Blue Book 2 Flashcards

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1
Q

When the terminology “the 3 phases of labor” is used, what does it mean?

A

If the statement refers to PHASES of labor, it means the 3-step process of latency, followed by active and transitional. (LAT order - just as its spelled in LATency)

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2
Q

Normal length of pregnancy is ____ to ____ days

A

240, 300

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3
Q

Pregnancy is divided into ____ trimesters

A

3

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4
Q

During the 1st trimester the woman experiences decreased or increased vaginal secretions?

A

increased

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5
Q

When are urine pregnancy tests positive?

A

At the time of the first missed period

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6
Q

Pregnancy tests test for the presence of what hormone?

A

HCG (human chorionic gonadotropin hormone)

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7
Q

Urine and blood pregnancy tests are enough evidence to be certain of pregnancy (T/F)?

A

false, these tests only suggest pregnancy

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8
Q

What is Hegar’s sign?

A

Uterine softening

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9
Q

What is Chadwick’s sign?

A

Blue-tint to the cervix

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10
Q

The first trimester goes from week ___ to week __

A

1-13

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11
Q

The second trimester goes from week ___ to week ___

A

14-27

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12
Q

Which week can mother first feel the fetus move?

A

16th-20th week, (the end of the 4th month into the 5th month)

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13
Q

What is the word used to ID the feeling that the mother experiences when the fetus moves?

A

quickening

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14
Q

The 3rd trimester goes from week ___ to week ___

A

28-40

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15
Q

In which trimester does the women most feel backache?

A

3rd

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16
Q

Which trimester is the fetus most susceptible to effects of outside agents?

A

1st

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17
Q

What is the name of the process in which outside agents cause birth defects in the fetus?

A

Teratogenesis

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18
Q

Which trimester is N&V most common?

A

1st

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19
Q

Which trimester do Braxton-Hicks contractions begin?

A

3rd

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20
Q

What are Braxton-Hicks?

A

Usually painless contractions that strengthen the uterus for labor

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21
Q

Which trimester does quickening occur?

A

2nd

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22
Q

Which trimester does venous congestion in the legs occur?

A

3rd

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23
Q

Which trimester does linea nigra appear?

A

2nd

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24
Q

What is linea nigra?

A

Single dark vertical line on the abdomen

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25
Q

Which trimester do striations occur?

A

2nd

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26
Q

What is chloasma?

A

Mask of pregnancy- pigmented area on face

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27
Q

Which trimester is constipation most common?

A

3rd

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28
Q

In addition to the nares, where else should the nurse assess for skin irritation when nasal cannulae are in use?

A

Behind and on top of the ears

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29
Q

What are two signs of hypoxia?

A

Restlessness and tachycardia

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30
Q

What is the highest flow rate appropriate for nasal cannulae?

A

6 L/min

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31
Q

How often should the nares of a client with O2 by nasal cannulae be assessed for skin breakdown?

A

Q 6-8hrs

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32
Q

What is the maximal O2 flow rate for the client with COPD?

A

2L/min

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33
Q

What are the signs of O2 toxicity?

A

confusion, HA

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34
Q

What can happen if the client with COPD is given a high flow rate of O2

A

they may stop breathing
respiratory depression

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35
Q

What is the problem with giving high flow rates of O2 by nasal cannulae?

A

dires mucous membranes

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36
Q

Can a client smoke in the room when the O2 is turned off?

A

No, the O2 delivery device must be removed from the wall or the tank out of the room before a client can smoke

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37
Q

When O2 is administered, it must be …

A

humidified

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38
Q

Masks deliver higher or lower concentrations of O2 than nasal cannulae?

A

higher

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39
Q

How often should the nurse check the flow rate of the O2?

A

at least once per shift

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40
Q

O2 is an explosive (T/F)?

A

False, it does not explode- it supports combustion

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41
Q

What structures in the brain are most affected in Parkinson’s

A

basal ganglia

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42
Q

The neurotransmitter imbalance that causes Parkinson’s is a ___ in _____ ______

A

Decrease, dopamine activity

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43
Q

What drugs can cause a Parkinson-like syndrome?

