ob_exam_1_20170205233115 Flashcards by Nicholas Mark

A 28 year old woman is pregnant presently and
had a history of delivering term twins followed
by a spontaneous abortion. What is her GP and
TPAL?

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Frequency of Visits

How often should a pregnant mother visit her provider when she is up to 28 weeks pregnant?

Every 4 weeks

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Describe what GP and TPAL mean

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Frequency of Visits

How often should a pregnant mother visit her provider when she is 37 weeks or later?

Every week

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A mother is pregnant for the fourth time. At home
she has a child who was born term. Her second
pregnancy ended at 10 weeks gestation. She then gave
birth to twins at 35 weeks and one of the twins died
soon after birth. Write her OB history.

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The greatest risk to the developing embryo is between ____ and ____ days after conception.

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A mother is pregnant for the fourth time.
One abortion at 8 weeks, and has a daughter
born at 40 weeks and a son at 34 weeks. What
is her obstetrical history?

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Frequency of Visits

How often should a pregnant mother visit her provider when she is 29 to 36 weeks?

every 2 weeks

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A mother is pregnant for the fourth time with a twin pregnancy at present. She lost a pregnancy at 12 weeks gestation, had one preterm birth 4 years ago and a term birth after. What is her G, P, TPAL?

G4P2 T1P1A1L2

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Uterine enlargement and breast enlargement.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Presumptive (subjective)

what the patient experiences

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Ultrasound verification of embryo or fetus, fetal movement felt by experienced clinician, and/or auscultation of fetal heart tones via Doppler.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Positive (diagnostic)

confirmation that the fetus is growing in the uterus

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Amenorrhea.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Presumptive (subjective)

what the patient experiences

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Braxton Hicks contractions.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Probable (objective)

signs that are detected on physical examination by the health care professional

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Positive pregnancy test.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Probable (objective)

signs that are detected on physical examination by the health care professional

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Bluish discoloration of the vaginal mucosa and cervix.

a. ) Chadwick’s Sign
b. ) Goodell’s Sign
c. ) Hegar’s Sign

Chadwick’s Sign

Chadwick’s Sign = Bluish discoloration of the vaginal mucosa and cervix.

Goodell’s Sign = Softening of the cervix.

Hegar’s Sign = Softening of the lower uterine segment or isthmus.

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What is normal weight gain for pregnant women?

25 to 35 pounds during entire pregnancy

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Abdominal enlargement.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Probable (objective)

signs that are detected on physical examination by the health care professional

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Quickening.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Presumptive (subjective)

what the patient experiences

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Ballotement.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Probable (objective)

signs that are detected on physical examination by the health care professional

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Softening of the lower uterine segment or isthmus.

a. ) Chadwick’s Sign
b. ) Goodell’s Sign
c. ) Hegar’s Sign

Hegar’s Sign

Chadwick’s Sign = Bluish discoloration of the vaginal mucosa and cervix.

Goodell’s Sign = Softening of the cervix.

Hegar’s Sign = Softening of the lower uterine segment or isthmus.

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Hyperpigmentation of skin

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Presumptive (subjective)

what the patient experiences

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Softening of the cervix.

a. ) Chadwick’s Sign
b. ) Goodell’s Sign
c. ) Hegar’s Sign

Goodell’s Sign

Chadwick’s Sign = Bluish discoloration of the vaginal mucosa and cervix.

Goodell’s Sign = Softening of the cervix.

Hegar’s Sign = Softening of the lower uterine segment or isthmus.

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Goodell’s sign, Chadwick’s sign, and Hegar’s sign.

a. ) Presumptive signs
b. ) Probable signs
c. ) Positive signs

Probable (objective)

signs that are detected on physical examination by the health care professional

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What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn?

a. ) The woman’s gums would become red and swollen and would bleed easily.
b. ) The uterus would contract more and peristalsis would increase.
c. ) Morning sickness would increase and would be prolonged.
d. ) The secretion of prolactin by the pituitary gland would be inhibited.

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Which of the following is a presumptive sign or symptom of pregnancy? a. ) Restlessness b. ) Elevated mood c. ) Urinary frequency d. ) Low backache

c.) Urinary frequency

When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? a. ) Human chorionic gonadotropin (hCG) b. ) Human placental lactogen (hPL) c. ) Follicle-stimulating hormone (FSH) d. ) Luteinizing hormone (LH)

a.) Human chorionic gonadotropin (hCG)

During pregnancy, which of the following should the expectant mother reduce or avoid? a. ) Raw meat or uncooked shellfish b. ) Fresh, washed fruits and vegetables c. ) Whole grains d. ) Protein and iron from meat sources

a.) Raw meat or uncooked shellfish

A feeling expressed by most women upon learning they are pregnant is: a. ) Acceptance b. ) Depression c. ) Jealousy d. ) Ambivalence

d.) Ambivalence

Reva Rubin identified four major tasks that the pregnant woman undertakes to form a mutually gratifying relationship with her infant. What is "binding in"? a. ) Ensuring safe passage through pregnancy, labor, and birth b. ) Seeking acceptance of this infant by others c. ) Seeking acceptance of self as mother to the infant d. ) Learning to give of oneself on behalf of the infant

**c.) Seeking acceptance of self as mother to the infant** ## Footnote Seeking acceptance of self as mother to the infant is the basis for establishing a mutually gradifying relationship between mother and infant. This "binding in" is a process that changes throughout the pregnancy, starting with the mothers acceptance of the pregnancy and then the infant as a separate entity. Ensuring safe passage through pregnancy , labor, and birth focusas on the mother

Which of the following biophysical profile findings indicate poor oxygenation to the fetus? a. ) Two pockets of amniotic dluid b. ) Well-flexed arms and legs c. ) Nonreactive fetal heart rate d. ) Fetal breathing movements noted

c.) Nonreactive fetal heart rate

The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which of the following? a. ) Prevent perineal lacerations b. ) Stimulate labor contractions c. ) Increase pelvic muscle tone d. ) Lose pregnancy weight quickly

c.) Increase pelvic muscle tone

During a clinic visit, a pregnant client at 30 weeks’ gestation tells the nurse, "I’ve had some mild cramps that are pretty irregular. What does this mean?" The cramps are probably: a. ) The beginning of labor in the very early stages b. ) An ominous nding indicating that the client is about to have a miscarriage c. ) Related to overhydration of the woman d. ) Braxton Hicks contractions, which occur throughout pregnancy

d.) Braxton Hicks contractions, which occur throughout pregnancy

The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which of the following should be included in it? Select all that apply. a. ) Prevent constipation by taking a daily laxative b. ) Balance your dietary intake by increasing your calories by 300 to 500 daily c. ) Continue your daily walking routine just as you did before this pregnancy d. ) Tetanus, measles, mumps, and rubella vaccines will be given to you now e. ) Avoid tub baths now that you are pregnant to prevent vaginal infections f. ) Sexual activity is permitted as long as your membranes are intact g. ) Increase your consumption of milk to meet your iron needs

b. ) Balance your dietary intake by increasing your calories by 300 to 500 daily c. ) Continue your daily walking routine just as you did before this pregnancy f. ) Sexual activity is permitted as long as your membranes are intact

A pregnant client's last normal menstrual period was on August 10. Using Nagele’s rule, the nurse calculates that her estimated date of birth (EDB) will be which of the following? a. ) June 23 b. ) July 10 c. ) July 30 d. ) May 17

d.) May 17

A woman began her last normal menstrual period on March 22, 2016. Using Negele's rulse, calculate her expected date of birth (EDB).

December 29, 2017

A nurse is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following would be included? (Select all that apply) a. ) Montgomery's glands b. ) Goodall's sign c. ) Ballottement d. ) Chadwick's sign e. ) Quickening

b. ) Goodall's sign c. ) Ballottement d. ) Chadwick's sign

What is a positive sign of pregnancy? a. ) Hegar's sign b. ) fetal movement felt by examiner c. ) uterine contractions d. ) positive pregnancy test

b.) fetal movement felt by examiner

Amanda is about 16 weeks pregnant and is concerned because she feels her "abdomen" contracting. She calls the primary care provider's office and speaks to the nurse. What is the nurse's most appropriate response to Amanda's concern? a. ) "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy." b. ) "You need to go to the emergency room right away." c. ) "You have nothing to be concerned about. I am sure you are not feeling contractions at this point in your pregnancy." d. ) "You need to come to the office to be examined."

a.) "What you are feeling are called Braxton Hicks contractions. They are considered practice contractions during pregnancy."

During pregnancy a woman has many psychological adaptations that must be made. The nurse must remember that the baby's father is also experiencing the pregnancy and has adaptations that must be made. Some fathers actually have symptoms of the pregnancy along with the mothers. What is this called? a. ) cretinism b. ) pregnancy syndrome c. ) couvade syndrome d. ) pseudo pregnancy

c.) couvade syndrome

As a pregnant woman lies on the examining table, she grows very short of breath and dizzy. This phenomenon probably happens because: a. ) her cerebral arteries are growing congested with blood. b. ) the uterus requires more blood in a supine position. c. ) sympathetic nerve responses cause dyspnea when a woman lies supine. d. ) blood is trapped in the vena cava in a supine position.

d.) blood is trapped in the vena cava in a supine position.

A pregnant woman tells the nurse she often has allergic responses to drugs. She is concerned that she will be allergic to her fetus or her body will reject the pregnancy. The nurse's reply would be based on which statement? a. ) The kidneys release a hormone during pregnancy to prevent this from happening. b. ) Immunologic activity is decreased during pregnancy. c. ) The level of aldosterone during pregnancy reduces production of IgG antibodies. d. ) The decreased corticosteroid activity during pregnancy ensures this will not happen.

b.) Immunologic activity is decreased during pregnancy.

Which change related to the vital signs is expected in pregnant women? a. ) Lung space increases. b. ) Temperature decreases. c. ) Pulse decreases. d. ) Blood pressure decreases.

d.) Blood pressure decreases.

During a routine antepartal visit, a pregnant woman says, "I've noticed my gums bleeding a bit since I've become pregnant. Is this normal?" The nurse bases the response on the understanding of which effect of pregnancy? a. ) effects of regurgitation from relaxation of the cardiac sphincter b. ) elevated progesterone levels c. ) increased venous pressure d. ) influence of estrogen and blood vessel proliferation

d.) influence of estrogen and blood vessel proliferation

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks pregnant. The nurse would expect this woman's heart rate to be approximately: a. ) 90 beats per minute. b. ) 95 beats per minute. c. ) 100 beats per minute. d. ) 85 beats per minute.

d.) 85 beats per minute.

The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply. a. ) amenorrhea b. ) fetal heartbeat c. ) ultrasound pictures d. ) morning sickness e. ) breast changes f. ) hydatidiform mole

a. ) amenorrhea d. ) morning sickness e. ) breast changes

Which assessment finding in the pregnant woman at 12 weeks of gestation should the nurse find most concerning? The inability to: a. ) feel fetal movements. b. ) palpate the fetal outline. c. ) detect fetal heart sounds with a Doppler. d. ) hear the fetal heartbeat with a stethoscope.

c.) detect fetal heart sounds with a Doppler.

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called? a. ) chloasma b. ) linea rubria c. ) ballottement d. ) Chadwick's sign SUBMIT ANSWER

a.) chloasma

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding? a. ) striae b. ) linea nigra c. ) bruising d. ) darkening of the umbilicus

c.) bruising

A woman in the last trimester of pregnancy reports sleeping poorly. She becomes light-headed and dizzy whenever she sleeps on her back, but she cannot sleep at all if she lies on her side. How would the nurse suggest she try sleeping? a. ) with a pillow under both hips b. ) with a pillow under her right hip c. ) with a pillow under her shoulders d. ) without a pillow

b.) with a pillow under her right hip

Many factors influence how a woman adapts psychologically to pregnancy. What is the psychological adaptation the woman must come to terms with during the second trimester? a. ) accept the baby b. ) accept the pregnancy c. ) prepare for parenthood d. ) prepare for labor and birth

a.) accept the baby

A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her? a. ) Wait until after two missed menstrual periods. b. ) Refrain from eating for 4 hours before testing. c. ) Arrange for prenatal care if the test is positive. d. ) Use a diluted urine specimen. SUBMIT ANSWER

c.) Arrange for prenatal care if the test is positive.

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week? a. ) 2/3 lb (.30 kg) b. ) 1 lb (.45 kg) c. ) 1.5 lb (.68 kg) d. ) 2 lb (.90 kg)

b.) 1 lb (.45 kg)

The obstetrical nurse knows that a woman's hormone levels change dramatically during pregnancy. Which hormonal actions accurately represent these changes? Select all that apply. a. ) maintaining the endometrium so that the embryo can implant b. ) decreasing the mother's blood volume and red blood cell mass to increase oxygen c. ) causing changes in the mother's metabolism so that nutrients are available for both d. ) decreasing the blood supply to the gastrointestinal tract and slowing peristaltic waves e. ) preparing the breasts for lactation, keeping the milk from coming in until birth occurs f. ) relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly

a. ) maintaining the endometrium so that the embryo can implant c. ) causing changes in the mother's metabolism so that nutrients are available for both e. ) preparing the breasts for lactation, keeping the milk from coming in until birth occurs f. ) relaxing the ligaments that connect the pelvic bones, allowing them to spread slightly

A client who has just given a blood sample for pregnancy testing in the health care provider's office asks the nurse what method of confirming pregnancy is the most accurate. The nurse explains the difference between presumptive symptoms, probable signs, and positive signs. What should the nurse mention as an example of a positive sign, which may be used to diagnose pregnancy? a. ) laboratory test of a urine specimen for hCG b. ) visualization of the fetus by ultrasound c. ) laboratory test of a blood serum specimen for hCG d. ) absence of a period

b.) visualization of the fetus by ultrasound

The hormone responsible for the initiation of lactation is what? a. ) estrogen b. ) oxytocin c. ) progesterone d. ) prolactin

d.) prolactin

A pregnant woman asks the nurse, "I've heard that I should avoid eating certain types of fish. So what fish can I eat?" Which type of fish would the nurse recommend? Select all that apply. a. ) tilefish b. ) shrimp c. ) catfish d. ) shark e. ) salmon

b. ) shrimp c. ) catfish e. ) salmon

Early in pregnancy, frequent urination results mainly from which cause? a. ) addition of fetal urine to maternal urine b. ) pressure on the bladder from the uterus c. ) decreased glomerular selectivity d. ) increased concentration of urine

b.) pressure on the bladder from the uterus

Pregnancy tests (both urine and blood) measure levels of which hormone to validate the existence of pregnancy? a. ) estrogen b. ) human chorionic gonadotropin (hCG) c. ) progesterone d. ) aldosterone

b.) human chorionic gonadotropin (hCG)

Positive signs of pregnancy are diagnostic, meaning nothing else can elicit that sign except pregnancy. What is the earliest positive sign of pregnancy? a. ) finding of hCG in the blood b. ) visualization of the gestational sac or fetus c. ) finding hCG in the urine d. ) positive home pregnancy test

b.) visualization of the gestational sac or fetus

_Labor Station_ ## Footnote Baby's head is entering the pelvis and pressure on baby's head will push it back up. a. ) Floating b. ) Ballotable c. ) Engagement

**Ballotable**

What is quickening? When does it usually occur?

