maternity

Question 1

impaled object

Answer 1

stabilization of the object is the first priority

IV line & fluids

Blood may be drawn

Question 2

when to activate the
rapid response team

Answer 2

to prevent a client from deterioration into a code/arrest

An acute change in any of the following:
HR <40 or >130/min
SBP <90 mm Hg
RR <8 or >28/min
O2 <90% despite oxygen
Urine output <50 mL/4 hr
LOC

Question 3

Arterial line
low pressure alarm

Answer 3

hypotension.
check the client for evidence of hypotension and the cause
hemorrhage at connection sites of the tubing and catheter.
verify that these connections are tight on admission of the client to the ICU.

A fast flush of the arterial line system (square wave test) should be performed after the nurse has ruled out a physiological cause of the low pressure alarm. This test helps to verify if the arterial line is functioning correctly.

The transducer should be leveled to the client’s phlebostatic axis

Question 4

Hypothermia

Answer 4

dysrhythmias

handle gently as spontaneous ventricular fibrillation could develop when moved or touched.
place client on a cardiac monitor ,
anticipate defibrillation

Two large-bore IV catheters
blood draw
Covering the client’s head

Question 5

Treatment of frostbite

Answer 5

X no massageX

Remove clothing
warm water soaks
analgesia
elevating injured areas
applying loose, nonadherent, sterile dressings
monitoring for compartment syndrome

Question 6

Breast engorgement

Answer 6

don’t breastfeed or hand express

ice packs to both breasts for 15-20 minutes every 3-4 hours

chilled, fresh cabbage leaves to both breasts

anti-inflammatory analgesic (eg, ibuprofen)

supportive bra, breast binder) until milk flow is diminished

Question 7

mom has not voided within 6-8 hours after birth

Answer 7

intermittent urinary catheterization may be indicated

Delayed voiding can increase the risk for postpartum hemorrhage

Urinary retention can cause bladder distension, which may be noted by a displaced and/or boggy uterus, or by a palpable bladder

Question 8

postterm gestation
≥42 weeks

Answer 8

Deep plantar creases over the entire sole of the foot

Dry, cracked, and peeling skin, especially on the hands and feet

Abundant scalp hair and long fingernails

Minimal to absent vernix caseosa

Signs of meconium passage in utero (eg, meconium-stained [yellowish-green] skin or nails)

Question 9

Cardiac arrest in infants

Answer 9

activate the emergency response system

assess for a pulse by palpating the brachial artery for 5-10 seconds

Chest compressions should be initiated after PPV if the heart rate remains <60/min

Question 10

weight loss
During the first 3-5 days of life

Answer 10

5%-10% of birth weight is expected due to fluid excretion (eg, urine, stool, respirations)

return to their birth weight after 7-14 days of life.

Weight loss >10% of birth weight warrants further evaluation.

Question 11

no stool (ie, meconium) is noted within 24-48 hours of birth

Answer 11

nurse should request immediate evaluation

imperforate anus is a congenital malformation of the anorectal opening that prevents normal stool passage

Question 12

newborn is experiencing a bowel obstruction?

Answer 12

Green vomit
-represents bile from the intestine, which could indicate a bowel obstruction.

Question 13

Hepatitis B virus infection is a bloodborne illness that poses a significant risk to the newborn

Answer 13

breast feeding is fine

Hepatitis B immunoglobulin and hepatitis B virus vaccine should be administered to the newborn within 12 hours of birth

Question 14

Average newborn head circumference

Answer 14

13-14 in (33-35 cm)

A smaller or larger head circumference may indicate an abnormal condition (eg, microcephaly, hydrocephalus).

Question 15

Asymmetric arm movement while testing the Moro reflex

a complication associated with a vacuum-assisted birth

Answer 15

fracture (eg, clavicular, humerus) or brachial plexus injury

Question 16

Moro reflex (ie, startle reflex)

Answer 16

present until age 3-6 months

a response to sudden loud noises and jarring of the crib

Initially, the newborn extends and raises the arms with fingers fanned out and then curls into the fetal position

Absence of the Moro reflex may indicate an underdeveloped or damaged brain or spinal cord and should be reported to the health care provider

Question 17

Transient acrocyanosis without central cyanosis during the first day of life

Answer 17

normal

promote warmth by placing the newborn skin-to-skin

Question 18

normal newborn vitals

Answer 18

BG 2.2-2.5 mmol/L

36.5 C

respirations 60/min
+ periodic pauses lasting <20 seconds

Question 19

Poorly controlled maternal diabetes

Answer 19

polycythemia (ie, hematocrit >65%).