A

Haldol, major tranquilizers - drugs that end in “-azine”

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44
Q

What is the classic motor manifestation of Parkinson’s?

A

pill-rolling and tremors

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45
Q

What type of rigidity is typical of Parkinson’s?

A

Cogwheel - Cogwheel’ rigidity is a combination of leadpipe rigidity and tremor which presents as a jerky resistance to passive movement as muscles tense and relax

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46
Q

Parkinson’s patients move fast or slow?

A

slow

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47
Q

What type of gait is seen in Parkinson’s?

A

shuffling, slow

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48
Q

Patients with Parkinson’s have ___ speech

A

monotone

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49
Q

Patients with Parkinon’s tend to have constipation or diarrhea?

A

constipation

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50
Q

Name 4 drugs used to treat Parkinson’s

A

Levodopa, Sinement, Symmetrol, Cogentin, Artane, Parlodel

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51
Q

In what type of chair should Parkinson’s patients sit?

A

firm, hard backed

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52
Q

What time of day can be particularly dangerous for the Parkinson’s patient?

A

Mealtime, d/t choking

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53
Q

When a patient is taking Levodopa he should have assistance getting out of bed because…

A

Of orthostatic hypotension

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54
Q

What vitamin should patients on Levodopa avoid?

A

B6, pyridoxine - Vitamin B6 reduces the effectiveness of levodopa

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55
Q

Levodopa should be given with or without food?

A

with food

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56
Q

What might Levodopa do to patients urine?

A

make it very dark

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57
Q

The tremors of Parkinson’s will get better or worse when they purposefully move or perform a task?

A

Better, they tremor more when not performing an action

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58
Q

The client on a PCA pump is less likely to have post-op complications than the client w/o a PCA pump (T/F)?

A

True, b/c the comfortable pt moves around more and is less likely to get thrombophlebitis, pulmonary embolus, fatigue, ileus and pneumonia

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59
Q

Clients with COPD are not good candidates for PCA pumps (T/F)?

A

True, d/t the effects of narcotics on central respiratory control

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60
Q

Name the 3 most common uses of PCA techniques

A

Post-op pain, cancer pain, sickle-cell crisis pain

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61
Q

PCA pumps allow a more constant level of serum drug than conventional analgesia (T/F)?

A

ture

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62
Q

A major disadvantage of PCA pump is that the client can take too much medication (T/F)?

A

False. It is not possible for a client to OD d/t the lock-out feature

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63
Q

Clients on PCA pumps use more medication than those receiving IM injections (T/F)

A

False, they use less

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64
Q

A disadvantage of PCA pumps is that the client does not ambulate as early d/t the machine (T/F)

A

False, PCA clients ambulate earlier and they pull their machine with them

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65
Q

When d/c a PCA infusion it is acceptable to discard the drug cartridge (T/F)

A

False, the whole cartridge system must be returned to the pharmacy d/t federal narcotic control laws

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66
Q

Comfort range of relative humidity is…

A

30-60%

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67
Q

Which patients should be forbidden to smoke? Smoke alone?

A

Those with oxygen in the room, confused, sleepy, drugged patients

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68
Q

When applying restraints remember to…

A

Avoid bruising the skin, cutting off circulation, and accidental entangling

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69
Q

List ways to ensure privacy…

A

Use drapes and screens during care in semi-private rooms

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70
Q

Plastic pillow cases are _____ (disadvantage)

A

Hot and slippery

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71
Q

When using restraints with clients who object, dont forget about ____ ______

A

False imprisonment

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72
Q

Individuals who are ill are ____ sensitive to noise than individuals who are well

A

more

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73
Q

When you are not at the bedside the bed should always be…

A

In the lowest position

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74
Q

Can nurses be held liable for an accident resulting from a client not being told how to use the call light?