_Labor Station_ ## Footnote Presents at 0 station (top of head reaches ischial spine). a. ) Floating b. ) Ballotable c. ) Engagement

**Engagement**

_Labor Station_ ## Footnote Will just see the baby's head. a. ) Floating b. ) Ballotable c. ) Engagement

**Floating**

When determining the frequency of contractions, the nurse would measure which of the following? a. ) Start of one contraction to the start of the next contraction b. ) Beginning of one contraction to the end of the same contraction c. ) Peak of one contraction to the peak of the next contraction d. ) End of one contraction to the beginning of the next contraction

**a.) Start of one contraction to the start of the next contraction** ## Footnote Frequency is measured from the start of one contraction to the start of the next contraction. The duration of a contraction is measured from the beginning of one contraction to the end of that same contraction. The intensity of two contractions is measured by comparing the peak of one contraction with the peak of the next contraction. The resting interval is measured from the end of one contraction to the beginning of the next contraction.

Which fetal lie is most conducive to a spontaneous vaginal birth? a. ) Transverse b. ) Longitudinal c. ) Perpendicular d. ) Oblique

**b.) Longitudinal** ## Footnote A longitudinal lie places the fetus in a vertical position, which would be the most conducive for a spontaneous vaginal birth. A transverse lie does not allow for a vaginal birth because the fetus is lying perpendicular to the maternal spine. A perpendicular lie describes the transverse lie, which would not be conducive for a spontaneous birth. An oblique lie would not allow for a spontaneous vaginal birth because the fetus would not fit through the maternal pelvis in this side-lying position.

Which of the following observations would suggest that placental separation is occurring? a. ) Uterus stops contracting altogether. b. ) Umbilical cord pulsations stop. c. ) Uterine shape changes to globular. d. ) Maternal blood pressure drops.

**c.) Uterine shape changes to globular.** ## Footnote After the placenta separates from the uterine wall, the shape of the uterus changes from discoid to globular. The uterus continues to contract throughout the placental separation process and the umbilical cord continues to pulsate for several minutes after placental separation occurs. Maternal blood pressure is not affected by placental separation because the maternal blood volume has increased dramatically during pregnancy to compensate for blood loss during birth.

As the nurse is explaining the difference between true versus false labor to her childbirth class, she states that the major difference between them is: a. ) Discomfort level is greater with false labor. b. ) Progressive cervical changes occur in true labor. c. ) There is a feeling of nausea with false labor. d. ) There is more fetal movement with true labor.

**b.) Progressive cervical changes occur in true labor.** ## Footnote Progressive cervical changes occur in true labor. This is not the case with false labor.

The shortest but most intense phase of labor is the: a. ) Latent phase b. ) Active phase c. ) Transition phase d. ) Placental expulsion phase

**c.) Transition phase** ## Footnote The **transition phase** of the first stage of labor occurs when the contractions are 1 to 2 minutes apart and the final dilation is taking place. The transition phase is the most difficult and, fortunately, the shortest phase for the woman, lasting approximately 1 hour in the first birth and perhaps 15 to 30 minutes in successive births. Many women are not able to cope well with the intensity of this short period, become restless, and request pain medications. During the **latent phase**, contractions are mild. The woman is in early labor and able to cope with the infrequent contractions. This phase can last hours. The **active phase** involves moderate contractions that allow for a brief rest period in between, helping the woman to be able to cope with the next contraction. This phase can last hours. The **placental expulsion phase** occurs during the third stage of labor. After separation of the placenta from the uterine wall, continued uterine contractions cause the placenta to be expelled. Although this phase can last 5 to 30 minutes, the contraction intensity is less than that of the transition phase.

A laboring woman is admitted to the labor and birth suite at 6-cm dilation. She would be in which phase of the first stage of labor? a. ) Latent b. ) Active c. ) Transition d. ) Early

**b.) Active** ## Footnote Cervical dilation of 6 cm indicates that the woman is in the active phase of the first stage of labor. In this phase, the cervix dilates from 3 to 7 cm with 40% to 80% effacement occurring. During the latent phase, the cervix dilates from 0 to 3 cm. During the transition phase, the cervix dilates from 8 to 10 cm. The first stage of labor is divided into three phases: latent, active, and transition. There is no early phase.

Which assessment would indicate that a woman is in true labor? a. ) Membranes are ruptured and uid is clear. b. ) Presenting part is engaged and not oating. c. ) Cervix is 4 cm dilated, 90% effaced. d. ) Contractions last 30 seconds, every 5 to 10 minutes.

## Footnote True labor is characterized by contractions occurring at regular intervals that increase in frequency, duration, and intensity. These contractions bring about progressive cervical dilation and effacement. Thus, a cervix dilated to 4 cm and 90% effaced indicates true labor. Rupture of membranes may occur before the onset of labor, at the onset of labor, or at any time during labor and thus is not indicative of true labor. Engagement occurs when the presenting part reaches 0 station; it typically occurs 2 weeks before term in primigravidas and several weeks before the onset of labor or at the beginning of labor for multiparas. Contractions of true labor typically last 30 to 60 seconds and occur approximately every 4 to 6 minutes.

When assessing a woman in the first stage of labor, the nurse recognizes that the most conclusive assessment that uterine contractions are effective would be: a. ) dilatation of cervix. b. ) rupture of amniotic membranes. c. ) bloody show. d. ) engagement of fetus.

a.) dilatation of cervix.

A woman in labor at the hospital has just received an epidural block. Which intervention is a priority before and during epidural placement? a. ) Monitor temperature every four hours, and give acetaminophen if 100.4 degrees or higher. b. ) Monitor the maternal apical pulse for bradycardia. c. ) Increase oral fluids every hour to prevent dehydration. d. ) Provide adequate IV fluids to maintain her blood pressure.

d.) Provide adequate IV fluids to maintain her blood pressure.

When assessing fetal heart rate patterns, which finding would alert the nurse to a possible problem? a. ) early decelerations b. ) accelerations c. ) variable decelerations d. ) prolonged decelerations

d.) prolonged decelerations

The nurse assesses her client and notes that the fetus is at +1 station. The nurse interprets +1 station as indicating that the fetal presenting part is at: a. ) 1 cm below the symphysis pubis. b. ) 1 cm below the ischial spine. c. ) 1 cm above the symphysis pubis. d. ) 1 cm above the ischial spine. SUBMIT ANSWER

b.) 1 cm below the ischial spine.

The student nurse is preparing to assess the fetal heart rate (FHR). She has determined that the fetal back is located toward the client's left side, the small parts toward the right side, and there is a vertex (occiput) presentation. The nurse should initially begin auscultation of the fetal heart rate in the mother's: a. ) left upper quadrant. b. ) right lower quadrant. c. ) left lower quadrant. d. ) right upper quadrant.

c.) left lower quadrant.

To assess the frequency of a woman's labor contractions, the nurse would time: a. ) the beginning of one contraction to the beginning of the next. b. ) how many contractions occur in 5 minutes. c. ) the end of one contraction to the beginning of the next. d. ) the interval between the acme of two consecutive contractions.

a.) the beginning of one contraction to the beginning of the next.

The nurse is reviewing the uterine contraction pattern and identifies the peak intensity, documenting this as which phase of the contraction? a. ) decrement b. ) increment c. ) diastole d. ) acme

d.) acme

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client? a. ) administrating IV naloxone b. ) administrating IV ephedrine c. ) starting an IV and hanging IV fluids d. ) maintaining the client in a supine position

c.) starting an IV and hanging IV fluids

A nurse is caring for a pregnant client who is in the active phase of labor. At what interval should the nurse monitor the client’s vital signs? a. ) every 45 minutes b. ) every 15 minutes c. ) every 1 hour d. ) every 30 minutes

d.) every 30 minutes

A client is a gravida 1, in the active phase of stage 1 labor. The fetal position is LOA. When the client's membranes rupture, the nurse should expect to see a: a. ) very large amount of blood. b. ) moderate amount of clear to straw-colored fluid. c. ) small segment of the umbilical cord. d. ) small amount of greenish fluid.

b.) moderate amount of clear to straw-colored fluid.

Which signs signify that the second stage of labor has begun? a. ) The urge to push occurs. b. ) Frequency of contractions are 5–6 minutes. c. ) Fetus is a –1 station. d. ) Emotions are calm and happy.

a.) The urge to push occurs.

The nurse is assessing the laboring client to determine fetal oxygenation status. What indirect assessment method will the nurse likely use? a. ) fetal oxygen saturation b. ) external electronic fetal monitoring c. ) fetal position d. ) fetal blood pH SUBMIT ANSWER

b.) external electronic fetal monitoring

The nurse explains Leopold’s maneuvers to a pregnant client. For which purposes are these maneuvers performed? Select all that apply. a. ) determining the size of the fetus b. ) determining the weight of the fetus c. ) determining the position of the fetus d. ) determining the presentation of the fetus e. ) determining the lie of the fetus

c. ) determining the position of the fetus d. ) determining the presentation of the fetus e. ) determining the lie of the fetus

A multigravida is admitted to the hospital in active labor. The client's and the fetus's condition have been good since admission. The client calls out to the nurse, "the baby is coming!" What is the first action of the nurse? a. ) Inspect the perineum. b. ) Auscultate the fetal heart tones. c. ) Time the contractions. d. ) Contact the primary care provider.

a.) Inspect the perineum.

As a woman enters the second stage of labor, her membranes spontaneously rupture. When this occurs, what would the nurse do next? a. ) Ask her to bear down with the next contraction. b. ) Test a sample of amniotic fluid for protein. c. ) Assess fetal heart rate for fetal safety. d. ) Elevate her hips to prevent cord prolapse.

c.) Assess fetal heart rate for fetal safety.

After administration of epidural anesthesia during labor, the client develops a temperature of 100.2°F (37.9°C). The client's husband is asking if she is "getting sick". How should the nurse respond to the client and her husband? a. ) "We will have to take her temperature every 30 minutes and might start antibiotics." b. ) "This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour." c. ) "Due to the length of your labor, you might be dehydrated and that may cause your temperature to rise; let's get you something to drink." d. ) "Can you tell me if you have been exposed to any illnesses you might be developing?"

b.) "This elevation in temperature is a possible side effect of the anesthesia. We will notify the provider and assess temperature again in an hour."

A nurse is required to obtain the fetal heart rate (FHR) for a pregnant client. If the presentation is cephalic, which maternal site should the nurse monitor to hear the FHR clearly? a. ) just below the maternal umbilicus b. ) above the level of the maternal umbilicus c. ) at the level of the maternal umbilicus d. ) lower quadrant of the maternal abdomen

d.) lower quadrant of the maternal abdomen

_Maternal Psychological Adaptation_ ## Footnote Partner's psychological adaptation. a. ) Taking-in phase b. ) Taking-hold phase c. ) Letting-go phase d. ) Degrossment

**Degrossment**

_Maternal Psychological Adaptation_ ## Footnote Time immediately after birth when the client needs others to meet her needs and relives the birth process. a. ) Taking-in phase b. ) Taking-hold phase c. ) Letting-go phase d. ) Degrossment

**Taking-in Phase**

_Maternal Psychological Adaptation_ ## Footnote The woman reestablishes relationships with others. a. ) Taking-in phase b. ) Taking-hold phase c. ) Letting-go phase d. ) Degrossment

**Letting-go phase**

_Maternal Psychological Adaptation_ ## Footnote Characterized by dependent and independent maternal behavior. a. ) Taking-in phase b. ) Taking-hold phase c. ) Letting-go phase d. ) Degrossment

**Taking-hold phase**

A postpartal woman has a history of thrombophlebitis. Which action would help the nurse determine if she is developing this postpartally? a. ) Assess for calf redness and edema. b. ) Take her temperature every 4 hours. c. ) Palpate her feet for tingling or numbness. d. ) Ask her if she feels any warmth in her legs.

a.) Assess for calf redness and edema.

Review of a woman's labor and birth record reveals a laceration that extends through the anal sphincter muscle. The nurse identifies this laceration as which type? a. ) fourth-degree laceration b. ) second-degree laceration c. ) third-degree laceration d. ) first-degree laceration

c.) third-degree laceration

A postpartum client who had a cesarean birth reports right calf pain to the nurse. The nurse observes that the client has nonpitting edema from her right knee to her foot. The nurse knows to prepare the client for which test first? a. ) noninvasive arterial studies of the right leg b. ) venogram of the right leg c. ) venous duplex ultrasound of the right leg d. ) transthoracic echocardiogram

c.) venous duplex ultrasound of the right leg

Elevation of a client’s temperature is a crucial first sign of infection. However, when is elevated temperature not a warning sign of impending infection? a. ) after any period of decreased intake b. ) when the white blood cell count is less than 10,000/mm³ c. ) during the first 24 hours after birth owing to dehydration from exertion d. ) when the elevated temperature exceeds 100.4° F (38° C)

c.) during the first 24 hours after birth owing to dehydration from exertion

A client gave birth 2 days ago and is preparing for discharge. The nurse assesses respirations to be 26 rpm and labored, and the client was short of breath ambulating from the bathroom this morning. Lung sounds are clear. The nurse alerts the primary care provider and the nurse-midwife to her concern that the client may be experiencing: a. ) mitral valve collapse. b. ) pulmonary embolism. c. ) thrombophlebitis. d. ) upper respiratory infection.

b.) pulmonary embolism.