Question 20

resp distress

Answer 20

Sustained tachypnea
nasal flaring,
retractions,
grunting

. Respiratory distress may be related to retained amniotic fluid in the lungs, meconium aspiration, or infection

Question 21

Teaching about newborn home care

Answer 21

Monitor for bulging or indentation of fontanels, which can indicate complications (eg, hydrocephalus, dehydration) because open fontanels are soft spots where the skull bones have not yet fused.

Fold the diaper under the cord to keep the cord dry and prevent irritation and contamination with urine or feces

Expect a loss up to 10% of birth weight in the first few days of life before the newborn begins to gain weight consistently

Feed the newborn every 2-3 hours due to small stomach capacity

Question 22

oxytocin is initiated at the lowest possible dose and titrated until contractions are of moderate-to-firm intensity and 2-3 minutes apart. The infusion is decreased/discontinued if uterine tachysystole (ie, >5 contractions in 10 minutes) or fetal distress occurs.

Answer 22

oxytocin LOW and SLOW

contractions 2-3 min apart :)

Question 23

give narcotics. during the PEAK of contractions

Answer 23

(eg, nalbuphine, butorphanol, meperidine)

can help decrease sedation of the fetus and subsequent newborn respiratory depression at birth

Question 24

Amniotomy = artificial rupture of membranes (AROM)

Answer 24

to augment or induce labor

Monitor the client’s temperature at least every 2 hours

Assess the fetal heart rate before and after

Note the amniotic fluid color, amount, and odor

side-lying or upright position

Question 25

vaginal birth after cesarean (VBAC)

Answer 25

increased risk for uterine rupture due to previous surgical scarring of the uterus first sign of uterine rupture is usually abnormal fetal heart rate (FHR) patterns sudden cessation of uterine contractions abnormal fetal heart rate (FHR) patterns

Question 26

uterine tachysystole (ie, >5 contractions in 10 minutes averaged over 30 minutes)

Answer 26

common adverse effect of oxytocin late decelerations, fetal tachycardia, bradycardia= -stop oxytocin immediately -side-lying position -oxygen via face mask at 8-10 L/min -IV fluid bolus -subcutaneous injection of terbutaline (Brethine) to relax the uterus if other interventions are unsuccessful Notifying the health care provider

Question 27

shoulder dystocia

Answer 27

Documenting the exact time of events (eg, birth of fetal head, shoulder dystocia maneuvers) Verbalizing passing time to guide decision-making by the health care provider (eg, "two minutes have passed") Performing maneuvers to relieve shoulder impaction (eg, McRoberts maneuver, suprapubic pressure) Requesting additional help

Question 28

forceps or a vacuum extractor

Answer 28

used to shorten the second (pushing) stage of labor nurse ensures that the client's bladder is empty, monitors for contractions, and documents the time that forceps or a vacuum extractor was applied. X never apply fundal pressure X

Question 29

intrauterine fetal demise (fetal death after 20 weeks gestation)

Answer 29

have an increased risk for DIC due to the release of thromboplastin from the retained fetus, which activates the coagulation cascade prioritize collecting blood specimens for baseline laboratory tests (eg, coagulation studies, platelet count apply a tocodynamometer to monitor for uterine contractions and initiate prescribed oxytocin after obtaining a blood specimen for laboratory tests

Question 30

Color of the amniotic fluid

Answer 30

should be colorless and without a foul odor. Yellow-green fluid can indicate fetal passage of meconium in utero and lead to respiratory distress in the newborn (ie, meconium aspiration syndrome)

Question 31

late deceleration

Answer 31

IV fluid bolus Repositioning the client laterally Discontinuing the IV oxytocin infusion

Question 32

recurrent variable decelerations

Answer 32

caused by umbilical cord compression. Vibroacoustic stimulation is used during nonreactive nonstress testing (ie, no accelerations) to provoke fetal movement. It is never performed during FHR decelerations or fetal bradycardia. amnioinfusion (ie, instillation of fluid into the uterine cavity) is indicated

Question 33

A client, gravida 4 para 3, at 38 weeks gestation arrives in the emergency department with strong contractions that began 1 hour ago. The client is diaphoretic, grunting, and yelling loudly that she wants an epidural because she feels the need to push. What priority action should the nurse take?

