/ Cover neonate's eyes with eye shield or patches
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D/ Monitor Skin temperature closely
E/ Reposition neonate q2h
F/ Cover neonate's eyes with eye shield or patches
Adverse affects of phototherapy include eye damage, dehydration and sensory deprivation. Interventions include exposing as much skin as possible; however their genital are covered.
Skin temperature should be monitored closely and increases to fluid to compensate for water loss is needed.
Repositioning q2h is needed, along with stimulation.
130
The nurse prepares to administer a Vitamin K shot to a neonate, and the mother asks the nurse why her infant needs the injection? What is the best response from the nurse?
A/ Your baby needs vitamin K to develop their immunity
B/ Vitamin K will help your baby from getting Jaundice
C/ Newborns have sterile bowels, and vitamin K will promote the growth of good bacteria in the bowel
D/ Babies are deficient in vitamin K, and this injection prevents your baby from bleeding.
D/ Bleeding
Vitamin K is needed to synthesize coagulation factors. It promotes liver formation of clotting factors.
131
A labouring client with preeclampsia is prescribed Magnesium sulfate 2g/h IV. The pharmacy sends the medication labelled Magnesium sulfate 20g/500mL in NS. To delivery the correct dose, the nurse should set up the pump to delivery at how many millilitres per hour? Record your answer to one decimal place.
50mL/hour
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2g / 20g x 500mL = 50mL/hour
Doc / Stock x volume
132
During routine assessment of a primigravida, the nurse determines the following vital signs:
145/96 BP
80 bpm HR
16 Respirations/min
What further information should he investigate to determine if she is suffering from preeclampsia?
Proteinuria (Protein in the urine)
Blood Pressure greater than 140/90 and protein in the urine are clinical signs of preeclampsia. If there is no protein in her urine, it may be transient Hypertension.
133
A 34-year-old multigravida with severe preeclampsia is undergoing Magnesium Sulfate treatment at 3g/h. To maintain safety of the client, the priority intervention is to:
A/ Maintain continuous fetal monitoring
B/ Routine blood work and urinalysis q6h
C/ Assess reflexes, clonus, visual disturbances and headaches
D/ Monitor maternal liver studies q4h
C/ Assess CNS system
CNS system functioning and freedom from injury is a priority in maintaining well-being for both mother and fetus.
Continuous fetal monitoring is important but only serves to monitor the fetus.
loss of reflexes could be a sign of Mg toxicity
134
A client at 28 weeks gestation enters the Emergency department complaining of a splitting headache. What actions are indicated by the nurse at this time? SELECT ALL THAT APPLY
A/ Reassure the client that headaches are a normal part of pregnancy
B/ Assess the client for vision changes or epigastric pain
C/ Obtain a non-stress test
D/ Assess the client's reflexes and presence of clonus
E/ Determine if the client has a documented ultrasound for this pregnancy
B/ Assess the client for vision changes or epigastric pain
C/ Obtain a non-stress test
D/ Assess the client's reflexes and presence of clonus
She may be showing signs of preeclampsia/eclampsia as headaches are a common sign.
Assess her vision and epigastric pain, along with reflexes and clonus (Uncontrollable reflex)
135
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A 16-year-old primigravida with severe preeclampsia at 37 weeks is in early active labour. The client's BP reaches 165/112. Which finding would alert the nurse that she may be about to experience a seizure?
A/ Decreased contraction intensity
B/ Decreased Temperature
C/ Epigastric Pain
D/ Hyporeflexia
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C/ Epigastric pain
This is thought to be related to Liver ischemia prior to seizure activity.
Typically, their temperature may increase prior to a seizure due to increased Intracranial pressures. They would also exhibit Hyperreflexia not Hyporeflexia
136
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Following an Eclamptic seizure the nurse would assess the client for which of the following?
A/ Polyuria
B/ Facial Flushing
C/ Hypotension
D/ Uterine Contractions
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D/ Uterine contractions
After the seizure, the client will be in a deep sleep or coma. So the nurse must determine and monitor for impending labour, this is done by observing for signs of contractions
Typically the client will have Oliguria (Abnormally small amounts of urine) instead of polyuria
They will also remain hypertensive after the seizure.
137
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A client at 29 weeks gestation begins to exhibit signs of labour after undergoing an eclamptic seizure. The nurse must assess the client for:
A/ Abruptio Placentae
B/ Transverse lie
C/ Placenta Accreta
D/ Uterine Atony
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A/ Abruptio Placentae
This is due to massive vasoconstriction during the seizure that results in hemorrhaging into the decidua basalis (Maternal part of the placenta)
Transverse lie (shoulder presentation) is related to relaxation of the abdominal wall, preterm fetus, placenta previa, abnormal uterus, contracted pelvis, and excessive amniotic fluid.
Placenta accreta (a rare phenomenon) is a condition in were the placenta abnormally adheres to the uterine lining
Uterine atony or a relaxed uterus may occur after childbirth, leading to postpartum hemorrhaging