Many clients experience a slight fever after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature? a. ) infection b. ) fluid volume overload c. ) change in the temperature from the birth room d. ) dehydration

d.) dehydration

A nurse assessing a postpartum client notices excessive bleeding. What should be the nurse's first action? a. ) Massage the boggy fundus until it is firm. b. ) Call the primary care provider. c. ) Document the findings. d. ) Nothing—excessive postpartum blood loss is normal.

a.) Massage the boggy fundus until it is firm.

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration? a. ) third degree b. ) second degree c. ) first degree d. ) fourth degree

d.) fourth degree

Upon assessment, a nurse notes the client has a pulse of 90 bpm, moderate lochia, and a boggy uterus. What should the nurse do next? a. ) Change the client's peri-pad. b. ) Assess the client's blood pressure. c. ) Notify the healthcare provider. d. ) Massage the client's fundus.

d.) Massage the client's fundus.

When completing the morning postpartum data collection, the nurse notices the client’s perineal pad is completely saturated. Which action should be the nurse’s first response? a. ) Have the charge nurse review the assessment. b. ) Immediately call the primary care provider. c. ) Ask the client when she last changed her perineal pad. d. ) Vigorously massage the fundus.

c.) Ask the client when she last changed her perineal pad.

A woman who had a cesarean birth of twins 6 hours ago reports shortness of breath and pain in her right calf. What complication should the nurse expect? a. ) pulmonary emboli b. ) infection c. ) hemorrhage d. ) fluid volume overload

c.) hemorrhage

A client who gave birth vaginally 16 hours ago states she does not need to void at this time. The nurse reviews the documentation and finds that the client has not voided for 7 hours. Which response by the nurse is indicated? a. ) "I’ll check on you in a few hours." b. ) "I’ll contact your primary care provider." c. ) "It’s not uncommon after birth for you to have a full bladder even though you can’t sense the fullness." d. ) "If you don’t attempt to void, I’ll need to catheterize you."

c.) "It’s not uncommon after birth for you to have a full bladder even though you can’t sense the fullness."

A nurse helps a postpartum woman out of bed for the first time postpartally and notices that she has a very heavy lochia flow. Which assessment finding would best help the nurse decide that the flow is within normal limits? a. ) The color of the flow is red. b. ) The flow contains large clots. c. ) Her uterus is soft to your touch. d. ) The flow is over 500 mL.

a.) The color of the flow is red.

When palpating for fundal height on a postpartal woman, which technique is preferable? a. ) placing one hand on the fundus, one on the perineum b. ) placing one hand at the base of the uterus, one on the fundus c. ) resting both hands on the fundus d. ) palpating the fundus with only fingertip pressure

b.) placing one hand at the base of the uterus, one on the fundus

A nurse is assessing a woman who gave birth vaginally approximately 24 hours ago. Which finding would the nurse report to the primary care provider immediately? a. ) pulse rate 75 beats per minute b. ) respiratory rate 16 breaths/minute c. ) oral temperature 100.8° F (38.2° C) d. ) uterine fundus 1 cm below umbilicus SUBMIT ANSWER

c.) oral temperature 100.8° F (38.2° C)

Does the APGAR score dictate resuscitation?

## Footnote **A full-term baby** has hypertonic flexion, elbow at the midline, plantar creases, larger raised breast tissue, an ear that has form to it, descended testes/large amount of rugae (boys) and larger labia (girls). **A pre-term baby** has more extended extremities, an elbow that moves way passed the midline, no resistance for heel-to-ear, smooth soles (foot), smaller/non-raised breast buds, ears that fold over/press together, and testes not descended/little rugae (boys) and labia minora that protrudes beyond the labia majora (girls).

**A full-term baby** has hypertonic flexion, elbow at the midline, plantar creases, larger raised breast tissue, an ear that has form to it, descended testes/large amount of rugae (boys) and larger labia (girls). **A pre-term baby** has more extended extremities, an elbow that moves way passed the midline, no resistance for heel-to-ear, smooth soles (foot), smaller/non-raised breast buds, ears that fold over/press together, and testes not descended/little rugae (boys) and labia minora that protrudes beyond the labia majora (girls).

What are the normal vital signs for a newborn?

Name 3 signs of respiratory distress for a newborn

**_Respiratory Distress_** 1. grunting 2. retractions 3. nasal flaring 4. cyanosis 5. rapid respirations 6. asymmetric chest expansion

True or False: Lung rales on auscultation can be normal during the first few hours of newborn transition.

True

How much larger is the head circumference than the chest circumference?

Newborn head is 2-3 cm larger than chest Head = 1/4 of the body

What is the significance of circumoral cyanosis? If baby is active - ? If baby is crying - ?

If baby is not active – stimulate baby and this should disappear. If baby is crying and this happens it could be a cardiovascular (CV) abnormality

What is meconium and when is it usually noted?

The first stool, usually dark and stick. Baby should have meconium within 24 hrs of life.

On a newborns head, this is a collection of blood that does not cross the suture line. a. ) Caput Succedaneum b. ) Cephalhematoma c. ) Molding

**Cephalhematoma** *collection of **blood** that does **NOT** cross the suture line*

What is pseudomenstruation?

White/red discharge in female diaper. Caused by hormones from mother. Reassure the parents that this is normal, as it can be scary for them. Teach them about this prior to going home so they can anticipate it (often happens).

On a newborns head, this is a collection of serous fluid that crosses the suture line. a. ) Caput Succedaneum b. ) Cephalhematoma c. ) Molding

**Caput Succedaneum** *collection of **serous fluid** that crosses the suture line*

Look like little white heads. Almost all babies have these. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Facial Milia**

Also known as nevus vasculosus. Rare and mostly is seen in pre-term infants at 2 weeks of age or later. Usually resolves by 3 years of age without tx. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Strawberry Masks** *nevus vasculosus*

Red rash all over the body that usually disappers within the first several weeks. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Erythema Toxicum**

Also known as nevus flammeus. Rare and can be associated with childhood cancer. This has to be removed/lessened by laser and these children must be monitored for cancer and other malformations. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Port Wine Stains** *nevus flammeus*

A red area often at nape of neck. These disappear usually by one year of age, and they can pop out or become brighter red when baby cries. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Stork Bites**

Elongated shape of infant's head due to overlapping cranial bones caused by passing through birth canal in vertex position. a. ) Caput Succedaneum b. ) Cephalhematoma c. ) Molding

**Molding**

Blue or purple and can look like brusies. Sometimes seen on Black, Asian, and/or Indian babies. It is important to point these out to parents and tell them not to worry about them and that they usually disappear by 1 year of age. ## Footnote a. ) Facial Milia b.) Stork Bites c. ) Erythema Toxicum d.) Mongolian Spots e. ) Port Wine Stains f.) Strawberry Masks

**Mongolian Spots**

The infant's temperature is 97.2° F (36.2° C) axillary an hour after birth. Which intervention is appropriate for the nurse? a. ) Place the infant under a radiant warmer or in a heated isolette. b. ) Place a second stockinette on the baby's head. c. ) Administer a warm bath with temperature slightly higher than usual. d. ) Take the infant to the mother for bonding.

a.) Place the infant under a radiant warmer or in a heated isolette.

What are small unopened or plugged sebaceous glands that occur in a newborn’s mouth and gums? a. ) Mongolian spots b. ) stork bites c. ) Epstein’s pearls d. ) milia

c.) Epstein’s pearls

As a part of the newborn assessment, the nurse examines the infant's skin. Which nursing observation would warrant further investigation? a. ) bright red, raised bumpy area noted above the right eye b. ) fine red rash noted over the chest and back c. ) small pink or red patches on the baby's eyelids and back of the neck d. ) blue or purplish splotches on buttocks

a.) bright red, raised bumpy area noted above the right eye

A nurse determines that a newborn has a 1-minute Apgar score of 5 points. What conclusion would the nurse make from this finding? a. ) The infant is adjusting well to extrauterine life. b. ) The infant is experiencing moderate difficulty in adjusting to extrauterine life. c. ) The infant probably has either a congenital heart defect or an immature respiratory system. d. ) The infant requires immediate and aggressive interventions for survival.

b.) The infant is experiencing moderate difficulty in adjusting to extrauterine life.

The AGPAR score is based on which 5 parameters? a. ) heart rate, breaths per minute, irritability, tone, and color b. ) heart rate, respiratory effort, temperature, tone, and color c. ) heart rate, muscle tone, reflex irritability, respiratory effort, and color d. ) heart rate, breaths per minute, irritability, reflexes, and color

c.) heart rate, muscle tone, reflex irritability, respiratory effort, and color

A nurse is observing respiratory effort in a newborn as part of Apgar scoring. Which method should the nurse use to do this? a. ) Observe chest movement. b. ) Observe response to a suction catheter in the nostrils. c. ) Observe resistance to any effort to extend the newborn's extremities. d. ) Observing and count the pulsations of the umbilical cord.

a.) Observe chest movement.

The nurse notices while holding him upright that a day-old newborn has a significantly indented anterior fontanelle. She immediately brings it to the attention of the physician. What does this finding most likely indicate? a. ) Vernix caseosa b. ) Dehydration c. ) Increased intracranial pressure d. ) Cyanosis

b.) Dehydration

A newborn is 7 minutes old. Her heart rate is 92 bpm, her cry is weak, her muscles are limp and flaccid, she makes a face when she is stimulated, and her body and extremities are pink. What would the nurse assign as her Apgar score? a. ) 4 b. ) 3 c. ) 6 d. ) 5

d.) 5

The nurse is assessing the abdomen of the neonate. When inspecting the umbilical cord area of a newborn, the nurse would expect which finding? a. ) three arteries and no veins b. ) one artery and two veins c. ) two arteries and two veins d. ) two arteries and one vein

d.) two arteries and one vein

The Ballard scoring system evaluates newborns on which two factors? a. ) physical maturity and neuromuscular maturity b. ) body maturity and cranial nerve maturity c. ) tone maturity and extremities maturity d. ) skin maturity and reflex maturity

a.) physical maturity and neuromuscular maturity

A nurse is performing a detailed assessment of a female newborn. Which observations indicate normal findings? Select all that apply. a. ) Mongolian spots b. ) enlarged fontanelles c. ) short, creased neck d. ) low-set ears e. ) swollen genitals

a. ) Mongolian spots c. ) short, creased neck e. ) swollen genitals

A new mother is nervous about sudden infant death syndrome (SIDS) and asks the nurse how to prevent it when the newborn is ready to sleep. Beside placing the infant on a firm sleep surface, what should the nurse tell the mother to do? Select all that apply. a. ) Let the newborn sleep in the same bed as the parents. b. ) Provide a pacifier when putting the infant to sleep. c. ) Not allow anyone to smoke around the infant. d. ) Place the infant on his or her back. e. ) Keep the infant dressed warmly at night.

c. ) Not allow anyone to smoke around the infant. d. ) Place the infant on his or her back.

Which measurements were most likely obtained from a normal newborn born at 38 weeks to a healthy mother with no maternal complications? a. ) weight = 2000 g, length = 17 inches (43 cm), head circumference = 32 cm, and chest circumference = 30 b. ) weight = 2500 g, length = 18 inches (46 cm), head circumference = 32 cm, and chest circumference = 30 cm c. ) weight = 3500 g, length = 20 inches (51 cm), head circumference = 34 cm, and chest circumference = 32 cm d. ) weight = 4500 g, length = 22 inches (56 cm), head circumference = 36 cm, and chest circumference = 34 cm

c.) weight = 3500 g, length = 20 inches (51 cm), head circumference = 34 cm, and chest circumference = 32 cm

A newborn has a heart rate of 90 beats per minute, a regular respiratory rate of 40 breaths per minute, tight flexion of the extremities, a grimace when stimulated, and acrocyanosis. The nurse assigns an Apgar score of: a. ) 6. b. ) 8. c. ) 5. d. ) 7.

d.) 7.

Which is the best place to perform a heel stick on a newborn? a. ) the calcaneus b. ) the fat pads on the lateral aspects of the foot c. ) the vascularized flat surface of the foot d. ) the front of the heel (the outer arch)

b.) the fat pads on the lateral aspects of the foot

The nurse is orienting a student to the nursery. The nurse understands that teaching has been effective when the student states that the signs of neonate respiratory distress include which findings? Select all that apply. a. ) nasal flaring b. ) respiratory rate greater than 60 breaths per minute c. ) blue hands and feet d. ) retractions e. ) heart rate greater than 100 beats per minute

a. ) nasal flaring b. ) respiratory rate greater than 60 breaths per minute d. ) retractions e. ) heart rate greater than 100 beats per minute

One minute after birth, the neonate’s heart rate is 98 beats per minute (bpm), respirations are slow and irregular, arms are flexed, hips are extended, the neonate has no grimace, and the hands/feet are acrocyanotic. What Apgar score should the nurse assign to the neonate? a. ) 4 b. ) 6 c. ) 5 d. ) 7

a.) 4

When assessing a newborn's gestational age, the nurse evaluates which parameter to indicate physical maturity? Select all that apply. a. ) scarf sign b. ) posture c. ) arm recoil d. ) genitals e. ) lanugo

d. ) genitals e. ) lanugo

A nurse is performing Apgar scoring on a newborn. The newborn demonstrates the following: a heart rate of 110 bpm; a good, strong cry; muscles of the extremities well flexed; a grimace in response to a slap to the sole of the foot; and normal pigment in most of the body, with blue at the extremities. Which score would be the total Apgar score for this newborn? a. ) 9 b. ) 6 c. ) 7 d. ) 8

d.) 8

The nurse receives report and enters the room to do the initial shift assessment and finds the laboring mother supine and EFM is not picking up the FHTs well. What is the priority action? a. ) Notify the physician using SBAR and ask him/her to come in to verify FHTs. b. ) Ask the resident to bring the US machine in and do the assessment. c) Reposition the mother so she is sitting up in bed, then readjust the US and toco. d. ) Check the maternal pulse to see if the machine is picking up maternal pulse instead.

c) Reposition the mother so she is sitting up in bed, then readjust the US and toco.