Answer 33

If a client arrives at the hospital in second-stage labor (ie, pushing), the nurse rapidly assesses whether birth is imminent by applying gloves and observing the perineum for bulging or crowning of the presenting fetal part

Question 34

Normal findings in labor

Answer 34

Fetal heart rate (FHR) baseline of 110-160/min FHR accelerations (ie, ≥15 beats above baseline for at least 15 seconds) Moderate FHR variability (ie, fluctuations in baseline of 6-25/min) Uterine contractions every 2-5 minutes, lasting 40-90 seconds Progressive cervical dilation, effacement, and fetal descent Clear amniotic fluid Bloody show and increased cervical mucus

Question 35

Oxytocin

Answer 35

via a secondary IV line frequent maternal/fetal assessment titrated to achieve an adequate contraction pattern without causing uterine tachysystole or fetal distress.

Question 36

cervical ripening medications (eg, misoprostol)

Answer 36

X not indicated for induction of labor in a client with a hx of C-section =significantly increases the risk for uterine rupture.

Question 37

Following the precipitous birth of a term newborn, what is the best action by the nurse while awaiting expulsion of the placenta and arrival of the health care provider?

Answer 37

prevent newborn cold stress by promptly drying and placing the newborn on the mother's abdomen for skin-to-skin contact

Question 38

interventions that can reduce complications of prematurity for the newborn

Answer 38

magnesium sulfate - seizure prevention IM corticosteroids (eg, betamethasone - lung development IV antibiotics for group B Streptococcus (GBS) prophylaxis (eg, penicillin)

Question 39

right occiput posterior "that's my occiput" "that's my posterior"

Answer 39

apply counterpressure to the client's sacrum during contractions to help alleviate back pain

Question 40

Umbilical cord prolapse knee to chest

Answer 40

client on the hands and knees with the buttocks elevated above the head (ie, knee-chest position use a sterile, gloved hand to lift the presenting part off the cord prepare the client for imminent delivery (eg, emergency cesarean birth)

Question 41

Leopold maneuvers

Answer 41

palpating the pregnant abdomen to identify the fetal presentation.

Question 42

shoulder dystocia

Answer 42

Suprapubic pressure and the McRoberts maneuver (ie, sharply flexing the thigh onto the maternal abdomen

Question 43

maximizing fetal oxygenation during pushing efforts:

Answer 43

Pushing while lying down in a lateral position Using an open-glottis pushing technique (ie, slow exhalation during pushing) -opposite of valsalva Pushing with every other contraction

Question 44

late decelerations and minimal variability of the fetal heart rate

Answer 44

dt placental insufficiency IV fluid bolus Repositioning the client laterally Discontinuing IV oxytocin infusion Placing an internal fetal scalp electrode Preparing for a potential cesarean birth if interventions do not successfully resolve the abnormal FHR

Question 45

perinatal asphyxia

Answer 45

Low Apgar scores: An Apgar (ie, Appearance/color, Pulse, Grimace/reaction, Activity/tone, Respiratory effort) score of <7 out of 10 at 5 minutes Neonatal seizures: Jerking movements that do not go away and ocular manifestations (eg, rapid eye movement, excessive blinking) low arterial blood pH

Question 46

Uterine inversion rare, obstetrical emergency

Answer 46

occurs after birth when the uterine fundus collapses (partially or completely) into the uterine cavity, causing sudden hemorrhage Successful manual replacement of the inverted uterus through the vaginal canal by the health care provider (HCP) is the first step in resolving the inversion and requires a soft, uncontracted uterus. Tocolytics (eg, terbutaline) or inhaled anesthetics may be needed to assist with uterine relaxation. If manual uterine replacement through the vagina is unsuccessful, emergency laparotomy (ie, replacement via abdominal incision) may be necessary Uterotonic medications (eg, oxytocin, carboprost) must be delayed or discontinued until after the HCP has corrected the inversion (ie, manual uterine replacement) After uterine replacement, uterotonics are administered to reinforce its location in the pelvis and control further bleeding.