A

yes

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75
Q

Dangers associated with drafts are…

A

Circulation of micro-organisms on air currents

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76
Q

The first thing a nurse should do when a client objects to side rails is…

A

Explain why they are being used

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77
Q

The comfort range of temperature is …

A

68-74

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78
Q

Is having the client verbally ID himself considered adequate for safety?

A

No, only ID bands are acceptable

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79
Q

Bed side rails should be up for the following individuals…

A

Elderly clients, unconscious, babies, young children, restless, confused

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80
Q

The S&S of sensory overload and sensory deprivation are…

A

Fear, panic, depression, inability to concentrate, restlessness, agitation

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81
Q

If a family member asks to have the side rails down while they are in the room you should…

A

Remember that you are responsible for the client’s safety - not his family, it might be unwise to permit this

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82
Q

Pillows are sterilized between uses (T/F)

A

false

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83
Q

What is the common name for pediculosis?

A

lice

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84
Q

What is a common finding with pediculosis pubis?

A

Reddish-brown dust in the underwear

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85
Q

What common household solution is used to remove nits?

A

Vinegar. Nits are the eggs of lice that adhere to the hair shaft

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86
Q

What shampoo is used for lice?

A

kwell

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87
Q

Where are head lice most commonly found?

A

At the back of the head and behind the ears

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88
Q

On what do lice feed?

A

blood

89
Q

After tx how long do you have to inspect for lice?

A

Inspect for 2 weeks to be sure that they are all gone

90
Q

What is the most common symptom of lice?

A

itching

91
Q

What is the most dangerous toxicity of Kwell?

A

CNS toxicity

92
Q

What is the typical of the lesions of pemphigus

A

Foul-smelling, blisters break easily, seen in the elderly, cause is unknown

93
Q

What is the characteristic lesion of pemphigus?

A

Large vesicular bullae

94
Q

What are bullae?

A

large blisters

95
Q

What chemical is added to the bath water of a client with pemphigus?

A

Potassium permanganate

96
Q

What precaution must be taken with potassium permanganate?

A

Be careful that no undissolved crystals touch the client; it will burn the skin

97
Q

What is the typical skin care of pemphigus?

A

Cool, wet dressings

98
Q

What unusual nursing dx is high priority in pemphigus?

A

Alteration in F&E balances - Because you may have lost bodily fluids due to oozing of the sores, you may receive fluids through a vein (intravenously), as well as electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — and protei

99
Q

What are the top 3 nursing interventions in pemphigus?

A

Oral care, protection from infection, encouraging high fluid intake

100
Q

What kinds of fluids will clients with pemphigus drink best?

A

cold fluids

101
Q

What drugs are most commonly used?

A

steroids

102
Q

Should steroids be given with meals?

A

always

103
Q

What is the #1 cause of death of pemphigus?

A

overwhelming infection

104
Q

Define pemphigus

A

An acute or chronic disease of adults, characterized by occurrence of successive crops of bullae that appear suddenly on apparently normal skin and disappear, leaving pigmented spots. It may be attended by itching and burning and constitutional disturbance. The disease if untreated is usually fatal. A characteristic finding is a positive Nikolsky sign: When pressure is applied tangential to the surface of affected skin, the outer layer of epidermis will detach from the lower layer (probably autoimmune)

105
Q

Define peritoneal dialysis

A

The removal of wastes, electrolytes and fluids from the body using the peritoneum as a dialyzing membrane

106
Q

When PD is being used the client must be on heparin (T/F)

A

False, you don’t need to be heparinized for peritoneal, but you do need to be heparinized for hemodialysis

107
Q

How long does one episode /course of PD last?

A

Could be 10 hours

108
Q

With PD there is a high/low risk of peritonitis?

A

high

109
Q

When fluid accumulates in the abd during PD what problem does the client experience first?

A

Dyspnea- SOB or difficulty breathing, d/t the inability of the diaphragm to descend

110
Q

What nutrient is lost in highest amounts during PD?

A

protein

111
Q

Can a client who had recent bowel surgery get PD?

A

no

112
Q

Should a client who is having breathing problems receive PD?

A

no

113
Q

What body surface must be punctured to administer PD?