The fetal monitor has shown late decelerations over the last three contractions. This pattern indicates the fetus is experiencing: a. ) head compression b. ) utero placental insufficiency c. ) umbilical cord compression d. ) maternal hypertension

**b.) utero placental insufficiency**

The fetal monitor has shown several late decelerations over the past 10 minutes. What does this pattern indicate? a. ) Umbilical cord compression b. ) Head compression c. ) Fetal hypoxia d. ) Maternal fever

**c.) Fetal hypoxia**

A nurse is analyzing a maternal client's fetal heart rate (FHR) strip monitor and notes that some early decelerations are present. The nurse explains to the client that early decelerations are most often related to: a. ) umbilical cord compression b. ) uteroplacental insufficiency c. ) fetal hypoxia d. ) fetal head compression

**d.) fetal head compression**

The labor nurse is caring for a G2P1 who is a 39 5/7 weeks gestation. The woman is in the active phase of labor at 6 cm. She calls on the light to say her water just broke. What is the nurse's initial action? a. ) Observe the EFM strip for accelerations b. ) Note the FHTs to verify there is no prolapsed cord c. ) Turn the patient on her side d. ) Apply oxygen mask at 10 L/min

**b.) Note the FHTs to verify there is no prolapsed cord**

You are caring for a multigravida who is being induced and is in the active phase of labor. You notice early decels on the EFM tracing. What is your nursing priority now? a. ) Continue routine assessment and monitoring b. ) Notify the physician/certified midwife c. ) Turn the patient on left side and give O₂ by mask d. ) Turn off the pitocin and increase IV fluids

**a.) Continue routine assessment and monitoring**

After several hours of labor, the EFM strip shows repetitive variable decelerations on the fetal strip. You would interpret the decelerations to be consistent with: a. ) umbilical cord compression b. ) breech presentation c. ) compression of the fetal head d. ) uteroplacental insufficiency

**a.) umbilical cord compression**

The OB nurse is monitoring a pregnant client at 32 weeks gestation who is 6 cm, and being induced due to a diagnosis of pre-eclampsia with severe features. The nurse notes persistent late decelerations despite doing POISE. What is the next step in caring for the client? a. ) Continue pitocin b. ) Turn the patient on the left side c. ) Start the amnio-infusion with normal saline d. ) Anticipate a emergent cesarean section

**d.) Anticipate a emergent cesarean section**

You are caring for a laboring woman whose water suddenly broke. You note it is clear, with a large amount on the blue pad. The FHTs are in the 80s and stay there. What is your primary action to this event? a. ) React with POISE b. ) Call the physician to come to a stat c/section c. ) Put the patient in Trendelenburg position d. ) Call the team leader to come help

**a.) React with POISE**

What is the physiology of blood flow to the fetus during a contraction? a. ) Blood flow increases b. ) Blood flow stops/ceases c. ) Blood flow decreases d. ) Blood flow is not affected

**b.) Blood flow stops/ceases**

The nurse observes variable decelerations on the EFM. What is the appropriate FIRST action to treat this pattern? a. ) Stop the Pitocin b. ) Turn the patient on one side, then another to see if it will relieve the decelerations c. ) Give oxygen by mask at 10 L/min d. ) Notify the care provider to get a prescription for amnio-infusion

**b.) Turn the patient on one side, then another to see if it will relieve the decelerations**

It has been six hours since the patient gave birth. Upon doing the next assessment, you palpate the patient's abdomen and it is soft. Your next move: a. ) Do nothing, this is considered normal b. ) Call the physician and state there is a problem c. ) React with POISE d. ) Massage the woman's uterus

d.) Massage the woman's uterus

Recovery. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**4^th stage of labor** *Primary task: stop the bleeding*

You need to calculate the woman's due date. She states that her last menstrual period was September 1^st a. ) June 8^th b. ) July 7^th c. ) August 1^st d. ) August 7^th

a.) June 8^th

\_\_\_\_\_ is presenting part of the fetal head at 0 station. a. ) Quickening b. ) Braxton-Hicks c. ) Lightening d. ) Engagement

**Engagement** is presenting part of the fetal head at 0 station.

Normal fetal heart rate is \_\_\_\_.

Normal fetal heart rate is **110 to 160**

10cm to birth. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**2^nd stage of labor** *Primary task: get the baby out*

True or false: After birth, the cervix does not return to its pre-pregnant shape

true

\_\_\_\_\_ is the time when the expectant mother first feels fetal movement. a. ) Quickening b. ) Braxton-Hicks c. ) Lightening d. ) Engagement

**Quickening** is the time when the expectant mother first feels fetal movement.

Primary task is to get the baby out. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**2^nd stage of labor** *Primary task: get the baby out*

\_\_\_\_\_ force is pushing during the second stage of labor. a. ) Primary b. ) Secondary

**b.) Secondary** * Primary force is uterine muscular contractions.* * Secondary force is pushing during the second stage of labor.*

\_\_\_\_\_ is the fetal head entering the maternal pelvis. a. ) Quickening b. ) Braxton-Hicks c. ) Lightening d. ) Engagement

**Lightening** is the fetal head entering the maternal pelvis.

Normal maternal weight gain during pregnancy is _____ pounds.

Normal maternal weight gain during pregnancy is: **25 to 35** pounds.

A woman comes in complaining of vaginal bleeding, as a nurse, your first step would be: a. ) Assess the woman by performing a vaginal exam b. ) Perform ultrasound and use a speculum to assess the woman c. ) Call the physician as this is an emergency d. ) Tell her that she is entering the first stage of labor

b.) Perform ultrasound and use a speculum to assess the woman

True or false: Ambivalence is a normal response during the first trimester of pregnancy

true

Fundal height = weeks gestation until ____ weeks

Fundal height = weeks gestation until **36** weeks

\_\_\_\_\_ force is pushing during the second stage of labor. a. ) Primary b. ) Secondary

**a.) Primary** * Primary force is uterine muscular contractions.* * Secondary force is pushing during the second stage of labor.*

Upon measuring, you find that the fundal height is greater than weeks gestation. The possible cause of such finding could be to: (select all that apply) a. ) Hydramnios b. ) Multiple gestation c. ) IUGR d. ) Uterine fibroids e. ) The patient is overweight

a. ) Hydramnios b. ) Multiple gestation d. ) Uterine fibroids

Labor to dilation. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**1^st stage of labor** *Primary task: dilate the cervix*

A woman comes in for a prenatal visit during pregnancy and asks when she should feel the fetal movement. You answer her question by saying: a. ) By 2 months into the pregnancy, you should be able to feel the baby move. b. ) This usually happens between 16 and 20 weeks into the pregnancy. c. ) If you do not feel the movement now, then we need to check your baby's heart rate. d. ) This usually happens between 20 and 30 weeks into the pregnancy.

b.) This usually happens between 16 and 20 weeks into the pregnancy.

False contractions are also called \_\_\_\_\_. a. ) Quickening b. ) Braxton-Hicks c. ) Lightening d. ) Engagement

False contractions are also called **Braxton-Hicks**

Primary task is to get the placenta out. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**3^rd stage of labor** *Primary task: get the placenta out*

The best way to measure the fundal height is to: a. ) measure in centimeters with a tape measure while the woman is lying flat on her back with knees slightly flexed. b. ) measure in inches with a tape measure while the woman is lying flat on her back with stretched out legs. c. ) measure in centimeters with a tape measure while the woman is lying on her side with knees slightly flexed.

a.) measure in centimeters with a tape measure while the woman is lying flat on her back with knees slightly flexed.

Sources of folic acid include: a. ) tomatoes, lentils, and quinoa b. ) dark green vegetables, bananas, and walnuts c. ) all fruits and vegetables d. ) broccoli, citrus fruits, peanuts, and liver

d.) broccoli, citrus fruits, peanuts, and liver

The greatest risk to the developing embryo is between ___ and ___ days.

The greatest risk to the developing embryo is between **17** and **56** days.

Blood loss average: Vaginal birth = ? Cesarean birth = ?

Blood loss average: Vaginal birth = 500 mL Cesarean birth = 1,000 mL

A woman complains of lightheadedness, fainting spells, and frequent palpitations. As a nurse, you know that she is experiencing vena caval syndrome and recommend her to: a. ) come in to the hospital as soon as possible. b. ) switch to a side-lying position. c. ) empty bladder frequently d. ) stop taking BP medications

b.) switch to a side-lying position.

A woman is pregnant for the fourth time. She has had one miscarriage at 9 weeks, and has a son born at 41 weeks and another son at 36 weeks. What is her obstetrical history?

G₄P₂ T₁P₁A₁L₂

Primary task is to stop the bleeding. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**4^th stage of labor** *Primary task: stop the bleeding*

What are the 5 factors affecting the labor process? (5 P's)

**Passageway** **Passenger** **Position** **Power** **Psychosocial**

When ROM (SROM or AROM) thou shalt:

When ROM (SROM or AROM) thou shalt **check fetal heart tones for cord prolapse**

True or false: You know the woman is in **true labor** because she has contractions at regular intervals, progressive effacement, and dilation of the cervix.

**true** You know the woman is in **true labor** because she has contractions at regular intervals, progressive effacement, and dilation of the cervix.

Primary task is to dilate the cervix. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**1^st stage of labor** *Primary task: dilate the cervix*

Birth of placenta. a. ) 1^st stage of labor b. ) 2^nd stage of labor c. ) 3^rd stage of labor d. ) 4^th stage of labor

**3^rd stage of labor** *Primary task: get the placenta out*

As a nurse, you would perform two tests to confirm that the membrane ruptured. What are they?

Nitrazene Ferning

Late decelerations. a. ) Cord compression b. ) Head compression c. ) Uteroplacental insufficiency

**Uteroplacental insufficiency**

Caused by head compression. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Early decelerations**

Caused by cord compression. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Variable decelerations**

Peak minus resting tone. a. ) Duration b. ) Frequency c. ) Resting d. ) Intensity

**Intensity** *only accurate with IUPC*

Interventions include changing position and amnioinfusion if the membrane has ruptured. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Variable decelerations**

Tone at rest between UC's. a. ) Duration b. ) Frequency c. ) Resting d. ) Intensity

**Resting** *only accurate with IUPC*

Variable decelerations. a. ) Cord compression b. ) Head compression c. ) Uteroplacental insufficiency

**Cord compression**

No intervention necessary. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Early decelerations**

If lochia goes back to rubra color = ?

If lochia goes back to rubra color = **hemorrhage**

Caused by uteroplacental insufficiency. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Late decelerations**

Early decelerations. a. ) Cord compression b. ) Head compression c. ) Uteroplacental insufficiency

**Head compression**

Interventions include POISE. a. ) Early decelerations b. ) Variable decelerations c. ) Late decelerations

**Late decelerations**

Beginning of UC until end of UC. a. ) Duration b. ) Frequency c. ) Resting d. ) Intensity

**Duration** *seconds*

In order to locate the FHR in LOA position, you would put the sono in which area? a. ) Place sono at the the umbilicus region b. ) Place sono in right epigastric area c. ) Place sono at the LLQ of the abdomen d. ) Place sono at the LUQ of the abdomen

c.) Place sono at the LLQ of the abdomen

Beginning of one UC until the beginning of the next UC. a. ) Duration b. ) Frequency c. ) Resting d. ) Intensity

**Frequency** *minutes*

\_\_\_\_\_\_ = partner psychological adaptation

**Engrossment** = partner psychological adaptation

The tests that require Rhogam for RH negative moms after procedure are _____ and \_\_\_\_\_.

The tests that require Rhogam for RH negative moms after procedure are: **amniocentesis** and **chorionic-villi sampling**.

_Commandment_ What is the difference between variability and variable decelerations?

Variability = oxygenation Variable decelerations = U/V/W & cord compression

_Commandment_ When ROM (SROM or AROM) occurs, what do you immediately check?

Immediately check FHT's for cord prolapse. If the FHT's become bradycardic, then do a vag exam to assess for prolapsed cord. Push that head up and rush to a c/s

_Commandment_ OB nurses always intervene first, THEN call the physician. There are however 2 exceptions, what are they?

1. ) There is abruption 2. ) Uterine rupture

_Commandment_ Any type of nipple stimulation (e.g., rubbing, baby sucking, hot shower water, intercourse, etc.) will cause the uterus to \_\_\_\_\_\_\_.

Any type of nipple stimulation (e.g., rubbing, baby sucking, hot shower water, intercourse, etc.) will cause the uterus to **contract** (during ante, intra, and postpartum).

_Commandment_ What are the 2 reasons you perform an amnioinfusion?

_Reasons for Amnioinfusion_ 1. To flush meconium poop out of lungs 2. To cushion the cord when variable decelerations are present

_Commandment_ Never perform a vaginal exam on any pregnant woman complaining of \_\_\_\_\_\_. What do you do instead?

Never perform a vaginal exam on any pregnant woman complaining of **vaginal** **bleeding**. Do speculum and ultrasound instead.

_Commandment_ If a mother complains of sore nipples, what two things do you need to assess?

1. ) Positioning 2. ) Latch-on techniques * These are usually the problem*

_Commandment_ What are the 4 H's you need to assess for all new babies?

Hypoxia Hypothermia Hypoglycemia *Hyperbilirubinemia*

_Commandment_ ## Footnote 1. ) Fundal height = weeks of gestation until \_\_\_\_\_. 2. ) If fundal height \> weeks of gestation, _____ may be present. 3. ) If fundal height \< weeks of gestation, _____ may be present.