Question 47

The precepting nurse is supervising a new obstetric nurse performing a labor admission assessment on a client with suspected spontaneous rupture of membranes. Which action by the new nurse would cause the precepting nurse to intervene? -X using nonsterile gloves to examine X

Answer 47

use sterile gloves during vaginal examination in the presence of ruptured membranes to prevent infection

Question 48

The nurse is caring for a client in active labor who is 8 cm dilated, trembling, and reporting the urge to push. Which of the following actions should the nurse take?

Answer 48

Maternal signs of the transition phase (8-10cm) include nausea/vomiting, trembling, increased pain, fear, irritability, anxiety, and self-doubt in the ability to birth. The nurse should provide emotional support, encouragement, and coach the client in breathing techniques

Question 49

second trimester 14 weeks 0 days to 27 weeks 6 days gestation

Answer 49

Quickening (ie, the client's first perception of light fetal movement), which is expected around 16-20 weeks gestation, depending on parity Increasing intake of iron-rich foods (eg, meat, dried fruit) and continue taking prenatal vitamins to prevent anemia caused by increased fetal iron requirements after 20 weeks gestation Expecting an ultrasound around 18-20 weeks gestation to evaluate fetal anatomy and the placenta Screening for gestational diabetes mellitus (GDM), which occurs between 24-28 weeks gestation (ie, 1-hour glucose challenge test); GDM is a complication of pregnancy caused by hormonally related maternal insulin resistance Educating on preterm labor warnings (eg, pelvic pressure, low back pain) and signs of preeclampsia, which are reviewed beginning at 20 weeks gestation

Question 50

Syphilis

Answer 50

Penicillin is the only adequate treatment for syphilis during pregnancy. If a pregnant client has a penicillin allergy, penicillin desensitization is necessary

Question 51

diet in preg

Answer 51

avoid consuming - unpasteurized milk products, -unwashed fruits and vegetables, -deli meat and hot dogs (unless heated until steaming hot), - raw fish/meat. - fish high in mercury (eg, shark, swordfish, king mackerel, tilefish).

Question 52

preg wt gain

Answer 52

total weight gain of 25-35 lb (11.3-15.9 kg) is appropriate for a client with a prepregnancy BMI of 21 kg/m2

Question 53

A nurse on the antepartum unit is caring for a client at 30 weeks gestation who was admitted with reports of vaginal bleeding. A diagnosis of placenta previa was confirmed by ultrasound. Which of the following should the nurse tell the client to anticipate?

Answer 53

additional ultrasound is usually performed around 36 weeks gestation to assess placental location risk of hemorrhage if contractions result in cervical change, a cesarean birth is planned for after 36 weeks gestation and prior to the onset of labor

Question 54

Active herpes lesions present at the onset of labor

Answer 54

indicate the need for cesarean birth.

Question 55

Spontaneous abortion (ie, miscarriage)

Answer 55

Avoid sexual intercourse and tampons as prescribed (eg, 2 weeks Report foul-smelling vaginal discharge, heavy vaginal bleeding, and severe pain Continue prenatal vitamins with iron to prevent anemia caused by blood loss and use ibuprofen to alleviate cramping

Question 56

Placenta previa

Answer 56

painless vaginal bleeding after 20 weeks gestation high risk for hemorrhage. initiate electronic fetal monitoring monitor pad counts initiate large-bore IV access collect a blood specimen for type and screen. Digital vaginal examinations are contraindicated.