A

the abd

114
Q

The solution introduced into the peritoneum during PD is called…

A

dialysate

115
Q

Before allowing the dialysate to flow into the peritoneal cavity it must be ___ to ____ temperature

A

warmed, body

116
Q

Before PD it is important the client be…

A

Weighed, to assess water loss or gain

117
Q

Before PD it is important the client be…

A

Weighed, to assess water loss or gainWhat force is used to introduce the dialysate into the peritoneum

118
Q

What force is used to introduce the dialysate into the peritoneum

A

Gravity only, no pumps

119
Q

How fast does the dialysate usually flow into the peritoneum?

A

in 10 mins

120
Q

How long is the dialysate allowed to remain in the peritoneum before it is drained out?

A

15-30 mins

121
Q

How long does it usually take for the dialysate to drain out of the perineum?

A

10 minutes (10 minutes flow in, 30 minutes in abd cavity, 10 minutes out = total of 50 minutes)

122
Q

If the dialysate does not drain out well, you would first…

A

Have them turn side to side

123
Q

What color is the dialysate when it comes out?

A

Straw colored- clear

124
Q

Should you raise the HOB to increase drainage of the dialysate?

A

yes

125
Q

How often do you measure vital signs during PD?

A

Q15min during the first cycle and qhour thereafter

126
Q

Can a client on PD: Sit in a chair? Eat? Urinate? Defecate?

A

yes to all

127
Q

If too much fluid is removed during PD, the client will experience…

A

decreased BP

128
Q

If the client absorbs too much of the dialysate the client will experience…

A

increased BP (circulatory overload)

129
Q

If the client complains of dyspnea during PD you would first ___, then ____

A

Slow the flow, elevate HOB

130
Q

Cloudy drainage in the dialysate most commonly means…

A

Peritonitis, (Not good, call MD)

131
Q

What would you do if you noticed a small amount of blood come out in the first few bottles that were infused?

A

Nothing, this is normal; the blood is due to the initial puncture of the abd

132
Q

What precautions are important in the care of the client receiving PD?

A

Safety, bc they get dizzy

133
Q

Is it I&O important to record during PD?

A

yes

134
Q

How high should the diasylate bag be when its being infused?

A

shoulder height

135
Q

What factor do clients with pernicious anemia lack?

A

Intrinsic factor. It has no other name

136
Q

What vitamin is not absorbed in a patient with pernicious anemia?

A

vitamin B12

137
Q

What is another name for Vitamin B-12

A

extrinsic factor

138
Q

Why isn’t Vitamin B-12 (extrinsic factor) absorbed in pernicious anemia?

A

Bc these patients lack intrinsic factor

139
Q

What happens when patients with pernicious anemia don’t absorb Vitamin B- 12?

A

Their RBC’s do not mature and they become seriously anemic

140
Q

What other disease can be confused with pernicious anemia?

A

Angina pectoris

141
Q

What are some classic and unique signs of pernicious anemia?

A

Beefy red tongue, numbness, and tingling of the hands, sores in the mouth, chest pain

142
Q

What is the medical treatment for pernicious anemia?

A

IM injections of Vitamin B-12

143
Q

How long must the client receive this medical treatment?

A

For the rest of their life

144
Q

Can we cure pernicious anemia?

A

No, just treat the symptoms

145
Q

What unique urine test is done to diagnose pernicious anemia?

A

The Schilling test

146
Q

Is it okay to give B-12 orally to a client with pernicious anemia?

A

No, it will never be absorbed d/t a lack of intrinsic factor

147
Q

What neurologic test do they do for this anemia?

A

The Romberg test (a test for balance); in normal people this test is negative, in the client with pernicious anemia this test becomes positive (A loss of balance is interpreted as a positive Romberg’s test)

148
Q

What is conservation? In what stage does it develop?

A

When the child realizes that number, weight, volume remain the same even when outward appearances change; Concrete Operational

149
Q

What is the age range of formal operation thinking?

A

12-15

150
Q

What is the sensori-motor stage of intellectual development?