1. ) Fundal height = weeks of gestation until **36 weeks**. 2. ) If fundal height \> weeks of gestation, **polyhydramnios, multiple gestation, or uterine fibroids** may exist. 3. ) If fundal height \< weeks of gestation, **IUGR** may be present.

_Commandment_ When a patient presents with any infection (anywhere in the body), what do you assess for?

When a patient presents with any infection (anywhere in the body), you should assess for **preterm labor**. When a patient presents with preterm labor, you should assess for **infection**. ***infection*** *and **preterm labor** are highly related*

_Commandment_ When a patient presents with preterm labor, you should assess for \_\_\_\_\_\_.

_Commandment_ The physiologic reason for inducing labor by AROM is to allow the release of _______ from the membrane lining the bag (the amnion) and the lining of the uterus (the decidua). The hard skull also puts more pressure on the cx so dilation is faster.

The physiologic reason for inducing labor by AROM is to allow the release of **prostaglandins** from the membrane lining the bag (the amnion) and the lining of the uterus (the decidua). The hard skull also puts more pressure on the cx so dilation is faster.

After performing a CVS (Chorionic Villi Sampling), mothers who are RH negative need to receive \_\_\_\_\_\_\_.

After performing a CVS (Chorionic Villi Sampling), mothers who are RH negative need to receive **_Rhogam_**.

In _____ pregnancy, ultrasound is more accurate to determine gestational age compared to performing ultrasound later in pregnancy.

In **early** pregnancy, ultrasound is more accurate to determine gestational age compared to performing ultrasound later in pregnancy.

Quad marker screening tests screen for neural tube defects (NTD's) and/or chromosome anomalies. Which of the following conditions can happen when the AFP is elevated? (select all that apply) a. ) NTD's (e.g. spina bifida) b. ) Multiple gestation c. ) fetal demise d. ) T21 (Trisomy 21, Down Syndrome)

Which test detects genetic and/or chromosomal abnormalities and produces **definitive results**?

Amniocentesis

Quad marker screening tests screen for neural tube defects (NTD's) and/or chromosome anomalies. Which of the following conditions can happen when the AFP is low, uE3 is low, inhibin A is low, and HCG is high? (select all that apply) a. ) NTD's (e.g. spina bifida) b. ) Multiple gestation c. ) fetal demise d. ) T21 (Trisomy 21, Down Syndrome)

Attempting to compensate for _______ results in hypoxia, hypoglycemia, and hyperbilirubinemia.

Attempting to compensate for **_cold stress / hypothermia_** results in hypoxia, hypoglycemia, and hyperbilirubinemia.

Flow of heat from body surface to cooler surrounding air or to air circulating over a body surface. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Convection**

Having the air conditioning on. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Convection**

Loss of body heat to cooler, solid surfaces in close proximity, but not in direct contact. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Radiation**

Cold walls of room or open incubator door. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Radiation**

Heat is lost when liquid or moisture from the skin and respiratory tract converts to vapor. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Evaporation**

Wet baby from amniotic fluid or bath. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Evaporation**

Transfer of heat from object to object when the two objects are in direct contact with each other. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Conduction**

Cold hands, cold scales, cold stethoscopes. a. ) Convection b. ) Radiation c. ) Evaporation d. ) Conduction

**Conduction**

Cessation of breathing during a newborn's respiratory cycle that lasts less than 15 seconds. a. ) Physiologic Apnea b. ) Pathologic Apnea

**Physiologic Apnea**

Cessation of breathing that lasts more than 15 seconds. a. ) Physiologic Apnea b. ) Pathologic Apnea

**Pathologic Apnea**

A newborn's temperature falls by ___ to ___ degrees C after birth due to evaporative losses. This triggers cold-induced metabolic responses and heat production.

Hypoglycemia is a blood glucose level of less than ___ mg/dL or a plasma concentration less than ___ mg/dL in the first 72 hours of life.

Normal newborn blood sugar = ____ mg/dL

40-60 mg/dL

The first ___ hours of life, high risk babies are at the greatest risk of developing hypoglycemia.

The first **_12_** **_hours_** of life, high risk babies are at the greatest risk of developing hypoglycemia.

High levels of bilirubin results in \_\_\_\_\_\_.

**jaundice / icterus**

Never present on the first 24 hours of life. Considered normal for newborns occuring 2 to 3 days of life due to imbalance between production and elimination of bilirubin and an immature liver system. a. ) Physiologic Jaundice b. ) Pathologic Jaundice

**Physiologic Jaundice**

When jaundice occurs before 24 hours of life in a term infant. a. ) Physiologic Jaundice b. ) Pathologic Jaundice

**Pathologic Jaundice**

Caused by conditions that cause excessive destruction of RBCs (i.e., biliary obstruction, biliary atresia, etc.). a. ) Physiologic Jaundice b. ) Pathologic Jaundice

**Pathologic Jaundice**

For babies with the following conditions are in the nursery. Which one is going to be high risk for physiologic jaundice? a. ) Cephalhematoma b. ) Caput succedaneum c. ) Harlequin coloring d. ) Mongolian spotting

Cephalhematoma

Cephalhematomas, bruises to the face and scapula, forceps mark, and vacuum delivery can all cause jaundice because they result in destruction of RBCs from the trauma. What are 2 other conditions that can cause jaundice?

Hydration and frequent stooling helps to promote the elimination of bilirubin. What is another method that is used to treat hyperbilirubinemia?

**Phototherapy**

At birth there are multiple changes in the cardiac and respiratory systems. What is one of the changes to occur at birth in the cardiovascular system? a. ) Oxygen is exchanged in the lungs. b. ) Fluid is removed from the alveoli and replaced with air. c. ) Pressure changes occur and result in closure of the ductus arteriosus. d. ) The oxygen in the blood decreases.

**c.) Pressure changes occur and result in closure of the ductus arteriosus.** ## Footnote The ductus arteriosus is one of the openings through which there was fetal circulation. At birth, or within the first few days, this closes and the heart becomes the source of movement of blood to and from the lungs. The exchange of oxygen in the lungs is not a function of the cardiovascular system; it is a function of the respiratory system. Again, the removal of fluid from the alveoli is not a function of the cardiovascular system. The oxygen content of the blood increases; it does not decrease.

The nurse describes the changes in stool that a new mother would see when feeding her newborn formula. Which description best indicates what the mother would observe after several days? a. ) greenish, tarry, thick black stool b. ) yellow-green, pasty, unpleasant-smelling stool c. ) sour-smelling, yellowish-gold stool d. ) thin, yellowish, seedy brown stool

**b.) yellow-green, pasty, unpleasant-smelling stool** ## Footnote The stool of formula-fed newborns varies depending on the type of formula ingested, but it typically is yellow, yellow-green, or greenish, loose, pasty, or formed with an unpleasant odor. Greenish-black tarry stool denotes meconium. Thin, yellowish, seedy brown stool characterizes the transitional stool that occurs after meconium. Sour-smelling yellowish-gold stool that is loose and stringy to pasty in consistency is typical of a breastfed newborn stool.

A nurse is assessing a newborn during the first 24 hours after birth. Which findings would the nurse recognize as normal? a. ) body temperature of 97.9° to 99.7° F (36.5° to 37.5° C) b. ) positive Ortolani sign c. ) rounded, symmetrical abdomen d. ) enlarged labia with pseudomenstruation e. ) heart rate of 90 to 100 bpm

**a.) body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)** ## Footnote On average, a newborn's temperature ranges from 97.9° to 99.7° F (36.5° to 37.5° C).

A nurse needs to monitor the blood glucose levels of a newborn under observation at a health care facility. When should the nurse check the newborn’s initial glucose level? a. ) 24 hours after admission to the nursery b. ) after the newborn has received the initial feeding c. ) on admission to the nursery d. ) 4 hours after admission to the nursery

**c.) on admission to the nursery** ## Footnote Typically, a newborn’s blood glucose levels are assessed with use of a heel stick sample of blood on admission to the nursery, not 4 or 24 hours after admission to the nursery. It is also not necessary or even reasonable to check the glucose level only after the newborn has been fed.

What should the nurse expect for a full-term newborn's weight during the first few days of life? a. ) There is a loss of 5% to 10% of the birth weight in the first few days in breastfed infants only. b. ) There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns. c. ) There is an increase in 3% to 5% of birth weight by day 3 in formula-fed babies. d. ) A formula-fed newborn should gain 3% to 5% of the initial birth weight in the first 48 hours, but a breastfed newborn may lose up to 3%.

**b.) There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns.** ## Footnote The nurse should expect the newborn who is breastfed or formula-fed to lose 5% to 10% of birth weight in the first few days of life.

Which newborn neuromuscular system adaptation would the nurse NOT expect to find? a. ) A plantar grasp reflex at 7 months of age b. ) A positive Babinski reflex at 2 months of age c. ) A Moro reflex at 3 months of age d. ) An extrusion reflux at 9 months of age

**d.) An extrusion reflux at 9 months of age** ## Footnote An extrusion reflux usually disappears around 4 months of age. A positive Babinski reflex can be seen until 3 months of age. The plantar grasp disappears around 8 to 9 months of age. The Moro reflex disappears around 4 to 5 months of age.

At what point should the nurse expect a healthy newborn to pass meconium? a. ) by 12 to 18 hours of life b. ) before birth c. ) within 1 to 2 hours of birth d. ) within 24 hours after birth

**d.) within 24 hours after birth** ## Footnote The healthy newborn should pass meconium within 24 hours of life.

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving? a. ) Reticulocyte count is 6%. b. ) Skin looks less jaundiced. c. ) Hematocrit is 38. d. ) Bilirubin level went from 15 to 11.

**d.) Bilirubin level went from 15 to 11.** ## Footnote The newborn has physiologic jaundice, which is related to decreased bilirubin conjugation. Newborns have relatively immature livers and cannot conjugate (break down) bilirubin as fast as needed. Bilirubin overproduction is responsible for causing jaundice. A serum bilirubin is the best way to determine whether the jaundice is improving. The other listed methods will not address the needed information.

A nurse is teaching a new mother about what to expect for bowel elimination in her newborn. Because the mother is breastfeeding, what should the nurse tell her about the newborn's stools? a. ) Stools should be greenish and formed in consistency. b. ) Stools should be yellow-green and loose. c. ) Stools should be brown and loose. d. ) Stools should be yellow-gold, loose, and stringy to pasty.

**d.) Stools should be yellow-gold, loose, and stringy to pasty.** ## Footnote The stools of a breast-fed newborn are yellow-gold, loose, and stringy to pasty in consistency. The stools of the formula-fed newborn vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor.

The nurse is assessing the stools of a 36-hour-old neonate who is being breastfed. The nurse determines that the stools are within normal parameters based on which finding? a. ) yellowy mustard color with seedy appearance b. ) greenish black with a tarry consistency c. ) brownish black with a mucus-like appearance d. ) tan in color with a firm consistency

**a.) yellowy mustard color with seedy appearance** ## Footnote The evolution of a stool pattern begins with a newborn's first stool, which is meconium. Meconium is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth. The first meconium stool passed is semi-sterile, but this changes rapidly with ingestion of bacteria through feedings. After feedings are initiated, a transitional stool develops, which is greenish brown to yellowish brown, thinner in consistency, and seedy in appearance. If breastfed, the stools will resemble light mustard with seed-like particles. If formula-fed, the stools will be tan or yellow in color and firmer. The neonate's stool should not appear brownish-black and mucous-like.

Upon assessing the newborn's respirations, which finding would cause the nurse to notify the primary care provider? a. ) a respiratory rate of 45 breaths per minute with acrocyanosis b. ) short periods of apnea that last 10 seconds in a pink newborn c. ) coughing and sneezing in the newborn d. ) a respiratory rate of 15 breaths per minute with nasal flaring

**d.) a respiratory rate of 15 breaths per minute with nasal flaring** ## Footnote Coughing and sneezing are normal reflexes present in the newborn. The respiratory rate of a newborn should be between 30 and 60 breaths per minute. Acrocyanosis can be a normal finding in a newborn and does not indicate respiratory distress. Short periods of apnea that last longer than 15 seconds in the absence of cyanosis can be normal. Nasal flaring is a sign of respiratory distress.

A nurse is teaching newborn care to students. The nurse correctly identifies which mechanism as the predominant form of heat loss in the newborn? a. ) radiation, convection, and conduction b. ) lack of brown adipose tissue c. ) nonshivering thermogenesis d. ) sweating and peripheral vasoconstriction

**a.) radiation, convection, and conduction** ## Footnote Heat loss in the newborn occurs primarily through radiation, convection, and conduction because of the newborn's large ratio of body surface to weight and because of the marked difference between core and skin temperatures. Nonshivering thermogenesis is a mechanism of heat production in the newborn. Lack of brown adipose tissue contributes to heat loss, particularly in premature infants, but it is not the predominant form of heat loss. Peripheral vasoconstriction is a method to increase heat production.

A nurse is caring for a 3-hour-old newborn boy. The nurse makes the initial assessment and finds the following: respiratory rate 30 bpm, BP 60/40 mm/Hg, heart rate 155 bpm, axillary temperature 98.2° F (36.8° C). The nurse assesses that the newborn is in a state of quiet alert. What should the nurse do? a. ) Stimulate the newborn. b. ) Document the data. c. ) Call the primary care provider. d. ) Inform the charge nurse.

A 2-month-old infant is admitted to a local health care facility with an axillary temperature of 96.8° F (36° C). Which observed manifestation would confirm the occurrence of cold stress in this client? a. ) hyperglycemia b. ) lethargy and hypotonia c. ) increased appetite d. ) increase in the body temperature

**b.) lethargy and hypotonia** ## Footnote The nurse should look for signs of lethargy and hypotonia in the newborn in order to confirm the occurrence of cold stress. Cold stress leads to a decrease, not increase, in the newborn's body temperature, blood glucose, and appetite.

All the options are signs of respiratory distress in the newborn except: a. ) coughing. b. ) chest retractions. c. ) nasal flaring. d. ) central cyanosis. e. ) respiratory rate \>50 breaths/minute. f. ) grunting.