Question 57

nitrazine pH test on vaginal secretions test for rupture of membranes

Answer 57

the presence of blood or semen may result in a false positive, as amniotic fluid is also alkaline positive: blue negative: yellow-green

Question 58

Physiologic changes to blood composition hemodilution

Answer 58

hemoglobin+ hematocrit =decreased WBC count=as high as 15,000/mm3 platelet count also may decrease somewhat but should remain within normal range (≥150,000/mm3

Question 59

The nurse is reinforcing instructions to a client at 34 weeks gestation who is preparing to travel by airplane. Which of the following instructions are appropriate?

Answer 59

Carry an updated copy of the prenatal record in case emergency medical care is necessary during travel Increase fluid intake Secure the lap belt under the gravid abdomen and across the hips Wear compression stockings and unrestrictive clothing Avoid traveling to Zika- or malaria-prevalent areas and remote areas with poor medical care or lack of sanitation

Question 60

measuring fundal height

Answer 60

After 20 weeks gestation, the fundal height measurement in centimeters should correlate closely with the number of weeks pregnant (eg, 24 cm = 24 weeks). should empty the bladder before having fundal height measured

Question 61

1st trimester

Answer 61

Detection of a fetal heart rate is possible using a Doppler by 10-12 weeks gestation Quickening, the awareness of fetal movements, occurs around 18-20 weeks gestation in primigravidas and at 14-16 weeks in multigravida

Question 62

Naegele's rule for estimating date of delivery EDB = (LMP − 3 months) + 7 days. *use first day of last period

Question 63

The nurse is providing education to a client diagnosed with a molar pregnancy. Which statement by the nurse requires intervention?

Answer 63

avoiding pregnancy during follow-up care to allow the health care provider to monitor for rising hCG levels, which may indicate malignant GTN

Question 64

The nurse is admitting a client at 39 weeks gestation who is scheduled for induction of labor due to oligohydramnios. When considering the indication for induction, the nurse should anticipate the need for

Answer 64

amnioinfusion (ie, transvaginal infusion of fluids) to help alleviate cord compression by providing extra fluid around the umbilical cord

Question 65

Placental abruption

Answer 65

abdominal and/or back pain, uterine contractions, uterine rigidity, and dark red vaginal bleeding. In severe cases, emergency cesarean birth is indicated Peripheral IV access with a 16- or 18-gauge catheter A blood specimen should be obtained for type and crossmatch continuous fetal monitoring

Question 66

morning sickness

Answer 66

dry, high-carbohydrate foods (eg, toast, crackers) and low-fat proteins clear, cold, carbonated beverages with ginger Eating foods high in vitamin B6 (eg, nuts, seeds, legumes)

Question 67

Live vaccines are contraindicated in pregnancy

Answer 67

Pregnancy should be avoided for at least 4 weeks after the immunization is given. nonimmune to rubella should receive the vaccine in the postpartum period

Question 68

GTPAL

Answer 68

G Gravidity The number of times a person has been pregnant, regardless of pregnancy outcome T Term The number of births at 37 weeks 0 days gestation & beyond P Preterm The number of births at 20 weeks 0 days to 36 weeks 6 days gestation A Abortions The number of pregnancies ending before 20 weeks 0 days gestation; these may be spontaneous (miscarriage) or induced abortions L Living The number of currently living children

Question 69

Preeclampsia

Answer 69

administering antihypertensives (eg, IV labetalol) to reduce blood pressure and IV magnesium sulfate to prevent eclamptic seizures. prepare the client for delivery of the fetus and placenta report increased blood pressure, severe symptoms (eg, unrelieved headaches, vision changes, vaginal bleeding), and decreased fetal movement. Monitor fetal kick counts daily

Question 70

indirect Coombs test

Answer 70

to screen for Rh sensitization any time hemorrhage secondary to placental abruption is suspected (eg, maternal trauma)

Question 71

Preconception care

Answer 71

updated vaccinations folic acid supplementation avoidance of alcohol, smoking, and illicit substances regular dental care.

Question 72

folic acid

Answer 72

Inadequate intake during the first 8 weeks after conception increases the risk for neural tube defects fortified grain products (eg, cereals, breads, pastas) green, leafy vegetables (eg, broccoli, asparagus daily supplement of at least 400 mcg of folic acid in addition to eating foods rich in folic acid. cooked beans, rice, fortified cereals, and peanut butter

Question 73

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