A

It is the intellectual stage of children from birth to 2 years

151
Q

What is the age range of concrete operational thinking?

A

7-11

152
Q

What is the age range of pre-operational thinking?

A

3-6

153
Q

What is the classic pattern in formal operational thinking?

A

Abstract reasoning

154
Q

What is egocentricity? In what stage is it found?

A

The child views everything from his frame of reference, common in pre-operational thinking

155
Q

In Placenta Previa the placenta is implanted ___ than it should be and lays over the ____ ____.

A

Lower, cervical os

156
Q

What is the classic symptom of Placenta Previa?

A

Painless 3rd trimester bleeding (hint: Painless Placenta Previa)

157
Q

In whom is Placenta Previa most likely to occur? Prima or multi

A

mltigravidas

158
Q

What is meant when the physician/nurse use the terms total (complete) or partial (incomplete) in reference to placenta previa?

A

Total or complete: placenta covers whole cervical opening
Partial or incomplete: placenta covers only part of the cervical opening

159
Q

What are 3 complications of placenta previa?

A

Shock, maternal death, fetal death

160
Q

What is the best and safest way to confirm placenta previa?

A

ultrasound

161
Q

Should a woman with placenta previa be hospitalized?

A

Yes, always if bleeding

162
Q

If a surgeon delays doing a C-section for placenta previa it is d/t: (reason for delay)

A

Immaturity of the fetus (they will want the child to mature)

163
Q

As soon as placenta previa is diagnosed, most pregnancies will be terminated via C- section if the fetus is mature (T/F)

A

ture

164
Q

If a woman is admitted with active bleeding with Placenta Previa you should monitor fetal heart tones ____

A

Continuously via fetal monitor

165
Q

It is not necessary to use electronic fetal monitoring when there is active bleeding in Placenta Previa (T/F)?

A

False, infant must always be monitored

166
Q

Will a woman with active bleeding in Placenta Previa be given any systemic pain relief during labor?

A

No, they don’t want to suppress the fetus

167
Q

If you were told to start the IV on the woman admitted for Placenta Previa, what gauge need would you use?

A

18 gauge, or any other one large enough to administer blood

168
Q

Pneumonia is an ____ in the ____ __ ____

A

Infection, alveoli of lungs

169
Q

Which blood gas disorder is most common in pneumonia?

A

Respiratory alkalosis, bc the hyperventilation blows off more CO2, than the consolidation traps in the blood

170
Q

What is polycythemia vera

A

A blood disease in which there is an increase in erythrocytes, leukocytes, and platelets

171
Q

What is the typical complexion of a client with polycythemia vera?

A

Ruddy red, almost purple

172
Q

What procedure is done to relieve S&S in polycythemia vera?

A

Phlebotomy

173
Q

What is phlebotomy?

A

Drain off 200-500 cc of blood from body (opposite of transfusion)

174
Q

What type of diet will ppl with polycythemia vera be on?

A

low iron

175
Q

What are the 3 signs of polycythemia vera?

A

HA, weakness, itching

176
Q

Is hemoglobin inc. or dec. in this disease?

A

increased

177
Q

What oral problem will people with polycythemia vera have?

A

Bleeding mucous membranes

178
Q

What organ will be enlarged in polycythemia vera?

A

The spleen, bc it is destroying the excessive RBCs

179
Q

D/t enlarged destruction of RBCs seen in polycythemia vera what blood level will be increased?

A

Uric acid levels will be high (remember- uric acid levels are always high when cells are being destroyed as in hemolysis, chemotherapy or radiation therapy)

180
Q

What drug is most commonly used in polycythemia vera?

A

Myleran (this is usually used for bone marrow cancer)

181
Q

How often should the client cough and deep breath post-op

A

q2hr

182
Q

How often should the post-op patient turn?

A

q2h

183
Q

How often should the pt use the incentive spirometer?

A

q1-2hr

184
Q

How often should the nurse auscultate the lung sounds post-op?

A

q4hr

185
Q

How often should the bedridden post-op patient do leg exercises?