**e.) respiratory rate \>50 breaths/minute.** ## Footnote Coughing and sneezing are normal reflexes present in newborns. The expected respiratory rate of newborn is 30 to 60 breaths per minute.

A preterm infant is experiencing cold stress after birth. For which symptom should the nurse assess to best validate the problem? a. ) metabolic alkalosis b. ) hyperglycemia c. ) apnea d. ) shivering

**c.) apnea** ## Footnote Preterm newborns are at a greater risk for cold stress than term or postterm newborns. Cold stress can cause hypoglycemia, increased respiratory distress and apnea, and metabolic acidosis. Preterm infants lack the ability to shiver in response to cold stress.

The nurse is providing teaching to a new mother who is breastfeeding. The mother demonstrates understanding of teaching when she identifies which characteristics as being true of the stool of breastfed newborns? Select all that apply. a. ) formed in consistency b. ) firm in shape c. ) yellowish gold color d. ) completely odorless e. ) stringy to pasty consistency

**c.) yellowish gold color** **e.) stringy to pasty consistency** The stools of a breastfed newborn are yellowish gold in color. They are not firm in shape or solid. The smell is usually sour. A formula-fed infant’s stools are formed in consistency, whereas a breastfed infant’s stools are stringy to pasty in consistency.

Forces of contractions, mild asphyxia, increased intracranial pressure, and cold stress all play a role in the newborn transition by releasing which critical component? a. ) norepinephrine b. ) catecholamines c. ) epinephrine d. ) cortisol

**b.) catecholamines** ## Footnote The physical forces of contractions at labor, mild asphyxia, increased intracranial pressure, and cold stress immediately experienced after birth lead to an increased release of catecholamines, which is critical for the changes involved in the transition to extrauterine life.

Baby Dina had a birth weight of 8 pounds and 4 ounces (3742 grams). On the fourth day of life baby weighed 7 pounds and 6 ounces (3345 grams). How much is the percentage of weight loss by the fourth day and should you be concerned?

**10.6% weight loss** **Yes, you should be concerned because infant is only 4 days old and has already more than 10 percent weight loss**

The birth weight was 6 lbs and 5 ounces. The current weight is 5 lbs and 7 ounces. What is the weight loss percentage? Should you be concerned?

1 pound = 454 grams 1 ounce = 28 grams

Initiate breastfeeding. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Baby is awake and alert. Appears hungry with rooting and strong suck reflex. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Requires close monitoring by the nurse because gagging, choking, and regurgitation may occur and require immediate intervention. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**2^nd Period of Reactivity**

Optimal period for bonding and interaction. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Baby has random bursts of movement (moro reflex). a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Baby has rapid respiration, flaring of nose, rapid and irregular heart rate, and bowel sounds may be absent. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

If you did not feed the infant, watch for S/S of hypoglycemia. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Increase in motor and muscle tone, and an increase in peristalsis (may pass first meconium). a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**2^nd Period of Reactivity**

Ideal time to give a bath, weigh, and do newborn hearing test because the baby will not wake up or suck. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**1^st Period of Reactivity**

Increase in heart rate and respiratory rate. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**2^nd Period of Reactivity**

Newborn awakens from sleep, shows interest in environmental stimuli. a. ) 1^st Period of Reactivity b. ) 2^nd Period of Reactivity

**2^nd Period of Reactivity**

What are the 6 infant states of consciousness? Rank them in order from least intense to most intense.

QAD QAC

Telling caregivers when they want to interact. a. ) Engagement Cues b. ) Disengagement Cues

**Engagement Cues**

Telling caregivers when they need to take a break or do something different. a. ) Engagement Cues b. ) Disengagement Cues

**Disengagement Cues**

Overstimulation. a. ) Engagement Cues b. ) Disengagement Cues

**Disengagement Cues**

Right after delivery in the golden hour (and beyond). a. ) Crawl b. ) Side-lying c. ) Cradle, Cross-Cradle d. ) Football hold , Cross-Cradle

**Crawl**

Post C/S mom, mom with H/A. a. ) Crawl b. ) Side-lying c. ) Cradle, Cross-Cradle d. ) Football hold , Cross-Cradle

**Side-lying**

Sore nipples. a. ) Crawl b. ) Side-lying c. ) Cradle, Cross-Cradle d. ) Football hold , Cross-Cradle

**Cradle, Cross-Cradle** ***you could even use football hold***

Twins. a. ) Crawl b. ) Side-lying c. ) Cradle, Cross-Cradle d. ) Football hold , Cross-Cradle

**Football hold , Cross-Cradle**

What is the length of time recommended for exclusive breastfeeding, according to Healthy People 2020? a. ) 3 months b. ) 6 months (please don’t memorize the %age, I just want you to know the time frame!) c. ) 18 months d. ) 24 months

b.) 6 months (please don’t memorize the %age, I just want you to know the time frame!)

Which statement is true? a. ) _Prolactin_ is the "milk-making" hormone that is stimulated while the mother is resting. b. ) _Oxytocin_ is the "let-down" hormone that can be inhibited by maternal pain and fatigue.

b.) _Oxytocin_ is the "let-down" hormone that can be inhibited by maternal pain and fatigue. (You can remember this, because oxytocin creates let-down, as well as the uterus to contract. Remember the **"Ouch"** on the Concept Map)

Colostrum is (select the true answer) a. ) 90 % water b. ) high in fat and calories c. ) high in protein & immunoglobulins

c.) high in protein & immunoglobulins (you can remember this, because the baby needs immunoglobulins to keep well especially in the first week of life. And remember it coats the gut, not allowing large pathogens to enter the gut)

How many calories should a breastfeeding mother have over _pre-pregnancy_? a. ) 100 b. ) 200 c. ) 500 d. ) 1000

c.) 500 500 calories for a breast feeding mother over pre-pregnancy

How many calories should a breastfeeding mother have over _pregnancy_? a. ) 100 b. ) 200 c. ) 300 d. ) 500

b.) 200 200 calories for a breastfeeding mother over pregnancy

How much formula is needed for a newborn baby? a. ) 30-40 kcal/lb/day b. ) 45-52 kcal/lb/day c. ) 55-60 kcal/lb/day

a.) 30-40 kcal/lb/day

Describe the difference in pain between incorrect LATCH and thrush. a. ) Pain with LATCH is in the middle of the feeding only b. ) Both have increased soreness at beginning & end of feeding c,) Thrush has continual pain and burning

c,) Thrush has continual pain and burning

A bottle feeding mother should… a. ) wear a comfortable bra b. ) wear a tight sports bra c. ) wear a tight ace bandage

b.) wear a tight sports bra

It is better for a mother who smokes to bottle feed her baby. a. ) FALSE. Encourage mom to breastfeed and decrease her tobacco use and get help. b. ) TRUE. Moms who use tobacco should never breastfeed.

a.) FALSE. Encourage mom to breastfeed and decrease her tobacco use and get help.

Select the conditions when mom should NOT breastfeed. a. ) Active/infected TB b. ) Current cancer treatment c. ) Active Herpes/Shingles on breast (not covered) d. ) Hepatitis C e. ) HIV f. ) Covered active Herpes on breast g. ) CMV h. ) A, B, C & E i. ) A, B, C, D & G j. ) All of the above

**h.) A, B, C & E** ## Footnote a. ) Active/infected TB b. ) Current cancer treatment c. ) Active Herpes/Shingles on breast (not covered) e. ) HIV

If mom has a low milk supply… a. ) Add formula between feedings b. ) Breastfeed frequently c. ) Add breast pumping between feedings d. ) A, B & C e. ) B & C

**e.) B & C** ## Footnote b. ) Breastfeed frequently c. ) Add breast pumping between feedings

Select the true statement (3 are false). a. ) Breastmilk should always be stored in glass bottles b. ) Breastmilk can remain in the freezer 5 months c. ) Breastmilk can remain in the refrigerator 8 weeks d. ) Breastmilk should be thawed by running hot water over the bottle/bag

b.) Breastmilk can remain in the freezer 5 months

Classic bleeding sign is brownish vaginal bleeding (prune juice like).

_Types of Spontaneous Abortion_ ## Footnote Heavy vaginal bleeding, intense cramping, cervical dilation, placenta remains but no fetus. a. ) threatened b. ) inevitable c. ) incomplete

In regards to monitoring Gestational Trophoblastic Disease, how long does the client need to be monitored for? Describe the process...

Which of the following conditions are associated with early bleeding (first half) of pregnancy?

Commonly due to fetal genetic abnormalities. a. ) 1^st trimester spontaneous abortion b. ) 2^nd trimester spontaneous abortion

**1^st trimester spontaneous abortion**

Which of the following conditions are associated with late bleeding (second half) of pregnancy?

Any pregnancy in which the fertilized ovum implants outside the uterine cavity.

_Types of Spontaneous Abortion_ ## Footnote Bleeding, rupture of membranes, cervix dilated, strong cramping, possible passage of products. a. ) threatened b. ) inevitable c. ) incomplete

If a client asks you information on what is the major cause of first trimester miscarriages, you would answer by saying: a. ) nausea and vomiting b. ) perinatal stress c. ) chromosomal abnormalities d. ) umbilical cord accidents

**c.) chromosomal abnormalities** Fetal genetic or chromosomal abnormalities are the most common cause of 1^st trimester abortions

More likely related to maternal conditions. a. ) 1^st trimester spontaneous abortion b. ) 2^nd trimester spontaneous abortion

**2^nd trimester spontaneous abortion**

_Types of Spontaneous Abortion_ ## Footnote Cervix is closed, placenta attached, some bleeding, no passage of fetal tissue. a. ) threatened b. ) inevitable c. ) incomplete

Amniotic fluid \<500 mL. a. ) Hydramnios (or polyhydramnios) b. ) Oligohydramnios

**Oligohydramnios**

Premature dilation of the cervix with painless contractions, minimal bleeding may be present.

**Cervical Insufficiency**

Has a sudden onset. a. ) Placenta Previa b. ) Abruptio Placenta

**Abruptio Placenta**

Bleeding condition that occurs during the last two trimesters of pregnancy because the placenta implants over the cervical os.

**Placenta Previa**

Bleeding is always visible, slightly more than profuse. a. ) Placenta Previa b. ) Abruptio Placenta

**Placenta Previa**

Uterus tone is firm to rigid. a. ) Placenta Previa b. ) Abruptio Placenta

**Abruptio Placenta**

Treatment includes indomethacin. a. ) Hydramnios (or polyhydramnios) b. ) Oligohydramnios

**Hydramnios (or polyhydramnios)**

Constant, uterine tenderness on palpation. a. ) Placenta Previa b. ) Abruptio Placenta

**Abruptio Placenta**

Placenta attaches itself too deeply into the wall of the uterus, but does not penetrate the uterine muscle.

**Placenta Accreta**

Painless. a. ) Placenta Previa b. ) Abruptio Placenta

**Placenta Previa**

Bleeding can be concealed or visible. a. ) Placenta Previa b. ) Abruptio Placenta

**Abruptio Placenta**

Uterus tone is soft and relaxed. a. ) Placenta Previa b. ) Abruptio Placenta

**Placenta Previa**

Onset is insidious. a. ) Placenta Previa b. ) Abruptio Placenta

**Placenta Previa**

Comprises spectrum of disorders that originate in the placenta. The cells that become the placenta proliferate making chorionic villi edematous and become grapelike clusters of a molar pregnancy.

**Gestational Trophoblastic Disease**

Any pregnancy in which the fertilzed ovum implants outside the uterine cavity.

**Ectopic Pregnancy**

Amniotic fluid \>2,000 mL. a. ) Hydramnios (or polyhydramnios) b. ) Oligohydramnios

**Hydramnios (or polyhydramnios)**

Dark red bleeding. a. ) Placenta Previa b. ) Abruptio Placenta

**Abruptio Placenta**

**Separation** of normally located placenta after 20^th week of gestation leading to hemorrhage and compromised fetal blood supply. Has a high mortality rate.

**Abruptio Placenta**

Blood is bright red. a. ) Placenta Previa b. ) Abruptio Placenta

**Placenta Previa**

A woman is admitted with a diagnosis of ectopic pregnancy. For which action would the nurse anticipate beginning preparation? a. ) bed rest for the next 4 weeks b. ) intravenous administration of a tocolytic c. ) immediate surgery d. ) internal uterine monitoring SUBMIT ANSWER

**c.) immediate surgery** ## Footnote Ectopic pregnancy means an embryo has implanted outside the uterus, usually in the fallopian tube. Surgery is usually necessary to remove the growing structure before the tube ruptures or repair the tube if rupture has already occurred. Bed rest will not correct the problem of an ectopic pregnancy. Administering a tocolytic is not indicated, nor is internal uterine monitoring.

A pregnant woman is admitted to the hospital with a diagnosis of placenta previa. Which action would be the priority for this woman on admission? a. ) assessing uterine contractions by an internal pressure gauge b. ) assessing fetal heart tones by use of an external monitor c. ) performing a vaginal examination to assess the extent of bleeding d. ) helping the woman remain ambulatory to reduce bleeding

**b.) assessing fetal heart tones by use of an external monitor** ## Footnote Not disrupting the placenta is a prime responsibility. An internal monitor, a vaginal examination, and remaining ambulatory could all do this and thus are contraindicated.

What would be the physiologic basis for a placenta previa? a. ) low placental implantation b. ) a placenta with multiple lobes c. ) a uterus with a midseptum d. ) a loose placental implantation

**a.) low placental implantation** ## Footnote The cause of placenta previa is usually unknown, but for some reason the placenta is implanted low instead of high on the uterus.

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect? a. ) ensures passage of all the products of conception b. ) alleviates strong uterine cramping c. ) suppresses the immune response to prevent isoimmunization d. ) halts the progression of the abortion

**a.) ensures passage of all the products of conception** ## Footnote Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rh (D) immunoglobulin is used to suppress the immune response and prevent isoimmunization.

Which medication would the nurse prepare to administer if prescribed as treatment for an unruptured ectopic pregnancy? a. ) ondansetron b. ) promethazine c. ) oxytocin d. ) methotrexate

**d.) methotrexate** ## Footnote **Methotrexate**, a folic acid antagonist that inhibits cell division in the developing embryo, is most commonly used to treat ectopic pregnancy. **Oxytocin** is used to stimulate uterine contractions and would be inappropriate for use with an ectopic pregnancy. **Promethazine** and **ondansetron** are antiemetics that may be used to treat hyperemesis gravidarum.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first? a. ) Provide emotional support to the client and significant other. b. ) Administer oxygen to the client. c. ) Obtain a surgical consent from the client. d. ) Assess the client’s vital signs.

**d.) Assess the client’s vital signs.** ## Footnote A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps.

A client with a history of cervical insufficiency is seen for reports of pink-tinged discharge and pelvic pressure. The primary care provider decides to perform a cervical cerclage. The nurse teaches the client about the procedure. Which client response indicates that the teaching has been effective? a. ) "Purse-string sutures are placed in the cervix to prevent it from dilating." b. ) "A cervical cap is placed so no amniotic fluid can escape." c. ) "The cervix is glued shut so no amniotic fluid can escape." d. ) "Staples are put in the cervix to prevent it from dilating."

**a.) "Purse-string sutures are placed in the cervix to prevent it from dilating."** ## Footnote The cerclage, or purse string suture is inserted into the cervix to prevent preterm cervical dilatation and pregnancy loss. Staples, glue, or a cervical cap will not prevent the cervix from dilating.

A 16-year-old client gave birth to a 12 weeks' gestation fetus last week. The client has come to the office for follow-up and while waiting in an examination room notices that on the schedule is written her name and "follow-up of spontaneous abortion." The client is upset about what is written on the schedule. How can the nurse best explain this terminology? a. ) "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy." b. ) "Oh, that just means it was a miscarriage." c. ) "Abortion is a medical term for any interruption of pregnancy before a fetus is viable." d. ) "Spontaneous abortion is the medical name for a miscarriage."

**a.) "Spontaneous abortion is a more specific term used to describe a spontaneous miscarriage, which is a loss of pregnancy before 20 weeks. This term does not imply that you did anything to affect the pregnancy."** ## Footnote Abortion is a medical term for any interruption of a pregnancy before a fetus is viable, but it is better to speak of these early pregnancy losses as spontaneous abortions to avoid confusion with intentional terminations of pregnancies. The other responses are correct, but they do not provide the client with the most complete and reassuring answer.

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable abortion? a. ) no passage of fetal tissue b. ) closed cervical os c. ) strong abdominal cramping d. ) slight vaginal bleeding

**c.) strong abdominal cramping** ## Footnote Strong abdominal cramping is associated with an inevitable spontaneous abortion. Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

A pregnant woman is diagnosed with abruptio placentae. When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect? a. ) bright red vaginal bleeding b. ) firm, rigid uterus on palpation c. ) fetal heart rate within normal range d. ) absence of pain

**b.) firm, rigid uterus on palpation** ## Footnote The uterus is firm-to-rigid to the touch with abruptio placentae. It is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. Bright red vaginal bleeding is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.

A client with preeclampsia is receiving magnesium sulfate. Which nursing assessment should be ongoing while the medication is being administered? a. ) urine protein b. ) ability to sleep c. ) hemoglobin d. ) respiratory rate

d.) respiratory rate

A client is admitted to labor and birth for management of severe preeclampsia. An IV infusion of magnesium sulfate is started. What is the primary goal for magnesium sulfate therapy? a. ) reverse edema b. ) decrease protein in urine c. ) decrease blood pressure d. ) prevent maternal seizures

A nurse has been assigned to assess a pregnant client for abruptio placenta. For which classic manifestation of this condition should the nurse assess? a. ) painless bright red vaginal bleeding b. ) generalized vasospasm c. ) increased fetal movement d. ) "knife-like" abdominal pain with vaginal bleeding

**d.) "knife-like" abdominal pain with vaginal bleeding** ## Footnote The classic manifestations of abruption placenta are painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement. Painless bright red vaginal bleeding is the clinical manifestation of placenta previa. Generalized vasospasm is the clinical manifestation of preeclampsia and not of abruptio placenta.

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination there is an elevated hCG level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition? a. ) ectopic pregnancy b. ) placenta previa c. ) gestational trophoblastic disease d. ) abruption of placenta

**c.) gestational trophoblastic disease** ## Footnote The client is most likely experiencing gestational trophoblastic disease or a molar pregnancy. In gestational trophoblastic disease or molar pregnancy, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Abruption of placenta is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa the placental attachment is at the lower uterine segment.

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between abruptio placenta and placenta previa. Which statement should the nurse include in the teaching? a. ) "Placenta previa causes painful, dark red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with bright red painless bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." b. ) "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." c. ) "Placenta previa causes painful, dark red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the fundus; abruptio placenta is associated with right red painless bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor." d. ) "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the fundus; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."

**b.) "Placenta previa causes painless, bright red bleeding during pregnancy due to an abnormally implanted placenta that is too close to or covers the cervix; abruptio placenta is associated with dark red painful bleeding caused by premature separation of the placenta from the wall of the uterus before the end of labor."** ## Footnote Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless bright red bleeding in the third trimester. Abruptio placenta is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor.

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate? a. ) infection b. ) central nervous system (CNS) involvement c. ) fetal distress related to hypoxia d. ) cord compression SUBMIT ANSWER

**c.) fetal distress related to hypoxia** ## Footnote When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement.

When assessing a pregnant woman with vaginal bleeding, the nurse would suspect a threatened abortion based on which finding? a. ) strong abdominal cramping b. ) cervical dilation c. ) passage of fetal tissue d. ) slight vaginal bleeding SUBMIT ANSWER

d.) slight vaginal bleeding

Your patient just had Dinoprostone (Cervidil) vaginal insert placed int the posterior fornix of the vaginal vault. What is the reason for doing this? a. ) To make the cervix softer b. ) To prevent bacteria from entering c. ) To stop preterm labor d. ) To augment labor

a.) To make the cervix softer

You are caring for a pregnant client on Magnesium Sulfate drip. Your assessment reveals her blood levels are reaching toxic levels. What IV med do you give her to reverse the effects? a. ) Terbutaline b. ) Oxytocin c. ) Calcium d. ) Brethine

c.) Calcium

A mother just received an epidural and is experiencing hypotension. Which drug would you administer to counteract the effect? a. ) Methylergonovine (Methergine) b. ) Naloxone (Narcan) c. ) Ephedrine d. ) Hydralazine (Apresoline)

c.) Ephedrine

Hemabate is used in emergency situations. What is the drug composed of? a. ) Multiple vasoconstrictors b. ) Powerful oxytocic c. ) Rapid acting sympathomimetics d. ) Specific type of prostaglandin

d.) Specific type of prostaglandin

You are recovering a woman who recently delivered twins who had severe pre-eclampsia. Her lochia is too heavy. Based on the patient data, which drug listed below is the appropriate measure to stop uterine hemorrhage (not prevent it) before taking her in to do an emergency hysterectomy? a. ) Methylergonomive Maleate (Methergine) b. ) Oxytocin (Pitocin) c. ) Terbutaline (Brethine) d. ) Hemabate (Prostaglandin F₂ or Prostaglandin M)

d.) Hemabate (Prostaglandin F₂ or Prostaglandin M)

You are caring for a pregnant client and the physician prescribes Betamethasone (Celestone). Why did s/he order it for the client? a. ) Inhibits prostaglandin secretion, thus decreasing UC's b. ) Stimulates surfactant production in the fetal lung tissue c. ) Decreases the quantity of acetylcholine, blocking neuromuscular transmission d. ) Increases the production of prolactin, to produce milk Next

b.) Stimulates surfactant production in the fetal lung tissue

You are on the high risk antepartal unit and taking care of a patient who was just admitted in preterm labor. Which drug below could be ordered for her to stop her contractions? a. ) Narcan b. ) Methylergonovine (Methergin) c. ) Betamethasone (Celestone) d. ) Nifedipine (Procardia)

**d.) Nifedipine (Procardia)** ## Footnote Procardia (Nifedipine) is a calcium channel blocker. You need calcium to contract--this drug blocks it so calcium cannot get into smooth muscle --ergo no UC's!

What blood type incompatibilities would necessitate Rhogam be given to an antepartum or postpartum patient? a. ) Mother is Rh positive and baby is Rh positive b. ) Mother is Rh positive and baby is Rh negative c. ) Mother is Rh negative and baby is Rh positive d. ) Mother is Rh negative and baby is Rh negative

c.) Mother is Rh negative and baby is Rh positive

You just gave your client the prescribed dose of Methylergonovine (Methergine). Which period of the childbearing cycle do we use Methergine when doing secondary interventions? a. ) Postpartal period b. ) Intrapartal period c. ) Antepartal period d. ) Pre-conceptual period

a.) Postpartal period

You are taking care of a pregant patient on a Magnesium sulfate (MgSO₄) drip. Why is your patient on this medication? a. ) To augment labor b. ) To stop labor c. ) To mature the baby's lungs d. ) To decrease pain sensation during labor

b.) To stop labor

A patient has just delivered and is bleeding a little more than you would like to see. You turn up the Pitocin in her LR bag, but the bleeding continues. Her VS are 99.0 F, 82, 16, 118/78, Pain=5. Which drug would you next need to give to control heavy postpartum bleeding? a. ) Narcan IV b. ) Cytotec P.V. c. ) Methergine IM d. ) Pitocin P.O.

c.) Methergine IM

You are caring for a gravida 1, age 38, diagnosed with Pre-eclampsia (previously called PIH). Her blood pressure is 168/105. What medication would you administer to get her BP under control so that she doesn't have a stroke? a. ) Magnesium Sulfate b. ) Prostaglandin c. ) Hydralazine (Apresoline) d. ) Ephedrine

c.) Hydralazine (Apresoline)

Oxytocin (Pitocin) is a medication we also use in the clinic for the postpartum mother in the form of a nasal spray. Why would a mother need it postpartally? a. ) Helps prevent coagulation problems associated with postpartum. b. ) Helps decrease edema due to its vasopressor and diuretic effects c. ) Helps sitmulate the milk ejection reflex in breastfeeding mothers d. ) Inhibits the mother from making milk when she chooses to bottlefeed.

c.) Helps sitmulate the milk ejection reflex in breastfeeding mothers

Magnesium sulfate drip is given during pregnancy to treat PIH. What is the physiological action of Magnesium Sulfate? a. ) Prevent seizures b. ) Eliminate facial edema c. ) Decrease blood pressure d. ) Improve kidney functioning

a.) Prevent seizures

A patient in labor was requesting pain medicine and you give her Nubain IVP. Unfortunately you forgot to do a vag exam prior to giving the medication, and she delivered a baby boy 45 minutes later. Now the baby is depressed. What medication intervention will you need to do to counteract the depression? a. ) Terbutaline (Brethine) b. ) Betamethasone (Celestone) c. ) Neonatal Narcan d. ) Epinephrine (Adrenalin)

c.) Neonatal Narcan

The baby has just been delivered vaginally 10 minutes ago. Erythromycin eye ointment (Ilotycin) has been ordered. Why is this medication ordered for newborns? a. ) To prevent vaginal normal flora from getting into the eyes b. ) To coat the eye with lubricant so they won't dry out c. ) To prevent blindness caused by chlamydia d. ) To help the baby's eyes to focus from a distance

c.) To prevent blindness caused by chlamydia

A patient has Colace ordered during her postpartum stay in the hospital. What is the mechanism of action for Colace? a. ) Adds cellulose to make it blander b. ) Irritates mucosal lining to stimulate peristalsis c. ) Produces more bulk to stimulate peristalsis d. ) Draws water into the stool to make it softer

d.) Draws water into the stool to make it softer

You are admitting a G1P0 at 30 weeks gestation who is in apparent preterm labor. Which of the following medications would the nurse administer in order to stop preterm labor? a. ) Cervidil (Prostaglandin E) b. ) Betamethasone (Celeston Solupan) c. ) Hydralazine (Apresoline) d. ) Magnesium Sulfate (MgSO₄)

d.) Magnesium Sulfate (MgSO₄)

For pre-eclamptic patients, Magnesium sufate (MgSO₄) drip is given primarily to: a. ) Increase renal perfusion b. ) Decrease peripheral edema c. ) Prevent seizures d. ) Decrease blood pressure

c.) Prevent seizures

You need to give a baby the Vit K shot. Which drug below is the generic name for Vit K? a. ) Phytonadione b. ) Ilotycin c. ) Promethazine d. ) Meperidine

a.) Phytonadione

What is the primary action of Terbutaline (Brethine) when given to an OB patient? a. ) Lower the risk of eclampsia b. ) Cause fetal lung maturity c. ) Quiet the myometrium of the uterus d. ) Increase ranal GFR to reduce fluid retention