A

q2hr

186
Q

The post-op pt should void by ___ hours post-op or you must call the MD

A

6-7hrs

187
Q

Will the typical post-op client have lung sounds? Bowel sounds? Increased temp?

A

Lung-yes; bowel sounds- no; Low grade temp- yes

188
Q

Unless contraindicated the pt should be out of bed no later than ___ hours post-op

A

24hr

189
Q

DVT is most common in what kinda surgery?

A

low abd or pelvic

190
Q

The most common complication of DVT is ____ ______

A

PE

191
Q

The best way to prevent thrombophlebitis is TED hose (T/F)

A

False, ambulation /exercise are the best way

192
Q

What is a paralytic ileus?

A

Paralysis of the bowel d/t surgery (common- especially in abd surgery)

193
Q

If a post-op pt complains of gas and cramping you should first ____ then ____

A

Assess then ambulate

194
Q

The onset of post-op infection is on the ___ or ____ day post-op day

A

2nd or 3rd, never before that (remember elevated temperatures earlier than the 2nd post-op is NOT an infection)

195
Q

Define dehiscence

A

Separation of the incisional edges

196
Q

Define evisceration

A

Protrusion of abd contents through a dehiscence

197
Q

What do you do for dehiscence?

A

Dec HOB (but not flat; can steri strip, then call MD

198
Q

What do you do, in order, for evisceration?

A

Dec HOB (but not flat); cover with sterile gauze moistened with sterile saline, call MD

199
Q

Pregnancy (dec/inc) the body’s insulin requirements

A

increases

200
Q

Can pregnancy convert a non-diabetic woman into a diabetic?

A

yes

201
Q

What name is given to diabetes that is brought on by pregnancy?

A

Gestational diabetes

202
Q

Diabetes with pregnancy is (more/less) common as the woman ages

A

more

203
Q

What is the #1 cause of infant illnesses when the mother has diabetes?

A

hypoglycemia

204
Q

When is infant hypoglycemia most likely to occur during L&D?

A

In the hours immediately following delivery

205
Q

Hormones of pregnancy work against insulin (T/F)

A

true

206
Q

A sign of gestational diabetes is excessive weight (loss/gain)

A

weight gain

207
Q

(Obese/ very thin) women are most likely to become diabetic during pregnancy

A

obese

208
Q

In gestational diabetes the client experiences a (dec/inc) in thirst

A

increase (polydipsia)

209
Q

In gestational diabetes the client experiences a (dec/inc) in urine output

A

increased (polyuria)

210
Q

Gestational diabetes is ass w/ (htn/hypotension)

A

HTN

211
Q

Gestational diabetes is ass w/ what OB history?

A

Prev. large baby (over 9lb.), unexplained stillbirth, miscarriage, congenital anomalies

212
Q

Women who have gestational diabetes tend to deliver infants who are (small/large)

A

Large for gestational age

213
Q

Gestational diabetics tend to get ____ infections

A

Monilial (yeast) infections

214
Q

What test confirms the diagnoses of gestational diabetes?

A

3 hr glucose tolerance test A blood sample will be collected when you arrive. This is your fasting blood glucose value. It provides a baseline for comparing other glucose values.
You will be asked to drink a sweet liquid containing a measured amount of glucose. It is best to drink the liquid quickly. For the standard glucose tolerance test, you will drink 75 grams or 100 grams.
Blood samples will be collected at timed intervals of 1, 2, and sometimes 3 hours after you drink the glucose. Blood samples may also be taken as soon as 30 minutes to more than 3 hours after you drink the glucose.

215
Q

What are the 2 main tx methods in gestational diabetes?

A

diet, insulin

216
Q

How often should a woman visit the doctor prenatally if diabetes is present?

A

Twice a month, then once per week in the 3rd trimester

217
Q

How many lbs/week is the diabetic allowed to gain the 2nd and 3rd trimesters?

A

1 lb a week (same as non-diabetic)

218
Q

Is severe carbs restriction required in gestational diabetes?

A

No, it could lead to ketosis