## Footnote * not b.) Cause fetal lung maturity* * not a.) Lower the risk of eclampsia*

Terbutaline (Brethine) is a sympatho-mimetic (it mimics the sympathetic branch of CNS). Brethine is used during pregnancy to cause which action? a. ) Hypotonic contractions b. ) anti-Hypertensive c. ) anti-hemolysis d. ) Tocolysis

d.) Tocolysis

You are caring for a postpartum patient who still shows signs of pre-eclampsia with severe features (previously called severe PIH). The physician prescribed routine Methergine 0.2 mg p.o. q 8 hours. What is the appropriate nursing action? a. ) Administer pain medication in tandem with Methergine b. ) Administer the medication c. ) Discontinue the medication and notify pharmacy d. ) Hold the medication and notify the physician

d.) Hold the medication and notify the physician

After administering Dinoprostone (Cervidil) to an induction candidate, the nurse should do which of the following? a. ) Instruct the patient to rub one nipple at a time to help w/ contractions b. ) Perform AROM to stimulate contractions c. ) Monitor UC's and FHR for one hour after insertion d. ) Have patient ambulate around the unit

c.) Monitor UC's and FHR for one hour after insertion

The nurse is administering oxytocin to a client in labor. During oxytocin infusion, why must the nurse monitor I&O closely? a. ) Because oxytocin causes water intoxication b. ) Because oxytocin has a diuretic effect c. ) Because oxytocin can be toxic to the kidneys. d. ) Because oxytocin causes excessive thirst

a.) Because oxytocin causes water intoxication

Prior to delivery, a client is treated with Magnesium Sulfate for pre-eclampsia. Her respiratory rate is 12 and DTRs are 0. Which of the following interventions would be most appropriate next? a. ) Monitor the blood pressure, urinary output, and the change in amount of sacral edema b. ) Put client in Left lateral position and bring the emergency box into her room. c. ) Notify the doctor and the operating room staff to prepare for c/s d. ) Turn off Magnesium, run a stat Mg level

d.) Turn off Magnesium, run a stat Mg level

You have just given a postpartum patient a Rubella vaccination. What must you counsel the patient about before she is discharged? a. ) If she developes a fever, she should wear a mask around her newborn b. ) She may experience headaches for about 2 days c. ) The best site for injection is the fat pads on the hip d. ) She must not get pregnant for 3 months

d.) She must not get pregnant for 3 months

You are taking care of a patient on MgSO₄ drip. What is the most serious side effect to monitor for when administering this drug? a. ) Cerebral edema b. ) Hypotonic reflexes c. ) Bradycardia d. ) Hypotension Next

b.) Hypotonic reflexes

Demerol, Stadol, and Nubain are three narcotic analgesics that are given to alleviate pain during the first stage of labor. What is the most important thing a nurse needs to assess when these drugs are given? a. ) How close the mother is to delivery b. ) When was the last time the bladder was emptied c. ) Change in the mother's LOC d. ) Fetal heart rate stability

a.) How close the mother is to delivery

You are caring for a diabetic patient experiencing preterm labor. She has been on Mag Sulfate for two days. This am she is contracting 2 in 10 minutes. The physician prescribes nifedipine to arrest UCs. What would you do with the prescription? a. ) Administer the med and document on MAR b. ) Withold it and notify the physician of the additive affect. c. ) Turn down the mag, wait one hour and administer the med d. ) Leave the magnesium the same, and give half the nifedipine now and half in 1 hour

b.) Withold it and notify the physician of the additive affect.

You are administering Hydralazine (Apresoline) to a severely preeclamptic patient. The appropriate blood pressure evaluations should be done every how many minutes after giving the medication? a. ) q 5 minutes til stable b. ) q 10 minute X 3 c. ) q 20 minutes, may repeat X1 d. ) q 20 minutes until stable

a.) q 5 minutes til stable

Mrs. Smith was admitted to L&D yesterday in preterm labor. She is 32 weeks gestation, and has been on 2 gms MgSO4 drip since admission. This morning she exhibits lethargy, DTR = 0. What will you anticipate giving as the antidote for Mag toxicity? a. ) Vitamin K b. ) Naloxone Hydrochloride c. ) Calcium Gluconate d. ) Epinephrine

c.) Calcium Gluconate

The Rubella Vaccine is a live virus vaccine. When administering the vaccine, the most important teaching factor to address is to: a. ) Suspend breastfeeding for 3 days, but to continue pumping b. ) Avoid pregnancy for 3 months after the injection. c. ) inform the client that the vaccine will stimulate active immunity d. ) determine if there is an allergy to neomycin

b.) Avoid pregnancy for 3 months after the injection.

A patient at term has been scheduled for induction at 0700. You admit her and begin the induction with pitocin. After two hours, you notice UC's q 2-3 minutes but they are mild in intensity. What should you do? a. ) Slow down the rate of infusion of the Pitocin drip b. ) Continue to increase Pitocin until UC's are stronger c. ) Perform AROM to make contractions stronger d. ) Discontinue the IV Pitocin--wait 30 minutes and restart it

b.) Continue to increase Pitocin until UC's are stronger

A mother gave birth to a baby boy this morning, and she is Rh neg. Which of the following would be a nursing judgement when administering Rhogam? a. ) Rhogam is given by sub-q injection in the arm b. ) Administer it because baby is Rh negative c. ) Rhogam must be given within 72 hrs of birth d. ) Do not administer unless mother is Rh positive

c.) Rhogam must be given within 72 hrs of birth

The CNM has ordered Methergine to be given p.o. q 6 hours to a postpartum client. What common side effect might the new mother experience? a. ) Severe afterpains b. ) nausea and gas c. ) Priapism d. ) Breast engorgement

**a.) Severe afterpains** So you may want to bring a pain pill at the same time!

No body movement, rhythmic breathing, bursts of sucking. a. ) Drowsy b. ) Active Alert c. ) Quiet Alert d. ) Quiet Sleep e. ) Active Sleep

**d.) Quiet Sleep**

Body activity, irregular breathing, easy to wake, a. ) Drowsy b. ) Active Alert c. ) Quiet Alert d. ) Quiet Sleep e. ) Active Sleep

**e.) Active Sleep**

Variable movement, irregular breathing, opens and closes eyes. a. ) Drowsy b. ) Active Alert c. ) Quiet Alert d. ) Quiet Sleep e. ) Active Sleep

**a.) Drowsy**

Little body movement, eyes open and bright, steady regular breathing. a. ) Drowsy b. ) Active Alert c. ) Quiet Alert d. ) Quiet Sleep e. ) Active Sleep

**c.) Quiet Alert**

Fussy, lots of body and facial movement. Common before feeding. a. ) Drowsy b. ) Active Alert c. ) Quiet Alert d. ) Quiet Sleep e. ) Active Sleep

**b.) Active Alert**

Cessation of breathing lasting more than 15 seconds. a. ) Pathologic Apnea b. ) Physiologic Apnea c. ) Periodic Breathing

**Pathologic Apnea**

Cessation of breathing during a newborn's respiratory cycle lasting less than 15 seconds. a. ) Pathologic Apnea b. ) Physiologic Apnea c. ) Periodic Breathing

**Physiologic Apnea**

Pauses in respiratory movements lasting up to 15 seconds during breathing cycle. a. ) Pathologic Apnea b. ) Physiologic Apnea c. ) Periodic Breathing

**Periodic Breathing**

Cold scales, cold stethoscope. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Conduction**

Cold hands. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Conduction**

Cold wall of room. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Radiation**

Air conditioner is on. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Convection**

Wet baby following bath. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Evaporation**

Open incubator door. a. ) Conduction b. ) Radiation c. ) Convection d. ) Evaporation

**Radiation**

Dark red bleeding, visible or concealed. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Abruptio** * Dark red bleeding, visible or concealed* * Uterus firm to rigid* * Fetal distress*

Placenta attaches itself to uterine wall. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Accreta** *Placenta attaches itself to uterine wall*

Fetal distress. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Abruptio** * Dark red bleeding, visible or concealed* * Uterus firm to rigid* * Fetal distress*

Uterus is soft and relaxed. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Previa** * Red bleeding, visible* * Uterus is soft and relaxed*

Red bleeding, visible. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Previa** * Red bleeding, visible.* * Uterus is soft and relaxed*

Premature dilation of cervix with painless contractions. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Cervical Insufficiency**

Uterus firm to rigid. a. ) Placenta Accreta b. ) Placenta Previa c. ) Placenta Abruptio d. ) Cervical Insufficiency

**Placenta Abruptio** * Dark red bleeding, visible or concealed* * Uterus firm to rigid* * Fetal distress*

Type of Thalassemia with mild persistent anemia. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Thalassemia Anemia Alpha** *Type of Thalassemia with **mild** persistent anemia*

Hereditary autosomal recessive disorder a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Thalassemia Anemia** *Hereditary autosomal recessive disorder*

Maternal risk: fatigue, weakness, malaise, anorexia, susceptibility to infection. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Iron Deficiency Anemia** *Maternal risk: fatigue, weakness, malaise, anorexia, susceptibility to infection.*

Fetal neural tube defects, spina bifida, anencephaly. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Folic Acid Deficiency** *Fetal neural tube defects, spina bifida, anencephaly.*

Maternal risks include: PTL, pre-eclampsia, eclampsia, and placenta abruption. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Sickle Cell Anemia** * Autosomal recessive disease* * Maternal risks:* * PTL * Pre-Eclampsia * Eclampsia * Placenta abruption

Type of Thassalemia causing severe maternal hemolysis, anemia, and premature death. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Thalassemia Anemia Beta** *Type of Thassalemia causing severe maternal hemolysis, anemia, and premature death*

Autosomal recessive disease. a. ) Sickle Cell Anemia b. ) Thalassemia Anemia c. ) Folic Acid Deficiency d. ) Thalassemia Anemia Alpha e. ) Thalassemia Anemia Beta f. ) Iron Deficiency Anemia

**Sickle Cell Anemia** * Autosomal recessive disease* * Maternal risks:* * PTL * Pre-Eclampsia * Eclampsia * Placenta abruption

Hypertension without proteinuria. a. ) Gestational Hypertension b. ) Preeclampsia c. ) Eclampsia

**Gestational Hypertension**

Hypertension with proteinuria. a. ) Gestational Hypertension b. ) Preeclampsia c. ) Eclampsia

**Preeclampsia**

Seizures present. a. ) Gestational Hypertension b. ) Preeclampsia c. ) Eclampsia

**Eclampsia**

Blood pressure \> 140/90. a. ) Mild Preeclampsia b. ) Severe Preeclampsia

**Mild Preeclampsia**

S/S include mild facial/hand edema and weight gain. a. ) Mild Preeclampsia b. ) Severe Preeclampsia

**Mild Preeclampsia**

Blood pressure \> 160/110. a. ) Mild Preeclampsia b. ) Severe Preeclampsia

**Severe Preeclampsia**

S/S include epigastric/RUQ pain, blurred vision, H/A, hyperreflexia. a. ) Mild Preeclampsia b. ) Severe Preeclampsia

**Severe Preeclampsia**

What is HELLP syndrome?

What medication is given for mag toxicity? Which med do you not want to give with mag sulfate?

When will a mother recieve Rhogam?

A woman is hospitalized with severe preeclampsia. The nurse is meal-planning with the patient and encourages a diet that is high in: a. ) Fruit b. ) Sodium c. ) Protein d. ) Carbohydrates

c.) Protein

The nurse is assessing a client who has severe preeclampsia. The assessment finding that should be reported to the physician is: a. ) Proteinuria b. ) Platelet count of 60,000 c. ) Urine output of 50 mL per hour d. ) DTR’s 2+

b.) Platelet count of 60,000

A pregnant woman is being treated with magnesium sulfate. The nurse is concerned that the patient is experiencing early drug toxicity. What assessment finding by the nurse indicates early magnesium sulfate toxicity? a. ) Respiratory rate of 16 b. ) Fetal heart rate 120 c. ) Complaints by the patient of feeling flushed and warm d. ) Patellar reflexes are weak or absent

d.) Patellar reflexes are weak or absent

A patient has preeclampsia. She is 36 weeks pregnant, and comes to the high-risk screening center for a non-stress test (NST). The nurse should explain to the patient that the NST is being done to determine: a. ) What effect her hypertension has had on the fetus b. ) Whether the fetus will be able to tolerate labor c. ) Whether fetal movement increases with braxton-hicks contractions d. ) What effect sitting position will have on her blood pressure

a.) What effect her hypertension has had on the fetus

The nurse identifies the following assessment findings on a client with preeclampsia: blood pressure 156/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 1+ on dipstick; and edema of the hands, ankles, and feet. On the next hourly assessment, which new assessment finding would be an indication of worsening of the preeclampsia? a. ) Blood pressure 158/104 b. ) Urinary output 20 mL/hour c. ) Reflexes 2+ d. ) Platelets 110,000

b.) Urinary output 20 mL/hour

A patient is being admitted to the labor area with the diagnosis of eclampsia. Which actions by the nurse are appropriate at this time? Select all that apply. a. ) Tape a tongue blade to the edge of the bed b. ) Pad the siderails and head of the bed c. ) Provide the patient with needed stimulation d. ) Provide the patient with grief counseling e. ) Pull the blinds and provide a dark, quiet environment

b. ) Pad the siderails and head of the bed e. ) Pull the blinds and provide a dark, quiet environment

A G1P0 client comes to the OB clinic for her first prenatal checkup. Her obstetrician determines she is 10 weeks gestation and orders a lab draw to determine blood type and Rh. Lab tests reveal mother's blood type is O neg. Four weeks later she experiences a miscarriage. What should be the follow-up plan? a. ) No sex for two months b. ) RhoGAM injection c. ) No pregnancy for one year d. ) Genetic testing on the product of conceptus

b.) RhoGAM injection

Identify all the events where a pregnant client requires a RhoGAM injection. Select all that apply. a. ) Mother's blood type O positive, Baby A neg b. ) Mother O neg, experiences a car accident c. ) Mother B neg, father O neg d. ) Mother O neg, gets amniocentesis at 20 weeks e. ) Mother A neg, Baby O neg f. ) Mother AB neg, Baby AB pos g. ) Mother A neg, Indirect Coomb's test +

b. ) Mother O neg, experiences a car accident d. ) Mother O neg, gets amniocentesis at 20 weeks f. ) Mother AB neg, Baby AB pos

A patient is diagnosed with severe pre-eclampsia and has a blood pressure of 190/100. What is the appropriate medication to give her to normalize the blood pressure? a. ) Magnesium Sulfate b. ) Terbutaline c. ) Labetelol d. ) Betamethesone

c.) Labetelol

The rationale for Magnesium Sulfate is to a. ) Provide minerals b. ) Prevent seizures c. ) Decrease BP d. ) Augment labor

b.) Prevent seizures

Which finding indicates HELLP syndrome in a pregnant woman? a. ) Increased edema b. ) Marked elevated blood pressure c. ) Thrombocytopenia d. ) Seizures

c.) Thrombocytopenia

The best treatment for eclampsia is to a. ) Deliver the baby b. ) Initiate Magnesium Sulfate c. ) Turn mom to the left lateral side d. ) Give BP meds

a.) Deliver the baby

ob_exam_1_20170205233115 Flashcards

(428 cards)